First-Aid Tip #3: How to Manage 3rd Degree Burns (aka Major Burns)

I hope you found yesterday's first aid tips for minor burns informative. To continue with these week's theme of first-aid tips - today I will teach you about 3rd degree burns (aka "major burns"), which should ALL be evaluated and treated by an MD!

3rd degree burns: 
-all 3 skin layers (epidermis, dermis and subcutaneous tissue) are affected
-muscles, bones, and/or tissue may be exposed
-areas might appear black and charred in appearance 
-interestingly you might experience numbness, rather than pain, since nerve endings may have been damaged by the burn
-if you are concerned with a 3rd degree burn, you must be evaluated by a physician

Here is a photo of a 3rd degree burn (notice the black, charred skin):

First Aid Tips for Third Degree Burns (Major Burns)

If you experience a major burn or you are faced to take care of someone with this type of burn make sure you do the following:

-If someone is around you, tell them to call 911!
-If you or someone else is on fire, remember STOP, DROP, & ROLL!
-Wrap the person or yourself in a thick material to smother the flames (a wool or cotton coat, rug, or blanket)
-Drench the person with buckets of cool water to put out any fires (AVOID Very COLD water as this can lead to hypothermia and increased heat loss from the areas which might be burnt)
-Inspect the individual to make sure there is nothing on fire
-Call 911!
-Do NOT remove clothing, as it might be stuck to the burnt skin
-Check to see if the person is breathing. If they are not breathing, open their mouth to look into the back of the throat for any blockage to the airway. If there is a blockage, attempt to remove it. If there is no blockage and you are sure the person is not breathing, begin mouth-to-mouth resuscitation and CPR if you know how
-Check to see if the person has a pulse. If the person does not have a pulse and is non-responsive, begin CPR if you know how
-Cover all burns with a sterile cloth or gauze dressing if available. If the burnt area is large, wrap it in a clean towel or sheet
-DO NOT apply ointments, ice, butter, creams to the burnt areas!
-If fingers or toes have been burned and can easily be separated -- then separate them with a a sterile cloth or gauze dressing
- Elevate the body part that is burned above the level of the heart if possible
- Continue to monitor the person's breathing and pulse until help arrives
-Stay calm, you have just saved someone's life!



Did you know?
Burn injuries are the nation’s third largest cause of accidental death and cause 300,000 serious injuries and 6,000 fatalities each year.
This is why it is so important to know what to do about burns, and to make sure that your workplace is safeguarded against burn injuries. Make sure to recognize the exposures for heat, chemicals, and electricity in your workplace!

Please feel free to leave comments below, and email me at DoctorDeenaMD@gmail.com with any questions that you may have.

**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**

First-Aid Tip #2: Treatment of Minor Burns (First Degree & Some Second Degree Burns)

First Aid for Minor Burns

To continue with this week's theme of first-aid tips, lets discuss the steps to treating a minor burn. Minor burns are so commonplace when using a hot curling iron, cooking with hot pans/dishware, or tanning on the beach. My tips will make you feel more comfortable in dealing with most minor burns and knowing when to seek medical attention.

Firstly - let's differentiate a minor burn from all other types of burns. There are 3 classifications for burns: 1st degree (aka "minor burn"), 2nd degree, and 3rd degree (aka "major burn").

Our skin has 3 layers. The top most layer is called the "epidermis", the middle layer is called the "dermis" , and the bottom layer is called the "subcutaneous tissue". The "degree" of a burn refers to how many layers of the skin have been burnt through. This is demonstrated in the image below:

(photo courtesy of www.thirdage.com)

1st degree burns: (think of what a sun burn might look like)

-only the outer layer of skin (the epidermis) is affected

-there is redness of the skin

-usually has minor swelling

-may or may not be painful

-generally NOT a medical emergency and can be treated at home unless substantial portions of the hands, feet, face, or a major joint (ankles, knees, hips, wrists, elbows, shoulders, and spine) are affected which requires seeking medical attention!

Here is an example of a 1st degree burn:

courtesy of http://s2.hubimg.com

2nd degree burns: 

-the 1st layer (the epidermis) and 2nd layer (the dermis) of the skin are affected

-blisters develop
-skin is very red
-it is severely painful
-there is significant swelling
-if the 2nd degree burn is smaller than 3 inches in diameter, it can be treated the same way you treat a minor burn
- if the 2nd degree burn is larger than 3 inches in diameter, you need to seek medical attention
- if the burn is on the hands, feet, face, groin or buttocks, or over a major joint (ankles, knees, hips, wrists, elbows, shoulders, and spine) you must seek medical help

Here is a photo of a 2nd degree burn (notice the large blisters in the center of the hand):

(Photo courtesy of Sciencedirect.com)

Now that we have identified what 1st and 2nd degree burns look like, let's focus on how to treat them. Remember minor burns refer to 1st degree burns and 2nd degree burns which are LESS THAN 3 inches in diameter. All other burns require medical attention!

First Aid Tips for Minor Burns at Home

1. Cool the burn: 
This will provide some pain relief and decrease swelling
- Run cool water over the burned area for 10 minutes or until your pain improves
- You can also fill a small bucket with cool water and place the burned area inside the bucket for 10 minutes or until the pain improves
- Do NOT put ice on the burn
- Do NOT use ice-cold water to cool the burn

2. Wrap the burn:
This will protect the skin which has been damaged and is very weak and fragile 
-Put a sterile gauze dressing or clean cloth over the burn
-Avoid applying any ointments over the burn
-Wrap the burn loosely,not too tight, so that you do not accidentally break a blister or peel off skin

3. Pain relief:
As your burn heals, the pain will slowly improve over time
-Treat your pain with non-prescription pain relievers like ibuprofen (Advil) or acetaminophen (Tylenol)
-If the pain is unbearable despite these medications, seek medical attention

4. Do not break blisters
This can lead to an infection. Allow the blisters to heal on their own!

5. If your skin itches as it heals, you can use Aloe-vera for some relief 1-2 days after initial injury

6. Watch for signs of infection
If your burn appears to be getting worse over time with increased redness, tenderness, or drainage of pus -- these may represent signs of an infection, and you should seek medical attention right away


Your burn should heal naturally over time, and may result in the healed skin being slightly darker than the surrounding skin (this is normal).


Here's a mythbuster for some fun--

True or False:
Toothpaste helps treat burns and allows it to heal faster.

Answer: False
Toothpaste is believed to be home remedy for burns because some varieties contain baking soda. Baking soda is thought to cool down the skin, thus "cooling off the burn". Baking soda is actually used in the initial treatment of some CHEMICAL BURNS (especially those caused by hydrochloric acid), which is why people might believe that it can treat ALL burns.
Despite this possible cooling effect of baking soda -- nothing is as cheap and convenient as cool water! Running cool water over your burn should always be your first step in treatment!
There are no great studies to compare baking soda/toothpaste versus cool water to treat burns.... but what I can tell you is that any lotions/ointments/creams that are put on top of a burn initially increases the risk of infection and delays healing time!

I hope you found this information helpful today. Check back tomorrow for more first-aid tips!

Please feel free to leave comments below, and email me at DoctorDeenaMD@gmail.com with any questions that you may have.


**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**

First-Aid Tip #1 for Minor Cuts & Scrapes

Dear Dr. Deena,
I am preparing for a camping trip outdoors. Do you have any easy first-aid advice?
KG

It's so important to plan ahead when it comes to first-aid, especially when traveling. I will dedicate this week to first-aid tips just for you, KG! 

I also want to keep this blog open to all of you-- to leave comments and to ask questions about first-aid tips (especially myths that you wish to challenge), or even to share the tips that work for you!

Today I will talk about first aid of minor cuts and scrapes. 
Not every cut requires a trip to the emergency room; however, taking the RIGHT care of a minor cut or scrape is very important to prevent infection and scarring. 

Always remember to see an MD right away if:
- you find that your cut or scrape is bleeding heavily despite pressure
- your cut looks deep (where fat/muscle/tendons are exposed)
- your cut appears very wide (you might possibly need stitches)
-there is a foreign object deep within the cut that you cannot retrieve on your own

                    First Aid Tips for Minor Cuts and Scrapes

1. Control Bleeding: 
If your cut is bleeding, apply gentle pressure with a clean cloth or gauze pad for at least 1 minute over the affected area.  If you have a known bleeding /clotting disorder or take "blood thinners" (medications like "Coumadin"), you will likely have to hold pressure for more time. If after at least 3-4 minutes of holding pressure, the blood continues to spurt out and has not decreased, seek medical attention right away.

2. Clean the Area:
This is the key step to infection prevention. Clean the cut/scrape with simple soap and water! Dampen a clean cloth with soap and water and  dab over the affected area. Make sure to clean the areas surrounding the cut/scrape as well. I would recommend cleaning all areas of skin which are at least 4-5 inches away from the cut/scrape, to destroy as much bacteria as possible. If there are any particles that you notice inside the wound, you can attempt to grab the debris with a tweezer (make sure that the tweezer has been cleaned with alcohol prior to using it).

3. Apply Antibiotic Ointment:
Once the area has been cleaned, apply a layer of antibiotic ointment such as Neosporin or Polysporin. This antibiotic will help prevent infection and promote the healing process . Ointment keeps the area moist which helps speed healing, and hopefully lessens the likelihood of a scar.

4. Keep the Area Covered:
Cover the cut/scrape with a bandage. Covering the area helps it heal by preventing exposure to debris, bacteria, or other irritants (including the rubbing of clothes over the affected area). You can change the bandage/dressing daily or any time that it becomes wet or dirty.

5. Do Not Pick Off Scabs:
 Picking off the scab can lead to larger scar formation and infections.

6. Be aware of signs of infection:
If you notice that the cut/scrape is getting more red, tender, warm, swollen or has increased drainage of pus --these may be signs of an infection and you should see an MD right away for evaluation! People who are more likely to develop infections of a wound include those with diabetes, blood disorders, cancer, peripheral vascular disease, or patients who have a weakened immune system (i.e. those who have immunodeficiency syndromes or diseases like HIV OR who take medications that suppress the immune system like chemotherapy, steroids, or post-organ transplant medications).

7. Get a Tetanus Booster Shot!
A tetanus booster shot is recommended to be given to individuals every 10 years.
If it has been more than 5 years since your last tetanus booster shot, an additional booster is recommended if:
- your cut is deep (generally if it is more than .25 inches deep or if it is wide open with muscle, fat, or tissue seen) 
- if your cut is contaminated with dirt, feces, saliva (especially if caused by animal bites) or soil

Below is a chart to follow to determine what tetanus prophylaxis you may need:

Fun Fact:
What is tetanus?
Tetanus is a fatal disease caused by a bacteria that lives in the soil, dust, and debris. It mainly effects the nervous system causing spasms (involuntary contractions) and generally effects the neck and jaw. Tetanus is known for causing "lock jaw" -- a condition where the jaw becomes so stiff that you cannot move it. Tetanus can also cause increased rigidity of the back muscles leading to neck hyper-extension and arching of the back -- a condition called "opisthotonos" (which comes from the Greek words "opistho" meaning "behind" and "tonos" meaning "tension"). Here is a painting that medical students often see when learning about tetanus and what "opishtotonos" looks like:

By Sir Charles Bell, 1809

 When tetanus affects the chest muscles, this can lead to difficulty breathing and ultimately death. This is why it is so important to get your tetanus vaccine and booster if needed!

Do you have any other questions about first-aid for minor cuts and scrapes? If yes - please email them to DoctorDeenaMD@gmail.com. I would also love to see your comments, especially to know what other first-aid advice you may want this week. 

First-aid week continues tomorrow with more useful tips!

**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**

Medical Management of Acid Reflux & GERD

Hi Dr. Deena,

Thanks for the tips. I have been suffering from acid reflux symptoms and have been taking "Nexium" for the past few months. Is it advisable to continue with this medication? Also could you please explain antacids more in brief. Would be interested in knowing. 
Thanks.

This is a great question, as there are so many people taking Nexium, "The Purple Pill". Many of these people take this medicine because they are unaware of the other treatments for GERD out there, which are just as effective and cheaper! Today I will focus your attention on the current medical treatment options for GERD, since yesterday I mentioned the non-medical alternatives. 

If you are experiencing mild symptoms of heartburn, I would recommend trying non-medical alternatives first. Many people will notice that avoiding certain food triggers will make them feel better fast. 

Treatment of GERD depends on the severity of your symptoms. Are they mild, moderate, or severe? 

Your symptoms are mild if:
-symptoms are NOT frequent (less than 2-3 times weekly)
-symptoms are easy to tolerate
-symptoms last for a short time during each episode
-symptoms do not interfere with your daily life and daily activities 

Your symptoms are moderate if: 
-symptoms are frequent (more than 2-3 times weekly)
-symptoms begin to interfere with daily activities like eating and sleeping

Your symptoms are severe if: 
-symptoms are so disabling and frequent that they prevent you from participating in many daily activities 

If you are concerned about having GERD you should speak to a physician; however, if you are in the moderate or severe category -- you DEFINITELY need to seek out a physician for evaluation.

Now that you know how to judge your severity of symptoms, let's focus on the treatment options that are available for GERD. The main medical treatment options include antacids, H-2 receptor antagonists, and proton pump inhibitors ("PPI's"). I will discuss each in detail below.

If you have mild symptoms of acid reflux then antacids might work for you. Antacids are substances that neutralize the acidity in your stomach. When there is increased acidity in the stomach, the pH (a measure of acid/base status) is low and these substances work by increasing the pH of the stomach to make it less acidic. Antacids are available without a prescription, and can be found in many different forms (oral tablets, liquid, syrup, etc). Depending on the antacid that you choose it may contain different elements,but the most common neutralizers are carbonate, bicarbonate, magnesium hydroxide, and aluminum hydroxide. Brand names for the antacids include Tums, Rolaids, Alka-Seltzer, Mylanta.

Antacids are ONLY BENEFICIAL FOR SHORT-TERM RELIEF since the acid is only neutralized briefly after each dose. 
If you find yourself taking antacid tablets more than 2-3 times a week, or if they are no longer working for you - I would recommend you speak to your physician for further evaluation. 

If antacids are not helpful to you, the next line of treatment medications are "H-2 blockers" or "H-2 receptor antagonists".  These medications block the actions of Histamine, which is a chemical that leads to increased acid production in the stomach. In the US examples of these drugs include (generic name is in parentheses):  Zantac (ranitidine), Pepcid (famotidine) and Tagamet (cimetidine).

If H-2 blockers do not help with your symptoms, the next line of treatment is "Proton Pump Inhibitors" (PPIs). These medications are the most effective at controlling GERD and they have the longest lasting effects. These medications inhibit the proton pump known as the H+/K+/ATPase, which is the final step to acid secretion in the stomach.  The medication you referred to in the website "Nexium" (generic is esomeprazole) is a proton pump inhibitor. Other medications in this class include: Prilosec (omeprazole), Prevacid (lansoprazole) or Protonix (pantoprazole).Since PPIs are the strongest and most effective treatment option - they also carry the most side effects. I will not go into the side effect profile of these medications because they vary, and can easily be found with a quick internet search.

To answer your question -- "if Nexium is a good medication to be taking" -- this can be a great medication in the short-term to give you relief of symptoms, but long-term treatment is associated with many side effects.
There is no concensus in the medical community over how long one should continue medical therapy for GERD. Most physicians will recommend lowering the dosage over time while watching for symptom improvement or progression, with hopes of ultimately stopping the medication completely. Most research has only looked at the short term benefits of medical treatment of GERD.
I would recommend asking your physician if you can attempt to taper off the Nexium over time (especially if you have been on it for greater than 3 months) and see how your symptoms respond. If the symptoms still persist - you may need further evaluation to try to better understand the cause of your acid reflux. As mentioned in my previous blog, there are many causes for GERD including hiatal hernia (due to weakening of the muscles of the diaphragm), H. Pylori (a bacterial infection), Peptic Ulcer Disease, etc. Other causes of GERD may require interventions such as antibiotics or surgery.  These causes need to be evaluated for and treated by your physician in order to see any improvement in your symptoms.

I hope all this information helps you make an informed medical decision on how to control your heartburn. Please feel free to be in touch, and thank you for your questions!

As always email any questions/comments to DoctorDeenaMD@gmail.com.

**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**

Non-medical Secrets to Controlling Acid Reflux (GERD)

Dear Dr. Deena,
I have really bad heartburn. Should I be concerned with GERD? What can I do to treat it?
Dana

Having heartburn can be really tough, and many of us (myself included) are subject to this condition...luckily there are some tips that might help you feel better!

GERD stands for Gastro-Esophageal Reflux Disease and is commonly referred to as "acid reflux". This condition occurs when the contents of the stomach move upwards (or "refluxes") into the esophagus and/or into the mouth. GERD effects 20% of our population; however, there are many people who are undiagnosed as they are unaware of this disease.

In order to better understand this disease, lets take a look at the anatomy of the stomach (the organ which collects and stores food) and the esophagus (the tube which connects the mouth to the stomach). 

(Courtesy of Uptodate.com)

Once food is swallowed, it travels from the mouth through the esophagus - which is a long tube consisting of muscles that contract to propel food forward. At the end of the esophagus, food must go through a "Gate-keeper" known as the lower esophageal sphincter ("LES") prior to entering the stomach. The LES is a muscle that contracts to prevent back-flow of food into the esophagus and relaxes to allow food to move forward into the stomach. When the LES is weak or in a relaxed state more food "refluxes" into the esophagus and mouth which is one way of how we develop GERD. GERD can also be caused by a weakness in the muscles of the diaphragm leading to a "hiatal hernia".


GERD can present with some of the following symptoms:
-heartburn (a "burning sensation" that is often in the upper abdomen, chest, or behind the breastbone)
-abdominal pain (generally in the upper part of the abdomen)
-regurgitation (food particles coming back up from the stomach into your mouth)
-vomiting
-difficulty swallowing
-pain with swallowing
-chronic cough
-voice changes/hoarseness of the voice
-sore throat
-increased salivation 
-waking up with a strange taste in one's mouth (generally a bitter taste)
--new onset of asthma (especially at an older age)
--persistent dental disease


The diagnosis of GERD is usually made by a physician after a full history and physical, especially if the patient states experiencing some of the above symptoms at least 2-3 times weekly. The diagnosis can sometimes be confirmed if symptoms improve after specific interventions.

Luckily if you have mild symptoms of acid reflux, my following tips  might help you:

1. Lose weight if you are obese. Obesity predisposes you to GERD and many other medical problems

2. Elevate the head of your bed up to 8 inches while sleeping (instead of lying flat). This allows gravity to help control reflux with food traveling downward rather than upward. This step is especially important if your heartburn occurs at night-time

3. Figure out what your triggers for increased acid production might be. Most of my patients have such different triggers ranging from orange juice to yogurt. If you notice certain foods are bothersome to you, avoid them and see if your symptoms improve. Common food triggers of acid reflux include citrus juices (orange, grapefruit juices), spicy foods, tomatoes, alcoholic beverages (especially wine)

5. Avoid substances that are known to cause relaxation of the LES (thus promoting acid reflux) like chocolate, peppermint and caffeine

6. Quit smoking! Smoking not only decreases salivation and saliva is a neutralizer of acid, but it also causes increases relaxation of the LES

7. Stress management! Stress is known to stimulate acid production in the stomach and can lead to worsening reflux

8. Eat your last meal 2-3 hours before bedtime

9. If you find that your acid reflux is worse after eating heavy meals, then attempt to eat smaller meals throughout the day

10. If you have a infrequent heart burn symptoms, try antacids (Rolaids, Tums, Mylanta) for short-term relief

If lifestyle changes do not help, then ask your physician if medications are right for you.

It is very important to have acid reflux examined and controlled with your MD because the complications related to this disease can be fatal! Most patients do not develop these complications but it is important to be aware of them. 

These complications include:

1. Ulcers
Ulcers are caused by damage to the tissue of the esophagus or stomach due to increased acid production. Ulcers can lead to bleeding in your digestive tract and is a medical emergency!

2. Changes to the voice with hoarseness or chronic sore throat
Acid reflux leads to inflammation of the throat and vocal cords

3. Esophageal Cancer 
Cancer can develop after a a long period of exposure to constant irritation and inflammation of the lining of the esophagus due to increased acid reflux

4. Barret's Esophagus
This condition is a risk factor for esophageal cancer. The stomach is an organ that is well-equipped to deal with a high acid environment, and the esophagus is not. In this condition the tissue lining and cells of the esophagus become distorted and abnormal, which can predispose patients to further irregular cell division/growth (cancer).



I hope you find this information helpful, and hopefully with my lifestyle change recommendations your acid reflux will improve! 

As always, please email your questions/comments to DoctorDeenaMD@gmail.com.

**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**

How To Screen Yourself Early for Breast Cancer *Viewer Discretion Advised*

Dear Dr. Deena,
I am 22 years old, and am concerned about my risk for breast cancer. I don't have a family history, but I hear how prevalent this is among women. Is there anything I can do to screen myself (I think I am too young for a mammogram). 
Thanks.
Jamie

Thanks for a wonderful question, Jamie. I am so proud of you in that you are really concerned about prevention at a young age! 

Breast cancer is the 2nd leading cause of cancer-related deaths in women, after lung cancer. According to the National Cancer Institute, "about 39,520 women in the U.S. were expected to die in 2011 from breast cancer, though death rates have been decreasing since 1990 — especially in women under 50. These decreases are thought to be the result of treatment advances, earlier detection through screening, and increased awareness."

Luckily some breast cancers may be detected early with a self-examination of the breast. Clinical data has shown that up to 40% of breast cancers are detected when women feel a lump on examination.

Make sure you perform the breast examination once a month, so that you get comfortable with what your breast normally feels like. This will make you more aware of what is normal for you.

Feeling a lump, bumpy tissue or tenderness in the breast before or during your period is quite common as the consistency of your breast tissue changes during this time due to hormones...this is why I recommend performing the self-examination AFTER you have completed your period.

Below are some easy steps that you can follow to screen yourself for breast cancer. If you are still confused, you can find videos on self-breast examinations with a quick internet search or on Youtube.

You can practice the breast exam in the shower, in front of a mirror, or lying down. Whichever you choose - I would recommend using the same position every time you repeat the examination.

Now that you know when and how often to perform the self breast exam...let's begin!

1st Step is INSPECTION:

1. Look at your breasts in the mirror 
Are your breasts the usual size and shape? (it is normal for one breast to be bigger than the other, you should mainly be concerned if something has changed over time)
Do you notice any redness anywhere?
Does your skin look smooth? Is there any dimpling? Are there any skin changes that look new?
Do you see any abnormal lumps? 


2. Look at your nipples in the mirror
Do the shape and size of your nipples look any different to you? 
Does the color and texture of your nipples feel the same to you?
Do you notice any blood or dry discharge from the nipple?

3. Now  raise your arms above your head (see image below) and repeat steps 1 and 2.

(Image courtesy of breastcancer.org)

Do you notice any of the above changes again with your breasts or nipples?

2nd Step is EXAMINATION:

**If you decide to perform the exam lying down - rest your head on a pillow and make sure to put the hand under your head like this:

(Image courtesy of breastcancer.org)

Perform the breast examination with the following steps: 

(Courtesy of B4bc.org)

If you notice something abnormal, be sure to contact your physician right away. 8 out of 10 lumps are completely benign (normal), but it is necessary to get further evaluation for diagnosis and to put your mind at ease!

Here are some photos of what is abnormal when inspecting your breasts, which should alert you to get more medical attention: 

(Viewer discretion advised)

--When inspecting the size and shape of your breast, it should normally be round all over. Any areas where the skin is pulled in (called "Dimpling") may be abnormal. Here is a photo of "dimpling" in the right breast (Circled in red):

(Image courtesy of www.dailyrecord.co.uk)

--Skin that looks red and inflamed is abnormal. Physicians call this "peau d'orange" because it looks like an orange peel: 

-- Ulcerations (areas of skin breakdown) or nodules (large lumps at the surface of the skin) are always abnormal. The patient below has both nodules and ulcerations of the left breast tissue:

(Courtesy of http://upload.wikimedia.org/wikipedia/commons/8/83/RecurrentbreastCA.gif)

--Inversion or retraction of the nipple is another abnormality to be aware of:

--Discharge from the nipple when you squeeze it (blood, milky discharge, pus, etc.) is abnormal:

--When performing the breast exam it is important to be aware of scaling of the nipple skin, bumps on the nipple, or any skin changes of the nipple as demonstrated in this image:

(Courtesy of carcinogenesis.com)

Nipples can sometimes become dry or irritated from clothing, and might appear scaly. For dry nipples, try using a small amount of moisturizing lotion to the affected area. If the skin remains the same despite moisturizing - you should be evaluated by a physician. 

I cannot reiterate enough that if you have any of the above findings, you should see a physician as soon as possible!!

Also -if you are over the Age of 40 OR younger than the Age of 40 (males included) with risk factors for breast cancer (such as a strong family history or carrying a known mutation of the BRCA1 or BRCA2 gene) you should consult with an MD on getting a mammogram. Mammograms detect breast cancers that you cannot see or feel on examination.

I hope this helps in your early screening for breast cancer! I wish you all the best of luck as you attempt to take control of your health through prevention.

Please continue to email all questions to: DoctorDeenaMD@gmail.com

**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**

Warning Signs for Heart Disease, ESPECIALLY in Women!

Since February is Heart Disease Awareness month – I wanted to focus your attention on heart disease especially in women.

Did you know that heart disease is the Number 1 cause of death in women in the USA!? This is why it is so important to understand heart disease and what we can do to identify and prevent it. 

What Is Heart Disease?

Heart disease is most commonly caused by a blockage of the coronary arteries (which are the main blood vessels that supply blood (thus oxygen) to the heart). The blockage is generally caused by “plaques” which consists of fat and  cholesterol.  Blockage of the blood vessels build up slowly over time, and during this process the patient may have no symptoms at all -- this is why heart disease is known as a “silent killer”.  

Once you develop symptoms of a heart attack (which I will discuss below), the blockage has become pretty severe.  In fact – physicians use these symptoms as a gauge of deciding on treatment options and interventions for heart disease.  The most common cause of heart disease is related to this build-up of plaque, but it can also be related to abnormalities in the structure of the heart (including valves)  and/or the rhythm of the heart. 

I will focus on helping you understand the most common cause of heart disease -- atherosclerosis (which is a build up of plaque in the arteries).

Your heart is the most important muscle in your body, and every muscle requires oxygen to function and stay alive.  Your heart’s job is to pump blood to every single organ in your body. When you exercise, the demand for oxygen in your body increases. It is the job of your heart to meet those increased demands. 

Chest pain is considered as the most typical symptom of heart disease that many people are familiar with. Interestingly – chest pain is the most common symptom in men NOT women!  Women, along with Diabetics, generally do not develop the typical symptoms of heart disease - thus it important to be aware of all other symptoms that can be associated with heart disease which include: 

• chest pain at rest
• chest pain during exercise  
• sharp pains that moves down the left (most commonly) or right arm
• jaw pain
• chest pressure (as it someone was standing on your chest)
• increased sweating
• nausea/vomiting
• dizziness
• light-headedness
• upper abdominal pain

According to the American Heart Association – 64% of women who die suddenly from a heart attack never exhibited prior symptoms!  This is why prevention is so important!

Being knowledgeable about heart disease can save your life and the lives of your loved ones. I hope you found this information helpful. As always, email questions/comments to DoctorDeenaMD@gmail.com.

**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**

Natural Aphrodisiacs - A Valentine's Day Special!

My friends often ask me questions about how to spice up their love life and increase libido. So in honor of Valentine’s Day, here is my top list of natural aphrodisiacs!

Aphrodisiacs are named after the Greek goddess of love, Aphrodite. Aphrodisiacs are known to increase sexual desire based not only on their chemical properties, but also on their physical properties - color, texture, smell, taste, shape, and how they appeal to our senses.

Most of the items listed below have not been proven by research or studies to be effective, but have been linked to years of story-telling and successful practice by experts in Alternative Medicine.

1. Bananas

 During ancient times in Central America, the sap of the red banana was considered as the "elixir of love" and was often presented to a newly married couple on their first night together. Interestingly Hindus (both past and present) often use bananas during wedding rituals and ceremonies as a symbol of love, sweetness, and fertility. Bananas are mixed in a drink with milk and honey, which Indian newlyweds feed to one another on the first night of marriage as a means of enhancing the sexual experience.

In addition to its suggestive shape, bananas are rich in Potassium and Vitamin B which are vital in the production of sex hormones.

2. Ginger

Ginger’s aphrodisiac qualities have been endorsed by the ancient Greek physician Dioscorides; a citation in Arabia’s "A Thousand and One Nights", and Italy’s famed University of Salerno medical school where it was prescribed as a rule for happy life in old age-“eat ginger, and you will love and be loved as in your youth.” 

Ginger is known to stimulate the circulatory system through vasodilation of blood vessels. These "vasodilatory" effects allow increased blood flow to all sexual organs, which is important for maintenance of erection and achieving orgasm. In ayurvedic medicine, ginger is also used to prevent heart disease and high cholesterol. 

     3. Honey

    Honey is one of the oldest known aphrodisiacs, and dates as far back as 500 B.C. Hippocrates, known as the "Father of Medicine", prescribed honey as a cure for impotence and increased sexual drive. In ancient Persia, people drank mead (honey wine) every day for a month (which is where the term "honeymoon" comes from) to ensure a lifetime of happiness and fertility.  Honey is rich in Vitamin B and boron which are important components of testosterone and estrogen respectively.

    4.  Oysters

Legend states that the great lover, Casanova, would eat more than 50 raw oysters for breakfast, which is how he maintained his sex drive and "manliness".  Interestingly, a research study performed at the NIH on animal models demonstrated that injecting the amino acids - D-aspartic acid and N-methyl-D-aspartate-  from mollusks (like oysters) showed an increase in testosterone (male sex hormone) and estrogen (female sex hormone) production. 

Oysters are also high in zinc, which is necessary for sperm production. 

5. Chocolate
You knew this one had to make the list! The cocoa bean has been used as an aphrodisiac since the days of Emperor Montezuma in Aztec times. Chocolate has phenylethylamine and serotonin, two chemicals that are known to uplift mood and increase energy. Chocolate also contains theobromine which boosts mood. It's no wonder why so many women rely on chocolate during times of PMS!
Chocolate is rich, smooth, and creamy - which on its own is quite sensual, appealing to every one of our senses. 

6. Licorice

Black licorice has been an aphrodisiac for centuries. In ancient China, people used licorice to enhance love and lust. In Roman times, licorice was fed to the military troops prior to battle to increase their stamina.  

The smell of licorice also appears to be particularly stimulating. Alan R. Hirsch, MD, neurological director of the Smell and Taste Treatment and Research Foundation in Chicago, researched into how different smells stimulate sexual arousal. He found that "the smell of black licorice increased the blood flow to the penis by 13 percent."

Licorice root extract is believed to have some estrogen-like properties and people actually use this to treat symptoms related to menstruation (i.e. abdominal cramps, bloating, irregular bleeding) and menopause (i.e. hot flashes, headaches). It is also believed that chewing on licorice root, can lead to an increased sexual vigor.

7.   Papaya

    The green papaya (which is unripened) is believed to be an aphrodisiac. Papaya has estrogenic properties which can boost female libido. It is an excellent source of vitamins C, A, K, as well as folate and Potassium - which are all important for a healthy reproductive system and sex hormone development.

In my opinion what truly will make the best impact on your sexual health and libido, are eating whichever foods make YOU feel healthy and beautiful. Once you feel good inside and on the outside.. it will automatically reflect in your personality, uplift your mood, and help you build confidence in and out of the bedroom.

I hope you all enjoy your Valentine's Day! 

As always, please email all questions to DoctorDeenaMD@gmail.com

**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**