21
May

Coming Out To Your Doctor

Coming Out To Your Doctor - Difficult & Private

Coming out to your doctor may be difficult, especially for if you are a teen.  Often, a teenager comes out with a million thoughts running

Coming Out To Your Doctor

Coming Out To Your Doctor - Photo by Sharon McCutcheon

through their head.  Will my doctor accept me?  Will my doctor help me?  Does my doctor understand me?  Will my doctor tell my parents/keep my secret?  According to poll conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health, 18% of all LGBTQ Americans refrain from seeing a physician for fear of discrimination

 

What If I'm Scared of Coming Out to My Doctor?

Coming out to you doctor may feel very scary and unsafe.  Consider asking your doctor if their office is a safe office where acceptance is commonplace.  Whenever the LGBTQ child is suffering, the most important thing I can say to them is, "You are safe.  You are safe here."  Because every child is special.  After all, one of the best gifts a pediatrician can give to any child, especially the LGBTQ child/teen is letting them know they are special and wonderful just as they are.  It is not my job to help the child/teen figure out their sexual orientation.  It is my job to make them feel comfortable enough so that I can help them with any health issues they may have to date. 

 

Come Out When You Are Ready

Coming out to your doctor can help you in many ways.  However, given the difficulty that this may involve, you may want to consider calling your/any doctor's office first to ask if they care for any LGBTQ patients.  Remember, you don't have to give your name out at the first call.  Ultimately, this may help you feel more comfortable and ready.  

 

How To Come Out To Your Doctor

There are many conversation starters you can use, such as "There's a conversation I need to have with you" or "How do you handle patient confidentiality?"  Consider telling the doctor in a matter-of-fact way.  Chances are, you are not the first LGBTQ patient they have ever had.  Follow up with a prepared list of questions that you have for your appointment.  There is a "Do Ask, Do Tell" brochure that may help answer questions about coming out to your doctor.  It is also important to know that there are laws that protect you and your doctor, so that your information is kept private.  Ask about confidentiality will make you feel safe as well.  In addition, you may consider bringing a friend, partner, or family member for support.

 

Doctors Can Offer Support in Many Ways

I've had teens come out to me as their doctor, some have been painful to witness.  Painful for me, because it incredibly hard to see someone suffer and be in such tremendous emotional turmoil and/or physical pain) for simply saying their sexual orientation and/or gender identity.  In the past, I reassured a transgender child in the midst of an immediate, intense, and severe panic attack by continually repeating, "You are safe.  It's okay.  You are safe here.  You don't have to talk about it, but if you do, I'm here for you."  I have had patients who became successful adults with great careers who thanked me for accepting them because I was the first person they came out to or that I cared for them and their issues with compassion and maybe even some tough love.  Most recently, I held and rocked a child that I cared for over 15 years until they stopped their uncontrollable shaking because they couldn't face themselves and their sexual orientation.   That child motivated me to write this blog.  I want to help other LGBTQ youths know that they don't have to suffer, that their doctor can help them.  Chances are your doctor cares and wants to help you in your journey to physical and mental health and peace.  

 

Do I Have to Tell My Doctor I'm LGBTQ?

It's best if you do tell your doctor.  Your doctor can't give you the best medical care if he/she doesn't know that you are a LBGTQ person.  A doctor needs to know a patient's sexual orientation, gender identity, and sexual activity history, to best help that patient and their medical and psychological needs. 

 

Medical Help & Disease Prevention Available

Sexual history will help me test for, diagnose and treat STDs.  Also, a pediatrician or internist will be able to teach you how to prevent HPV and offer the HPV vaccine to prevent this cancer and wart causing disease.  In addition, if you are HIV negative, but at high risk for developing HIV, then your doctor may start PrEP medicationWhat is PrEP?  Pre-Exposure Prophylaxis (PrEP) is Truvada, which is a daily pill that when taken helps prevent HIV in people who are high-risk by up to 92%.  Your doctor may start this medication, if you agree to take it every day and follow-up with appointments every three (3) months.  Consider bringing a List of Top Ten Issues LGBTQ People Can Discuss with Their Doctor with you to your appointment.  In addition, if you are a transgender youth or adult, your doctor, yes, even your pediatrician, can refer you to a specialist for hormonal treatment.

 

Psychological Help Available

A doctor will also be able to make some psychological recommendations, if needed.  LGBTQ teens are more likely to suffer from anxiety, depression, have increased risk of suicide, abuse, may need referral to a psychologist, a psychiatrist, and/or a support group, like the Gay Straight Alliance (GSA), and GSA Network.  GSA is a student-led or community based organization.  GSA is an important resource on social media on Twitter (@GLSEN)  and Facebook.  GSA Network is also a resource available on Twitter (@GSANetwork) and Facebook.  Local support groups area usual available for GSA and GSA Network on social media and in as clubs many schools.  Lastly, your doctor is a source of support, simply be accepting you and caring for you.

 

Doctors Willing to Learn LGBTQ Issues & Needs

Your doctor may be comfortable with caring for you as a LGBTQ patient.  However, we are not classically trained to care for LGBTQ patients, so there usually is a learning curve.  However, if your doctor says, "I don't know how to care for that issue, but let me do my research; I'll get back with you on that particular issue," then you have a great doctor indeed.  A doctor that's willing to learn, cares for you, and is honest is the best kind of doctor.

 

Additional Resources for LGBTQ Teens & Parents

• Coming Out: Information for Parents of LGBTQ Teens is a helpful resource from the American Academy of Pediatrics. 

 

• How To Support Your Child Who is Questioning Their Sexual Orientation by Everyday Feminism which includes definitions of many LGBTQ+ terms.

 

• Transgender Children & Youth: Understanding the Basics by the Human Rights Campaign.

 

• Teens & Gender from an NPR interview which includes many gender terms, such as gender questioning, gender queer, gender fluid, agender, etc.

 

• Sexual Attraction & Orientation by Kids Health.

 

• This blog also has information on Children & Affirmations and Daily Affirmations & Quotes that are helpful in general.

 

 

12
Jan

Flu Season Severe 2017-2018

fight the flu prevention symptoms vaccineFlu Season Today?

As of the end of December 2017, the flu season is officially moderately severe.  The flu is widespread in 46 states.  This is up from 36 states in the previous week.  The U.S Centers for Disease Control and Prevention (CDC) research reveals that flu hospitalization is about 3 times higher than it was in the same time period in 2016.  In addition, the flu season started earlier this year than it did in 2016.  During the same time period in 2016, only 12 states had reported widespread activity, as compared to 46 states this flu season.  This pretty much matches what I’ve been seeing in our office in Florida.  About 3 weeks ago, we began to diagnose multiple children with the flu every day.

 

Why is this Flu Season Severe?

This season’s dominate flu strain is an Influenza A strain, H3N2, which is a particularly severe and causes more symptoms than other strains typically do.

 

What Are Flu Symptoms?

Flu symptoms typically include a fever and nasal congestion at a minimum. Other symptoms may include weakness, nausea, vomiting, diarrhea, headache, body aches, and more.

 

What To Do If I Think I Have the Flu?

If you are feeling sick with flu-like symptoms, you may want to consider going to see a doctor, especially within the first 48 hours of your illness.  Your doctor may be able to prescribe an anti-viral medication against the flu, Tamiflu, which is effective in preventing worsening symptoms of the flu by stopping its replication.  However, if you’ve been sick with the flu for more than 48 hours, Tamiflu is not effective.

 

I Have the Flu.  Now What?

Follow your doctor’s instructions.  Drink plenty of fluids.  Rest.  Stay home.  Do not go to work, school, religious gatherings, or other community gatherings or events.  By going out, you increase the risk of spreading the flu.  In addition, as the flu weakens the immune system, if you go out, you place yourself at risk for contracting a secondary bacterial infection, such as pneumonia, sinusitis, or an ear infection.

 

How Do I Prevent Myself From Getting the Flu?

Good old-fashioned hand washing is helpful, as flu droplets may linger on countertops and other objects. Hand washing prevents many other common infections as well (http://drsilvatotstweensandteens.com/2013/01/new-norovirus-highly-contagious-virus.html).

The good news is that the CDC reports that this season’s flu vaccine strains are a good match to the live flu virus strains that are circulating (http://bit.ly/2CLWaCZ).  That means the flu vaccine is providing good protection against the flu by preventing the flu so far.

The best course of action is to make sure you and your children get the flu vaccine.  It’s not too late.  No one knows exactly when the flu season ends.  From the looks of it, it will probably continue for another few months.  There is still time to protect yourself.  Get the flu vaccine at your doctor’s office, health department, school, or pharmacy today.

29
Mar

Zika Virus | Health Information

zika virus symptomsZika Virus | International Public Health Emergency

 

Zika Virus is a global health scare, especially for pregnant women.  Due to the October 2015 cluster of 524 cases of newborns in Brazil diagnosed with microcephaly and other neurological disorders reported in Brazil, World Health Organization (WHO) has stated that it is as a Public Health Emergency of International Concern. (bit.ly/1PYrRKs)

What are the symptoms of the Zika Virus?

zika virus microcephalyWhen humans become infected, they may develop symptoms which include fever, itchy rash, headache, red eyes, joint pain, muscle pain, and temporary paralysis.  Typically, symptoms last for 2 to 7 days.  Incubation period is unknown, but ranges from a few days to a week (1.usa.gov/1MMg1Qi).

There has also been an increase in incidence of Guillain-Barré syndrome that has coincided with increased incidence of Zika Virus. (bit.ly/22Tg8mx)

Pregnant women infected with the virus have had newborns with microcephaly and brain damage.  It is believed that the virus has spread from the infected mother to baby in utero and during delivery.  Zika virus has been found in the brain tissue of these infected babies.

Where Did Zika Virus Start?


zika_americas_03-18-2016_webAccording to WHO, it was originally detected in a rhesus monkey in Zika Forest, Uganda in 1947 and in humans in Nigeria in 1954 (bit.ly/1QeAEcO).  Before 2015, the virus was found in Africa, Southeast Asia, and the Pacific Islands.  Currently, there are many countries around the world with local mosquito-borne Zika virus disease cases as noted on the CDC website at 1.usa.gov/1Mv4zhb  Currently, countries affected by local transmission include Aruba, Barbados, Bolivia, Bonaire, Brazil, Colombia, Puerto Rico, Costa Rica, Cuba, Curacao, Dominica, Dominican Republic, Ecuador, El Salvador, French Guiana, Guadeloupe, Guatemala, Guyana, Haiti, Honduras, Jamaica, Martinique, Mexico, Nicaragua, Panama, Paraguay, Saint Martin, Saint Vincent and the Grenadines, Sint Maarten, Suriname, Trinidad & Tobago, U.S. Virgin Islands, and Venezuela).

 Is Zika Virus in the United States?

zika-by-state-report_03-23-2016_webYes.  However, only travel associated cases have been reported in the United States.  However, "local mosquito-borne transmission of Zika virus has been reported in the Commonwealth of Puerto Rico, the US Virgin Islands, and America Samoa." (1.usa.gov/1RvWNAq)  As of March 28, there have been 273 travel associated cases have been found in the U.S., including in Hawaii.  There have been 258 locally acquired cases in Puerto Rico, 10 in the U.S. Virgin Islands & 14 cases in the American Samoas.  

 

How is Zika Virus Transmitted?

It is most commonly transmitted by a mosquito bite.  It can also be sexually transmitted and via blood transfusion. It is unknown how common sexual or blood transmission is among humans.

Can Zika Virus Be Sexually Transmitted?

Yes.  The CDC recently reported on February 2, that this virus was sexually transmitted in Texas, USA (cnn.it/1WSuiRd).  In addition, Florida confirmed on March 9 & California confirmed on March 25, that they too have had their first case of sexually transmitted Zika Virus. As a result of confirmed sexual transmission of the virus, the CDC now recommends that if you are a pregnant women whose "male sexual partner has traveled to or lives in an area with active Zika virus transmission, you should abstain from sex or use condoms the right way every time you have vaginal, anal, and oral sex for the duration of the pregnancy."  The case in Texas did not involve pregnancy.  However, keep in mind that this illness can infect anyone.

Other countries, confirmed that they too have had their first case of sexually transmitted Zika Virus.  France confirmed this occurred on February 27.  Chile confirmed firmed this on March 27.  Be aware that more cases and countries are confirming sexual transmission of the virus.

What Can I Do to Prevent Zika Virus?

Use insect repellent, especially when outdoors.  Avoid travel to areas with active Zika Virus transmission.  If you cannot avoid travel to an area with active transmission, then practice abstinence or use birth control while traveling in that area.  Abstain from sex if your partner has traveled to an area with active transmission.  

What Insect Repellent is Best to Zika Virus Infection?

The CDC recommends the use of insect repellents with active ingredients registered with the U.S. Environmental Protection Agency (EPA) for use to be applied to skin and clothing.  EPA registered insect repellents contain DEET, picaridin, IR3535, and some oil of lemon eucalyptus and para-menthane-diol.  Insect repellents with these active ingredients products offer longer-lasting protection.  Insect repellents containing oil of lemon eucalyptus should not to be used on children under the age of three years.  Insect repellents can be used by pregnant and nursing women.  The CDC has many details about use, efficacy, and safety of insect repellents available at 1.usa.gov/25rRxr1.

I'm Worried Myself or My Child Might Have Zika Virus.  What Should I Do?

First, know the symptoms.  Typically, at a minimum, an infected person may have a low grade fever which is frequently accompanied by and a rash.  Next, contact your doctor.  If your doctor is concerned that you or your child might be infected with Zika Virus, they will advise you to schedule an appointment for a more detailed evaluation.  Lastly, if your doctor thinks that you may need to be tested for Zika Virus, then your doctor will refer you to your local health department.  Currently, only local health departments have testing for the Zika Virus. 

Is There a Travel Advisory Due to Zika Virus? 

Yes. There is a Alert Level 2, Practice Enhanced Precautions in areas with active transmission (1.usa.gov/1MMaER1).  There is not yet a Warning Level 3, Avoid Nonessential Travel for areas with active transmission.

I'm Not Pregnant & Plan to Travel to an Area with Zika Virus.  Is There Anything I Should Do?

It is advised to not travel to areas with the Zika Virus.  However, if you do travel to an area where Zika Virus is present, then use insect repellent at all times, especially when outdoors.  It is also recommended that if you are a women that is not currently pregnant, that you take birth control as it is estimated that 50% of all pregnancies are estimated to be unplanned.

I'm Pregnant and I've Traveled to an Area with Zika Virus.  What Should I Do?

Talk to your OB/GYN doctor before any travel, especially if you are traveling to an area with active Zika Virus transmission. Follow up with a phone call with your doctor immediately upon return.  Depending upon your experience or exposure, they may have additional recommendations for you and your unborn baby.

Is a Vaccine for Zika Virus Available?

Not yet.  However, there is work on a vaccine.  As of February, the National Institutes for Health (NIH) has stated that Zika Virus Vaccine trials will begin this summer (wapo.st/1pTCPZO).  They have built upon research on similar viruses, Dengue and West Nile.  They are likely to be able to do a small scale trial of about 20 to 30 people in Summer 2016 with large scale trials likely to occur in 2017.  Until a Zika Virus Vaccine is available, use insect repellent, travel with caution, if pregnant prevent exposure in your travel and with your sexual partner. 

 

30
Oct

Ebola Virus

ebola - imageedit_14_3363191172

What is Ebola? 

Ebola is a virus that was first discovered in 1976 near the Ebola River in Africa. Sporadic outbreaks have occurred in Africa since then. There are five (5) strains of Ebola that infect animals in Africa. Four of the strains infect humans.

 

What are the Signs & Symptoms of Ebola?

Symptoms include fever, headache, muscle aches, vomiting, diarrhea, abdominal pain, unexplained bleeding or bruising.  Ebola can only be spread when symptoms begin. Symptoms typically occur between 8 to 10 days after infection.  However, symptoms may occur as late as 21 days after exposure to Ebola. 

 

How is Ebola Spread?

If a person is ill with Ebola virus, they can spread it by blood, body fluids (urine, saliva, sweat, feces, vomit, breast milk, and semen).  It can also be transmitted via objects contaminated with the virus (like needles and syringes). Lastly, it can spread via infected bats, apes, gorillas, and monkeys. (http://1.usa.gov/1rCptdl)

 

Where is the Ebola Outbreak? Where Has Ebola Spread?

This year is the largest Ebola outbreak in history.  It has taken place largely in West Africa.  Currently, areas designated by the U.S. Centers for Disease Control and Prevention (CDC) as having widespread transmission of Ebola are in West Africa, specifically Guinea, Liberia, and Sierra Leone.  Countries that have had travel associated transmission and local transmission are (Port Harcourt and Lagos) Nigeria, (Madrid) Spain, and (Dallas and New York City), New York.  Countries that have had travel associated transmission are (Kayes) Mali and (Dakar) Senegal.

 

Are there are recent updates in Florida?

As of October 26, 2014, Florida Governor Scott issued an order mandating the Department of Health to have a 21 day monitoring of anyone who has returned from areas where individuals have been infected by Ebola virus, as designated by the CDC. (http://bit.ly/1wH4o6M) New York, New Jersey, Illinois and now Florida have instituted a 21 day health evaluation plan. Twice daily monitoring is to include measuring temperature twice daily.  Gov. Scott also stated that if individuals monitored are assessed to be high-risk, then a mandatory quarantine will be required.

 

Are There U.S. Guidelines for Healthcare Workers Caring for Patients with Ebola?

The CDC has issued guidelines for healthcare workers and healthcare settings for those caring for patients infected with, suspected to be infected with, or having died of Ebola. (http://1.usa.gov/1yJblVf) There are also CDC Ebola waste management guidelines. On October 14, 2014, the CDC admitted that they were unprepared for Ebola in the U.S. (http://bit.ly/1E4V6F4)  Since then, the CDC has formed the previously mentioned guidelines.  

 

Are there flight Restrictions from Africa?

As of October 21, 2014, the U.S. Homeland security Department announced that travelers from Guinea, Liberia, and Sierra Leone have limited airport entry into the U.S.  They are limited to five (5)  international airports in New York, New Jersey, Atlanta, Chicago, and Washington, DC.  These airports will have extra screening of passengers for possible Ebola exposure, which include taking temperatures and other assessments as well.  All U.S. airports are screen for possible Ebola exposure. (http://www.cdc.gov/vhf/ebola/pdf/ebola-algorithm.pdf)  Currently, there is no travel ban from or to Guinea, Liberia, and Sierra Leone to U.S. due to Ebola.

 

It is highly unlikely that Ebola will spread in the U.S. as it has in endemic West Africa. However, we must keep a vigilant eye on developments, travel screenings are necessary, and healthcare workers must follow CDC guidelines to prevent spread of this disease.

 

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