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How to Save Your Skin: What Everyone Should Know About Skin Cancer

8/29/2017

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While skin cancer is nearly as publicized as either breast or ovarian cancer, it is in fact the most common cause of cancer in men and women, nearly 1 in 5 people in the U.S. over their lifetimes with nearly 10,000 new cases diagnosed each day.  Of new cases found each year, most are non-melanoma cases (either basal cell or squamous cell) but about 90,000 are melanoma cases, which has a markedly higher mortality rate.  That’s such an unfortunate number of people to lose to a type of cancer with known, avoidable risk factors, so here’s a quick overview of the types of skin cancer and your best chance to avoid them.

What are the main types of skin cancer?  First, there’s non-melanoma skin cancer (NMSC), which includes squamous cell cancer (SCC) and basal cell cancer (BCC).  These cases make up the majority of skin cancer diagnoses with roughly 5 million cases affecting 3 million people in 2012.  The incidence of both cancers has increased markedly since the  1970s and over 250% since the beginning of this millennium, with women having the greatest increase during this time.  Fortunately, less than 4,000 women die each year from NMSC in the U.S.  Still, the surgery for complete removal of these lesions can cause significant disfiguration (not only do the skin lesions have to be removed, but also a “margin” around the incision needs to be free of cancer cells to decrease the chance of recurrence).  

The other main type of skin cancer is melanoma.  While less common, about 1 in 10 affected individuals aren’t expected to survive the disease.  This type of skin cancer has is much more aggressive and can spread throughout the body via the bloodstream.  In fact, melanoma can even be spread from a pregnant woman across the placenta to her baby.

So, how do I avoid getting skin cancer?  The number one risk factor for development of skin cancer is UV exposure.  Notice that UV exposure doesn’t just include sun light, but this also (and especially) includes tanning beds.  Daily use of sunscreen, seeking shade and long pants/sleeves can cut a person’s risk of being affected in half, which is a good thing, because having had even one blistering sunburn during a person’s early years can double the chance of melanoma.  Not to mention, blockage of daily UV rays decreases some of the signs of skin aging, and who really wants to look older at this point in our lives anyway?  Other risk factors include large number of moles (>50), irregular or large moles, history of excessive sunburn, tanning beds, blond or red hair, skin that burns easily and personal or family history of skin cancer.

When do I need to seek help?  Some people with either a personal or family history of skin cancer require regular surveillance with a dermatologist to begin with, but others should be inclined to seek further evaluation with change is shape, size, or color of a current mole or skin lesion.  Sore spots that don’t heal, constant itching or bleeding areas may also require further attention.  These findings are typically spotted during self-performed exams.

Does this mean you have to stay out of the sun entirely?  Not at all (at least for most people), especially when we want to take full advantage of our summers since it seems like winter is always coming here in Idaho Falls.  Still, it does mean taking precautions to decrease sun and UV exposure as well as keeping a close eye on your moles and skin lesions.  You can always make this a team sport if you want as well ;)  Either way, be sure to contact your dermatologist if you notice any of these warning signs, and take the time to enjoy your summer safely!  

Dr. Nick
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What’s the big deal about deli meats and sushi while I’m pregnant?

8/15/2017

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“So, I just found out I am pregnant and went to the doctor for my first prenatal visit.  The first thing I was given was a long list of food restrictions.  All I am craving is a deli sandwich- is it really that dangerous?”  I get this question from my patients all the time.  So, lets break some of these food restrictions down and explore the real reason they exist.  

So the vast majority of food restrictions in pregnancy come from concerns about food contamination.  If you eat raw eggs or fish, you could be at risk of salmonella, e. coli, or campylobacter.  Is this any different if you are pregnant or not.  No.  These bacteria can make you sick and will probably cause you a lot of GI distress (fever, vomiting and diarrhea).  Given the changes in your immune system during pregnancy, though, any of these infections would also be more likely to make you ill than usual.  However, these bacteria are not likely going to cause an intrauterine infection that is specifically dangerous to your baby.  Also, pregnant women are typically advised to limit seafood intake to about 3 times per week due to concern about exposure to mercury (that's also why fish at the bottom of the food chain are preferable - lower mercury concentration).  

So what can affect my baby? Exposure toxoplasmosis or listeria while pregnant.

Lets talk about toxoplasmosis first.  Toxoplasmosis is a parasite that is most frequently associated with cat litter (it is the reason your doctor will tell you not to clean the litter box if you have cats because it puts you at risk of exposure).  You can also contract toxoplasmosis through raw meat and unwashed vegetables. If you are not pregnant, exposure to toxoplasmosis can cause some minor flu like symptoms or no symptoms at all.  However, if you are pregnant the fetus can become infected and this can cause your baby to have blindness, mental retardation and have seizures.  So how do you avoid exposure?  Avoid undercooked and raw meats and wash your fruits and vegetables well.  Also avoid dried or cured meats.  And, of course, do not handle kitty litter while pregnant. 

Now on to Listeria…listeria is harder to avoid and pregnant women are far more susceptible to this bacteria (about a third of cases every year occur in pregnant women).  If you are infected while pregnant, you are at increased risk of stillbirth, preterm birth, and infected newborns.  The source of listeria infections are not always easy to determine and everything from cantelope, sprouts, and celery have been linked to outbreaks of listeria. This is why it is harder to avoid than toxoplasmosis.  However, there are some consistent causes of listeria which while pregnant you should avoid.  They include the following: queso fresco, other raw milk cheeses (unpasteurized dairy products), and deli turkey.  

So in summary…
  • Wash your vegetables well and avoid rare/raw meat
  • Avoid queso fresco, other raw milk cheeses and deli turkey (this is why you are better off avoiding deli meats if you can)
  • Sushi and raw eggs puts you at risk of salmonella and campylobacter, which will cause a lot of GI distress but are less likely to affect the baby

That being said, you are pregnant, and some indulgences should be allowed (the baby made you crave it, after all ;)  Just to try to avoid likely sources of food-borne infection, and be sure to ask your doctor if you have any questions about what foods may make you sick.

​Dr. Pam
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Implications of Genital and Oral Herpes Outbreaks During Pregnancy and After Delivery

8/8/2017

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Given the recent news stories about the effects of herpes infections in newborns, I thought I’d help explain the significance of neonatal exposure and how it can affect a baby’s health.  First, though, I’d like to review a little background information on the virus.  Herpes refers to a group of viruses that can cause lesions (typically blister-like bumps) and pain.  This lesions can affect the mouth, genitals, anus or skin in other regions.  Other symptoms can include ulcer-like lesions, pain with urination (particularly if urine gets on one of the ulcers, fever, itching, enlarged lymph nodes or vaginal discharge.

There are 2 main types of herpes, herpes simplex 1 (HSV1) and herpes simplex 2 (HSV2).  Typically, HSV1 affects the mouth and causes “fever blisters,” and HSV2 more commonly affects the genitalia.  That being said, there can be genital outbreaks of HSV1 in some cases.  More than 50% of Americans are infected with HSV1, and between 18-23% of people in the U.S. have been infected with HSV2.  (Of note, none of these infections were transmitted via a toilet seat).

Primary outbreaks of herpes tend to be more painful than recurring outbreaks, although some people may not experience symptoms for months to years after exposure.  Recurrent outbreaks are often more frequent at first, but gradually slow in both frequency and severity.  Transmission typically occurs during skin-to-skin contact, such as with unprotected intercourse.  Spread of the virus is most common either just before a blister is formed or once it is present; however, even an asymptomatic carrier may pass along the virus.  Treatment of symptoms and outbreaks are possible, but once someone is a carrier of the virus, there isn’t a cure.

So, what’s that mean for my baby?  Babies exposed to herpes viruses can develop meningitis, a severe neurologic illness that involves inflammation of the covering of the brain and spinal cord.  Some symptoms can include fever, light sensitivity, neck pain, and headache, although babies may just show signs of drowsiness or poor feedings.  Sometimes, these babies can have blister-like lesions.  If spread throughout the bloodstream, the virus can cause kidney and liver failure or even death.  Even for babies who have more mild infections, observation in the NICU and long courses of antiviral medications are often advised.

How do I avoid passing the virus to my baby?  Be sure to let your ob/gyn know if you’ve ever had any painful genital lesions or been diagnosed with genital herpes.  Suppressive (preventative) treatment may be indicated, especially for moms considering a vaginal delivery, and for those who have an outbreak (or pre-outbreak symptoms) at time of delivery, cesarean section is recommended.  This is even more important for moms who are having a primary genital herpes outbreak as they are 30 times more likely to infect their baby during the labor process and pass along the virus to the baby in over half of cases.  As for transmission of HSV1, avoid kissing or exposing your baby to your saliva/skin lesions if you have an active outbreak, ie fever blisters, or if you are having symptoms that are suggestive of an impending outbreak, especially during the first two months of life.  Occasionally, these lesions can affect the breast, so be sure to notify your doctor if blister-like lesions develop on your breast.

That being said, don’t be afraid to love on your little girl or guy.  Just be sure to use common sense and reasonable precautions to avoid transmission of herpes after delivery, and if you aren’t sure if something is safe, be sure to ask your doctor.  We hope you all enjoy some good baby snuggles and get to have happy, healthy babies :)

Dr Nick
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