Tuesday, August 22, 2017

Probiotics - What and When?

Probiotics contain microorganisms that are similar to the beneficial bacterial that occur naturally in our intestinal tract.  There is solid scientific evidence that these microbes can help certain conditions. We know that the gut microbiome is altered by disease, with antibiotics, infection and even constipation. Probiotics have an important role in keeping the gut equilibrium by directly interacting with immune cells.  But all probiotics are not alike and it can be confusing for doctors and patients to know what to take.


Consider this a little primer with conditions, probiotic names and prices. 


Probiotics come in two main forms: food and dietary supplements.  There are so many different brands and formulations and quality control is not well regulated. The effectiveness is specific to the disease and the dose taken.


1. Diarrhea after taking antibiotics (or to protect your GI tract when you take an antibiotic)-
    DanActive - $5
    Align -         $50
    Bio-K+ -      $17-27
    Culturelle-   $40
    Forastor-      $50


2. Ulcerative Colitis
     Activa -       $6
     Align-          $50
     Bacid-          $20
     Culturelle-   $40


3.  Irritable bowel
     Activa-        $6
     Align-          $50
     Bacid-          $20
     Culturelle-    $40


4.  Constipation
     Any of the above.  Activa yogurt is easy and effective.  The active bacteria is Bifidobacterium     animalis.


I always tell my patients to take probiotics along with antibiotics and after they are done to restore the normal gut bacteria that are wiped out by antibiotics.  They are generally considered safe, even in children.

Monday, February 6, 2017

Face Pain? It Could be TMJ





In primary care we commonly see patients with ear pain, sinus pain or headache.  It's often hard for patients to self diagnose where the pain is originating and they want treatment for sinus or ear infections.   When examination of the ear or sinuses doesn't show a problem, many times we find out that it is from the jaw.


TMJ  (Temporomandibular Joint) or TMD (Temporomandibular Disorder) is a common cause of facial pain and can affect as many as 10-15% of adults.  It presents with pain, ear discomfort, headache and jaw pain. It is caused by inflammation in the joint that opens the jaw, right in front of the ear and sometimes there can be a snapping of the jaw as it is widely opened.  You can think of this joint as a hinge that connects the jawbone to the skull.  Like any joint, it can get inflamed and the surrounding muscles of the jaw hurt.


The treatment for TMJ is resting the jaw from wide opening and anti-inflammatory medication.  Most of the time it resolves within about 2 weeks.  Some patients get relief with a mouth splint that keeps them from grinding or clenching the jaw at night. For severe cases, physical therapy with ultrasound and ice can help.  Rarely a corticosteroid injection or botox can relieve pain and relax the muscles.


Remember, not all face pain is from sinuses or ears and antibiotics will not help if it is TMJ pain. Usually a course of anti-inflammatory medication (ibuprofen, aleeve)  is all that is needed.

Friday, February 3, 2017

What Defunding Planned Parenthood Really Means







Planned Parenthood clinics have been a  political football for over a decade. Planned Parenthood operates about 650 health centers across the United States and 2.7 million men and women visit the clinics each year.  In fact, an estimated 1 in 5 women has received care from PP at least once in her life.  For many women, Planned Parenthood may be the only place to receive reproductive health care near where they live.  They provide basic women's preventive care (pap smears, STD testing and treatment, counseling, contraception, IUD placement and long acting reversible contraception) and even basic primary care.


 Of all the health services Planned Parenthood provides, they report that about 3% are for abortion.  Most women receive other services at the same time (pregnancy testing, future contraception) that can skew this number and critics say the abortion percentage is higher, (calculated to as high as 7%), but there is no dispute that Planned Parenthood provides more needed health care for women that goes far beyond terminating pregnancies.


Repeal of the Affordable Care Act would ban Planned Parenthood from receiving Medicaid reimbursements and federal family-planning funds, accounting for loss of over $500 million in government funding per year, about 2/5 of its total revenue.  It is important to know that Medicaid funds already cannot be used for pregnancy termination unless the mother's life is in danger.  So defunding Planned Parenthood is really defunding women's health care.  Period.


We currently have a shortage of primary care doctors in the United States and fewer doctors have sufficient training and expertise in the full range of reproductive health services.  Planned Parenthood provides this needed care.


Defunding Planned Parenthood is an act that Congress should not undertake. American women deserve better.

Probiotics - What and When?

Probiotics contain microorganisms that are similar to the beneficial bacterial that occur naturally in our intestinal tract.  There is so...