Two 喵咪社区 experts share their advice.

Jennifer R. Marks, MD, general internist, Internal Medicine

It should always be the patient who has ultimate agency over their medical decisions 鈥� not a family member, nor even their physician. Ideally, your decision should be driven by good clinical evidence and accurate data that is applicable to your specific situation.

It鈥檚 best to make sure your medical information is based on proven, objective facts rather than relying on emotions or opinion-based advice.

It should always be the patient who has ultimate agency over their medical decisions — not a family member, nor even their physician.

Jennifer R. Marks, MD

If you鈥檙e feeling conflicted about opposing advice, from a family member or other source of information, the best thing you can do is be open and honest with your care provider and let them know the context of your concerns.

Your care provider can only address the conflicts you share with them. Once they are aware of your concerns, they can help ensure you have the right information and insights to help you make the best possible decisions for your unique medical circumstances.

Umair U. Ghani, MD, medical oncologist, 喵咪社区 Norris Comprehensive Cancer Center

Knowing the source of your information is essential. As your doctor, I rely on evidence-based medicine to make recommendations. I use clinical trial data, research findings and years of experience to design a care plan tailored specifically to your condition.

By contrast, advice from family or friends 鈥� though often shared with love 鈥� may not be appropriate for your particular diagnosis, stage or medical history.

That鈥檚 not to say you should automatically discredit all medical advice from family members. Sometimes family members do have valuable insights or observations to share that can be helpful to you and worth discussing.

The most important thing you can do is be open with your doctor about the other advice you’re hearing.

Umair U. Ghani, MD

The most important thing you can do is be open with your doctor about the other advice you鈥檙e hearing. That transparency allows us to work together to determine the safest and most effective plan for your health.

In some cases, your doctor can organize a family meeting to address everyone鈥檚 questions together. This can help ensure everyone is on the same page and that decisions are made collaboratively.

The post How to Weigh Family Advice Against a Doctor’s Advice appeared first on 喵咪社区.

Five 喵咪社区 experts share possible causes and treatment options.

Dermatologic issues

鈥淥ne of the most common explanations for itch is dry skin,鈥� says dermatologist Melvin Chiu, MD. 鈥淎nother common reason is eczema, where skin is predisposed to itchy rashes. And a reaction to something touching the skin can create itchy rashes called contact dermatitis.鈥�

Symptoms:

• Rashes at itch site
• Worsening itch after scratching
• Asthma or seasonal allergies (with eczema)

Treatment:

• Warm (not hot) showers
• Fragrance-free moisturizers
• Anti-inflammatory creams and medications
• Avoiding the trigger causing the itch

Vascular issues

Venous insufficiency is a condition in which veins鈥� valves don鈥檛 work well, causing fluid to pool in the legs and produce ulcers, swelling and inflammation. As podiatrist Chia-Ding Shih, DPM, explains, 鈥淭his inflammation is called stasis dermatitis, and it can itch.鈥�

Symptoms:

• Brown discoloration around ankle and lower leg
• Dry skin
• May affect only one leg

Treatment:

• Unna boot (a calamine-impregnated bandage)
• Compression dressing
• Topical steroid

Consult a vascular surgeon if you鈥檙e experiencing these issues.

Liver issues

鈥淧ersistent chronic itch is a common manifestation of some types of liver disease, especially in the absence of rash,鈥� says hepatologist Lily Dara, MD.

In some forms of liver disease, such as primary biliary cholangitis, immune cells attack the liver鈥檚 bile ducts, destroying them and causing bile acids to accumulate in the bloodstream and cause an itch called cholestatic pruritus.

Symptoms:

• No associated rash
• Itch that worsens at night
• Sudden onset of itch later in life
• Family history of autoimmune disorders
• Use of medications that damage the liver (hepatoxicity)

Treatment:

• Medications: bile-acid sequestrants, rifampicin, opioid antagonists, SSRIs, ileal bile acid transporter inhibitors (IBATs)

Diabetes

Pain management physician Michael Bottros, MD, notes that high blood sugar associated with diabetes can cause itchy skin, as can damage to blood vessels. Diabetes-related nerve damage can lead to 鈥渁berrant signaling鈥� that might also feel like an itch, Dr. Bottros says.

Symptoms:

• Prickly, 鈥渃rawling-ants鈥� itch
• Itch that worsens at night

Treatment:

• Medications that address nerve pain
• Physical therapy

Neurologic issues

As with diabetes-related itch, 鈥淚tching can represent a form of neuropathic sensory disturbance,鈥� says neurologist Lilyana Amezcua, MD. For example, nerve pain following shingles can manifest as itch, she says, and some patients with multiple sclerosis also experience itch because of the condition.

Symptoms:

• Other neuropathic symptoms, like tingling, burning and numbness
• Itch on one side of the body (with shingles)
• Heat sensitivity in addition to itch (with multiple sclerosis)

Treatment:

• Depends on cause; speak to your doctor

The post What Is Causing My Itchiness? appeared first on 喵咪社区.

Making decisions about your health can be difficult. How can you be confident about which treatment plan is best? Two 喵咪社区 experts share their advice.

Ram Kiran Alluri, MD, orthopaedic surgeon, 喵咪社区 Spine Center

When there is a lack of trust in a treatment plan, the best thing you can do is get a second opinion. If the second opinion aligns with the first doctor鈥檚 recommendation, then it can help give you more confidence that the right course of action is being implemented.

If the second opinion vastly diverges, then it can give you more information about options, and you can decide what works best for you.

In spine surgery especially, there are many different ways to treat the same problem.

A patient鈥檚 comfort with a treatment plan is probably the most critical aspect of successful patient care.

Ram Kiran Alluri, MD

At a multidisciplinary clinic, like the 喵咪社区 Spine Center, you can get opinions and consultations with practitioners from a variety of specialties. It is very common for me to send my patients to get a second opinion from one of my neurosurgery colleagues or to get an opinion regarding nonoperative treatment from my interventional colleagues.

A patient鈥檚 comfort with a treatment plan is probably the most critical aspect of successful patient care. The best thing to do if you are not comfortable with the first treatment plan offered to you is to tell your doctor about your concerns and seek more information from multiple sources.

Frances Chow, MD, neuro-oncologist, 喵咪社区 Brain Tumor Center

Uncertainty is very common, especially in the beginning, when you don鈥檛 know what to expect with prognosis or how treatments may make you feel. Cancer is a frightening diagnosis, but our goal is to work with you to help you feel confident about the future.

Educate yourself about your tumor and your options. Cancer diagnoses and treatments can be complex. Your treatment team鈥檚 role is to share information, answer the hard questions and guide you through each step.

“Once you get into a routine…what was once unfamiliar, uncertain and frightening suddenly becomes a set of more manageable tasks.”

Frances Chow, MD

Focus on what you can control by setting small goals that are achievable. Every task is an accomplishment, whether it鈥檚 waking up in the morning, making yourself a meal or putting in the effort to go outside and take time for yourself.

Once you get into a routine, such as going to radiation every morning or taking daily chemotherapy pills, what was once unfamiliar, uncertain and frightening suddenly becomes a set of more manageable tasks.

The post How to Manage Uncertainty About a Treatment Plan appeared first on 喵咪社区.

Unexplained weight gain or loss can be a cause of concern. Experts from 喵咪社区 share possible explanations.

Obesity, PCOS or thyroid issues

• Thyroid hormone levels
• Excess cortisol
• Polycystic ovarian syndrome
• (PCOS)
• In rare cases, an insulin-secreting tumor
• Obesity in general

鈥淚f someone who is overweight or obese loses weight, their resting metabolic rate decreases and their appetite increases, which is a big reason people end up regaining weight,鈥� says endocrinologist Alyssa Dominguez, MD.

鈥淵our thyroid is another culprit of weight fluctuations. If thyroid hormone levels are abnormally high, they can cause weight loss. If they鈥檙e too low, they can cause up to 10 pounds of weight gain.鈥�

Cancer

• Colorectal cancer
• Gastric cancer
• Pancreatic cancer
• Other types of cancer, such as leukemia

鈥淢any cancers can cause weight loss,鈥� says colorectal surgeon Joongho Shin, MD. 鈥淢any forms of it induce a type of immune response that results in decreased appetite, fatigue, night sweats and weight loss. So, unintended weight loss should raise a red flag.鈥�

Psychiatric conditions

• Eating disorders
• Mood and anxiety disorders, such as major depressive disorder
• Grief
• Substance abuse disorder

鈥淐hanges in appetite and weight occur across different types of eating disorders,鈥� says psychologist Kathryn Smith, PhD. 鈥淢ood also has a powerful effect on appetite and weight change, which may not be intentional. Stress can increase cortisol, which can affect appetite and eating, so there鈥檚 a very strong connection between the mind and body with respect to weight fluctuations.鈥�

Digestive problems

• Constipation
• Water retention
• Certain drugs, such as steroid, antidiarrheal or diabetes medications

鈥淗igh-protein diets are very popular right now, and they can be associated with constipation, which can lead to a few pounds of temporary weight fluctuations,鈥� says gastroenterologist Danse Bi, MD. 鈥淚f you鈥檙e on a high-protein diet, you should make sure you鈥檙e eating enough fiber and vegetables and drinking enough fluids.鈥�

Menstrual cycles, perimenopause and menopause

• Menstrual cycle hormone changes
• Menopause
• Perimenopause
• Endometriosis
• Pregnancy and postpartum

鈥淢enopause is associated with slow, gradual weight gain due to changes in metabolism that happen because of declining hormone levels,鈥� says gynecologist Anna Reinert, MD. 鈥淵ou can try to reverse some of those hormone level changes with hormone replacement therapy, but it doesn鈥檛 work for everyone.鈥�

The post What May Be Causing Unexpected Weight Changes? appeared first on 喵咪社区.

Steven Siegel, MD, PhD, chief mental health and wellness officer, 喵咪社区 Psychiatry and Behavioral Services

There are three facets of health anxiety: 1) worry over aging and loss of function, 2) stress about a disease that you have, 3) fear of a disease in the news or a condition you don鈥檛 have.

To address the first type, accepting that aging is a normal process is a huge help. If you鈥檙e specifically worried about things like mobility, strength and balance, then it鈥檚 important to practice these things.

Even adding simple stretching to your routine can improve your mindset so you no longer feel that you鈥檙e marching toward the worst reality.

“Everything that’s happened to somebody else isn’t necessarily going to happen to you.”

Steven Siegel, MD, PhD

For anxiety around a diagnosed disease, stay in good communication with your clinician and be explicit about your concerns.

The worst-case scenario in your head or in articles online might not be what your doctor thinks is happening to you. They can help vet your worries and give a balanced perspective.

In terms of worrying about diseases or conditions you don鈥檛 have, really be intentional about remembering that everything in the media isn鈥檛 your reality.

Everything that鈥檚 happened to somebody else isn鈥檛 necessarily going to happen to you.

Jai Chung, NP-C, nurse practitioner, Cardiology and Internal Medicine

Anxiety is big and it鈥檚 everywhere. There are many layers and roots to it, and it affects anyone from patients to family members and providers. The best skill you can have to manage it is to identify where it鈥檚 coming from.

If you are seeking a solution for a troublesome symptom, often anxiety stems from wondering if anyone can help you. As clinicians, it鈥檚 important for us to address your concerns. We can help relieve your stress by clearly explaining your diagnosis and reassuring you about the available treatments we offer for your condition.

“The best skill you can have to manage [anxiety] is to identify where it鈥檚 coming from.”

Jai Chung, NP-C

In this situation, the most important thing you can do is ask your provider all your questions.

Postoperative depression is also a cause of anxiety for cardiology patients. After a major surgery, it鈥檚 very common to experience a deconditioning period 鈥� both physically and mentally.

The best course of action for this is to understand this period is completely normal and not permanent. We can offer medications to relieve symptoms, but many times just understanding that this is a normal part of recovery can help ease your mind.

The post How to Manage Health Anxiety appeared first on 喵咪社区.

Five 喵咪社区 experts explain common causes and how to treat them.

Digestion problems

鈥淭he digestive system 鈥� or gastrointestinal (GI) tract 鈥� is a large network of organs, and each one is vulnerable to different conditions or illnesses,鈥� says gastroenterologist James Buxbaum, MD. Differentiating between the many possibilities depends on location and type of pain.

Three common examples include:

Celiac: Pain and nausea after eating gluten.

Pancreatitis: Severe pain in the uppercentral abdomen.

Inflammatory bowel disease (IBD): Cramping, diarrhea (sometimes with blood) or constipation.

Treatment options: Dietary adjustments, quitting alcohol and smoking, medications.

Urinary tract infections (UTIs):

UTIs are common in people with female urinary tracts. 鈥淚t鈥檚 normal to get one or two infections a year,鈥� says urogynecologist Elodi Dielubanza, MD. 鈥淏ut if you鈥檙e getting them more frequently, talk to your doctor so they can investigate the root cause. And stay hydrated 鈥� urinating flushes away UTI-causing bacteria.鈥�

Symptoms:

• Acute lower abdominal pain.
• Painful, burning urination.
• Blood in urine.
• Fever (sometimes).

Treatment: Antibiotics.

Gynecological conditions:

鈥淔or people who menstruate, severe pain that occurs monthly can suggest a gynecological condition such as endometriosis or fibroids,鈥� says gynecologist Anna Reinert, MD.

Endometriosis symptoms:

• Debilitating pain for one to several days.
• Usually does not show up on imaging.

Fibroid symptoms:

• Feeling of fullness or weight in the pelvic area.
• Heavy menstrual flow.

Treatment options: Medication, minimally invasive surgery.

Gallbladder stones

Genetics, a fatty diet and blood disorders like sickle cell anemia can lead to gallstones, which 鈥渃an cause inflammation or block bile flow after a fatty meal, leading to biliary colic,鈥� says Mohd Raashid Sheikh, MD, MHA, a hepatobiliary surgeon.

Symptoms:

• Sharp pain in the upper-right abdomen.
• Pain may radiate to right shoulder.
• Nausea or vomiting (sometimes).

Treatment: Gallbladder removal.

Urinary retention

鈥淯rinary retention occurs when the bladder doesn鈥檛 empty completely,鈥� says urologist Jullet Han, MD. 鈥淐auses include an enlarged prostate, uncontrolled diabetes, nerve injuries, bladder tumors or pelvic organ prolapse. It can lead to discomfort and, if untreated, affect kidney function, so seeing a doctor is important.鈥�

Symptoms:

• Lower abdomen fullness or pain.
• Not voiding urine for a long time, or small, frequent voids.

Treatment options: Foley catheterization, medications, surgery or pessary.

The post What Is Causing My Abdominal Pain? appeared first on 喵咪社区.

For Phuong Gallagher, whose stage 3 colorectal cancer diagnosis at age 29 soon progressed to stage 4, survivorship felt isolating.

鈥淲丑别苍 I looked around the cancer center, all I saw were people at least twice my age,鈥� she says. 鈥淭here was nobody who was going through the career- or family-planning decisions that I had to make suddenly.鈥�

Now, 18 years post-diagnosis at age 47, Phuong is still undergoing treatment and clinical trials at 喵咪社区 Norris Comprehensive Cancer Center, part of 喵咪社区, under the care of oncologist Heinz-Josef Lenz, MD.

She also works as a patient and research advocate.

Here are Phuong鈥檚 tips to other young cancer patients:

Seek a second opinion

It鈥檚 hard to make decisions in the absence of information. If you鈥檙e not getting the answers you need, seek a second opinion, or a third or a fourth.

Find a community

Either in person or online, it helps to talk to people who really get it. The first time that I met others in my position, it was life-changing. I no longer felt so alone in my cancer journey.

Look for a forward-thinking cancer center

Immediately, Dr. Lenz did a full genetic panel and identified my biomarkers. We often discuss clinical trials to explore when appropriate. It鈥檚 the opposite of my previous treatment, and especially important because there have been tremendous advances in treatments.

Consider treatments’ long-term effects

It鈥檚 worth considering all available options, because some treatments have long-lasting impacts. Because we are now living longer, those long-term effects can play a big role in your quality of life.

The post Young Cancer Patient Reflects on Survivorship appeared first on 喵咪社区.

Experts from 喵咪社区 share screenings you might need.

Breast Cancer

When to start: Age 40.

How often: Yearly.

Unless: Your doctor determines you have high risk.

Then: Ask your medical provider about when to start screening. In addition to yearly mammograms, you may benefit from additional imaging such as MRI or contrast mammograms.

鈥淚f you find a change between yearly mammograms, we encourage you to return sooner,鈥� says Maria Nelson, MD, a surgical breast oncologist with Keck Medicine.

鈥淲丑别苍 breast cancer is caught early enough, there鈥檚 a high chance for a cure.鈥�

Cervical Cancer

When to start: Age 21.

How often: Every three to five years.

Unless: You have a weakened immune system (for example, from HIV or an organ transplant), or a history of abnormal cervical screenings.

Then: You may need more frequent screenings.

Vaccination is also important. 鈥淭he HPV vaccine is approved for people up to the age of 46,鈥� says Keck Medicine gynecologic oncologist Xiaoyue Mona Guo, MD. 鈥淚t guards against the most common viruses that cause cervical cancer. It鈥檚 not total protection, but it helps a great deal.鈥�

Skin Cancer

When to start: In your 20s.

How often: First two screenings six months apart, then once a year.

Unless: Family history, prior skin cancers or a history of bad sunburns.

Then: Never too early to start. You may need screenings every three to six months.

Skin cancer is the most common form of cancer in the United States, so Keck Medicine dermatologist David Sawcer, MD, PhD, also recommends self-screening between appointments. 鈥淭hat鈥檚 something we鈥檒l teach you how to do when you come in,鈥� he says.

Colorectal Cancer

When to start: Age 45.

How often: Every 10 years.

Unless: Family history, chronic inflammation of the large intestines or an abnormal colonoscopy result.

Then: Talk with your doctor. If a parent or sibling has had colorectal cancer, start 10 years younger than their age at diagnosis.

鈥淭he good thing about a colonoscopy is if we find polyps, we can remove them right then and there to analyze for cancer,鈥� says Keck Medicine colorectal surgeon Sang W. Lee, MD. 鈥淚t鈥檚 all taken care of at once, and it doesn鈥檛 need to be done very often.鈥�

Prostate Cancer

When to start: Age 45.

How often: Every one to three years.

Unless: Risk factors like family history or certain gene mutations.

Then: It鈥檚 recommended to start around age 40 and screen annually.

鈥淭he newest guidelines recommend a PSA blood test for the initial screening,鈥� says Anne Schuckman, MD, a urologic oncologist with 喵咪社区 Urology, 鈥渟o if their prostate-specific antigen (PSA) levels are normal, a man won鈥檛 always need the digital rectal exam that patients often worry about.鈥�

The post When Should I Get Screened for Cancer? appeared first on 喵咪社区.

H. Paco Kang, MD, orthopaedic oncologist and surgeon, 喵咪社区 Sarcoma Program

Any cancer diagnosis is life-changing in a fundamental way, whether curable or not. The hardest part is often before the diagnosis, when you do not know what is wrong.

People almost feel more at peace once they have a diagnosis, even if it is a bad one, because then they have some forward momentum and a plan of action.

The initial diagnosis can be overwhelming. Make sure when you visit your physician that you have written out all your questions.

The hardest part is often before the diagnosis, when you do not know what is wrong.

H. Paco Kang, MD

It is important that you and your support team have a complete understanding of your treatment plan. Try to focus on each step of the treatment plan.

Join a support group with individuals that have the same diagnosis. There may also be support groups for your family members.

Even if you are cured from your diagnosis, long-term surveillance is usually necessary. MRIs and other tests are usually required on an intermittent basis to make sure there are no new tumors.

These tests can be anxiety-provoking. Your support group of other individuals with your diagnosis can be very helpful to you over time because of their shared experience.

The post How to Approach a Life-Changing Diagnosis appeared first on 喵咪社区.

鈥淓nuresis in adults is more common than people think,鈥� says David Ginsberg, MD, a urologist and urogynecologist with 喵咪社区 Urology, part of 喵咪社区.

鈥淐auses include urinary tract infection and sleep apnea, but the most common cause is overactive bladder.鈥�

Overactive bladder (OAB) is a clinical syndrome that often leads to frequent urination and a sudden, uncontrolled need or urge to urinate (often associated with what urologists call 鈥渦rge incontinence鈥�).

People may sleep through the need to urinate, resulting in enuresis.

While OAB can happen to anyone, women are more likely to have urinary leakage because they don鈥檛 have prostates to block the flow of urine. Older women are more likely to be affected, but young women and teens can also have this condition.

鈥淚 would urge anyone bothered by enuresis or overactive bladder to see a doctor,鈥� Dr. Ginsberg says. 鈥淲e have many options to evaluate, treat and improve these symptoms.鈥�

The post What Causes Adult Bedwetting? appeared first on 喵咪社区.