Month: May 2018

Ellen (name changed by request) was just 19 years old when she was rushed to the emergency room. The problem? Excruciating pain during sex. The diagnosis was human papillomavirus (HPV), which had created abnormalities in Ellen’s vagina, resulting in pain—and later a diagnosis of cancer.
“I was young. I felt this awful fear,” Ellen tells HealthyWay. “Who would want to be with me? How do you tell someone that you are a carrier for an STD? I had a lot of guilt and disgust.”
It’s true that HPV is a sexually transmitted infection or STI (a term that’s replaced the phrase sexually transmitted disease or STD in medical circles in recent years), and with it has come an unfortunate stigma for the women and men who are diagnosed.
But while cancer and other complications from HPV are real, the truth is, being sexually active in America means your chances of coming in contact with HPV are sky high. It’s almost guaranteed that sexually active Americans will encounter this common STI at some time in their lives.
Sounds like an exaggeration, right? One virus can’t possibly be so prevalent that nearly everyone will be exposed to it at one point or another. Guess again.
The Centers for Disease Control and Prevention (CDC) has labeled HPV as the “most common sexually transmitted infection in the United States.” CDC literature even goes so far as to state that “HPV is so common that nearly all sexually active men and women get the virus at some point in their lives.” Every day, approximately 14,000 individuals ages 13 to 24 are infected with HPV, and every year, more than 30,000 cases of cancer are tied to human papillomavirus.
With 40 distinct types, human papillomavirus isn’t just prevalent. This STI is also wildly contagious, which is why at any given time an estimated 42.5 percent of Americans in the 18 to 59 age range are walking around with a case of HPV.
“Other than abstinence, there is no reliable way to prevent transmission,” says Steven Vasilev, MD, a gynecologic oncologist and medical director of integrative gynecologic oncology at John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, California. He tells HealthyWay that “A condom will not help prevent transmission, because the virus can be present on multiple genital areas, not just the penis. Other than vaccination at an early age, before exposure to the virus, there is no reliable medical way to prevent spread.”
For Ellen, HPV came with a sexual assault when she was just a tween. For hundreds of thousands more Americans, HPV can come at any time as a result of a sexual encounter, be it one that’s consensual or not.
Because it’s so contagious, the risk is high. But with warnings that some types of HPV (although not all) can cause cancer and it’s nearly impossible to avoid, how worried should you be about HPV? And is there anything you can do to protect yourself or your family?
We asked the experts to weigh in on the real deal with this STI.

What is HPV, anyway?

Short for human papillomavirus, HPV is a virus, just as its name would imply. That means it’s a microscopic organism that replicates inside the cells of a host organism. According to Amesh A. Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security, human papillomavirus chooses mucosal surfaces as host and tends to live in or on the vagina, penis, anus, and/or mouth, which is where it spreads from person to person via sexual contact.
That means HPV infection can be genital, anal, or oral, depending on the mode of sexual contact, Adalja says. In other words? Oral sex, anal sex, and any other form of genital-to-genital contact can spread HPV. So unlike with pregnancy, simply avoiding sex that puts a cisgender male’s penis in contact with that of a cisgender female will not keep someone safe. Even the use of condoms in those cases can still do little to prevent transmission, as HPV lives in the area around the vagina and anus, not just inside.
Because there are 40 different types of HPV, what happens next depends on what kind you’ve contracted. Most types will cure themselves, passing through the body in six to 12 months without ever showing any symptoms, Vasilev says. But it’s not always that simple.
“Sexual activity timing could be such that the infection is passed back and forth between a monogamous couple for a prolonged period of time,” Vasilev says. What’s more, certain types of HPV can cause complications—some as serious as cancer.

Low-Risk HPV

Most types of HPV are what’s termed “low risk” by doctors. That doesn’t mean it won’t cause problems in your life, but it does mean it’s unlikely to cause cancer.
Low-risk HPV includes the types that cause warts or, as they’re known in medical circles, papillomas (hence the name), says Gerald J. Botko, DMD, a master of the Academy of General Dentistry and dentist chief of service at VA Miami Healthcare System. These warts typically crop up in the genitals and anus of men and women, although women may also have small cauliflower-type growths on the cervix and/or vagina, and oral warts are a possibility. The warts are usually painless but cause some irritation, itching, or burning, Botko continues. Low-risk genital HPV typically goes away on its own without treatment.
“In oral HPV infections, the warts colonize in the back of the mouth (throat), including the tongue, base, and tonsils,” Botko explains. In those cases, contagious lesions found in the gingiva (gums) and palate typically have to be excised surgically for a cure, although sometimes oral HPV can go away on its own as well.
Low-risk HPV can also cause wart-like lesions called condylomas. Again, these can be found on the genitals or in the mouth (the latter from oral–genital contact). Condylomas can cause disfigurement and are difficult to treat, Botko says.
Although low-risk HPV types 6 and 11 cause 90 percent of genital warts, they are still termed low risk because they rarely cause cancer, Botko says.

High-Risk HPV

About a dozen of the 40 types of HPV are considered high risk, but there are just a few that have been linked to cancer. Despite that bit of good news, it turns out that 79 percent of the cancers of the vaginal region, anal region, and mouth are caused by HPV. Researchers have tied most of those back to human papillomavirus types 16 and 18. According to the National Cancer Institute, the most common types are:

• Cervical cancer: Types 16 and 18 are responsible for about 70 percent of all cases of cervical cancer.
• Anal cancer: Approximately 95 percent of anal cancers are caused by HPV, most by type 16.
• Oropharyngeal cancers (which includes cancers of the middle part of the throat, including the soft palate, the base of the tongue, and the tonsils): Approximately 70 percent of oropharyngeal cancers are caused by HPV, more than half by type 16.
• Vaginal cancer: About 65 percent of cases are caused by HPV, most by type 16.
• Vulvar cancer: Approximately half of all vulvar cancers are linked to HPV, most caused by type 16.
• Penile cancer: More than a third of all penile cancers are caused by HPV, most by type 16.

Unfortunately, high-risk HPV tends to be silent, says Renée Volny Darko, DO, an OB-GYN and founder and CEO of Pre-med Strategies, Inc. That means there aren’t signs that scream “I have HPV,” such as pain or itching. Typically, the first sign of infection will be a precancerous lesion—or cancer itself.

Finding HPV Before It Turns to Cancer

Because HPV doesn’t have symptoms until it causes a disease such as genital warts or cancer, most people don’t show up in a doctor’s office complaining that they have an issue. Men can’t currently be tested for HPV, as no such test exists. With women, however, testing can be done at your annual exam to determine if you have HPV.
Although it can’t be picked up via a regular Pap smear, Darko says HPV can be tested from the same sample collected for your Pap smear.
Confused?
“A Pap smear is looking at cells of the cervix under a microscope to determine if they are normal or abnormal,” Darko explains. “HPV can be hiding in cervical cells. Another test can be done on that same sample of cervical cells to determine if HPV is present in the cells.”
If HPV types that are considered low or high risk are noted, your doctor will advise you on the next steps. For example, those tied to cancer may indicate you should have more frequent screenings to ensure that no such cancer has developed.

Preventing HPV Before It Starts

So nothing prevents HPV, right? Sticking to oral or anal sex, condoms—none of that will keep you safe?
Yes and no. Some HPV cases simply can’t be avoided, save for complete abstinence, but Darko says, “HPV vaccine is the next best line of prevention against several types of HPV.”
For children and women under the age of 26, there is now a trio of options out there to prevent the highest-risk forms of human papillomavirus. Gardasil and Cervarix have both been found to help prevent HPV type 16 and 18 infection. Gardasil 9, a more recent vaccine, prevents types 6, 11, 16, 18, 31, 33, 45, 52, and 58.
The vaccine can be given up until age 26, even if you’ve already been sexually active. If you’re pregnant, it’s best to put off the vaccination, says Lara Millar, MD, a radiation oncologist with the Eastern Virginia Medical School, as there’s not enough research on the safety of the vaccine for pregnant women. If you’re afraid you may contract HPV in the meantime and put your baby at risk, Millar says transmission from mother to child can happen but is extremely uncommon.
If at all possible, it’s recommended that you get the HPV vaccine well before pregnancy—and even before having sex.
Darko advocates that parents in particular talk to their children’s pediatrician about it earlier rather than later, no matter how uncomfortable it is to think of their child one day encountering an STI.
“The vaccine is most protective when it is given before the first sexual encounter. So it is recommended for males and females as early as age 11 years,” she says.
Kids who get a dose of the vaccine typically only need one follow-up shot, whereas older women and men who opt for vaccination may require three doses to be fully vaccinated.

Is it worth it?

Consider this: Since the U.S. Food and Drug Administration’s approval of vaccination for human papillomavirus more than a decade ago, doctors have seen a reduction in infection rates. Six years after the vaccine’s approval, a study of infection rates for the four most common high-risk types of HPV showed a 64 percent decrease among females age 14 to 19 years and a 34 percent decrease among those age 20 to 24 years.
It’s also worth using condoms and dental dams regardless of whether you’ve gotten the shot, Darko says. Although they are not 100 percent effective in preventing HPV, contraceptives like these can prevent other STIs (and pregnancy). And if the HPV infection is living inside the vagina or anus or on the penis (rather than outside on labial tissue or near the penis), that coverage may indeed make a difference.
One final note of relief? Although the internet is rife with myths on how HPV is spread, the American Cancer Society assures women and men both that they cannot contract human papillomavirus via a dirty toilet seat, by swimming in a pool or hot tub, or by simply being unclean.

You might have heard of Hashimoto’s disease, an endocrine disease that’s become more visible in the media over the past few years. Recently, celebrities like model Gigi Hadid and Jane the Virgin actress Gina Rodriguez have spoken up about the realities of life with Hashimoto’s.
Rodriguez in particular has spoken about how she’s struggled with depression, forgetfulness, fatigue, and fluctuating weight—all of which are symptoms of Hashimoto’s disease. Hadid has also shared on social media how difficult it is to live with Hashimoto’s while working in the modeling industry, where her weight is constantly under scrutiny.

Hadid and Rodriguez are not alone. According to Andres Palacio, MD, an endocrinologist with Tenet Florida Physician Services, Hashimoto’s disease can be found in up to 10 percent of the population. Studies indicate that Hashimoto’s may be up to eight times more common in women than in men.

But despite the fact that the condition is fairly common, many of us aren’t familiar with the signs and symptoms of Hashimoto’s. If you think you could potentially have Hashimoto’s disease, or if you’re simply curious and want to learn more, read on.

What is Hashimoto’s disease?

Hashimoto’s disease is an autoimmune disease, meaning that the body’s immune system attacks the bodily tissues. It’s also recognized as a chronic illness.
Hashimoto’s specifically affects the thyroid gland, which is a part of the endocrine system. The endocrine system is responsible for regulating the hormones throughout the body. According to Palacio, other than in cases caused by an iodine deficiency, Hashimoto’s disease is the most common cause of hypothyroidism.

Hashimoto’s disease can also cause thyroiditis, which is an inflammation of the thyroid. Because of this, Hashimoto’s disease might also be called Hashimoto’s thyroiditis. It’s important to note that thyroiditis isn’t always caused by Hashimoto’s disease, nor is it only linked to hypothyroidism. “[Thyroiditis] can be caused by viruses or autoimmune processes. It can present both as hyperthyroidism [producing too much hormone] or hypothyroidism [producing too little hormone],” Palacio notes.

Hashimoto’s disease is most likely to appear in people between the ages of 40 and 60. You’re also more likely to have Hashimoto’s disease if you have other health conditions such as Addison’s disease, rheumatoid arthritis, lupus, autoimmune hepatitis, vitiligo, pernicious anemia, and type 1 diabetes.

What are the symptoms of Hashimoto’s disease?

Because the disease attacks the thyroid gland, people with Hashimoto’s have low levels of thyroxine, a hormone made in the thyroid that is essential for many bodily functions such as digestion and brain development.  
Palacio notes that Hashimoto’s can sometimes include the development of a goiter. According to the American Thyroid Association, a goiter occurs when the thyroid swells, making it look like a large mass in the neck near the Adam’s apple. It’s important to note that a goiter could be caused by hypothyroidism or hyperthyroidism. As such, it can be caused by Hashimoto’s disease, but it can also be caused by conditions, such as Graves’ disease, that cause hyperthyroidism.

• Sore, stiff, or weak muscles
• Weight gain
• Fatigue
• Pale, dry skin
• Constipation
• A puffy face
• Menorrhagia (excessive or prolonged menstrual bleeding)
• Depression
• Brittle nails and hair loss
• Memory loss

Because hypothyroidism affects thyroid levels, Hashimoto’s can also lead to high cholesterol, which can in turn cause heart conditions.

How is Hashimoto’s disease diagnosed?

Hashimoto’s disease is diagnosed by measuring thyroid-stimulating hormone (TSH) along with thyroid peroxidase (TPO) antibodies, Palacio says. Since Hashimoto’s is an autoimmune disorder, it’s usually accompanied by a high amount of TPO antibodies.
Unfortunately, getting a diagnosis isn’t always easy.
Kathryne struggled to find a diagnosis for her extreme fatigue for 18 years before she was finally diagnosed with Hashimoto’s disease just three years ago. The 52-year-old strategist and mother says that “It became so extreme that I could barely walk up a short flight of stairs. At that time, I was only being seen by regular, general practice doctors. I didn’t have any idea what was going on, so I didn’t know that I should have pushed harder for answers. It was many, many months before they even thought to do a thyroid test,” she recalls. For the next 10 years, she was treated for hypothyroidism.

How can Hashimoto’s disease be treated?

Hashimoto’s is a chronic illness, meaning there is no cure. But it can be effectively treated with medication.
“The main recommendation for patients when they have Hashimoto’s is to take their medication appropriately—on an empty stomach, with water, and at least 60 minutes before having any food,” Palacio says.
The medication often prescribed for Hashimoto’s is levothyroxine, a synthetic version of thyroxine that ensures that hormones are at an optimum level. Palacio notes that people being treated will also have to have their hormone and antibody levels checked every six to 12 months.

The pain in my jaw was back, and it wasn’t going away this time. I went to the dentist to get it checked out and one of my deepest fears came to life: I’d need to get my wisdom teeth removed. Even worse: It wouldn’t be your standard dental office procedure—there were complications and I’d need to see a specialist. I asked him about how to find a doctor to help me, and he referred me to an oral surgeon. That’s when the real trouble began.
“You should have had this procedure done years ago,” scolded the oral surgeon during our consultation a few days later. “Why didn’t you have this done yet?”
I cowered in the chair, my jaw throbbing with pain, unsure of how to respond. He met with me for all of five minutes, during which he explained that the oral surgery would cost about $7,000 (a sum that I, a recent college grad, did not have) and told me I should speak with another staff member about taking out a loan. He left in a huff.
How could I trust this doctor, who chastised me and hardly explained the surgery, to take care of me with compassion during an invasive procedure?
I decided to shop around, but it turned out that the intricacies of healthcare in the U.S. make it extremely difficult to figure out how to find a doctor who fits your needs and your budget. Few medical offices reveal prices ahead of time, and ratings from patients are often mixed (if you can even find them).
After nearly two dozen unsuccessful calls to oral surgeons in the Bay Area drove me to tears, I ended up on the phone with the sweetest receptionist at an oral surgery office who explained that the doctor was an expert in this particular procedure and was willing to work with me on financing. I went to a consultation that lasted more than an hour, and the oral surgeon patiently explained exactly what would happen during the procedure and why it was important for my health.
This was a doctor I felt I could trust. The entire experience—from going under anesthesia and getting a bone graft to healing and eventually getting the stitches removed—went better (and cost less) than I had expected. What a relief!
A great oral surgeon is just one of many doctors we might need in our lives. No matter what type of care you’re looking for, you’ll need a solid strategy for how to choose a doctor. R. Ruth Linden, PhD, who helps people find medical experts in her role as health advocate and president of Tree of Life Health Advocates, a private health-advocacy firm in San Francisco, shares her insights on how to find a doctor you can trust.

How to Find a Doctor Who Can Help You With Your Goals

With so many factors involved in how to choose a doctor, it can be tough to know exactly where to start. Linden recommends coming up with a list of healthcare-related goals you’re hoping to achieve by working with a medical professional.
“What do you want to get out of the appointment, and the relationship? In order to get your needs met, you need to know exactly what they are. Ask yourself what your goals are,” she says.
Examples of goals might be successfully managing a chronic illness, improving your sleep habits, developing a healthier diet, or overcoming depression. These goals will not only give you (and your doctor) clarity about what you expect to achieve, but they’ll also inform the type of medical professional from whom you seek care.
Your first stop might be a primary care physician, internist, or family doctor. These types of doctors are trained in helping patients manage their general health, diagnosing diseases and illnesses, administering treatments, and dealing with everyday concerns. Most of these doctors hold MD (medical doctor) degrees, and they practice the form of medicine most Americans are familiar with, which is known as allopathic medicine.
A minority of doctors choose to get a DO (doctor of osteopathic medicine) degree. They undergo practically the same training as their MD colleagues, but they also spend another 200 hours or so learning more about the musculoskeletal system and osteopathic manipulation, a technique in which a doctor uses touch to diagnose and treat patients.
Both types of doctors undergo years of training and need to pass a licensing exam to earn their white coats. Whether you choose a DO or an MD depends on your preferences and who is available in your area.
Some health concerns require the intervention of a specialist. For example, most women choose to get birth control, screenings for sexually transmitted diseases, and Pap smears from an obstetrician-gynecologist (OB-GYN). Allergists and immunologists treat disorders of the immune system such as food allergies, asthma, and eczema. Otolaryngologists treat disorders and diseases in patients’ ears, noses, and throats. Dermatologists treat problems with the skin, nails, and hair. As for mental health, both psychologists and psychiatrists can help treat depression, anxiety, addiction, and other concerns, but only the latter can prescribe medications, like antidepressants.
The list of areas and treatment types doctors can specialize in runs long, and some people choose to see doctors who are trained in traditions outside of allopathic medicine. Naturopaths, for example, are doctors who use natural approaches, such as acupuncture and nutrition, to address health issues.
You may need to get a referral from your primary care physician to get treatment from a specialty doctor depending on your particular medical needs and insurance requirements. In most cases, they’ll recommend a handful of specialists for you to choose from. If for some reason you’re sent to a specialist you don’t want to work with going forward, you can explore options for seeing someone else with your insurer, or by asking for another referral from your PCP.

Finding a Doctor Who Takes Your Insurance

Once you come up with your list of goals and potential specialists who can address your particular concerns, the next step in how to find a doctor is thinking about your budget. If you’re insured, you’ll need to decide whether you want to work with someone in network with your health insurance.
“An in-network provider will reduce your out-of-pocket costs, but sometimes it’s challenging or even impossible to find a great doctor who takes your insurance,” says Linden.
You can usually find an up-to-date list of in-network providers on your insurance provider’s website. If nothing comes up, which is more likely to happen when you’re looking for a specialist, you’ll have to broaden your search—and consider your willingness to pay more.

How to Find a Doctor: Building a Short List

Once you’ve determined whether you’re going to use your health insurance, it’s time to come up with a list of candidates. A Google search for doctors is likely to yield an unwieldy array of options, which is why Linden recommends starting your search the old-fashioned way: by asking your friends, family, and colleagues for recommendations.
Online resources such as Yelp, ZocDoc, Healthgrades, and RateMDs can also give you an inside look at other patients’ experiences with particular doctors. But take those reviews with a grain of salt, says Linden.
“People use online review sites to comment on all kinds of irrelevant things, like parking, the elevator, the demeanor of the front desk staff. These are things you might want to be aware of, but many times, they’re not the doctor’s responsibility and don’t reflect on how they care for patients,” she says.
Qualifications play a big role in how to choose a doctor. Merely having an MD isn’t enough to prove that a doctor provides high-quality care, says Linden, who only refers her clients to board-certified professionals.
“It’s very important to see someone who’s board certified,” says Linden. “That credential assures you that the doctor has completed his or her training and passed a national exam. It’s a minimal standard, as far as I’m concerned.”
Doctors will typically share their certifications in the bio sections of their websites. You can cross-reference their board certifications with the Administrators in Medicine DocFinder, the American Board of Medical Specialties Certification Matters site, or the American Board of Family Medicine doctor finder.
Gender is another important factor in how to choose a doctor. Some patients feel indifferent about whether their physician is a man or a woman, while others may struggle to feel comfortable receiving care from someone of the opposite gender.
“I find that women tend to prefer to see women doctors, while men don’t care,” says Linden.
It takes a lot more than the right gender, a recommendation from a friend, and solid credentials to make a doctor the right fit for you, though. You also have to consider the logistics of working with any medical professional. Is their practice close driving or walking distance from where you live or work? Is the doctor accepting new patients right now? Can you get in for an appointment relatively soon? A “no” answer to any of these questions doesn’t make a doctor a poor choice for you, but you should think about whether or not it’s worth it to travel far or wait a long time to be seen at a practice.
“Long wait lists for an appointment are not a red flag. I referred a client to to the very best internist in her area, who had 4,000 five-star Yelp reviews. She couldn’t be seen for months because she’s in demand, but she’s worth waiting for if you don’t need to be seen right away,” says Linden.
All of these factors should help you narrow down your list of candidates to just a select few doctors. Then, go with your gut—if you’re naturally drawn to one of the physicians, it’s time to see if he or she is the right doctor for you. Call up the practice and schedule an appointment.

Finding The Right Match

Your relationship with your doctor will be an incredibly intimate experience. He or she will know some of the most personal details of your life, ranging from your family medical history and allergies to your sexual history and substance use. Getting the best personalized care depends on how open and honest you can be with your doctor.
“There’s a loop I like to work through with each client when introducing them to a new physician,” says Linden. “It consists of three legs: preparing for the appointment, asking questions during the appointment, and debriefing after the appointment.”
Get ready for your initial appointment by referring to your health goals and drafting a list of questions for the doctor. Think about what you hope to get from the appointment, says Linden, who offers several examples of potential inquiries for a doctor:

• I take blood pressure medication but I want to make some lifestyle changes so I no longer need the prescription. Is that something you can help me with?
• I’ve been feeling depressed. Can you talk to me about the pros and cons of starting an antidepressant?
• I want to lose 20 pounds. Can you provide nutritional guidance to help me?

“You can’t make a decision about whether that doctor is a match for you unless you understand your own expectations,” says Linden.
Meeting with the doctor gives you the opportunity to ask those questions and evaluate the physician’s communication style and bedside manner. Linden emphasizes the importance of asserting your preferences and needs during this initial appointment.
“You have to learn to advocate for yourself. We all become passive in a medical setting because of the power differential between doctor and patient, but you have to be assertive. If you need to be handled with special care, tell the doctor so they have the opportunity to treat you extra gently,” she says.
If the doctor frequently interrupts you, fails to address your preferences, or isn’t flexible in her handling of patients, she’s probably not the right fit for you. Take some time to reflect on how things went after the appointment.
“Did you feel your questions were answered? Did the doctor meet your expectations? What happened and how did you feel about it?” asks Linden.
Hopefully the legwork you did as you decided how to choose a doctor led you to a physician with expertise in your health concerns and a style that resonates with you. And if not, keep searching—it can be frustrating to try out different physicians, but it pays off tenfold when you finally find a doctor you trust.