Sunday, December 16, 2018

Viral Gastroenteritis By Dr. Matt Bogard

Viral Gastroenteritis
By Dr. Matt Bogard

Nearly all of us have fallen victim to the "stomach flu;" it starts out innocently enough when you realize you feel a little run-down, but soon it rears its ugly head as you scramble (repeatedly) to the bathroom hoping to make it before your insides explode. 

              The medical term for the stomach flu is "gastroenteritis" and is often caused by a viral infection of the stomach and intestines.  Norovirus, rotavirus, adenovirus, and sapovirus are common offenders.  People get infected by touching an infected person or a surface with the virus on it and then either touch their own mouth or their food before washing their hands.  Common symptoms of viral gastroenteritis include the expected nausea, vomiting, and diarrhea.  Victims may also report fevers, stomach cramping, decreased appetite, and headaches and muscle aches from dehydration.  In fact, the dehydration can become severe and life-threatening in young children and elderly people.

              Fortunately, most people with viral gastroenteritis do not need specific treatment as the virus will run its course and you will recover.  The most important thing to do is maintain hydration.  Water and sports drinks, particularly those lower in sugar, are a great way to replenish both your fluids and electrolytes.  Oral rehydration solutions like Pedialyte contain additional electrolytes for young children but are less palatable.  I always tell my pregnant patients your urine should be "lighter in color than lemonade" and, if not, you need more water.

              It's also best to alter your diet a little, if you can keep foods down.  Cereals and lean meats, bland foods, and whole grains are good choices.  Avoid juices and colas -they can make the diarrhea worse.  Protein is also important to healing your gut - peanut butter and lean meats are a good source.  Once you are up to it, yogurts containing lactobacillus may help restore the normal bacteria to your bowels.  You should also avoid taking any anti-diarrhea medications - it oftentimes just prolongs the illness.  Your body is working to expel the virus by any means it can, and slowing your bowels with anti-diarrhea medication prevents your body from doing so.

Dr. Matt Bogard, M.D. is a medical doctor.  He is board-certified in Family Medicine and Board-Eligible in Emergency Medicine.  He sees patients of all ages, genders, and complaints.


References:

Dr. Matthew Bogard, Iowa doctor, is an emergency medicine doctor primarily at the Lucas County Health Center in Chariton, Iowa. Presently, he is Board Certified in Family Medicine by the National Board of Physicians and Surgeons and the American Academy of Family Physicians.

Vasectomy: An Excellent Choice for the Couple Finished Conceiving, by Matt Bogard, M.D.

Vasectomy: An Excellent Choice for the Couple Finished Conceiving

Matt Bogard, M.D.

During the obstetrical and gynecologic portions of my training I observed the OB/GYN physicians counsel their female patients extensively on all of the various birth control options: pills, patches, barrier devices, vaginal ring, intrauterine devices, implantable hormones, and permanent surgical procedures.  All are great options for certain couples depending on how long-lasting they desire the effects to be. 

Unfortunately, vasectomy was rarely brought up as an option.  It's a procedure Obstetrician/Gynecologist physicians don't perform, and since it is performed on the male partner rather than the female, I think the gynecologists often forgot about it.  This is unfortunate because it's a great option for many couples.

Vasectomy is a minor surgical procedure performed on a male so that he can no longer get a woman pregnant.  It is meant as a permanent procedure that prevents the release of sperm when a man ejaculates.  Sperm typically travel from the testicles to the outside world through a tube called the vas deferens, which is permanently blocked during the procedure.  Sperm can no longer reach the outside world to get a woman pregnant, but the other fluid the male ejaculates still flows normally. 

The procedure is performed in the doctor's office rather than the operating room where we perform tubal ligations on women.  This reduces the costs considerably.  It is performed with local anesthetic to numb the area rather than the need to put a patient completely to sleep as with tubal ligations, further reducing costs as well as being safer.  The doctor finds the vas deferens within the scrotum by feel and then makes a small puncture wound in the skin of the scrotum, ties off the vas deferens with suture, and repeats the process on the other side.  It typically takes about a half hour to perform.
I tell my patients to take it easy for several days after vasectomy.  Pain and discomfort are typically minimal, and most patients report back the recovery was much less than they expected.  The puncture sites heal within a few days.

It is important to understand that a man is still able to impregnate a woman for up to three months after a vasectomy is performed, and because of this we have you return with a semen sample to be analyzed in the lab before declaring the vasectomy a success.  After receiving a vasectomy, a couple should still use another form of birth control until we confirm the success with this semen sample.
If you and your partner are finished having children and are interested in a cost-effective, safe, and permanent method of birth control, a vasectomy may be the perfect option.

Dr. Matt Bogard, M.D. is a medical doctor.  He is board-certified in Family Medicine and Board-Eligible in Emergency Medicine.  He sees patients of all ages, genders, and complaints.


References:

Dr. Matthew Bogard, Iowa doctor, is an emergency medicine doctor primarily at the Lucas County Health Center in Chariton, Iowa. Presently, he is Board Certified in Family Medicine by the National Board of Physicians and Surgeons and the American Academy of Family Physicians.

Sports Physicals: Seizing the Opportunity for a Comprehensive Health Evaluation By Matt Bogard, M.D.


Sports Physicals: Seizing the Opportunity for a Comprehensive Health Evaluation

By Matt Bogard, M.D.

This past February a high school wrestler collapsed during the Iowa High School State Wrestling Tournament.  Shortly thereafter he experienced a seizure and became unresponsive.  Fortunately, doctors were present at the tournament and had an automatic external defibrillator - a machine which analyzed his heart rhythm and delivered a life-saving electrical impulse to restore his heart to normal function.  In the hospital, he was found to have a condition called Wolfe-Parkinson-White Syndrome - an extra electrical pathway that predisposes him to fatal heart arrhythmias.  He underwent a procedure to eradicate the extra pathway and is doing fine.

While this patient's story has a happy ending, he would have died at the wrestling tournament had it not been for the efforts of those who came to his aid and the availability of the defibrillator.
It is important for student athletes to see their primary care doctor for a comprehensive medical exam and sports clearance.  This allows ample time for your child's healthcare provider to collect an appropriate history, evaluate risk factors, and perform a thorough exam.  It also allows us to catch up on vaccines and provide a private environment to discuss any concerns you or your child may have.


Dr. Matt Bogard, M.D. is a medical doctor.  He is board-certified in Family Medicine and Board-Eligible in Emergency Medicine.  He sees patients of all ages, genders, and complaints.




Dr. Matthew Bogard, Iowa doctor, is an emergency medicine doctor primarily at the Lucas County Health Center in Chariton, Iowa. Presently, he is Board Certified in Family Medicine by the National Board of Physicians and Surgeons and the American Academy of Family Physicians.

Dr. Matthew Bogard, Iowa Doctor - Safe Sun Exposure - Enjoying the Sun and Preventing Skin Cancer


Safe Sun Exposure - Enjoying the Sun and Preventing Skin Cancer

A good friend of mine is a dermatologist who specializes in treating skin cancers.  He is quick to remind people, "There is no such thing as a healthy tan."  Whether you get your ultraviolet fix from Mother Nature or from a tanning booth, tanned skin contains cells with permanent damage to their DNA and a chance of morphing into cancer.  About half of all cancers nationwide are skin cancers and their frequency is increasing.  Melanoma in particular is becoming far more common, especially in younger patients (in their 20's and 30's), which is especially alarming because melanoma has a high risk of metastasizing and causing death.

The sun gives off heat and ultraviolet (UV) light.  There are two types of UV light - A and B.  UVA light is "aging" light - the waveform of UVA light allows it to penetrate deeply into the skin where it interferes with the support structures of the skin, damaging elastin and collagen, and causing wrinkles and skin sagging.  UVB light is "burning" light - the waveform is shorter so it causes reddening (sunburn) and darkening (tanning) of the skin, along with causing far more genetic mutations and the vast majority of cancers.

Here are some tips to help you practice "Safe Sun" this summer:

1. Avoid direct sunlight on your skin during peak sunlight hours. Two-thirds of each day’s UVB radiation reaches the earth between 10 AM and 2 PM, when filtration by the atmosphere is the least.  The morning or evening is the best time to be outside.
2. Sunglasses that block 100% UV help protect your eyes against cataracts.  Cover up with loose, cool long-sleeved shirts and pants, and a hat with at least a 3-inch rim all the way around. 
3. Use a broad-spectrum sunscreen (meaning it screens both UVA and UVB) with a sun protection factor (SPF) of at least 15 on all exposed skin, even on hazy days.  Apply liberally about 30 minutes prior to sun exposure, and reapply after swimming or excessive sweating.
4.  Avoid long periods of direct sunlight on your skin, especially if it is unusual for you to be out that long. This type of sunlight exposure is linked more to skin cancer. Be aware of how long you are outside.
5. Avoid sunburn at any age. The majority of skin cancer patients have had sunburns, and sunburn is probably the leading preventable cause of melanoma.
6. Keep infants under six months out of direct sun and covered by protective clothing.  Apply sunscreen anytime infants are going to be outside as their skin is more delicate.
7. Habits acquired in childhood carry throughout life. One of the most important is sun protection. Approximately 80 percent of our lifetime sun exposure is acquired in the first 18 years.
8. Be aware of reflected sun off snow, sand, and water.

Dr. Matt Bogard, M.D. is a medical doctor.  He is board-certified in Family Medicine and Board-Eligible in Emergency Medicine.  He sees patients of all ages, genders, and complaints.


Dr. Matthew Bogard, Iowa doctor, is an emergency medicine doctor primarily at the Lucas County Health Center in Chariton, Iowa. Presently, he is Board Certified in Family Medicine by the National Board of Physicians and Surgeons and the American Academy of Family Physicians.

Postpartum Hemorrhage - by Matt Bogard, M.D.

Postpartum Hemorrhage
Matt Bogard, M.D.
Background
          The physician who chooses to practice obstetrics engages in a physiologic process that has occurred for thousands of years prior to the advent of modern medicine.  For the Family Medicine Obstetrician, attending the deliveries of his or her patients further expands on the concept of comprehensive care.
          While laboring and vaginal delivery is often a positive experience for patients and providers alike, it is a process wrought with potential consequences that may be devastating to the mother, the fetus, or both.  The obstetrician must be vigilant and suspicious of the potential for complications to develop, and must have at his or her disposal appropriate medications, supplies, tools, and personnel for necessary intervention. 
          The recent increase in alternative birthing centers, including home deliveries, places the laboring patient in a precarious position – in the event of a complication the attendant may lack the ability to appropriately intervene.  These situations have led to recent legal challenges.1,2
          Postpartum hemorrhage is a complication of labor that requires immediate aggressive intervention to ensure maternal well-being.  Postpartum hemorrhage is classically considered to be blood loss of greater than 500mL during or following the third stage of labor, and has an incidence of nearly 18%.3  Severe postpartum hemorrhage occurs with more than 1 liter of blood loss and occurs in nearly 3% of vaginal deliveries. 

Causes
          There are many potential causes of postpartum hemorrhage.  Uterine atony is causative in approximately 70% of PPH cases.4  The second most common causative group, seen in 20% of cases, is urogenital trauma in the form of laceration, hematoma, rupture, or uterine inversion.  Retained tissue accounts for approximately 10% of postpartum hemorrhage occurrences.  A very small minority of hemorrhage is caused by coagulopathy or bleeding diathesis. 

Risk factors
There are multiple risk factors a physician must consider when contemplating the possibility of postpartum hemorrhage.  Anemia, easy bruising, clotting disorders, history of prior postpartum hemorrhage, multiple gestation, prolonged third stage of labor, episiotomy, and fetal macrosomia are all contributing factors.5  A retrospective study examining oxytoxin use during labor and the incidence of PPH found women with severe PPH secondary to uterine atony were exposed to significantly more oxytocin during labor when compared to matched controls (10,054 mU AUC compared to 3762 mU AUC in controls).6  This should prompt increased suspicion for PPH in women after a lengthy induction or augmentation.  Interestingly, regional epidural analgesia was found to be a protective factor against severe blood loss in women with postpartum hemorrhage.7

Initial resuscitation
          Acute-onset hemorrhage is a situation with which every physician should have comfort in the initial management.  Evaluation of the ABCs of life support typically centers on Circulation.  Establishment of vascular access via two large-bore peripheral IVs or one central line is necessary and should be followed with immediate fluid resuscitation comprised of isotonic fluids, either Lactated Ringer’s solution or Normal Saline.  Oxygen therapy, typically via nonrebreather mask, is initiated along with serial assessment of vital signs.  Ongoing brisk bleeding may prompt ordering of complete blood counts, coagulation profile, and type and cross donor blood products in case transfusion later becomes warranted.  In one hospital-based study, the prevalence of severe PPH was 2.36%, and the rate of transfusion of blood and blood products was 1.6%.8  In the same study, transfusion of packed red blood cells and blood component therapy was significantly more common in women after caesarean section, compared to those who delivered vaginally.  The provider must also beware that blood counts take multiple hours to stabilize after resolved hemorrhage and initial labs may not accurately portray the patient’s status.

Pneumonic Aids
          There are two helpful pneumonic aids the astute obstetrician should memorize to guide initial treatment strategies.  A recent study9 examined use of the acronym "HEMOSTASIS" in management of the patient with postpartum hemorrhage.  HEMOSTASIS includes: ask for Help; Establish etiology; Massage the uterus; Oxytocin infusion and prostaglandins; Shift to operating theater; Tamponade test; Apply compression sutures; Systematic pelvic devascularization; Interventional radiology; Subtotal/total abdominal hysterectomy.  Practitioners completing the ALSO course are taught to consider the four causative T’s of the postpartum hemorrhage:  Tone, Trauma, Tissue, Thrombin.

Vaginal Delivery Postpartum Hemorrhage
          Active Management, rather than Expectant Management, of the third stage of labor is the single best approach to prevention of postpartum hemorrhage.10 This involves administration of pitocin or other uterotonic shortly after delivery of the anterior shoulder, uterine massage prior to and after placental delivery, and controlled cord traction throughout the third stage.  When compared to Expectant Management of the third stage, in which the placenta is allowed to separate either spontaneously or aided only by gravity or nipple stimulation, the Number Needed to Treat with Active Management to prevent one case of PPH is 12.11
          Pitocin remains the primary uterotonic of choice in most cases of Active Management of the third stage of labor, in part because it may be given intravenous, intramuscular, or direct injection in the uterine vein.  Routine use of misoprostol plus pitocin resulted in modest reductions of blood loss in the third stage of labor in one study, but the effects did not reach statistical significance.12
          When postpartum hemorrhage develops following a vaginal delivery, the obstetrician should first assume uterine atony and begin immediate massage, either abdominal massage or bimanual with one hand on the abdomen and one in the vaginal vault compressing the uterus.  The labor nurse should simultaneously administer oxytocin.  The physician may reasonably elect to also administer 1mg of the Prostaglandin E1, misoprostol, rectally. 
          Additional medications available include prostaglandin F-2α, Hemabate, which may be given in patients without history of pulmonary disease, and one of two ergot alkaloids, Methergine and Ergonovine, in patients without underlying hypertension or preeclampsia. 
          As the uterus develops tone, a detailed inspection should be undertaken looking for obvious or occult trauma.  Dissolvable suture is employed to close any lacerations discovered and achieve hemostasis.  A change in vital signs out of proportion to perceived blood loss coupled with pain may represent hematoma formation.  Large or enlarging hematomas should be incised and the contained clot evacuated before applying hemostatic suture, often a figure-of-eight.13
          The third stage of labor has a mean length of 8-10 minutes and the placenta is considered retained after 30 minutes.14  Umbilical vein injection of oxytocin may accelerate the rate of placental separation.  If this fails, manual exploration with a gloved hand is typically the next step, and much easier to complete in the patient with regional anesthesia.  Finally, it may become necessary to perform curettage of the uterine cavity.15
          If the obstetrician fails to identify a cleavage plane between placenta and uterus, one must suspect invasive placenta, whether it be an accreta, increta, or percreta.  The usual treatment is hysterectomy and warrants urgent consultation with an appropriate surgeon.16
Ongoing uterine atony and hemorrhage may be treated with intrauterine balloon tamponade.  The Bakri Balloon is a 24-French catheter with a 500mL balloon that has multiple successful case reports.
In a recent study, tamponade catheters controlled postpartum hemorrhage in 18 of 20 cases (90%).17
          Finally, less than 1% of postpartum hemorrhage cases is caused by a coagulation disorder.  In these cases, treatment involves replacement of deficiencies via appropriate blood products.  Packed red blood cells, platelets, and cryoprecipitate or clotting factors may become necessary.

Operative Postpartum Hemorrhage
          The surgeon in a Cesarean Section has several additional therapies at his or her disposal.  The surgeon is always appropriate to begin with the steps outlined for vaginal deliveries; oxytocin administration, vigorous massage, prostaglandins, and ergot alkaloids.
          Uterine compression sutures running through the full thickness of both anterior and posterior uterine walls are a newer operative development for surgical management of uterine atony. Christopher B-Lynch was the first to highlight this procedure. 18 Additional similar techniques have also recently been described, such as the Hayman modification to the B-Lynch procedure.19  Both the B-Lynch and Hayman involve anchoring bilateral absorbable suture in the lower uterine segment and looping over the fundus in an anterior-posterior direction.
          A recent paper evaluated in a prospective observational study the use of a "uterine sandwich" technique (B-Lynch uterine compression sutures in association with Bakri intrauterine tamponade balloon) in women with unsuccessful medical treatment for postpartum hemorrhage.  The combined technique was successful in avoiding hysterectomy in all studied cases and was without postpartum morbidity.20
          The next operative step in controlling postpartum hemorrhage, particularly in cases with adequate uterine tone, is application of bilateral O’Leary sutures to the uterine arteries with zero or number one absorbable sutures.21
          An additional potential treatment is bilateral embolization of the uterine arteries, which appears to be an effective means by which to control postpartum hemorrhage, especially when caused by with placenta accreta.22
          In cases where all other medical or surgical methods have been employed, total or subtotal hysterectomy is the ultimate solution.

Footnotes

[1] Jose Martinez.  “Midwife Who Starred In 'Business Of Being Born' Sued By Parents Who Blame Her For Stillbirth.”  New York Daily Times.  http://articles.nydailynews.com/2009-10-22/local/17934735_1_midwife-baby-birth.
2 “Midwife Charged in Virginia With Involuntary Manslaughter.”  Fox News.  http://www.foxnews.com/us/2011/04/20/midwife-charged-virginia-involuntary-manslaughter/.
3 The Prevention and Management of Postpartum Haemorrhage.  WHO Report of Technical Working Group, 1990
4 Hossain N, Shah T, Khan N, Shah N, Khan NH.  Transfusion Of Blood And Blood Component Therapy For Postpartum Hemorrhage At A Tertiary Referral Center.  J Pak Med Assoc. 2011 Apr;61(4):343-5.
5 Advanced Life Support in Obstetrics Course Syllabus.  American Academy of Family Physicians.  2006.
6 Grotegut CA, Paglia MJ, Johnson LN, Thames B, James AH.  Oxytocin Exposure During Labor Among Women With Postpartum Hemorrhage Secondary To Uterine Atony.  Am J Obstet Gynecol. 2011 Jan;204(1):56.e1-6. Epub 2010 Nov 3.
7 Driessen M, Bouvier-Colle MH, Dupont C, Khoshnood B, Rudigoz RC, Deneux-Tharaux C.  Postpartum Hemorrhage Resulting From Uterine Atony After Vaginal Delivery: Factors Associated With Severity.  Obstet Gynecol. 2011 Jan;117(1):21-31.
8 Hossain.
9 Varatharajan L, Chandraharan E, Sutton J, Lowe V, Arulkumaran S.  Outcome Of The Management Of Massive Postpartum Hemorrhage Using The Algorithm "HEMOSTASIS".  Int J Gynaecol Obstet. 2011 May;113(2):152-4. Epub 2011 Mar 10.
10 Janice M. Anderson, M.D., and Duncan Etches, M.D., “Prevention And Management Of Postpartum Hemorrhage.”  American Family Physician. 2007 Mar 15;75(6):875-882.
11 ALSO
12 Fawole AO, Sotiloye OS, Hunyinbo KI, Umezulike AC, Okunlola MA, Adekanle DA, Osamor J, Adeyanju O, Olowookere OO, Adekunle AO, Singata M, Mangesi L, Hofmeyr GJ.  A Double-Blind, Randomized, Placebo-Controlled Trial Of Misoprostol And Routine Uterotonics For The Prevention Of Postpartum Hemorrhage.  Int J Gynaecol Obstet. 2011 Feb;112(2):107-11. Epub 2010 Dec 4.
13 Benrubi C, Neuman C, Nuss RC, Thompson RJ.  Vulvar and Vaginal Heatomas: A Retrospective Study of Conservative Versus Operative Management.  South Med Journal.  1987; 80(8):991-94
14 ALSO
15 Anderson
16 ALSO
17 Dabelea V, Schultze PM, McDuffie RS Jr.  Intrauterine Balloon Tamponade In The Management Of Postpartum Hemorrhage.  Am J Perinatol. 2007 Jun;24(6):359-64. Epub 2007 Jun 13.
18 Allam MS, B-Lynch C.  The B-Lynch And Other Uterine Compression Suture Techniques. Int J Gynaecol Obstet. 2005 Jun;89(3):236-41. Epub 2005 Apr 19.
19 Ghezzi F, Cromi A, Uccella S, Raio L, Bolis P, Surbek D. The Hayman Technique: A Simple Method To Treat Postpartum Haemorrhage.  BJOG. 2007 Mar;114(3):362-5.
20 Yoong W, Ridout A, Memtsa M, Stavroulis A, Aref-Adib M, Ramsay-Marcelle Z, Fakokunde A.
Application Of Uterine Compression Suture In Association With Intrauterine Balloon Tamponade ("Uterine Sandwich") For Postpartum Hemorrhage. Acta Obstet Gynecol Scand. 2011 Apr 18. Doi: 10.1111/J.1600-0412.2011.01153.X.
21 ALSO
22 Jung Hn, Shin Sw, Choi Sj, Cho Sk, Park Kb, Park Hs, Kang M, Choo Sw, Do Ys, Choo Iw.

Uterine Artery Embolization For Emergent Management Of Postpartum Hemorrhage Associated With Placenta Accreta.  Acta Radiol. 2011 Mar 28.
Dr. Matthew Bogard, Iowa doctor, is an emergency medicine doctor primarily at the Lucas County Health Center in Chariton, Iowa. Presently, he is Board Certified in Family Medicine by the National Board of Physicians and Surgeons and the American Academy of Family Physicians.

Dr. Matthew Bogard, Iowa Doctor - Preconception Planning



Preconception Planning - The pre-flight for an important journey

I am an avid pilot.  The freedom to hop in our small plane, see the countryside from above, and travel provides immeasurable satisfaction, but many decisions about the safety of the flight must be made prior to firing up the engine.  Pilots conduct a thorough pre-flight checklist of the airplane's condition as well as our own preparedness, because there is no way to "pull over on the shoulder" once airborne.  In much the same way, it is important to plan and prepare for pregnancy ahead of time to give your baby the best chance for a healthy start.  About half of pregnancies in the United States are unintended, and most turn out just fine, but having everything ready to go lowers stress for the parents-to-be.

Optimizing your health prior to becoming pregnant is very important because nearly half of women don't see the doctor about their pregnancy until they are already into their second trimester (greater than 13 weeks along), and by then many of the baby's organs have already formed.  In fact, by the time even the most diligent mothers realize they are pregnant (around 6 weeks), the central nervous system, eyes, heart, arms, and legs are already developed.

One of the most important things to do prior to pregnancy is eliminate things in your life potentially harmful to your baby.  Stopping smoking and moderating alcohol intake are two of the most common interventions mothers-to-be must consider.  In 2002 in the United States, about 7 percent of preterm-related deaths, nearly 20 percent of babies with growth restrictions, and about 30 percent of sudden infant death syndrome (SIDS) deaths were attributable to mothers smoking. In addition, smoking and secondhand smoke exposure increase the risk of infertility, stillbirth, congenital malformations and placental problems complicating pregnancy. 

Current recommendations are to also completely abstain from alcohol intake during pregnancy.  A British study in 2011 found that one small alcoholic beverage daily did not increase pregnancy risks, but the complications increased dramatically when drinking any more than that.  We have never definitively found a "safe" level of alcohol intake during pregnancy and still recommend avoiding it altogether.

Folic acid is instrumental in preventing congenital abnormalities like spina bifida.  In 1998, the FDA required breads, cereals, flours, pastas, rice, and other grains be fortified with folic acid to help prevent birth defects, and follow-up studies show it has decreased neural tube defects by 25%.  Since nearly half of pregnancies are unplanned, this fortification increases the chance that every mother-to-be gets enough folic acid.  However, if you are trying to conceive, I recommend taking daily prenatal vitamins containing folic acid before becoming pregnant.

There are other important things to discuss with your doctor prior to conceiving.  We should review any medications you take regularly to ensure they are safe during the pregnancy, and make substitutions if necessary.  Certain important immunizations like rubella cannot be administered during pregnancy and should be updated before you conceive.  Women with diabetes are at particular risk of problems due to both the fluctuations in your body's glucose levels and some of the medications prescribed to manage diabetes.  Chronic conditions like being underweight or overweight, high blood pressure, asthma, and thyroid abnormalities must also be closely monitored before and during pregnancy.

Dr. Matt Bogard, M.D. is a medical doctor.  He is board-certified in Family Medicine and Board-Eligible in Emergency Medicine.  He sees patients of all ages, genders, and complaints.



Dr. Matthew Bogard, Iowa doctor, is an emergency medicine doctor primarily at the Lucas County Health Center in Chariton, Iowa. Presently, he is Board Certified in Family Medicine by the National Board of Physicians and Surgeons and the American Academy of Family Physicians.

Dr. Matthew Bogard, Iowa Doctor - Influenza

Influenza, also known as the flu, is a respiratory illness caused by the highly contagious influenza virus. These virus particles are spread by droplets, such as when a person coughs or sneezes into the air, as well as by direct contact with an infected individual. Influenza is most prevalent from October to May.

Symptoms of influenza infection can range from mild to severe. They might include sudden onset of high fever, chills, cough and sore throat, fatigue, and muscle or joint pain. This typically starts two days after exposure to the virus and may last for up to a week in healthy people. Certain individuals are at greater risk for longer, more severe infections or complications from the infection – these groups include children under the age of 2, adults over the age of 65, and people with certain medical conditions such as chronic heart, lung, kidney, liver and metabolic disease (diabetes) or weakened immune systems. Complications of influenza infection include hospitalization, pneumonia, dehydration, worsening of underlying medical conditions such as asthma or congestive heart failure, and death.

The most effective method of preventing influenza transmission is vaccination. The “flu shot” protects against 3 or 4 of the most common influenza strains circulating during the upcoming “flu season.” These strains are identified by the World Health Organization (WHO), which carefully monitors virus activity throughout the year.  The flu vaccine causes your body to develop antibodies to the virus strains in the flu vaccine, lessening the chance of catching influenza.  Getting vaccinated also prevents the spread of influenza to others who have higher risk of complications, such as young children or the elderly.  Influenza vaccination prevents 70 to 90% of influenza illnesses in healthy adults and reduces complications in elderly and at-risk patients by 60% and deaths by 80%.

You cannot get the flu from the flu shot, but some people do have mild flu-like symptoms because the shot activates your immune system to build immunity against the virus.  The most common side effects from the influenza vaccine are redness or tenderness at the site of the injection.  Headache and low-grade fever may also occur.  The influenza vaccine is made up of either inactivated (not infectious) strains of virus or no virus at all (these are called recombinant). There is a nasal spray vaccination that is available for healthy children and adults which does contain “live virus;” however, the virus has been weakened so it is not possible for it to cause illness. It takes two weeks for the influenza vaccination to cause the body to develop immunity. Individuals who contract influenza within that time were likely already exposed to the virus or their body had not fully developed immunity.

It is important to remember that the influenza vaccination does not protect against the common cold or gastroenteritis, which some people call the “stomach flu.” It is not recommended for children under the age of 6 months, those with life-threatening allergies to eggs, or those who have a history of Guillain-Barre syndrome. Everyone else should be immunized annually, especially if you have any chronic illnesses, are immunosuppressed, pregnant, or if there is the possibility for exposure to the illness or for transmitting it to high-risk individuals (for example, those who work at a nursing home or daycare).  Because babies cannot be vaccinated and can become very ill, anyone who interacts with babies should receive a flu vaccine.  Even if you get the influenza vaccine, it is important to continue good hand washing to prevent the spread of influenza virus and other cold viruses.


Dr. Matt Bogard, M.D. is a medical doctor.  He is board-certified in Family Medicine and Board-Eligible in Emergency Medicine.  He sees patients of all ages, genders, and complaints.



Dr. Matthew Bogard, Iowa doctor, is an emergency medicine doctor primarily at the Lucas County Health Center in Chariton, Iowa. Presently, he is Board Certified in Family Medicine by the National Board of Physicians and Surgeons and the American Academy of Family Physicians.

Friday, December 14, 2018

Dr. Matthew Bogard, Iowa Doctor - Hypertension: Detecting the Silent Killer – Part 1


Hypertension: Detecting the Silent Killer – Part 1


Our house had low water pressure when I was a child.  We had a well and the pressure tank never pushed water out of a faucet or hose with much force.  On the other hand, I had a friend who lived in town in a low-laying neighborhood and you could almost strip paint with his garden hose.  It's a good illustration that too much or too little of a good thing isn't a good thing.  Such is the case with your blood pressure.

Blood pressure refers to the pressure your blood places on the inner walls of your arteries, which are the vessels that carry oxygen-rich blood from the heart out to the other organs in the body.  Blood pressure is defined by two separate measurements.  The systolic pressure is the pressure in the arteries when the heart contracts (or beats) and the diastolic pressure is the pressure during the relaxation of the arteries between heart beats.  We typically report these as the systolic pressure over the diastolic pressure (120/80 for instance). 

More often than not, the problem is high blood pressure, or hypertension in medical terms.  Untreated high blood pressure increases the strain on the heart and arteries and eventually causes damage to your body's organs.  It also increases the risk of having a stroke, heart attack, heart failure, or kidney failure.  According to a recent study, hypertension is controlled in only about 25% of people with the disease.

Hypertension is a common health problem. In the US, approximately 25% of the overall population has hypertension.  It is more common as people grow older: among folks over age 60 years, hypertension occurs in 65 percent of African-American men, 80 percent of African-American women, 55 percent of white men, and 65 percent of white women.  Unfortunately, there are typically no symptoms of this silent killer so many people with the disease do not know they have it.  This is why we check your blood pressure at every doctor’s visit even if you’re just in for a runny nose or sprained ankle: we want to catch this chronic condition as soon as it hits and act early to prevent complications.

Next week I will discuss what specific blood pressures warrant this diagnosis, things you can do to lessen the chances of having hypertension, as well as the ways we treat it by lowering your blood pressure.

References:
Blog: https://matthewbogardmd.blogspot.com/
LinkedIn Profile: https://www.linkedin.com/in/matthewbogard/
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*** Dr. Matthew Bogard, Iowa doctor, is an emergency medicine doctor primarily at the Lucas County Health Center in Chariton, Iowa. Presently, he is Board Certified in Family Medicine by the National Board of Physicians and Surgeons and the American Academy of Family Physicians.