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Prairie Doc Perspective Week of October 27th, 2024
“HPV causes cancer, and can be prevented” By Andrew Ellsworth, MD What do warts, pap smears, cervical cancer, head and neck cancer, and a vaccine all have in common? Three letters: HPV Human papillomavirus ( HPV) is a common virus that can cause growths on skin and mucous membranes. There are over one hundred different types of HPV, and while some cause common warts, others can cause cancer. HPV may be spread by skin to skin contact. The virus can enter your body through even the smallest tear in your skin. Warts caused by HPV can be contagious, either through direct contact with a wart or when someone touches something already touched by a wart. Genital or oral HPV infections can spread through sexual contact or through skin to skin contact in the genital region, anus, mouth, or back of the throat. Unfortunately it can be difficult to prevent HPV infections that cause common warts. It is helpful to avoid picking at a wart to avoid spreading it. Plantar warts located on the bottom of your feet can be prevented by wearing shoes or sandals in public pools and locker rooms. The treatment of common warts can be difficult as well. Some warts go away on their own, while others may grow despite attempts at treatment. No treatment is perfect. Persistence, however, is a key for success. Whether you treat a wart with an over-the-counter method such as salicylic acid, or go to the doctor to have it frozen, be prepared to treat the wart several times in consecutive months for full resolution. Genital warts can be prevented by abstinence, and limited by being in a mutually monogamous relationship, limiting your sexual partners, and using a condom, which can form a barrier for HPV and other sexually transmitted diseases. Thankfully, there is a vaccine which is very effective at decreasing the risk of cancers caused by HPV such as cervical cancer and some cancers in the mouth and back of the throat. It can also decrease the risk of genital warts and genital cancers. The HPV vaccine is recommended for girls and boys often at ages 11 or 12 and can be given as early as age 9 and up to age 45. It is most effective before exposure to HPV. The immune response is better at a younger age, so when given before age 15, only two shots are recommended in the series, while three shots are recommended if started after age 15. For decades, women have undergone pap smears to help catch cervical cancer in the early stages for better detection and treatment. The HPV vaccine can prevent the underlying cause of cervical cancer, can decrease the need for pap smears, and has been effective in decreasing rates of cervical cancer. Once one of the most common causes of death for American women, cervical cancer death rates were cut in half starting in the mid 1970’s with better detection and screening from pap smears. Now, a recent study in Scotland detected ZERO cases of cervical cancer in women born between 1988-1996 who were fully vaccinated against HPV before age 14. This highlights the effectiveness and benefit of the HPV vaccine. Andrew Ellsworth, MD. is part of The Prairie Doc® team of physicians and currently practices Family Medicine at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, Youtube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB or streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust. Prairie Doc Perspective Week of October 20th, 2024
“Diabetes” By Kelly Evans-Hullinger, MD FACP The saying goes, “newer isn’t always better,” and while I typically tend to agree with that, newer might be better when it comes to glucose monitoring technology. In recent years we have seen rapid development and uptake of new types of glucometers, leaving fewer and fewer patients with diabetes using the old standby fingerstick method of blood sugar monitoring. Let me be clear: not every patient with diabetes needs a fancy new continuous glucometer (CGM). The cost might be higher, and there is certainly more data to sort through with a continuous glucometer. So who stands to benefit the most? The most compelling reason to upgrade to a CGM would be a tendency to get low blood sugars (hypoglycemia), especially if that patient does not get any symptoms or awareness of that. Hypoglycemia can be very dangerous, causing loss of consciousness, seizures, and coma. A CGM can detect a pattern of dropping sugar levels and alarm to a patient’s (or their loved one’s) device as a signal to preempt a possibly dangerous episode of low blood sugar. Patients at highest risk of this are those on insulin, elderly patients, and those with more complicated or challenging diabetes. Other reasons for patients to pursue a CGM might vary. Often in patients with poorly controlled diabetes, the data collected by a CGM can aid decision making on changes to medication, diet, and exercise at the right times of day. Some patients just truly hate pricking their fingertips, and using a CGM gives them information they can’t otherwise obtain if avoiding fingersticks. I can think of numerous patients in my own practice whose diabetes was poorly controlled, started using a CGM, then returned to clinic with major improvement in their control as manifested by their hemoglobin A1c lab, even without any changes to their medications. I attribute this to the unavoidable real time feedback a CGM gives, which probably motivates patients to change behavior in diet and exercise in ways that are hard to achieve otherwise. Continuous glucometers aren’t for everyone; some patients have excellent control of their diabetes and no hypoglycemia without this technology, in which case it probably isn’t necessary. In patients who do pursue their use, it is important to work with a clinician who can help interpret the data the CGM provides and adjust treatment accordingly. In short, talk to your endocrinologist or primary care provider if you think a CGM might be for you. Kelly Evans-Hullinger, MD. is part of The Prairie Doc® team of physicians and currently practices Internal Medicine at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, Youtube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust. Prairie Doc Perspective Week of October 13th, 2024
“Sometimes Your Hip Pain isn’t Your Hip” By Andrew Ellsworth, MD “Doc, my right hip has been bothering me. Do you think I need a new hip?” “First, tell me more about your hip pain.” Hip pain is a common complaint which can have a variety of causes. The first thing that comes to mind is arthritis of the hip joint. The hip is a ball and socket joint. The main upper leg bone, the femur, has a rounded top called the head. Under the head of the femur is the neck, which can often be what breaks when someone suffers a hip fracture. Arthritis and wear and tear over time can cause the cartilage in the ball and socket joint to break down and become thinner and irregular. This can cause pain especially with movement and walking. A simple x-ray of the hip can help show signs of arthritis of the hip joint. Sometimes one can try physical therapy, non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen, or perhaps a steroid injection to help calm down the inflammation and pain. Over time, if those efforts do not help enough or if the arthritis is advanced enough, sometimes a hip replacement may be beneficial. However, when someone reports hip pain, it may not actually be their hip joint that is the problem. Arthritis of the low back, degenerative disc disease, sciatic nerve pain, lumbar stenosis, and other problems with the back can cause pain that feels like it is in the hip. Sometimes that pain is felt deep in the buttocks. Sometimes arthritis or inflammation of the sacroiliac joint, where the low back connects to the pelvis, can cause pain. This may often be felt as low back pain, but can present as hip pain. Another cause of hip pain is bursitis or inflammation of the bursa sac located on the greater trochanter of the hip, the large upper outside edge of the femur where the neck connects to the shaft of the femur. You may be able to feel this hard area of your hip at your side. This is a common area for pain. While this pain is located at the hip, it is not coming from the hip joint. Our body has bursa sacs near bones in many places, essentially fluid-filled pads that can help protect the nearby bone and tendons and reduce friction between tissues of the body. Greater trochanteric bursitis can result from a fall, repetitive motion, weakness of muscles, or be associated with some diseases. Usually rest, NSAIDs, time, and physical therapy can help it to improve. Exercises can help by strengthening the surrounding muscles which can decrease the rubbing and friction over the bursa sac. A steroid injection can often be helpful. Surgery is rarely needed. Other causes of hip pain can be from a pelvic bone fracture, tendinopathy, a muscle strain, a labral tear, other musculoskeletal problems, constipation, infection, and rarely cancer. Thus, if you are suffering from hip pain, it may be time to see your medical provider, and start figuring out whether your hip is really the problem. Andrew Ellsworth, MD. is part of The Prairie Doc® team of physicians and currently practices family medicine at Avera Medical Group in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org, Facebook, Instagram, Youtube and Threads. Prairie Doc Programming includes On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on SDPB or streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust. Prairie Doc Perspective Week of October 6th, 2024
“Prairie Doc or Prairie Bot?” By Jill Kruse, DO Artificial Intelligence or A.I. has gone from Science Fiction to a reality. This technology continues to evolve and find new applications in the world, including the world of medicine. With any new advancement, there are pros and cons to be considered when implementing it into regular use, especially in medicine. In 2023 the Journal of Medical Internet Research published an article where they had ChatGPT take 2 of the 3 USMLE exams. Step 1 is taken by third year medical students and all physicians must pass all three tests in order to become licensed as a physician. The program was given 4 different practice tests and scored between 44 to 64.4% correct. Over 60% is considered a passing score. The headlines read that ChatGPT passes medical boards. While this headline was shocking, reading the article gives more nuances to that declaration. There were three different AI programs used, and only one had a passing score for one of the four sample tests, the easiest step 1. When the exams themselves were broken down, the AI was able to answer the “easy” questions with the greatest accuracy. Questions were graded on a score from 1 (easy) to 5 (difficult). However, it was unable to answer any of the level 5 questions. When the program was given a “hint”, the performance increased to 22% correct of the level 5 questions. Students taking the test do not get hints. For this article I decided to ask Chat GPT to list “5 ways AI will improve the practice of medicine in the next 5 years” and “5 ways AI may harm the practice of medicine in the next 5 years.” Here is what the program came up with. Here are the 5 ways ChatGPT thought AI could improve the practice of medicine
Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices as a hospitalist in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook, Instagram, and Threads featuring On Call with the Prairie Doc®, a medical Q&A show (most Thursdays at 7pm on streaming on Facebook), 2 podcasts, and a Radio program (on SDPB), providing health information based on science, built on trust for 23 Seasons. |
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