I am going to be traveling this summer and have some concerns about traveler’s diarrhea. What are the symptoms, and how do I treat or minimize problems associated with traveler’s diarrhea?

Traveler’s diarrhea is a common problem for 40-60% of people who travel from countries with higher resources to those of lower resources. Symptoms occur within 4-14 days of travel. Symptoms include multiple unformed stools, along with varied symptoms of nausea, vomiting, abdominal pain or cramping, fever, or blood in stools. Traveler’s diarrhea is often self-limiting, passing within 2-3 days without treatment, however dehydration is a risk that can cause serious complications.

It is a good idea if traveling to a country where traveler’s diarrhea is a likely concern to get a prescription for prophylactic antibiotics, so that you can self-treat in the event it occurs. Maintaining good hydration is key to preventing complications. Alternating fluids that are sweet and salty for maintaining hydration and calories, like broth, fruit juices, or similar fluids is advised. Pedialyte is good for children and rehydration fluids are another alternative. Continue to eat bland foods that are low risk for GI distress. Over the counter Pepto-Bismol can help with symptoms. Medical attention should be sought if symptoms are persistent or worsening after starting antibiotics and if you are unable to eat or drink.

http://www.uptodate.com/contents/travelers-diarrhea-clinical-manifestations-diagnosis-and-treatment?source=search_result&search=hydration&selectedTitle=7%7E150

I have been hearing the news talk a lot about the flu lately. How do I know if I have the flu or just a cold?

It can be difficult to tell the difference between a cold and the flu. They have many of the same symptoms.

The cold is a caused by a virus and is one of the most common acute illnesses. Symptoms may include runny nose, nasal congestion, sneezing, sore throat, headache, low fever, cough and just overall not feeling well. Eye irritation, swelling of the nasal passages, and a red throat could also be present. The lungs sound clear.  It is easily transmitted by direct contact with infected person or contaminated objects, droplets from sneezing and coughing and close, personal contact. The virus can survive for up to 2 hours on the skin. Time from exposure to symptom onset is 2-3 days. Symptoms and viral shedding generally peak at about day 3, however, individuals may continue to shed the virus for 2 weeks. A cold generally starts with a sore throat, then progresses to nasal symptoms then to cough. They generally last 3-10 days but may last as long as 2 weeks.

Influenza typically presents with similar symptoms, however, they are usually more severe. Hallmark symptoms include headache, high fever, weakness and body aches as well as respiratory tract symptoms of cough and sore throat. It is caused by the viruses influenza A and influenza B, commonly during the winter months. Transmission is through secretions of infected individuals, which can come from coughing, sneezing and contact with contaminated surfaces. Time from exposure to symptom onset is 1-4 days but commonly 2 days. Shedding of the virus can begin 24-48 hours before illness occurs and lasts from 5-7 days, but as long as 10 days. It may last longer in certain individuals, including children, elderly, those who are immunocompromised and those with chronic illnesses. It is most often a self limiting illness but can cause increased morbidity and mortality, particularly in these groups of people. Diagnosis can be obtained through clinical evaluation or  laboratory testing.

There are things that you can do to feel better if you have a cold or the flu. They include getting plenty of rest, drinking lots of fluids (water, sports drinks, broths) so that you stay hydrated, using a humidifier home (which adds moisture to the dry air), salt water gargles for sore throats and Tylenol/ibuprofen for fever and body aches.  Prescription antiviral medications such as Tamiflu are available for treatment of the flu in certain cases. These types of medications do lead to milder symptoms and faster recovery but you can recover from the flu without these medications.  Antibiotics are not useful in treating either the common cold or the flu, however,  both of these conditions can lead to bacterial infections which can be effectively managed with antibiotics. Over the counter medications that manage symptoms are also acceptable treatments for both illnesses.

Centers for Disease Control and Prevention (2013). Seasonal Influenza (Flu). Retrieved from http://www.cdc.gov/flu/index.htm.

Flu.gov. (2013).  Symptoms and treatment. Retrieved from http://www.flu.gov/#.

Up to Date (2016). The Common Cold in Adults: Diagnosis and clinical features. Retrieved from http://www.uptodate.com/contents/the-common-cold-in-adults-diagnosis-and-clinical-features?source=search_result&search=common+cold&selectedTitle=2%7E150

I have been battling athlete’s foot for awhile now. It’s on the tops of my feet, my inner elbows, and has recently spread to a spot on my stomach. I’ve used Lamisil and Lotrimin OTC products, but nothing seems to phase it. I also apply a powder with talc to my feet before I put on a pair of shoes. I don’t know what else to do. Any suggestions?

Athlete’s foot (tinea pedis) is a dermatophyte, or fungal infection that is common on the skin and nails. The top layer of skin is involved.  It spreads to other areas of the body and  generally occurs on the hands, nails and groin area. Itchy, red vesicles or inflammation and areas of scaling are present on the toes,  soles of the feet and in between the toes.

This fungal infection is contagious and may be contracted from contact with objects such as showers, floors and pool areas. It can also be spread to other people or to other parts of the body. It is also possible for these fungal infections to have a secondary bacterial component.

Treatment is sometimes difficult because this is an infection that reoccurs. Tea tree oil may be effective in treating the itch associated with athletes foot but does not cure the problem. The most common, and usually effective form of treatment are topical antifungals. Topical antifungals have a cure rate of > 85% for acute infections. Some may require treatment once or twice daily for up to 4 to 6 weeks to get this infection under control. There are several types of antifungals, including Azoles (Miconazole, Clotrimazole & Ketoconazole), Ethanoloimines (Loprox), Allylamines (Lamisil & Naftin) and Polyene antibiotics (Amphotericin & Nystatin). Azoles are very commonly used and work well. Allylamines tend to be a little more effective than Azoles but are often costly. Polyene antibiotics are useful in treatment of superficial candidal infections and are not effective for dermatophyte infections.  Combination antifungal corticosteroid products (Lotrisone) sometimes worsen tinea infections.

Combination therapy should be considered for those who have not seen a change after 3 weeks of treatment. This consists of using 1 drug class during the day and a different drug class at night, such as alternating the use of an azole and an allylmine.

Oral agents may also be utilized with favorable outcomes, however, these medications do pose additional risks. Treatment duration is 1-6 weeks. Lamisil is frequently used. Other options include Sporanox and Diflucan.

It is important to wear footwear that is not occlusive, such as sandals. Sweaty feet contribute to this fungal development so always make sure that feet are completely dry. Cotton socks are a good option due to their absorbency.  Antifungal foot powder should be applied to feet and shoes.

In response to the question, it seems that you are doing the right things. I would consider a longer course of treatment with the Lamisil for 2-3 weeks or combination treatment with 2 different classes of antifungals. Consider having this evaluated by a medical provider because it could require treatment with prescription medication,  have a bacterial component or be something other than athletes foot.

Up to Date (2015). Dermatophyte (Tinea) Infections. Accessed from http://www.uptodate.com/contents/dermatophyte-tinea-infections?source=search_result&search=athletes+foot&selectedTitle=1%7E48

I have a question about receiving the HPV vaccine.  I am a 25 year old female, who is not sexually active (and never has been in the past), and I have not received the HPV shot.  Based on my current understanding, the HPV vaccination is recommended up until the age of 26.

Here are my questions:

1. Do I need to be vaccinated right now or can I wait until I am planning on being sexually active?  Am I at risk of contracting HPV without any sexual contact?
2. (just curious) Why is the recommended age limit 26?  Is this based on risk factors of contracting the virus for young women being highest between those ages? or is there a decrease in vaccine effectiveness after the age of 26?

I would go ahead and get the HPV vaccine now instead of waiting. The 3 dose series can be given over a six month period of time and is best for optimal vaccine benefit. The FDA approved age range for this vaccine is 9-26 years old. It is most effective if given before sexual activity has started.  Any form of sexual contact may increase risk of HPV infection. The research does show that the vaccine provides protection even if given after sexual activity has started, but to lesser degree. It shows that for those who have never been exposed to HPV (no sexual activity), there is a 93-100% likelihood of preventing development of abnormal cervical cells or severe HPV disease. This is compared to 30-44% for those who were sexually active before receiving the vaccine. You are correct that you are not at risk if you are not participating in any form of sexual activity.

The FDA approved age range is due to the research that was conducted regarding this vaccine. 26 is the age limit to provide this but some providers may give at later ages for various reasons (but this is not the recommendation) and this still provides some benefit. The vaccine produces antibodies to fight infection and this seems to be more effective at the younger age so the protection from the vaccine may be decreased with increasing age of administration. I do also agree with your thoughts on age and risk factors. HPV is very common in adolescents and young women throughout their 20s. There are various subtypes of HPV and some do not directly cause cancer. Many times these infections can resolve on their own. Even those who receive the HPV vaccine should receive screenings for cervical cancer according to guidelines and personal history.

I’ve been having severe sinus pain and headaches without a runny or stuffy nose for quite a while. It feels like a combination of pressure and a strong aching mostly in the mask area of my face, although sometimes it spreads around to the back of my head. I’ve tried antihistamines and pseudoephedrine, but they don’t seem make much of a difference one way or another. I regularly wash my sinuses with saline and have tried changing up the frequency with no change in my symptoms. In the fall I was given steroid nasal spray which helped with the inflammation some, but didn’t really change the aching. I have a humidifier (that I clean regularly) that I run at night which seems to ease the symptoms some. The only thing that seems to even make a dent in the pain is quite a bit of caffeine mixed with the max daily dose of ibuprofen. I’m definitely running out of ideas and don’t want to be taking that much ibuprofen long term!

It is possible that the pain that you describe are related to your sinuses. However, you mention that you do not have a problem with congestion or runny nose, which are generally prominent symptoms related to sinus problems. Antihistamines, saline rinses, humidifiers and nasal sprays would all help with sinus symptoms but these things are not making a difference in your symptoms.  Imaging may be helpful in determining if there is an abnormality with your sinuses or other abnormalities such as lesions or abscesses.

The symptoms that you are experiencing could be related to a headache syndrome or some form of atypical facial pain.  Cluster headaches, tension headaches and particularly migraine headaches may present as facial pain or pain in the sinus area. Further evaluation may be needed to determine if specific headache treatment eases your pain.

Up to Date (2015) Overview of Craniofacial pain. Retrieved from http://www.uptodate.com/contents/overview-of-craniofacial-pain?source=search_result&search=sinus+pain&selectedTitle=1%7E150

Do you perform pap smears?

Yes. Pap smears can be done through Student Health Clinic. The Pap test has to be billed through insurance, because it is considered a send out lab. However, the visit associated with the collection of the Pap test is free. I currently recommend Pap test’s every 3 years if normal, more often if abnormal. Birth control prescriptions are available through Student health Clinic, as well. They can be provided independent of Pap testing, if the test is not needed that year.

Do I need to make an appointment to get a refill on my oral contraceptive prescription that I regularly get from the student health clinic? I had a pap smear last year about this time so I think I’m up to date on that.

This depends on each individual and their health history. If you could email me with your name and date of birth, I can take a look at your medical record and let you know what we need do next.

I am struggling with anxiety. Can the student health services help me?

Student Health services can help you with your anxiety. You can be evaluated in the Student Health Clinic. We will make sure that a medical problem is not causing your symptoms. The Student Wellness Program is also available for student use. They can provide a variety of treatment options to help you with this condition. You may reach the Student Wellness Program at (501) 686-8408.

I am a female in my mid 20’s, and I found a hard lump in my breast yesterday. I looked through resources that said to see a doctor, but some also mentioned that it could be due to hormone fluctuations. Should I see a doctor asap or just watch for any changes? What should I expect at the doctor? Will the doctor just examine it, or will it also involve testing?

Yes, you should have this lump evaluated by a medical professional. It is possible that this is related to fibrocystic breast changes. Mass is generally movable. You may notice changes due to your menstrual cycle and hormone fluctuations. You may have tenderness at the site of the mass that decreases after your cycle.

More worrisome symptoms include a firm, fixed mass that is painless. No changes noted with menstrual cycle. You may notice some nipple discharge, enlarged lymph nodes, or dimpling of the skin.

A clinical breast exam will be performed. Then, an ultrasound of the breast may be performed. This allows us to determine if this is a solid mass or a fluid filled cyst. Other possible diagnostic studies include mammogram or biopsy, depending on the type of mass.

 

I typically get a sore throat during the cold winter months, at what point do I need an antibiotic?

Pharyngitis or sore throat is a common complaint with changes in weather, especially in cooler months.  Triggers for the sore throat tend to come from sinus drainage that collects in the back of the throat, causing increased swelling and pressure.  Typically these symptoms are connected to viral upper respiratory infections (URI)/the common cold or sinusitis.    Antibiotics are not indicated for sore throats caused by viral infections.  Because viral infections do not respond to antibiotics, these sore throats should be managed with conservative therapy.  Typically recommended conservative therapy would include throat lozenges, warm salt water gargles, and acetaminophen or ibuprofen over the counter as directed for pain.  Starting a cold preparation over the counter as directed may also help to alleviate some of the drainage that maybe attributing to the symptoms. Viral symptoms will typically improve on their own in 7-14 days, with 10 days being the average.  Medical evaluation and consideration for prescription medication should be obtained if the sore throat is accompanied  by fever, rash, difficulty swallowing, malaise, fatigue, headache, change in voice, or if sore throat has been persistent greater than 7 days despite conservative therapy.

http://www.uptodate.com/contents/symptomatic-treatment-of-acute-pharyngitis-in-adults?source=machineLearning&search=antibiotic+use+with+pharyngitis&selectedTitle=2%7E150&sectionRank=1&anchor=H2014924#H2014924

http://www.uptodate.com/contents/evaluation-of-acute-pharyngitis-in-adults?source=search_result&search=antibiotic+use+with+pharyngitis&selectedTitle=3%7E150

I have moments of blacking out where I can’t control what I do. When I come to I am usually tired, and friends say I was being aggressive. What can I do about these episodes?

I would recommend seeking an evaluation through your Primary Care Physician or the UAMS Student Wellness Clinic.

 

For the past two weeks my breasts and nipples has been extremely sensitive to the point that taking off my bra is painful. I am two days late on my period (but have taken two pregnancy tests that have out negative) and have had some discharge that is unusual for me (it seems to be clear and slimy but has white spots in it), should I come in for an appointment or self treat for a yeast infection?

I would come in for an appointment. Breast exam maybe needed and further evaluation of menses.