Category: Health

Health including mental and physical.

My ADHD Story

I was recommended to get evaluated for ADHD by my pediatric attending during my 3rd-year clinical rotations. I did not listen to her recommendations until I started to see her reasoning as I was functionally struggling, but always in near breakdown.

I was in denial because I saw ADHD as a form of weakness and even now still struggle with this idea (I know it is silly but my truth). I finally decided to get evaluated at the end of my third year of medical school. I got diagnosed and was started on the medication, methylphenidate. I tried it for a week or two and decided it wasn’t doing anything and I just needed to change my habits and learn to control my focus.

I continued to struggle but there were also a lot of other things happening in my personal life that I continued to make excuses for my symptoms.

My excuses:

  • My constant inner restlessness is all from my anxiety.
  • my anxiety is from having generalized anxiety disorder (GAD).
  • My impatience and impulsivity are part of my personality
  • My inattentiveness is my selective hearing and daydreaming habits from my childhood
  • My disorganization is just my lack of good habits
  • My forgetfulness is from being distracted by so much work.
  • My distracting behavior is from having so many things on my plate.
  • Remarks by friends and family are just remarks and it doesn’t mean anything.

 

 

I continued to just functionally struggle. I worked really, really hard and the payoff was average. Over time, I burnt out more frequently.

My mom was diagnosed with breast cancer. I began to get moody, and easily irritable and my anxiety even worsened. I continued to work on coping mechanisms and thought I was doing okay. I thought I was handling it well. I started my intern year of family medicine residency. The stress of my mom’s cancer and the stress of residency was taking on a further toll on me with uncontrolled ADHD.

 

I was struggling with residency as an intern and I had mentioned a history of ADHD to one of my attendings during an evaluation. I was again recommended to discuss treatment with my PCP.

 

 

I have been on methylphenidate for over a year now and my anxiety is more controlled, and my inner restlessness, impatience, impulsivity, distractibility, and disorganization have improved. On the days I don’t take my medication there is a difference compared to when I do. Often noted by others more than myself. I am learning to accept external help for my ADHD.

LYSSE

I struggled for years, I mean really struggled when I could have had it a little less difficult.

This was all shared as a reminder of the various insecurities everyone deals with. truthfully, I still struggle with admitting that I have ADHD out loud as I find this a weakness like I am making an excuse for not being good enough.

As always, my posts are always a self-reminder and a reminder that you are not alone.

@Dr.Mursi.MD

Response to Hardship

The Process of Healing – Journal Entry 1

Through these journal entries, I hope to help myself find meaning in life again after the loss of my mom. I share such a private journey publicly in the hopes of helping someone out there who is also in a lot of pain. You are not alone in your feelings. I am here with you. This can be our healing process. To make the most of these journal entries, I encourage you to be an active participant and journal along with me. Write out your thoughts after reading each journey entry. It can be concerning the topic I talk about or just your current existing thoughts running through your head, keeping you distracted.

 

HOW I RESPOND TO HARDSHIP

I have always believed there are three ways that you can respond to a painful happening in your life

 

 

1. You can get stuck in the past and drown in your sorrows.
2. You can deny its existence and just go with the flow of life.
3. You can acknowledge the pain and actively work on how to grow and
improve.

My response to hardship has mostly been about the next step. What do I have to do next to survive the hardship? What I have to focus on to make the burden of the pain I feel… less. I believe I am a person who often chooses the third option, but at times I feel I do practice the second.

What do I have to focus on to make the burden of the pain I feel… less.

You Are a Warrior

⚠️ My personal self-assessment post. I share as it may help someone else.

Are you worrying about things and feeling anxious/upset/overwhelmed? Here is a self-eval task that I did right before posting this and the outcome, keep reading.

💢 I started typing out what I worry about without pausing.
💢 As I kept typing I had a realization towards the end (one I have had before but reminded again about).
💢 I read through it and realized the theme of it and possibly the root cause.
💢 I begin taking deep breaths, slow and steady. 4 counts in and 6 counts out.
💢 I type out my thoughts base on my realization
💢 Then I remind myself what if I stopped worrying and believe that it will all work out. What if it all works out?

FIGS

Now you try it!

Keep reading to see my self-analysis thoughts.

My freestyle:
I am a worrier. I worry about what happens next. I worry about my goals and where I want to be. I worry about not doing enough today for tomorrow to be better. I worry about missing something today that I would regret not finding sooner. I worry things are not happening now. I worry that if it doesn’t happen soon, then it won’t happen. I especially worry about losing time. I don’t want to lose time, so I want it now so I can be in that state longer or have it for longer.

FIGS

My self-analysis:
My worrying makes me pushy. I push for things now. As soon as I have decided I want it, I act on it or make it known without a second thought. This has affected my relationships because when people are not on my page, I leave them behind. I move forward on my own. My family and friends would be screaming right now in agreement. I have known this about myself for some time now and it is difficult to change a habit which has also lead me to my achievements. Today it was brought to my attention that I could lose something very special because of my worries which causes me to be very pushy.

My reminder:
Instead of worrying about what happens far in the future work on what happens today, this week, this month. Let it all work out naturally because it will all work out nicely in the end. Enjoy the moments of now instead of waiting for the moments of tomorrow. This chapter will be a chapter you will look back. If you rush through it now, you will regret rushing the opportunity of life that you were given.

I hope that made sense.
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FIGS

We Need Actual Therapists To See Our Hospitalized Patients. Here is why:

If you work in a hospital setting, you know that most adult patients have multiple chronic diseases. While we take care of their physical illnesses, we are neglecting their mental health.

How many times have you left a patient’s room and they were still distraught with the news you delivered, or they are sad and disheartened being in the hospital. While yes, you gave a thorough explanation, several minutes to take the information in, and gave them the appropriate time to ask questions. You even provided them a touch of human interaction by placing your hand on their shoulder but was all that enough? Not likely.

Once physicians leave the room, it isn’t clear whether the patients are mentally handling their illnesses. It isn’t clear whether they are emotionally stable. It isn’t clear whether they know coping mechanisms. In fact, you may even acknowledge that they are emotionally drained. You may even ask them if they want to talk to a pastor (likely only a pastor is an option even though there are multiple faiths in America–besides the point), or you actually ask about their mental state. Then what? Most of the time, they deny being depressed. Let’s say they actually admit to being depressed and you offer them antidepressants. Awesome, add another medication to the list! Maybe you even acknowledged that they need a therapist and you connect them with the social worker who provides them with a list of therapists. Most likely, the social worker tells the patient to look at the back of their insurance card and call the behavioral health number to see what is covered by their insurance. Do I have all the scenarios down? And how long do you think it takes for a therapist to actually see the patients as an outpatient? MONTHS and MONTHS!!!

Dealing with physical health conditions is stressful and mentally exhausting. When patients are mentally exhausted, emotionally unstable they are less likely to take care of themselves. This increases their return to the hospital as their chronic diseases worsen. If money is your motivation, this costs billions of dollars because of constant readmissions and further requirements of treatment of their progressed diseases. AND this causes further progression of their mental illness(es) which adds emotionally unstable people in a society that may have other domino effects. The point being, mental health needs to be acknowledged and better addressed.

So, what can we do? I strongly believe we need to provide actual therapists to come and see patients. Similar to how we place consults for physical therapists or case management, we would place consults for a therapist.

You might ask, well, where the hell are the psychiatrists? That is a good point. They only show up when patients are in an active state of suicide, homicide, or self-harm (or having a psychotic breakdown, etc). In terms of the hospitalists, they are seeing a number of patients and often do not have the appropriate time that the patient actually needs and deserves. Plus, not all doctors know how to or are appropriately trained to provide appropriate mental health advice. Therapists would provide patients their undivided attention also provide them with coping mechanisms and mental health goals that they can work on during the patient’s admission. Also, this increases job opportunities.

The days I have more time to talk and listen to my hospitalized patients, I see a huge difference in their spirit and mental state of mind. I can’t say enough how absolutely honored I feel knowing I have lifted their spirits. While I would always and forever make my best effort to do this more often, the reality is that there isn’t enough time every time. The reality also is that not all doctors may put that effort, therefore there isn’t consistency. While a hired therapist’s job is to be consistent. Hiring hospital therapists will provide patients with the mental health support they deserve, therefore bettering their outcomes in their physical health, etc. I can’t prove it just yet but I can just about guarantee it.

What are your thoughts? Does this make sense? Do you currently work in a hospital that provides therapists?

Distrust in Medicine, an ongoing conversation

Distrust in Medical Professionals, an ongoing conversation ☝🏼

There are various working parts that contribute to this.
My intention in this post is to first and foremost remind myself to avoid these mistakes that can endanger my patient’s trust in me but to also advocate for patients and provide a reminder for physicians.

Over the past 2 years now, I have a better understanding of why there is such distrust in medical professionals, especially now as a resident while being an advocate for my mom during her hospitalizations. I believe one of the key components that play a large role in this mistrust is the lack of proper communication with patients and the lack of taking the time to understand them.

Here are some reasons that I believe play a part in the mistrust in medical professionals.

🗣 Rushing through and not providing a thorough explanation to educate/inform patients on what is going on with their health. This is especially something I take to heart because I truly believe that we can make a difference in the number of chronic disease incidence by simply taking the time to educate our patients.

🗣 Patients are left in the dark, this is especially something that occurs in the hospital setting. Patients often do not know what tests were done and why. They don’t know what the plan is or are confused because they are receiving different information from different specialists. The lack of proper updates and proper explanation of patients’ health management not only causes mistrust but also causes poor compliance and poor outcome. Often patients put their full trust in the team and believe that everything is done exactly right. And while I naively believed this to be true, it isn’t always. And this isn’t to add further mistrust, but it is to say that physicians should deliver honest and thorough information, which may decrease the chances of mistakes, but patients should learn to ask tough questions and be an active participant in their care. I think medicine is incredible, but it is flawed and the people running it are also flawed (not perfect).

🗣 When patients state their concerns and their concerns are then downplayed or dismissed altogether. This can cause a disconnect, especially when patients are made to feel like an idiot for even stating those concerns. This can lead to keeping crucial information that could help to establish the diagnosis and lead to being placed in situations, like ending in the emergency department when it could have been prevented had they felt comfortable confiding to their PCP, for example.

🗣 The use of condescending or annoyed tone when speaking to patients. This is the absolute worst. There is a difference between talking to patients in a stern and confident manner versus a demeaning and cocky manner. Similar to what was mentioned previously, patients will avoid deliverance of important information because there is that insecurity that can form in patients due to the way they were spoken to.

🗣 Physicians may see the patient’s diagnosis on a regular basis, but the patient may be learning about it for the first time. I think this can be due to becoming immune to a routine: diagnose, treat, on to the next patient, diagnose, treat, on to the next patient — which can unintentionally lead to the false belief that the patient knows more than they actually do. To run away from the room soon after delivering the news can lead to not only distrust but improper care.

This was a long post. I got really into it.
Again, my intention is to first and foremost remind myself to avoid these mistakes that can endanger my patient’s trust in me, and also to advocate for and teach patients and provide a reminder for physicians.

8 Ways to Use Hateful Comments As Your Fuel to Success

You think you are your own worst critic, but I think the internet could beat you at that. We all know that the internet can be brutal! Here are 8 ways you can use hateful comments as your fuel to success:

1. Learn, learn, LEARN from the criticism by evaluating yourself.

DO NOT let the hate become your definition. DO NOT allow it to get in your head and heart, but listen to what they have to say. Use it to evaluate your wrongs and change yourself for the better. Remember, you are human and you are capable of making mistakes. You are also capable of learning and growing from those mistakes.  Recognize when you have done wrong and this will empower you to be better.

2. Be more accepting of others based on this experience.

When you experience hate first-hand, you know the feeling of being treated horribly. Use this to vow that you would never treat someone like you have been treated. Always remind yourself that everyone is going through something and that lashing out is never the answer. Accept people for their flaws and provide them lessons through kindness. You will gain empathy which you can then use to help others going through a similar experience. You can motivate them and provided them support.

3. Be kind and humble even when they only have hateful words to share.

Taking the time to validate your every move simply is another invitation for criticism from the wrong people. Most likely, hateful people will continue to hate and nothing you say will change their minds. Hateful comments always stem from something, whether it was a trigger from a hurtful experience from their past or anger that has grown in them. People will only take the time to write out comments to hurt you because they are hurt themselves. Trust your path of growth. You will be better off than to validate yourself to them. 



4. Learn to control your anger.

This is challenging when people say things about you after, for example, only seeing a 12-second video of you and defining you by it. It can make you really angry because they had all the opportunity to look into who you are but instead they utilize one content and spread hateful assumptions of who you are as a whole. Whether they are big youtube stars or wanting to be influencers (clearly I am still hurting from my own experience). You can’t change the past but you can take advantage of their actions by learning to control your anger and using this lesson throughout life. Stay calm and know you are worth more than their words and assumptions of who you are.

5. Ignore negative opinions of you.

Not everyone will like you and not everyone will agree with you. That is okay. We all have our own thoughts, mindsets, opinions, and interests. Focus on the positive. Be around positive people with a growth mindset and not people with constant negative opinions. Block hateful comments that provide you little value.

6. Love yourself including all of your flaws and failures.

People will use your past to attack you and bring you down, for example, use your past failures. They may use it to define you and attack your character. BE PROUD of your failures as they are the beautiful life-lessons that build you to be the warrior that you are. Do NOT conform to anybody’s beliefs. Again, love yourself for all your flaws and failures which are leading you to greatness.


7. Use their hate to motivate

Let their words sink in enough to push you forward. For example, people may tell you you are not good enough, you are not worthy. Use these negative comments to motivate you to learn and strive for success. You do not need to prove anything to anyone but yourself. Utilize their hate to fuel your fire to success. Work hard to be the best you can be.

8. Truly, Move-forward

What has happened has happened. It is in the past. It cannot be changed. If you did something wrong and you were criticized for it, learn from it, accept that it happened and move on. Learn from this very experience. You truly have gained so much from it and you will only see it with time. Don’t let it spiral you down a hole of depression and self-hate. People on the internet can care less about what happens to you, but your loved ones and the followers that support you, care a hell of a lot. Move forward! Focus on the good of it, the lesson. People will now learn through you.

Netflix and Quarantine.

Hello ladies and gentlemen. I hope as you stay home to help put out the fire (the pandemic) you are keeping sane. I have been using this time to get things done around the house as well as do things I have been putting off. and of course Netflixing!

Here is a list of Shows and Stand up comedies that will have you screaming (in laughter, shock, and amazement).

Let’s start with some shows

Shows

  • YOU
    There are 2 seasons and if you haven’t started it, you are missing out. It isn’t a show I would watch with my mom and dad though, a lot of sexual scenes (but nothing like Game of Thrones). It is definitely going to keep you on the edge of your seat the entire time. Actually, during season 2, at first I was like — the hell is this, BUT KEEP WATCHING. The writers did SUCH AN INCREDIBLE JOB. I was guessing some of the things but it had such a plot twist that I did not see coming!! I was literally screaming OMGOSH as I had my headphones in and everyone around me confused. MUST WATCH.
  • New Girl
    You most likely have seen this already. I started watching this earlier this year for the first time and my gosh it is HILARIOUS. Nick is my favorite, well Schmitt is pretty hilarious too. Hmm, then again so is Jess. I really can’t decide who I love most, but as I am watching it again, I think Nick is by far my most favorite with all of his puns!! If you want a good laugh, watch New Girl! It is super witty and comical. There are a lot of sexual references, so I wouldn’t watch it with my parents or even siblings.
  • Black Mirror
    This is an insane series involving futuristic technology. The idea behind it makes you nervous and scared. I have only watched a handful of them. You do not need to watch it in sequence. I was pretty invested in a few of the episodes:
    Season 4 Episode 2 – Arkangel.
    Season 4, Episode 6 – Black Museum.
    Season 3, Episode 3 – Shut up and Dance.
  • Love is Blind
    It is quite interesting. It is a reality TV show, and it is one that you can’t help yourself but get invested in. I talked about this in my story before. It is just one of those shows that you feel silly for watching, but you can’t help it.
  • The Haunting of Hill House
    This is SUCH A GREAT SHOW! The writers did an excellent job. You HAVE to pay close attention because you miss out on important information if you don’t. It is creepy and fair warning you will get scared if you are watching it by yourself. I encourage watching it with family members that also like thriller/horror. It is NOT gorry. Definitely one I would watch with my mom.
  • The 100
    I was in love with season 1 and 2 but it died out for me season 3, to be honest. However, it is SO, SO, SO GOOD! I watched this a while ago, but one I always recommend. Their acting skills = ON POINT. I don’t think there is even one that does an average job. Actually all of these shows, their acting skills are absolutely incredible. You won’t be disappointed.
  • Gotham
    This is another series that I watched the first and second, but never got back into it. MY GOSH, the production of this show. They are all so fantastic. It keeps you on the edge of your seat the whole time. I LOVE Penguin, although a bad guy, the person that plays him really does a fantastic job. All of them do really. This is also one I could watch with family. It is a little intense here and there, but nothing too major.
  • Anne with an E
    This is one of the CUTEST shows I have seen since Gilmore Girls. The setting is in the late 19 century in Canada. It is just so… I can’t describe the excitement I get watching it. It gives you this sense of realization about life now and then — how simple things were back then and how different. It is super cute.

Stand-up Comedy

You guys, if you have not seen the following, you are MISSING OUT! They are HILARIOUS! I was laughing from the start to the end. There are so many stand-up comedy acts now on Netflix, but these ones are A MUST-WATCH! I love Hasan Minhaj, he is one of my favorites. His Patriot Act show is also amazing! I actually watched Ronny Chieng after seeing him open up for Hasan Minhaj live. Ronny Chieng is SO DAMN FUNNY.

  • Ricky Gervais Humanity
  • Asian Comedian Destroys America (Ronny Chieng)
  • Aziz Ansari Right now
  • Hasan Minhaj Homecoming king
  • Kevin Hart Irresponsible

My Start Of Intermittent Fasting

Hi you guys!! It has been a minute since I wrote a blog post! What have you guys been up to? Here is a quick update on my life.

  1. I was studying for Step 3 then a few personal things happened and I had to take a step back — but I am starting it up again soon!
  2. My older sister and brother-in-law made me an AUNT!!! I was SO excited to meet this baby for the longest time (even before my sister found the love of her life). It is a BOY and he is incredibly cute, smart (I can already tell), OH SO HANDSOME, and the sweetest little boy I have ever laid eyes on. I mean, well, there is also my little brother who is amazing too. Follow me on my IG and you can meet him through my stories! @Dr.Mursi.MD
  3. I applied for residency TODAY! Keep me in your prayers! Also, keep a lookout for residency posts (both, here on my blog and on my YouTube channel).
  4. I GAIN FREAKIN’ WEIGHT. I am so upset because I gained ~20 pounds while studying for step 1 and then lost about 10 pounds of it and now I am back up 10 pounds again (keep reading I will tell you my weight now and my goal)! How the hell did I get here?! I can answer that: Age. Metabolism. Laziness. Unable to control my sweet tooth.

So, intermittent fasting, I have been on and off with this and it does some serious pound-shredding if you are consistent! When I live on my own, I am pretty good about keeping my weight off, it is when I come home from my parent’s house! I swear my mom is my weight’s worst nightmare. She just keeps FEEDING ME.

I have warned her: “Mother, if you tell me to eat more again, I will stop eating completely and go hungry and it will be your fault that I die of starvation! Is that what you want? Me to go hungry?” LOL!! Then she stopped forcing me to eat extra for fear that I wouldn’t eat. Little does she know…. All jokes aside (well, I wasn’t joking..) I am getting into some serious business of feeling my healthier self again.

I currently weigh 140 lbs and my goal is 120. I would like to lose 20 pounds in total–of course, promptly. I have NEVER been about the numbers, but as I am getting older, it is time to be careful. I will be starting my intermittent fasting today. It is currently 6:41 PM. Would you like to start it with me?

I will fast for 14 hours starting now. I am using an app called Zero. You can select the hours you want to fast. Remember, you can drink water during this time, but nothing else. I will check back in one week to update you guys on my weight. I will have to take my weight at the same time (6:30ish PM). Let’s start!!! Here is a screenshot showing my timer. Now it is YOUR TURN, check your start weight, select your goal weight, mark your calendar, and get the app — oh, and start your fasting today!

We can try to lose the pounds together!!

See you in a week in my next post!!

Much Love,
Mursi

Sunburn | Cause, Prevention & Treatment

We all know what sunburn is (most likely had one at some point), but I don’t think we know enough about it. Let’s take a better look at what happens when you have too much ultraviolet radiation (UVR), why you should protect yourself and how to protect youself.

Excessive sun exposure can lead to acute sunburn (aka solar erythema). The sun damages the DNA directly when you get extensive sun exposure leading to inflammation and the killing of skin cells. This inflammation also causes vasodilation of the skin’s blood vessels leading to the appearance of redness and it can even cause swelling if the burn is pretty bad. Your sunburn will appear red about 3-4 hours post sun exposure. This is why when you are laying under the sun on the beach, you won’t get red right away. You will see it 3-4 hours after. The damage of your skin layer begins within 2 hours after UV exposure.

Why do your sunburn itch and hurt? It’s from the release of mediators including histamine (which causes the itch) and there the formation of prostaglandins (which cause the pain).

After going to the beach, several hours later I felt fever, chills, nauseous and even vomited. What is going on?” This is from sun exposure. Sunburn most commonly presents with redness of the skin with pain after 3-4 hours of exposure to the sun. You can also have fever, chills, malaise, nausea, vomiting in severe cases. It can blister. The redness will resolve within a week and the skin will peel.

Why do I have swelling after sun exposure? Usually, after sun exposure you have redness, warmth, tenderness, you can even have edema (swelling), and blistering. Swelling can occur in severe sunburn could be due to the inflammatory reaction leading to leakage of capillaries. Blistering is seen in severe cases as well, which mean either you have superficial partial-thickness or deep partial-thickness burn. The deep partial-thickness burn is a second-degree burn. Severe sunburn can also lead to dehydration, heat exhaustion and heatstroke.

BUT I REALLY WANT TO GET A TANIf you are trying to get a tan, sunbath when there is less intense sun exposure (don’t lay during peak hours of sunshine (12 AM – 2 PM — this may vary depending on your location). Also, lay for a short duration. I understand your desire of wanting a tan! I want that glowing tanned skin look too! In fact, when you get a tan, this will increase in skin pigmentation and will provide some protection against further UVR-induced damage. You will have more melanin (which is what you have more or less of depending on your skin color; if you are dark skinned you have more melanin and if you are light skin, you have less melanin; more melanin = more protection). BUT REMEMBER, you should always, ALWAYS wear sunscreen. Even when you want to get a tan.

Is it true that if I wear clothing do it will protect me from the sun? Not always. UVR can transmit through clothing, especially if it is wet. Look into what clothing is more protective.

My recommendation: ALWAYS use sunscreen and use it 15 minutes be for leaving your house. Be good at reapplication after 2-3 hours or after getting out of the water (pool or beach, etc).

Prevention: Use sun protection factor (SPF) of 30 (there hasn’t been an indicating that states using higher SPF is more protective). SPF 30 is more than sufficient. And as long as you are using it prior to 30 minutes to sun exposure and reapplying every 2-3 hours or after swimming, sweating or toweling off, you will be well protected. Avoiding the sun during the period of peak solar radiation can help prevent sunburns (10AM-4PM). Let’s be honest, when we go to the beach, we want to swim during these hours, I usually avoid going outside between 12-2, because this is when its the strongest. However, when I go to the beach, this is the best time to be swimming because it feels so good to be under the hot sun and in the cool water. Just be good about reapplying sunscreen. Have an umbrella with you and get under the umbrella after you get out of the sun and apply your sunscreen. Let it set. Protective clothing includes wide-brimmed hat or sun visor.

Treatment: Naproxen, this will inhibit inflammatory reaction and pain by decreasing the activity of cyclooxygenase, which decreases the production of prostaglandins which is what is causing the pain.

Aspirin, ibuprofen can also be used. Ibuprofen is usually the drug of choice for mild to moderate pain. If you have hypersensitivity to aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs), then acetaminophen is better, especially if you have GI or renal issues or are on oral anticoagulants. Elderly will do better with acetaminophen to avoid any GI and renal adverse effects. Acetaminophen will help with the pain but it doesn’t have an anti-inflammatory effect.

The best thing to do for your sunburn is taking cool baths or showers, using NSAIDs for the pain and to decrease the inflammation and avoid further sun exposure.

Bacterial Vaginosis

I have itching, burning, irritation and/or abnormal discharge DOWN THERE!? What is HAPPENING to me?! This is so embarrassing!”

Let’s break it down and see the possible causes; what you need to do now and what you need to do in the future. Ultimately, this post is guidance and to give you a better understanding of what may be happening and why. You need to see your primary care to get the proper diagnosis. My goal is to teach and help you understand about certain infections.

If you have been itching, burning or having an abnormal discharge, you might be suffering from a type of vulvovaginitis, which is inflammation of the vulva or vagina. It could be mild or severe. It could occur for the first time and not come back again, or come back again often. In order to treat it appropriately, the type needs to be identified. Is it a yeast infection? Is it bacterial vaginosis? Is it trichomoniasis?

The most common cause of vaginitis is bacterial vaginosis (BV). The next common cause is candidiasis and then it is trichomoniasis. They affect the vulva and the vagina, but other infections can also affect these areas, such as sexually transmitted diseases like herpes, syphilis, chalmydia, gonorrhea. Often when women have vulvovaginitis, they do not have symptoms (70% of the time).

If you are having the symptoms for the first time, you should see your doctor without doing any self-treatment based on what you have read on the internet. Get it diagnosed. What is the cause? If you do self-treatment with nonprescription medications, it may compromise the evaluation. I highly recommend going to your primary care and getting it evaluated not to a blog or youtube channel that gives home remedies.

What will happen during the doctor visit? You will be asked a series of questions then have a speculum examination done to obtain a sample to do various tests on. Then a diagnosis is given and a treatment.

Let’s talk about the normal vulva and vagina:
The vulva contains hair follicles and sebaceous, sweat and apocrine glands. While the vagina does not have these things but is made up of nonkeratinized cells. The vagina is influenced by estrogen stimulation. After puberty, the vaginal tissues will react to estrogen and it will increase glycogen levels which will favor the growth of specific bacteria, lactobacilli, which are the good bacteria. They break down the glycogen into lactic acid and brings the pH at a range of 3.5 – 4.5. This pH level is normal after puberty and before menopause. So, if you test the vaginal pH and have anything above 4.5, this would be abnormal.

Discharges:
There are normal discharges from the vagina. So, do not freak out when you have a discharge. You can have mucus coming from the cervix, exudates from accessory glands, exfoliated squamous cells from the vaginal wall. It could lead to white or off-white color and provides an increased consistency. This is normal. The amount varies depending on many factors, which includes your hormones, hydration status, pregnancy, immunosuppression, and inflammation. Normal vaginal secretions do not have an odor. So, discharge can be normal, but if you ever have an odor — THIS IS NOT NORMAL. No, you won’t normally have a perfume like smell, but you shouldn’t have a bad smell. Pay attention to the smell and if it seems different, bad, then this could be a sign of an infection.

Let’s talk about bacterial vaginosis.
This is due to low levels of the normal bacteria (lactobacilli) and an overgrowth of anaerobic organisms. I know this might be a bit much, but the lactobacilli (the good bacteria in the vagina) produce hydrogen peroxide that breaks down glycogen, which is produced by the vaginal tissues. This causes the pH low to be low (between 3.5-4.5). So, the normal vaginal pH should be between 3.5-4.5. And in bacterial vaginosis you have lower than normal amounts of the lactobacilli, the pH will be higher than normal. This causes overgrowth of the bad bacteria in the vagina. In BV there is this musty or fishy odor and a gray-white to yellow discharge and a pH above 4.5. When you visit your primary care, they will take do a speculum exam and take a sample to check pH, look for clue cells under the microscope (clue cells are epithelial cells with clumps of bacteria clustered on their surfaces).

So, in BV you have abnormal gray discharge, pH level of greater than 4.5 and positive whiff test and presence of clue cells. They are treated with metronidazole oral or topical, or you can be treated with clindamycin. If you are pregnant, you can still be treated with these drugs as they are not teratogenic (these drugs won’t affect your pregnancy).

Vulvovaginal Candidiasis
This is caused by airborne fungi, 90% of it is Candida albicans. This is NOT an STI and they do not generally coexist with other infections. This is more likely to occur in pregnant women, patients on broad-spectrum antibiotics, diabetics, obese, immunosuppressed, those on OCP, those on corticosteroids. Wearing tight clothing or keeping a warm and moist environment can increase candida infection. the most common symptom is itching. But up to 20% of women are asymptomatic. Burning, ezxternal dysuria and dyspareunia are also findings. There is a discharge that looks like cottage cheese. They have a pH of 4 to 4.5. It is odorless. You can have a reliable diagnosis based on history and physical exam alone. OTC treatments are safe and effective but if they do not respond to OTC treatment or they have recurrence soon after treatment should have a definitive diagnosis. If you are self-treating, before visiting the doctors, you need to stop the treatment for three days prior to visiting the doctors. Diagnosis will require visualization of blastospores or pseudohyphae on saline or 10% KOH microscopy or a positive culture in symptomatic woman. Latex agglutination tests may be used if it is a non-Candida albican strain because they do not demonstrate pseudohyphae on wet prep. Treatment requires the topical application of imidazole (miconazole, clotrimazole, butoconazole or terconazole in cream or suppository form placed intravaginally. Or a short-term oral therapy with low0dos *150mg) of fluconazole. Pregnant women should be treated with topical agents due to an increase in the risk of birth defects associated with high obese (400-800) of fluconazole. Although it has high cure rates, there is still a 20-30% chance of recurrence after 1 month. There is an option of weekly therapy with fluconazole for 6 months, which has been shown to be effective in preventing recurrent candidiasis in 50% of women. Intermittent therapy with topical agents weekly or twice weekly can be used as preventative care. When a patient is given antibiotics for systemic inflammation, they should be prescribed antifungal for ppx.

Trichomonas vulvovaginitis
This is an infection that is transmitted through sexual contact but can occur from fomites (poop) and oht tubs. It is assoicated with PID, endometritis, infertility, ectopic pregnancy and preterm birth. It often coexists with other sexually transmitted disease and BV. It has also been shown to facilitate HIV transmission. It can present with itching, burning copious discharge and an odor, as well as pain during urination and during sex. The discharge is often frothy, thin, yellow-green in color but even gray in color. pH is above 4.5. There may be edema or erythema of the vulva. On exam there could be strawberry patches in the cervix, but this is not often seen in every case. The diagnosis is confimred by microscopic examination of vaginal secretions in normal saline. THis wet smea will show large mature epithelial cells with WBC and trichomonas organisms. Those that are diagnosed with this should be screen for other STDs esepcially gonorrhea and chlamydia. It is treated with oral metronidzaole or tinidazole. Their sexual parter needs to be treated as well other wise it will lead to reinfection due to the partner not being treated because they stil lhave it. When on this medication, abstaine from alcohol because it will lead to disulfiram like reaction. Trichomoniasis is assosited with preterm delievery, PROM and low brith weight. Pregnant patiens should be treated and metronixazole is considered safe for use during pregnancy. However, treatemtn may not prevent these pregnacy complications. They do not need to be followed-up to see if it is gone. it is not cost- effective.

BV and trichomoniasis can be hard to distinguish so if you have symptoms, it is important to get it diagnosed. If it is trichomonias, you have these protozoans in the vaginal that need to be eliminated by metronidazole and also your partner needs to be treated for it.