House Call, MD: Health Carefully Explained

by Marissa Camilon, MD 2011 | camilon@myhousecallmd.com

While it may be better to see life through rose-colored glasses, acquiring pink eye is not the recommended approach. Anyone who has suffered through this highly contagious and (usually) brief condition can testify to the suffering it causes. You’re itchy, you’re watery and you’re incontestably uncomfortable. Your eyes are your window to the world and, as such, you can’t give them a rest for several days at a time while they heal.  In a nutshell, pink eye sucks.  Luckily, it’s pretty easy to treat and usually lasts for a short amount of time.  What you may not know, however, is that the conventional ways to treat it, the ones passed down from your grandma’s aunt’s nanny, may not be what is the best treatment for your eyes.

What it Pink Eye?

“Pink eye” is more commonly known in the medical world as conjunctivitis, or inflammation of your conjunctiva (the moist layer of tissue that covers most of your eye and the inside of your eyelids). There are many causes for inflammation in this area that are broken down into two major categories: infectious and non-infectious causes. Under the infectious category we have conjunctivitis caused by viruses or bacteria.  Under the non-infectious category we have allergic and non-allergic causes (an example of a non-allergic cause is spilling chemicals in your eyes). While studies show mixed results, most physicians in the trenches will tell you that the most common cause of conjunctivitis is viral.  This makes sense since viral conjunctivitis is extremely infectious (it spreads like fires in the Hollywood Hills in the late summer), spread through any type of bodily secretions, especially secretions from the eye.  That’s where those darn bugs have it figured all out, right?  They make our eyes insanely itchy causing us to rub them all day typically right before we touch phones, doorknobs, and other people’s hands.  That’s also the reason that most of viral outbreaks occur in schools or daycare centers (i.e. places where objects can easily go from eye to hand to mouth to who knows where else).

How do you know if it’s serious?

Historically, you decide to visit the doctor (or more commonly you take your child to the doctor) when you notice the tell-tale pink eyes, complete with extra discharge and dried mucus crusting your eye lid closed in the morning (that seems to be the standard diagnostic criteria in town).  Before you completely write it off as “just another episode of pink eye,” there are a couple of things you should keep in mind. First, there can be more serious causes of pink eye than a simple virus so let your doctor know if you:

• wear contacts

• 
  

  have concurrent headaches and nausea

• have suddenly blurry vision

• have a very, very strong feeling that there is something inside your eye

Any of these signs can indicate that something more serious is going on and is worthy of sharing with your doctor during your appointment.

How to Treat Pink Eye

Now we return to your doctor’s appointment.  While we all want the “magic bullet” to cure our medical ails, pink eye is another case where this just doesn’t work.  Since most cases of pink eye are viral in origin, antibiotics (i.e. medications that kill bacteria) won’t do anything for it (this little tidbit of information may not be what you have heard in the past).  Previously, antibiotics were generally given to those with pink eye, even when they were suspected to be viral, to prevent any bacterial infection that could occur on top of the viral infection.  Even as late as 1994, treatment guidelines stated that antibiotic treatment was always necessary for that exact reason (the prevention of a bacterial “super-infection”…not as cool as it sounds).  Since then, new research has shown that these bacterial super-infections rarely occur and that antibiotic treatment may actually be harmful. Giving someone antibiotics without any infectious bacteria means exposing normal, “naïve” bacteria to antibiotics that they can build resistance to.  The result is the evolution of stronger, antibiotic resistant bacteria that are harder to treat in the future. In the words of Homer Simpson, “Doh!”

This strategic change in our approach to treating pink eye is still slowly making its way through American society.  One major issue is the long-standing rule at schools and nurseries stating that children should be treated with antibiotics before returning to school.  Their goal is to decrease the number of children who can potentially become infected. Remember that we are most likely dealing with a viral infection that will not be killed by antibiotics.  The only real way to control the spread of viral conjunctivitis is to not share napkins, utensils or cups and, like we’ve heard so many times, by washing your hands!  The second major battle takes place with people who have heard or seen the previous use of antibiotics during cases of “pink eye.”  These people will go to the doctor expecting to be handed antibiotic eye drops and put pressure on their doctor to prescribe them as they did in the past.  Luckily, these two issues can be rectified with education about the self-limiting, viral nature of this disease.

For those sitting in the waiting room, here’s some good news: in the majority of cases, this is a self-limited condition that can be treated symptomatically. That means using over the counter antihistamines, decongestants or lubricating agents to relieve the dryness and discomfort in your eyes.  So while you may not get the “cure” to pink eye at the doctor’s office, you can definitely get some help with the real troublesome stuff so that you can live your life while your body’s immune system does exactly what it was designed to do.

Questions? E-mail the Author: camilon@myhousecallmd.com

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References:

1. Azar MJ, Dhaliwal DK, Bower KS, Kowalksi RP, Gordon YJ. “Possible consequences of shaking hands with your patients with epidemic keratoconjunctivitis.” Am J Ophthalmol 1996, June; 121 (6): 711-2.

2. Bennett C, David S. “Treatment of viral conjunctivitis in children/in reply.” American Academy of Family Physicians 2003; 67 (9): 1873-5.

3. O’Brien T, Jeng B, McDonald M, Raizman M. “Acute conjunctivitis: truth and misconceptions.” Current Medical Research and Opinion 2009; 25 (8): 1953-61.

4. Rose P, Harnden A, Brueggemann A, Perera R, Sheikh A, Crook D, Mant D. “Chloramphenicol treatment for acute infective conjunctivitis in children in primary care: a randomized double-blind placebo-controlled trial.” Lancet 2005; 366: 37-43.

5. Weiss A. “Acute Conjunctivitis in Childhood.” Current Problems in Pediatrics 1994; 4-11.

by Sarah Gilman-Short, MD 2010 | sarah@myhousecallmd.com

Almost every woman has, at one time, experienced that “Ummm… something’s not quite right down there…” sensation. Today we’ll be discussing three cases of vaginas gone wrong – Bacterial Vaginosis, Candida Vulvovaginitis, and Trichomoniasis. Not the sexiest part of womanhood, but often an unavoidable aspect of it. All three have simple treatments and sound much more sinister than they actually are.

Firstly, let’s just say that, contrary to what some people (even some male doctors) believe, not all vaginal discharge is abnormal. Happy, well-adjusted vaginas can regularly release a small amount of milky, whitish, or clear fluid daily.  This fluid is made up of sloughed off cells from the vaginal lining (vaginal cells slough off just like your other skin cells). The color and consistency of the fluid can change with your menstrual cycle. Yes, it’s true – the vagina is a self-cleaning organ. And even though it may be slightly unpleasant to think about, normal vaginas are full of bacteria (just like many other places in the body…your nose, for instance, is packed full of bacteria). Every woman’s “vaginal flora,” as we medical folk call it, is made up of a personalized balance of different species of bacteria, kind of like how every forest has a slightly different mix of foliage. Most vaginas are in a peaceful symbiosis with Lactobacillus acidophilus and Staphylococcus epidermidis.

Things go wrong when this delicate vaginal balance is disrupted. Here are some ways this could happen:

• Douching: We thought that people stopped doing this in the seventies, but it turns out that it is still popular in some social circles. A word from the wise: Don’t do it! It’s never a good idea – you are flooding your personal space with a bunch of annoying, irritating chemicals that will make your vagina unhappy and make it easier for that delicate balance to be disrupted. Also, if you have a STI, (and you might not even know it if you do) douching can push the evil bacteria into your uterus and fallopian tubes in an ugly, infectious tidal wave, making the problem much, much worse. The best way to clean down there is with some gentle soap and water on the outside. Also falling into the “no no” category would be other irritants such as hygiene sprays, bubble baths, and perfumed detergents. Your vagina does not have to smell like flowers!

• Antibiotics: Remember the idyllic forest analogy? Taking antibiotics can kill the healthy bacteria your vagina likes and needs, making room for other bacteria or yeast that your vagina hates. But of course, this isn’t a reason for not taking antibiotics if you really need them. An imbalanced vagina is easier to treat than Scarlet Fever.

• Contraception: Oral contraceptive pills, IUD’s, condoms, and spermicide (especially nonoxynol-9) have been associated with increased yeast infections. Once again, this is not a good reason to stop using contraception – yeast infections, though annoying, are much less annoying than unwanted babies and incurable STD’s.

• Health conditions: Diabetes, pregnancy, or infections can mess with your vaginal flora.

• Sluttiness: Just kidding, we don’t judge – but having unprotected sex can put you at high risk for a lot of bad things, including Trichomoniasis.

• Who knows? Women can get BV or yeast infections out of nowhere, for no identifiable reason whatsoever.  It sucks, but there’s a lot that we doctors just don’t know.

Bacterial Vaginosis (BV)

BV is a very common cause of vaginal annoyance – a third of women who visit their doctor complaining of a vaginal issue end up being diagnosed with BV. Although almost half of women with BV have no symptoms at all, most complain of a fishy-smelling discharge that can be yellow, creamy white, green, or gray (have we ruined your appetite yet?  Our sincere apologies). They can also have some minor itching. No one knows the exact cause of BV, but we know that somehow there is an overgrowth of new, annoying bacteria in the vagina, usually Gardnerella vaginalis, Mobiluncus, or Mycoplasma hominis (the can be seen in the picture to the right…the little dark spots mixed in with the large healthy cells are the unwanted intruders). BV can be more likely to rear its ugly head when a woman has been involved with a new sexual partner, and studies have shown a concordance of BV between lesbian partners; however, there is no clear evidence that it is sexually transmitted.

Candida Vulvovaginitis (a fancy term for a yeast infection)

Candida is a yeast – yes, similar to the yeast that makes your bread and beer delicious – that is present on many people’s skin, but can make vaginas exceptionally angry. This is the type of yeast that many women self-treat with over-the-counter creams but it is, in fact, less common than BV, accounting for about a quarter of the women who come to the doctor with vaginal symptoms. Women with yeast infections often have a thick, curd-like white discharge that kind of smells, well, yeasty. Unlike BV, yeast infections can make your vagina and vulva notably painful, itchy, and red. As we said before, many women will try over-the-counter creams but, if for some reason the symptoms persist or come back, it is important to see a doctor and make sure there isn’t something more serious going on. Studies have shown that most women aren’t very good at diagnosing yeast infections on their own so don’t hesitate to go in for a check-up if you’re unsure.

Trichomoniasis

Trichomoniasis is caused by a little protozoan with a tail (named Trichomonas) that swims around in seminal or vaginal fluid, causing mischief. Trichomonas, although cute, is without a doubt an STI, and can be easily prevented by wearing condoms with every sexual encounter. Trichomonas can live on objects like sex toys and towels and can also be found in urine. Women with Trichomoniasis usually have a significant amount of thin, discolored, foamy discharge, as well as a strange odor and itching. When the infection gets really bad, it can cause fever and lower abdominal pain (but these can be symptoms of other serious infections as well). Trichomonas also likes company – a third of women who have it will have another STI at the same time.

Your Take Home Message

Vaginas can be rather finicky and complicated. Happy, healthy vaginas have their own natural balance of bacteria and anything that disrupts that delicate balance can cause itching, discharge, or odor. If you think that your vagina’s balance is off, it’s a good idea to see a doctor. With a quick swab of your vagina (you don’t usually need a speculum for this) and examination via microscope or laboratory, he or she can diagnose the problem and treat it accordingly. All three conditions can be cured quite easily so there’s no reason to try and fight it off alone. We’re here for you… might as well let us help!

Questions?  E-mail Sarah: sarah@myhousecallmd.com