Susan Goodlerner, M.D. / article #4

What are the options for treating pre-cancerous growths that come from the sun?

Until recently these growths (Actinic Keratoses) have been treated by freezing with liquid nitrogen (cryosurgery) or with topical chemotherapy, both of which can cause side effects. Cryosurgery can cause hypopigmentation, or white spots; topical chemotherapy can cause the skin to become red, itchy and blistery for about a month.

A new, more elegant treatment is Photodynamic Therapy (PDT), which is covered by Medicare and most PPO health plans. The area is first treated with a topical clear gel. This medicine can be activated after one to two hours by an appropriate light source-pulsed dye laser; intense pulsed light (IPL); or the recently FDA-approved blue light. The entire face can be treated quickly-in 10-15 minutes. Post-treatment, most patients have a sunburn-like reaction with some redness and peeling for two or three days. The end result is smoother, healthier skin.

Susan Goodlerner, M.D. Diplomate,
American Board of Dermatology Member,
South Bay Independent Physicians Medical Group, Inc.
Please log onto www.sbipmedicalgroup.com for archived articles

The average age when a patient goes into natural menopause is 51 years old. However, it can take place as early as 40 or as late as 55.

Surgical menopause can occur when the ovaries are removed surgically. The symptoms of impending menopause are:
" Irregular periods that eventually stop
" Hot flashes / night sweats 86%
" Vaginal dryness, due to low estrogen
" Bone loss, due to reduced estrogen

Mehdi Hemmat, M.D.
Diplomate, American Board of Obstetrics and Gynecology
Member, South Bay Independent Physicians Medical Group, Inc.

What is the difference between Colonoscopy, Sigmoidoscopy and Virtual Colonoscopy?

All are early screening procedures for colorectal cancer. It is recommended that everyone undergo one of these procedures starting at age 50, and at regular intervals thereafter. For individuals with increased risk factors, such as family history of colorectal cancer, rectal bleeding, abdominal pain, or a change in bowel habits, testing should be done before age 50.

All three studies require preparatory bowel cleansing consisting of a clear liquid diet and laxatives the evening before the procedure. Colonoscopy is the most thorough study. A fiber optic scope is used to inspect the entire colon where polyps or other suspicious tissue are removed for testing. Sedation is necessary when undergoing a colonoscopy because of discomfort caused by the test.

Flexible sigmoidoscopy is similar to colonoscopy, but is done with a shorter scope, which extends only into the lower colon. It does not examine the upper colon, and is therefore less complete than a colonoscopy. However, it involves much less discomfort, does not require sedation and is a reasonable alternative for individuals having no special risk factors.

Virtual colonoscopy is the newest procedure. The bowel is inflated with air, and a computed tomographic (CT) scan, a special type of x-ray, is taken of the entire colon. It is still considered somewhat experimental and may be less sensitive than direct observation methods, but is easier on the patient.

If any suspicious lesions are found during either a sigmoidoscopy or virtual colonoscopy, a full colonoscopy is then required for direct examination and biopsy of lesions. Flexible sigmoidoscopy can usually be done by your primary care physician. Colonoscopy requires a visit to a specialist in Gastroenterology. Virtual colonoscopy is a radiological procedure done at special imaging centers.

Brian D. Borsook, M.D., Ph.D.
Diplomate, American Board of Family Practice; Licensed Psychologist
Member, South Bay Independent Physicians Medical Group, Inc.
Please log onto www.sbipmedicalgroup.com for archived articles

Shoulder bursitis is a common inflammatory condition of a fluid filled sac in the shoulder that functions as a cushion between the rotator cuff tendons and bone. Symptoms usually occur in patients over forty who are involved with repetitive overhead activities often related to sporting activities or work. Shoulder bursitis can occur from a specific injury but frequently is noted without any significant trauma. Patients usually complain of a sharp deep pain within the shoulder often radiating down the outer side of the upper arm when raising the arm overhead. Pain during sleep is also common.

Standard treatment consists of anti-inflammatory medication and physical therapy for strengthening of the rotator cuff and shoulder girdle musculature. Often an injection of cortico-steroid medication directly into the bursa is required to reduce or cure the patient's symptoms. Failure of non-operative treatment can be associated with a bony spur located above the bursa. Removal of the spur and inflamed bursa can be accomplished with a short outpatient arthroscopic surgical procedure. Following a brief period of rest and rehabilitation, patients are expected and encouraged to return to normal activities.

Peter S. Borden, MD
Diplomate, of American Board of Orthopaedic Surgery
Shoulder and Knee Sports Medicine Specialist
Member, South Bay Independent Physicians Medical Group, Inc.

Yes, and no. Cranberry juice contains an elusive ingredient which has been shown to reduce the incidence of bladder infections. However, cranberry juice is also very acidic, which is not good for the urinary tract. Some people have a sensitive bladder lining, and they develop pain and burning with urination when they consume acidic fruits and beverages.

The same symptoms can also occur after eating spicy foods and drinking beverages containing alcohol, caffeine, and carbonated (fizzy) beverages. Many times these individuals think they have a bladder infection, while in fact they do not. Many patients have told me, "I keep drinking cranberry juice, but it just keeps burning". When they stop drinking the cranberry juice the pain magically resolves.

Cranberry juice, cola, coffee and tea also contain oxalate, which contributes to kidney stone formation. Ask anyone who has had a kidney stone how painful it is and you will surely want to avoid getting one. If you have already had a kidney stone it is especially important to reduce the oxalate in your diet. Other sources of oxalate include spinach, beets, nuts, chocolate and many fruits. Those wishing to avoid a kidney stone are also advised to avoid excessive sodium intake, but in all but rare cases calcium restriction is not necessary.

Jill G.Byers, M.D,
Diplomate, American Board of Urology
Member, South Bay Independent Physicians Medical Group, Inc.

Influenza or the "flu" is an acute respiratory infection caused by the Influenza virus. Symptoms include headache, body aches, fatigue, fever, chills, and dry cough. Rarely are there symptoms of sore throat and nasal congestion. The duration of the illness ranges from 1 to 2 weeks. Treatment is primarily symptomatic and includes getting plenty of rest, drinking fluids and taking over the counter pain relievers/fever reducers and cough suppressants. Medications that may shorten the duration and severity of the illness are available by prescription.

A serious and sometimes fatal complication of the flu is pneumonia. Make sure to report to your doctor if symptoms worsen or fail to improve. Fortunately, there is a vaccine against influenza. Currently there are two forms of the vaccine. One form is injected. A newer form is sprayed into the nose. It is best to get vaccinated early in the Fall, before the flu season begins. Ask your doctor if you are a candidate for the flu vaccine.

Elizabeth D. Duenas, M.D.
Diplomate, American Board of Family Practice
Member, South Bay Independent Physicians Medical Group, Inc.

All facial lines are created by muscle contractions and increased by sun damage and smoking. If a facial wrinkle is primarily present when animating the face, Botox ™ can be used to prevent the muscle contracting for 3 to 4 months. Crow's feet, frown lines and forehead wrinkles, are well treated with Botox, but not areas around the mouth and lips.

If a wrinkle or line is already present, injectable filler is a better solution. Collagen injections are easy to accomplish but only last 3 to 4 months. Radiance™ (calcium hydroxylapatite) lasts 3-5 years and is growing in popularity because of its long lasting characteristics. Both can be used to enlarge lips, minimize lines around the mouth and lips, fill wrinkles and grooves in the cheeks, forehead and other facial areas.

Harold J. Kaplan, M.D., FACS
Diplomate, American Board of Facial Plastic Surgeons
Member, South Bay Independent Physicians Medical Group, Inc.