My HPV Hurts!

My HPV Hurts!

Dr. Jay Goldberg, MD – Women’s Care of Beverly Hills

What is HPV?

HPV is a virus of which there are more than 100 types.  Most strains of the virus have no affect or may simply be a type that causes common warts on hands and feet.  For most men and women, HPV infections have no symptoms and go away on their own.  Roughly speaking, 30 types of HPV affect the genital area, and some women do not clear their infection, thus resulting in changes to the genital area.  HPV 16 and HPV 18 cause approximately 70% of the cervical cancer cases and roughly 90% of the strains involved in genital warts are HPV 6 and HPV 11.

How is HPV transmitted?

HPV is transmitted through contact, usually intimate skin-to-skin contact.  Because there are so many types of HPV, it is possible to contract one or more HPV infections in your lifetime.  The more sexual partners you have, the greater the likelihood of contracting HPV.  The best way to avoid HPV transmission is to avoid direct contact with the genital area.

Is HPV common?

Recent studies report that 25% of women aged 15 – 59 currently have HPV, and that over 80% of women will have had at least one HPV infection in their lifetime.

How does HPV cause cancer?

The cervix is at the top of the vagina and leads to the uterus.  A PAP smear is performed on the cervix by a physician, and is currently the best way to determine abnormal cells on the cervix.  Certain types of HPV can cause changes in the cells of the cervix that can first become precancerous and then cancerous if not detected and treated properly.

How do I prevent HPV?

Avoiding sexual contact with an infected person is the only 100% effective prevention method.  A physician should perform a PAP smear starting at the onset of sexual activity and no later than 21 years old.  Nowadays, most physician test for HPV when the PAP smear is abnormal. If sexually active, the best way to avoid cervical cancer is to obtain annual gynecologic examinations and follow through with your physician’s recommendations.

What is the HPV vaccine?

Merck’s vaccine, Gardasil is the first vaccine developed to prevent cervical cancer, precancerous genital lesions, and genital warts due to HPV. 

Who should get the HPV vaccine?

The Centers for Disease Control and Prevention (CDC) recommends the HPV vaccine for all 11 and 12 year old girls. The recommendation allows for vaccination to begin at age nine. Vaccination also is recommended for females aged 13 through 26 years who have not been previously vaccinated or who have not completed the full series of shots.

Are there other HPV vaccines in development?

GlaxoSmithKline’s Cervarix is another HPV vaccine and it’s in the final stages of clinical testing, but it is not yet licensed. The hope is that this vaccine will protect against the two types of HPV that cause most cervical cancers.

What if my PAP smear is abnormal and I test positive for HPV?

If the HPV infection has caused abnormal cell changes, there are four main treatments:

 

•     Watch and wait. Sometimes the cell changes — called cervical dysplasia, precancerous cell changes, or cervical intraepithelial neoplasia — will heal on their own.
•     Cryotherapy. This involves freezing the abnormal cells with liquid nitrogen.
•     Conization. This procedure, also known as a cone biopsy, removes the abnormal areas.
•     LEEP or Loop Electrosurgical Excision Procedure. The abnormal cells are removed with a painless electrical current.

The goal is to remove all the abnormal cells and thus remove most or all of the cells with HPV.

 Tell me more about genital warts.

The types of HPV that cause genital warts are different from the types that cause cervical cancer.  They appear anywhere in the genital area from inside the vagina to the lips of the vagina to the perineum and anal area, and can also occur in the groin and under pubic hair.  Genital warts classically have a cauliflower-shaped appearance, but can be raised, flat, single, clustered, small and large.

 When do genital warts first appear and how long do they last?

Genital warts may appear within a few weeks of contact, a few months, and rarely, years.  This makes it difficult to nail down exactly when the transmission occurred.  How long warts are present is dependent on how well your immune system responds to HPV and how well the warts respond to various medical treatments. 

What treatments are available for genital warts?

Speak with your physician.  Every physician has had different experiences and has different comfort levels, but options are:

 

• At home treatment with prescription creams
• In office treatments
• Acid application by your physician
• Cryotherapy
• Electrocautery and/or laser therapy (sometimes performed in an operating room setting)

_______________________________________________________________________

 Thanks to Dr. Jay Goldberg for his expert insight and advice! 

You can read more about HPV here at My Blank Hurts!

The vaccines for HPV are controversial.  Here is an article from the New York Times. It’s a long but thought-provoking article that begs many questions about a number of things including the marketing practices of Big Pharma, the necessity of the vaccines, the benefits, risks, costs, and more.  Good reading.

Be informed, and be well.

Meredith Soelberg, MPT, MBA

Complementary Medicines

What do you know about complementary medicine?  And how can it help me with my pain?

GREAT QUESTION.  Thanks for asking.  I had the pleasure of meeting with Nina Yannoukos, BSH, Lead Practitioner / Homeopath at Pharmaca Integrative Pharmacy in the Pacific Palisades, CA, and Partner at Restoration Health who shared her expertise in complementary medicine and related pain management products with me.  Here’s what I learned from Nina, and I’ve included links to additional information for your review if you feel like digging more deeply.

 Complementary medicine is a ‘compliment’ to conventional medicine with which westerners are most familiar.  Complementary medicine is not the same as alternative medicine.  According to The National Center for Complementary and Alternative Medicine (NCCAM), a component of the National Institutes on Health (NIH), complementary medicine is used together with conventional medicine. An example of a complementary therapy is using aromatherapy, a therapy in which the scent of essential oils from flowers, herbs, and trees is inhaled to promote health and well-being to help reduce a patient’s discomfort following surgery.

Alternative medicine is used in place of conventional medicine. An example of an alternative therapy is using a special diet to treat cancer rather than surgery, radiation, or chemotherapy that may be recommended by a conventional doctor.   

 For tons of details on complementary and alternative medicine (CAM), go to the National Center for Complementary and Alternative Medicine (NCCAM).

Nina Yannoukos, BSH, of Pharmaca Integrative Pharmacy and Restoration Health gave me a tutorial on complementary medicine and its component parts, which include homeopathics, supplements (vitamins, minerals, amino acids, etc.) and herbs (Western and Chinese).  And, more specifically, she introduced me to different homeopathics, supplements and herbs that her patients have found helpful for different types of pain.

 Definitions:

Homeopathics – small diluted remedies in various potencies to stimulate the body’s immune system.

Herbals – plant-based remedies in crude form

Supplements – products that contain substances like vitamins, minerals, foods, botanicals, amino acids and are intended to supplement the usual intake of these substances.

 For more on homeopathy, go to NCAAM’s section on homeopathy here.

 Here are Nina’s recommendations and comments:

 Herbals:

 Zyflamend by New Chapter (www.newchapter.com)

Nina shared this product with me when I asked her to introduce me to some products that may not be especially well known, but are effective and that she thinks more people should be aware of.  “It’s not well-known, but it’s extremely effective for joint and muscle pain due to inflammation.  It’s a miracle herbal remedy of our time.”

Back and Neck Rescue by Peaceful Mountain

This is a topical product.  There are numerous products in the Rescue Line by this company.  In Nina’s experience, she has found Back and Neck Rescue to be particularly helpful for customers.

Infla-profen by GAIA Herbs

This is a new product, and Nina says it is especially helpful for back and joint pain.

 St. John’s Wart Oil by GAIA Herbs 

This is a topical product specifically for nerve pain.

GI Encap by Thorne Research

According to Nina, this product helps with Irritable Bowel Syndrome (IBS) pain and ulcer pain.

 Digestive Enzymes and Herbs by Pioneer

Nina feels this product helps with overall gastrointestinal health and comfort.

Supplements:

Glucosamine + Chondroitin + MSM with Magnesium and Vitamin C by Jarrow Formulas

According to Nina, this supplement can help with overall joint health and joint pain. 

In doing some additional research, I found controversy among experts about the effects of glucosamine + chondroitin for the prevention of osteoporosis and joint pain.  Here are two articles with different conclusions about these supplements and their effectiveness:

http://www.quackwatch.org/01QuackeryRelatedTopics/DSH/glucosamine.html

http://arthritis.webmd.com/tc/glucosamine-and-chondroitin-topic-overview

Ionic Fizz Magnesium Plus by Pure Essence Labs

According to Nina, magnesium is an important mineral that is very helpful for pain.  She feels that this particular product is unusual because the magnesium is in powder form and therefore is absorbed by the body better. 

Here’s an article (I found) on the risks of insufficient magnesium intake including heart disease, diabetes, muscle cramping, myalgias (including fibromyalgia) and back pain, as well as a 10 point summary on ways that magnesium can help you, and how much is recommended: 

http://www.usaweekend.com/02_issues/020901/020901eatsmart.html

Homeopathics:

 Traumeel by Heel, Inc. 

According to Nina, this homeopathic remedy is not especially well known.  It can relieve muscle, joint, and nerve pain.

 In a recent study published in Complement Ther Med Journal, traumeel was found to be as effective as conventional medicines in the management of mild to moderate injuries (sprains, strains, contusions of ankles, knees and hands). Traumeel was safe in use and judged by physicians to be better tolerated than conventional medicines.  Click here for the study.

So… all this should give you something to chew on… If you’re interested in complementary medicine to help with painful conditions, I think a good place to start is at the National Center for Complementary and Alternative Medicine (NCCAM) associated with the National Institutes of Health (NIH).  Get informed. 

Look for the MyBlankHurts! Alternative Medicine Practitioner Finder coming soon.

Good luck, and good health!

Meredith Soelberg, MPT, MBA

My Sciatica Hurts!

Q: I’ve had sciatic pain down the back of my right leg for 2 weeks. What should I do?

I’m glad you asked!

I’ll respond based on my training and experience as a physical therapist and will talk you through a conservative approach to managing acute sciatica.

Here’s a link if you want to know more about me…
http://www.myblankhurts.com/aboutus-bios.php

What is sciatica anyway?

Sciatica is pain, tingling, or numbness caused by an irritation of the nerve roots of the sciatic nerve. The sciatic nerve is formed by the nerve roots exiting the spinal cord of the lower back. Branches of the sciatic nerve extend through the buttocks and down the back of each leg to the ankle and foot. The pain, tingling or numbness often extends from the low back, to the buttocks and the back of the upper and lower leg (though it’s possible for back pain to be absent). The lower down the leg the pain extends, the more significant the involvement typically. The pain can be one sided (unilateral) or two sided (bilateral), though most often it is unilateral.

What causes sciatica?

It’s most commonly caused by:
1. Herniated intervertebral disc / discs (herniated nucleus pulposus – HNP) – the center (nucleus) of the cushion (the disc) between the vertebra of your spine seeps out of it’s normal confines, causing the disc to bulge. If the bulge of the disc is significant enough, it pushes out into areas normally occupied by the nerves, thus irritating / compressing the sciatic nerve roots in the low back. This disorder is rarely associated with a single injury or incident; it is caused by the accumulated effects of months or even years of forward bending and lifting and / or sitting in a slumped, forward bent posture.
2. Spinal stenosis – bone abnormality that narrows the spinal space causing vulnerability to inflammation of the disc, which can create pressure on the nerve. Spinal stenosis occurs more commonly in older adults.
3. Piriformis syndrome – compression of the sciatic nerve as it passes through the piriformis muscle of the hip.

Other potential causes include facet joint osteoarthritis or other arthropathies (spinal joint diseases), spinal cord infection or tumor, or spondylolisthesis (spinal degeneration that leads to instability and resultant shifting of vertebrae on each other).

According to the AAFP (American Academy of Family Practice www.aafp.org), only 4% of back pain patients actually suffer from sciatica. Of those with sciatica, only 1% has bladder involvement and / or symptoms down both legs.

Who can help?

A first step in taking care of the pain is to obtain a proper diagnosis of the problem and its cause. Any of the following clinicians should be able to assist with a diagnosis and treatment recommendation:

Family practice doctor
Internist
Osteopath
Orthopedist
Chiropractor
Physical therapist

What is the evaluation like?

The clinician should do a physical examination and ask you a number of important questions regarding your pain and overall health which will help her determine the need for diagnostic tests such as x-rays, CT scan or MRI. Some clinicians advocate x-ray and / or MRI, while others, especially if you are otherwise healthy and with insignificant history, will recommend conservative treatment for 6 weeks, and then x-ray and MRI testing only if your pain doesn’t improve.

What will make it better?

Once any potential red flags from the evaluation are addressed and emergency medical causes are ruled out such as cauda equina syndrome, tumor or infection, and the most likely cause has been determined, conservative care is recommended for at least the first 6 weeks. Should symptoms not improve or should they worsen, you should be further evaluated for steroid injections or surgery.

What is conservative care?

1. Ice and / or heat
2. Acetaminophen (Tylenol) or NSAIDS (non-steroidals like Advil)
3. Normal activities of daily living as long as symptoms do not worsen
4. Prescribed exercise program incorporating flexion or extension and stabilizing (depending on the cause)
5. General fitness that incorporates aerobic and stretching exercises that do not worsen the pain
6. Ergonomics education (lifting and posture training) to minimize exacerbation
7. Spinal joint mobilization (physical therapists, osteopaths, chiropractors)
8. Spinal manipulation (perhaps osteopaths and chiropractors)
9. Return to work
10. Close clinical monitoring
11. Self-care education

I would start with a PT, and one that is an orthopedic certified specialist or has been practicing in orthopedics for 5+ years. These therapists see A LOT of sciatica. You can find a local PT that is a member of the American Physical Therapy Association by going to www.apta.org. On the home page you’ll find a “find a PT” button.

Potentially helpful products:

Lumbar roll – DEPENDING ON THE CAUSE of your sciatica, a lumbar roll can help to keep the spine in a more optimal position to relieve pressure on the nerve roots when sitting at your desk, in your car, and at home.
I found one here at Relax the Back for 17.95

And another here at The Price Saver for 12.95

Body pillow – A body pillow can help keep the pelvis and spine in its best position for relief during sleep. A physical therapist can help with the best position DEPENDING ON WHAT’S CAUSING your sciatica. I found some at Bed Bath and Beyond here
And at Relax the Back here

Treat Your Own Back by Robin McKenzie, PT – Robin McKenzie is a PT that developed a back exercise program that can be very successful for patients with sciatica, depending on the pathology. Her method can be especially effective for patients with herniated discs, but can cause more pain for patients with spinal stenosis. Many physical therapists are trained in the McKenzie method. This book is intended for self-care. I think it’s best used in conjunction with a physical therapist.

Helpful Videos:

Here’s a link to an intro to McKenzie exercises on You Tube

Dr. Aaron Filler MD, PhD
Dr. Filler has an MD from the University of Chicago, a PhD from Harvard University, and is also a Fellow of the Royal College of Surgeons in England. He is an expert in spine and nerve pain based in Santa Monica, CA. www.nervemed.com

These two videos are produced by Dr. Filler for commercial and educational purposes. He has plenty of plugs for his practice, his technologies and techniques, but at the same time, he is an expert in his field and in these videos he provides a good deal of insight about back pain, sciatica, its causes, and options. He calls Piriformis Syndrome one of the most under diagnosed causes of sciatica, and the reason for many unsuccessful back surgeries.

Piriformis Syndrome Video

Do You Really Need Back Surgery Video

Other helpful sites:

Medline Plus – from the National Library of Medicine and National Institutes of Health
http://www.nlm.nih.gov/medlineplus/

You can learn more about sciatica at My Blank Hurts! by clicking here

Good luck, and good health!

Meredith Soelberg, MPT, MBA

My QB Hurts! – Ben Roethlisberger Shoulder Separation

Steelers’ QB “Big Ben” Roethlisberger played on Sunday against the Colts but he didn’t play especially well.  He didn’t blame his separated shoulder.  What IS a shoulder separation exactly, anyway?  Should he really be playing? 

Signed,

GoingforthebombinRI

——————-

GOOD QUESTIONS…

According to the Associated Press on November 6^th, Roethlisberger’s MRI exam on Tuesday “is very similar (to his previous one), but it is not the same as it has been,” Tomlin said.  Well that’s clear as mud. I’ll attempt to shed some light…

Shoulder Separation:

As defined by the American Academy of Orthopedic Surgeons (AAOS – www.aaos.org ), a shoulder separation is not truly an injury to the shoulder joint. The injury actually involves the acromioclavicular joint (also called the AC joint). The AC joint is where the collarbone (clavicle) meets the highest point of the shoulder blade (acromion).  In an AC shoulder separation, the collarbone separates from the shoulder blade.  It’s most commonly caused by a fall onto the tip of the shoulder or onto an outstretched arm. 

Steelers’ QB “Big Ben” Roethlisberger has Shoulder Separation

 

According to news reports, Roethlisberger re-injured his previously separated shoulder late in the 2^nd quarter during Monday Night Football on November 3^rd against the Redskins.  He ran a quarterback sneak and got tackled and fell on his shoulder.  There’s no information about the grade of the injury, (grade I, II, or III) but there’s no talk of surgery.

How does it get better?

Treatment for a grade one or grade two separation usually consists of pain medications and a short period of rest using a shoulder sling. The rehabilitation program may be directed by a physical or occupational therapist, and athletic trainer.

Some surgeons prefer to repair severe grade three AC separations, especially in high-level throwing athletes.

If surgery’s not warranted, therapists and trainers begin range-of-motion exercises as pain eases, followed by a program of strengthening. At first, exercises are done with the arm kept below shoulder level. The program advances to include strength exercises for the rotator cuff and shoulder blade muscles. In most cases, the pain goes away almost completely within three weeks. Full recovery can take three to six weeks for grade two separations and up to 12 weeks for grade three separations. Since there is little danger of making the condition worse, a person can usually do whatever activities can be tolerated.

The Steeler’s management and Roethlisberger seem to be downplaying the significance of his injury.  It’s likely a more mild-to-moderate separation (Grade I or II).  To get Roethlisberger back in the saddle ASAP, he’ll be doing all of the above, but his medical team will probably add some additional management in the form of steroid injection to reduce the inflammation, which will help to reduce pain so that he can be back in action sooner, as well as taping of the shoulder – White, McConnell, or Kinesio taping. 

These tapes assist muscles and joints in different ways.  If you’re interested, I found a nice summary at the following site:

http://www.westwoodpt.com/pages/services/soft-tissue-healing/taping.php#McConnell

(We saw a lot of Kinesio Taping at the Summer Olympics in Beijing.  Perhaps the most visible was on Kerri Walsh, Women’s Volleyball Olympic Gold Medalist.)

Here’s an interview about Kinesio Taping if you’re interested…

http://www.cnbc.com/id/15840232?video=827733771

Should Big Ben be playing?  Well, he CAN play, as we’re seeing.  And “should” really depends on one’s perspective.  The bad news is, Roethlisberger may struggle with this throughout the season and have to wait for the off-season before giving it the recovery time it needs.  And it’s certainly vulnerable to further injury when passing or being tackled.

Such are the burdens ‘shouldered’ by professional football players…

Meredith Soelberg, MPT, MBA