An Ultrasound Success Story!

In a recent clinic visit, a patient of our's came in with what looked like appendicitis.  We quickly got our patient in to our on-site ultrasound suite where pictures of the inflamed appendix were obtained, and our patient was quickly sent on to the emergency room at Steven's Hospital.  Because our radiology department uses state of the art digital technology, the pictures were instantly sent from our computers to the computers at Steven's Hospital where the radiologist could immediately review them.  By the time our patient had arrived at the emergency room, the films had been sent and reviewed, the emergency doctor had contacted the surgeon on call and our patient spent less than 10 minutes in the emergency room start to finish.

Several important tests are now available to help women maintain the best possible health as they age.  The most common ones used are mammography and bone density screening. 

Mammography Screening

Mammography has been available for many years, and, although many new imaging tests have been looked at, it remains the gold standard of evaluation for breast lumps and breast cancer.  The precise age at which the benefits from screening mammography justify the potential harms is a subjective judgement and should take into account patient preferences and physician recommendations.  Patients must be informed of the potential benefits (reduced chance of dying from breast cancer), potential harms (such as false positive results, unnecessary biopsies), and the limitations of the test that apply to women their age.  Studies have shown that the balance of benefits and potential harms of mammography improves with increasing age between the ages of 40 and 70.

So, when should you start receiving routine screening for breast cancer?  Most North American medical organizations agree that routine mammography should be performed annually in women over the age of 50.  There is some controversy regarding screening in women age 40-49.  Routine annual mammography is definitely recommended for women age 40-49 who are at high risk of breast cancer (women with a family history of breast cancer in a mother or sister, or a family history of pre-menopausal breast cancer, along with women with a previous breast biopsy with atypical cells and women with first childbirth after age 30). In other low risk women, most authorities recommend mammography every 1-2 years in women age 40-49.

Many women are frightened of mammograms – both for fear of the procedure and fear of the results.  With modern equipment, the discomfort of mammograms is quite minimal, especially if done with an experienced, well-trained technician.  Most studies reveal that about 6.5% of screening mammograms will have some abnormality that requires additional testing, such as additional mammogram views or ultrasound.  However, the vast majority of these turn out to be benign lesions.

Breast cancer is the most common non-skin malignancy in the United States, and second only to lung cancer as a cause of cancer-related death.  Most studies have shown that breast cancer screening with mammography reduces mortality from breast cancer.  With early detection and the therapies available now, breast cancer is often curable.  So, everyone, get up to date on your mammograms!

Bone Density Screening

Bone density screening is relatively new in the range of preventative screening tests.  There are several test options for bone density screening, but the DEXA scan is considered the gold standard.  This test allows your physician to test the density of your bones, hopefully detecting bone loss and treating it before hip or vertebral fractures occur.   Osteoporosis occurs primarily after menopause, with as many as 20-30% of Caucasian women having true osteoporosis and as many as 54% having low bone density, or osteopenia.

Osteoporosis presents an enormous burden on elderly women.  Osteoporotic fractures often lead to significant decrease in quality of life, including loss of independence, but they also incur substantial costs to the individual and our overburdened health care system. 

Screening for bone density is usually started in the post-menopausal age group.  The test involves a simple painless scan of the spine and hip to determine bone density as compared with normals of the same age.  Osteopenia (low bone density) and frank osteoporosis both increase fracture risk.  There are now many interventions for treatment of this very serious disabling disease.  You should discuss with your physician obtaining this evaluation if you are in this age group, especially if you have risk factors such as family history of osteoporosis, smoking, use of medications such as steroids or anticonvulsants, excess alcohol consumption, white or Asian race, and low body weight.  It is also recommended that all women take 1200-1500 mg of calcium per day and participate in regular weight-bearing exercise for 30-45 minutes 4-5 days a week to help prevent osteoporosis. 

With these excellent screening tests, women can live happier, healthier, more independent lives.  It is recommended that all women discuss these important tests with their physician on a regular basis. 

There are a number of common medical problems during the summer that often receive most, if not all, of their treatment at home, on the beach, the hiking trail or the camp site.  Specifically I will discuss sunburns, bee stings and poison ivy.  Although these problems seldom end up being seen in the doctor’s office, the medical care that is given can dramatically affect how fast these problems resolve, and the amount of discomfort experienced during the healing process

Sunburn

I am hoping that it is safe to assume that we are actually going to get some more sunshine in the coming months.  With this sun will come sunburns. 

The easiest, and best solution for sunburns is to simply avoid getting burnt.  Everyone knows about sunscreen but what is all this SPF business?  SPF stands for “Sun Protective Factor”.  The number with the SPF is what fraction of the sunlight gets through the sunscreen.  An SPF of 10 means 1/10^th or 10% of the sunlight gets through, a SPF of 15 means 1/15^th or 6.6% of the sunlight gets through.  Ideally sunscreen should be applied 30 minutes before sun exposure so that it can soak in.  It should then be reapplied every 3 to 4 hours.  If you want to go in the water, a waterproof sunscreen helps but it will wash off after 30 minutes in the water but more importantly it comes off immediately if you towel dry.

In the northwest, we often get fooled by cloudy skies into thinking that we won’t get burnt, but 70% of the sun’s rays still get through most cloud cover.  A good rule of thumb is that if you can see your shadow you have the potential to get burnt.  The suns rays also seem to be most dangerous between 10 am and 3 pm because the exposure is more direct.

Inevitably, even with the best intentions, most everyone will get burnt.  One of the biggest problems with sunburns is that the burn can begin after 30 minutes in the sun but it may not start turning red or hurting until 2 to 4 hours later, allowing people to worsen the exposure.  If you do start getting burned try your best to avoid any further exposure, and this advice continues until the burn is fully resolved.

If you do get burnt the best initial steps to take are to soak the burn in cool water for at least 15 minutes followed by gently wrapping all burned areas in cloth saturated in cool water.  A T-shirt or thin towel works well.  Pain medication started early helps immensely, specifically acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) taken around the clock for the first few days.  The symptoms of the burn should pass their peak in 72 hours.

Applying Aloe Vera preparations or an over the counter hydrocortisone cream three times a day can also be helpful.  Applying butter is just plain bad (it is just an old wife’s tale, nothing against old wives). Vaseline and other ointments will keep sweat and heat from escaping from your burns (also bad).  Anesthetic sprays can often irritate burnt skin or cause allergic reactions on damaged skin, so try to avoid these too.

A lot of your body’s water will evaporate through burnt skin so make sure to replenish this by drinking lots of extra fluids.

Most sunburns are first-degree burns.  You know you have a second-degree burn if you get blisters.  With blisters you have to worry about infection.  If the blisters are intact let them be, but if they break open you can trim off the dead skin.  Make sure you apply an antibiotic cream or ointment twice a day, just to the open blisters.  This is the one time and place that it is okay to apply an ointment to a burn.  If the broken blisters start oozing yellow pus or if you notice red streaking you may have an infection and you should see your doctor.

Over 1 to 2 weeks the burns will heal.  Burned skin itches as it heals. Try not to scratch your burns and just in case keep your fingernails cut short.  If your burns don’t seem to be healing well you should also see your doctor.

Bee Stings

            There are two major types of bees.  Honeybees and bumblebees are one type, and generally they avoid people and only sting in defense.  The other types of bees include yellow jackets, hornets and wasps.  These bees are attracted to bright colors and strong smells and will often sting without being provoked.  Ninety-five (95) percent of all stings are from yellow jackets.  All types of bees can sting repeatedly.

            If you get stung, the first and most important thing to do is try to locate and remove any stinger that may be left in your skin.  It is most often honeybees that leave their stingers.  It is an old wife’s tale that scraping the stinger out is better than pulling it out.  Studies have been done that show it does not matter how you get the stinger out what matters is that you do it as quickly as possible.

Once the stinger is out several things should be done.  Immediately applying an ice cube reduces pain, swelling and the spread of venom.  At the same time you should elevate the stung body part (if possible).

 Next you want to apply something to neutralize the venom.  Several things can work for this purpose including a paste with meat tenderizer, or baking soda, but if these aren’t available, an aluminum-based deodorant can also help.  Apply any of the above “neutralizers” for 20 minutes.

The final step is to make a balm with over the counter Benadryl cream and hydrocortisone cream mixed.  Also a pain medication would be appropriate at this point, specifically ibuprofen (Advil, Motrin) is preferred.  Usually the pain improves by 2 hours, but it is not uncommon for swelling to continue for up to 24 hours.  Continued elevation remains important for the first day.

Under certain circumstances, like disturbing a hive, you may get stung more than once.  Ten or more stings can cause vomiting, diarrhea, headache and fever.  If any of this occurs you should contact your doctor.

Some people are allergic to bee stings.  If you are allergic or think you may be you should see your doctor and make sure you have an “Epi-Pen” or an “Ana-Kit”.  If you already have one, make sure it is not expired.  Having this medication available if you are allergic can be life saving.  Each year 4 times as many deaths occur from bee stings than snakebites.  Therefore, regardless of allergy if you get stung on the tongue, or if you encounter difficulty breathing or swallowing you should call your doctor or 911.

Poison Ivy

The northwest is a great place for growing poison ivy, and many people have a particular knack for finding it.  If you can identify it before you roll in it you can save yourself a lot of itching.  The plant has 3 large shiny green leaves (sounds like most every plant in the forest).  The sap that comes from broken leaves turns black which can help in identifying this plant and avoiding it.  If it is too hard to avoid the poison ivy (for example if you are like my 2 ½ year old son) you can prevent the irritants from getting to you by applying a product called Ivy Block or Organo Clay.

If you notice the very common welts and itching from poison ivy, the first thing to do is thoroughly wash the area with soap and water.  Preferably if you can wash within 10 minutes of exposure you may be able to avoid problems.  If you wait more than an hour to wash the area, the oils have already soaked in and washing is likely useless.  They do sell a product called Ivy Cleanse that you can buy to help wash it off, a good idea for hikers and campers.

After washing you should remove any contaminated clothes.  These clothes will keep the irritant on them for a week unless washed.

Applying ice for 20 minutes can be very helpful, followed by gently wrapping all areas in cloth saturated in cool water, just like for sunburn.

Later you can apply calamine lotion, Burow’s solution or any of the Aveeno products that contain oatmeal.  You can also try over the counter hydrocortisone cream.  Try to avoid anesthetic sprays that can cause more irritation.

You should contact your doctor if the rash involves your face, eyes or lips.  You should also call your doctor if you notice any signs of infection like yellow pus, red streaks, or spreading redness.

            Hopefully this summer, with a little sunscreen, and a little bee and ivy avoidance, you won’t need any of these first aid tricks, but if you do, I hope they will be helpful.