5 Reasons to Consider the Human Papilloma Virus (HPV) Vaccine in 2020: Prevention of Warts and Cervical Cancer in Adults.

By Natan Schleider, M.D. Written January 14th, 2020 3 MINUTE READ

Vintage Medicine Container for Treatment of Warts. Circa Early 1900s.

Basic Facts About Human Papilloma Virus (HPV) and Disease in the USA as of 2020:

Human Papilloma Virus (HPV) is the most common sexually transmitted infection in the United States infecting 1 in 4 Americans (79 million of the infected based on USA population of 330 million in 2020). This virus likes grows in skin cells where sexual contact has occurred and condoms do not prevent it. While causing a bunch of different cancers like Cervical Cancer, Anal Cancer, and Mouth (Oropharyngeal), it far more commonly causes little painless fleshy bumps called warts.

While ‘painless’ in that warts do not hurt physically, the look at you (former) new partner’s face running out the door after seeing your wart hurts. Getting the wart removed by the doctor also hurts and they can be stubborn and grow back.

HOW TO KNOW IF YOU OR YOUR PARTNER HAVE HPV:

HPV infection may not be obvious to the naked eye (nor obvious to the infected patient which is why doctor do PAP smears and HPV DNA tests during women’s health exams) sitting dormant for months to years until causing a wart or cancer, it is difficult to know whether your partner carries HPV. By the way, there is no test to confirm skin infection of HPV in men, at least nothing done routinely. We do not swab or scrape a man’s genital region to look for HPV infection, If anyone reading this wants to know why, contact me.

While the HPV vaccine better known as Gardasil has been recommended since 2006 for ages 11-26, now all men and women should consider it so….

Five Reason to Consider the HPV Gardasil Vaccine If You Have Never Been Vaccinated:

  1. You are sexually active and your partner is infected with HPV.
  2. You want to reduce your risk of getting HPV infection and are open to vaccination
  3. While considered about the risks of safety of any vaccine, 8-10 years of data not only in adults (more in children) show no evidence of any long term disease or risks of the vaccine.
  4. You do not like cancer.
  5. You have not figured out a clever, cool way to ask prospective or current sexual partners about HPV infection–if there is one?

Given this new information, I will be contacting my doctor for the Gardasil vaccine and will keep you posted. Thanks for reading.

Citation

Oshman LD, Davis AM. Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices (ACIP). JAMA. Published online January 13, 2020. doi:10.1001/jama.2019.18411

Four Ways to Treat Chronic Pain WITHOUT Medications

Written By Natan Schleider M.D. on January 13th, 2020

3 MINUTE READ

Dr. Gustav Zander, a Swedish physician known for inventing mechanotherapy, which was defined in 1890 as “the employment of mechanical means for the cure of disease.” Zander exhibited his exercise machines at the 1876 Centennial Exhibition in Philadelphia where they won a gold medal. By 1906 Zander had established his first gyms with these machines in 146 countries.

In my arsenal of pain management treatments are plenty of evidence based treatments that do not require you to swallow a pill.

If you suffer from chronic pain, your doctor may walk into the cold exam room you’ve been waiting in with your paper gown and say something like: “Here at A1 Pain Management Center, an integrative, multi-modal, team delivers interdisciplinary care. Before initiating analgesics, my staff will give you some resources. Follow up one week.” Was that English?

Below are definitions and explanations of 5 ways to manage chronic pain you are likely to hear about so let’s sort through the jargon.

  1. Mind Body Therapy incorporates a blend of light exercises and meditation along a continuum. Examples include meditation, mindfulness, mindful based stress reduction (MBSR), yoga, and Tai Chi. Evidence supports that Mind Body Therapy causes SMALL improvement in chronic pain with moderate improvement range of motion, depression and anxiety.
  2. Exercise Therapy is most effective for patients with orthopedic or musculo-skeletal pain like chronic back, shoulder, hip, or knee pain. Examples included graded, resistance, aerobic, and pilates exercise. Medical evidence, while not strong, does suggest that exercise therapy causes SMALL to MODERATE reduction in chronic pain with improved quality of life.
  3. Manual Therapy involves another trained professional helping your movements and include Rehabilitation, Manipulation (IE chiropractic movement, osteopathic manipulative movement, passive movements done with physical therapist), Acupuncture, and Massage. While massage therapy has data to support short term improvement, manipulation and acupuncture can provide chronic pain relief for short to intermediate amounts of time (days to weeks).
  4. Psychological Therapy, namely cognitive behavioral therapy (CBT) and Acceptance and Commitment Therapy (ACT) can improve chronic pain. These will be helpful for those patients who are interested in cause, effect, and prevention of pain triggers; however, if you are thinking ‘I don’t see how sitting around and talking about crap is going to help my back pain’ then exercise or manual therapy may be more for you.

So what did the doctor mean with all that jargon before?

Essentially the doctor is saying that there are resources other than pills, surgery, and injections that can help chronic pain. It is up to the patient and doctor to chose which work and which do not. That said, unlike a pill, all above therapies will involve the patient be willing to put in time and effort.

Source: Using Non-Pharmacologic Treatment Modalities: Practical Guidance for Pain Management by American Medical Association December 12th, 2018

Three Keys to Ensuring a Lifetime of Healthy Bones: Vitamin D Supplementation Effective for Bone Health but ONLY with Calcium supplementation

By Natan Schleider, M.D. Written January 8th, 2020

Young child with Rickets, a disease common in the USA until the early 1900s resulting from inadeuqte intake of Vitamin D and or Calcium and or Sunlight. Image circa 1900.

If your doctor told you your Vitamin D levels are low and you live in the United States, join the club. In my practice here in New York City, at least 50% of my patients labs (along with my own labs) show low levels of Vitamin D (below 32 ng/mL is considered deificient with 10-20 mg pg/mL or lower considered severely deficient).

‘So should I be taking a Vitamin D supplement? Get a prescription supplement from your doctor? Isn’t sunlight enough to increase my Vitamin D levels which will probably increase when summer returns?’

These are all common questions and reasonable ones!

A little basic science: Vitamin D is a fat soluble vitamin (like Vitamins A, K, and E) which is why it is packaged in a light brownish clear round or oval capsule at the pharmacy and found in good quantities in fatty fish (and in edible mushrooms exposed to ultraviolet light). When the USA began fortifying cow’s milk with Vitamin D (breast milk does not have as much as we would like), cases of rickets dropped significantly by the mid 1920 to 1930s. Vitamin D increases absorption of magnesium, calcium, and phosphate in the intestine. Since our bones like a good steady supply of calcium, we need Vitamin D to get it absorbed or risk osteoporosis (severe thinning of bone to the point patient is high risk for bone fracture, especially of the hip or vertebrae of spine). That frail looking older person that looks like they have a hump (called Dowager’s Hump almost always due to broken weak vertebrae in the neck or upper back) on their back you see walking around might walking with normal posture had they followed the advice below when they were younger and taken Vitamin D with calcium daily.

There are different types of Vitamin D (five actually but I will just mention the important kinds that will confuse us as they are named on labs or at the pharmacy):

  1. Cholecalciferol is the name for Vitamin D3 which is available over the counter at the pharmacy (usually at doses of 1000 to 4000 International Units, take 1 capsule daily). Vitamin D3 is the ACTIVE form of Vitamin D but it only becomes active if we ingest enough Vitamin D2 or ergocalciferol.
  2. Ergocalciferol is the name of Vitamin D2 which is found in foods and or in supplements. Ergocalciferol is INACTIVE when swallowed but our intestines turn it into Vitamin D3 as does sun exposure.
  3. SINCE I ALWAYS TRY TO WEAR SUNBLOCK AND SUN PROTECTIVE CLOTHING REGARDLESS OF SEASON TO KEEP MY SKIN FROM GETTING WRINKLED AND SPOTTY, I DO NOT RECOMMEND SUN EXPOSURE FOR MY VITAMIN D DEFICIENT PATIENTS; HOWEVER, AS I DO NOT LIKE TO FORCE ANY PATIENTS TO TAKE A PILL WHEN THEY DO NOT WANT TO, SO ABOUT 15 MINUTES OF NATURAL SUNLIGHT A DAY AND NO MORE COULD ALSO WORK PRESUMING YOU HAVE ENOUGH VITAMIN D IN YOUR DIET. SINCE I DO NOT LIKE HAVING BLOOD TESTS DONE EVERY FEW MONTHS TO SEE IF I NEED VITAMIN D SEASONALLY OR ALL YEAR ROUND I ADVISE AND TAKE IT ALL YEAR.

If you are found to be Vitamin D deficient on your labs, many doctors (including me) will recommend Vitamin D supplementation BUT they often forget to mention the following: you MUST add calcium supplements with Vitamin D supplements or the extra Vitamin D you are taking will likely not have enough calcium for our bones. THIS IS WHAT WAS CONCLUDED IN A LARGE STUDY IN THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION DECEMBER 2019. Calcium needs to be taken twice daily minimum for best absorption, I usually recommend and take 600 mg in the morning and 600 mg in the evening. You can also use some antacids like TUMS for calcium supplementation and take care of mild heartburn and bones all at once.

While on the subject of Vitamin D, other studies show that taking Vitamin D reduces risk of falls in elderly patients and reduces stress fractures in high impact athletes.

While my smart patients know that Vitamin D3 is the better form of Vitamin D to supplement, many patients prefer prescription strength Vitamin D2 ergocaciferol 50,000 International Units once a week which can be easier to remember, just don’t forget the daily calcium!

SOURCE: Yao P, Bennett D, Mafham M, et al. Vitamin D and Calcium for the Prevention of Fracture: A Systematic Review and Meta-analysis. JAMA Netw Open. 2019;2(12):e1917789. doi: https://doi.org/10.1001/jamanetworkopen.2019.17789