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Archive for April, 2013

Doctor 3

Women’s health just took a leap forward with the passage of California Senate Bill 1538, authored by former state Senator Joe Simitian, which requires that women with dense breast tissue as determined by a mammogram be informed that they have the condition.

Women with dense breast tissue will be made aware of the fact that a tumor may not be seen on the mammogram, that they are at a higher risk for breast cancer, and that they should talk to a doctor about the condition. They will also be informed about other breast screening options.

This law came about as a suggestion to Mr. Simitian from a local Santa Cruz woman, Amy Colton, who has dense breast tissue and developed breast cancer in spite of having had routine mammograms. Kudos to Amy for championing this issue.

About 40 percent of all women have dense breast tissue, and many are unaware of their condition. Well over half of the cases of breast cancer in these women were missed with only routine mammography.

After skin cancer, breast cancer is the most common cancer in women in the U.S. Although, we usually associate breast cancer in women, it does occasionally occur in men.

The most common symptoms of breast cancer are:

– A breast lump

– Any change in the nipple, especially discharge or bleeding

– A change to the breast skin, such as the appearance of a dimple or pitting of the skin

– A change in size or shape of the breast

It is not clear why some women get breast cancer and some don’t.

It would seem that breast cancer is caused by an interaction between one’s genetic make-up and/or one’s environment. About 10 percent of breast cancer can be linked to inherited defective genes passed down through generations of a family. Blood tests are available to determine who may have these genes.

Known risk factors for breast cancer are:

– Increasing age — it’s more common in women older than 55

– A family or personal history of breast cancer

– Inherited genes

– Beginning your period at a young age or beginning menopause at an older age

– Post-menopausal hormone therapy, using a combination of estrogen and progesterone

– Drinking alcohol

Tests and procedures to detect breast cancer include:

– Breast exam, including self-exams as well as routine exams from a doctor

– Mammograms

– Breast ultrasounds

– Using a needle for a biopsy (removing a specimen of the suspected tissue for examination)

Current treatment guidelines for breast cancer are too large of a topic for this report.

Let me just say that tremendous strides are being made in the successful treatment of this disease.

Fortunately, the majority of breast changes do not turn out to be cancerous. Even if you have had a recent normal mammogram, see your doctor if you find any changes in your breasts, and work with your doctor to have routine breast exams and testing.

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Poison Oak

Poison Oak

It’s that time of year again when I treat an increasing number of patients suffering from poison oak rash.

Having treated thousands of cases of poison oak in my career, I’d like to share with you what I’ve learned about this miserable affliction.

The poison oak plant, which is so prevalent in our locale, contains an oil in its sap called urushiol. This oil is found in all parts of the plant — leaves, stems and roots.

Even in extremely minute quantities — say, a billionth of a gram — it can cause a very severe allergic reaction in the skin. This usually occurs within 24 to 36 hours of exposure.

Roughly 85 percent of the population is susceptible to this rash, and a lucky 15 percent has a natural resistance to it. Unfortunately, I’m in the first group.

You can be exposed to the oil by direct contact with any part of the plant or by indirect contact with an object that has urushiol oil on it, such as your own hands, clothing or tools. There have been reported cases of the smoke from burning poison oak causing either a skin rash or a reaction in the lungs, although I have never seen this in any patient I’ve treated.

Once you make contact with the oil, you have only a matter of minutes to wash it off before it will bind to the skin and begin the allergic rash.

The best way to remove the oil from the skin is to rinse with lots of water and then wash with soap and water. Most any kind of soap will do. Also, wash any object that may have come in contact with the oil using soap and water, including the clothes you were wearing.

Don’t forget to do the same to your shoes, tools and pets. Urushiol oil can remain active on inanimate objects for more than a year.

There are a number of over-the-counter products, including Tecnu and Zanfel, that are sold to be used on the skin after exposure to poison oak to remove the oil. I have heard mixed reviews on their effectiveness. For now, I’ll stick with water and soap.

A poison oak rash will always eventually clear up on its own if one is willing to wait it out. And there are abundant home remedies to cure poison oak, none of which has been proven to be effective.

However, there is effective, proven and safe medical treatment for those who wish not to suffer for several weeks.

Your doctor may prescribe some form of a steroid cream that is stronger and much more effective than over-the-counter cortisone cream.

If the rash is more serious, and especially if it involves the face, systemic treatment may be necessary. This involves the use of cortisone pills called prednisone, which is my preferred treatment, or a steroid shot. Either of these treatments is safe and very effective for most patients.

Your doctor will help determine the best treatment for your particular condition.

The bottom line is that you should avoid contact with poison oak, wash your skin and clothing as soon as possible if you do come in contact with any part of the plant, and see your doctor for effective medical treatment.

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