Doc, I've got a question

Common warts, also known as Verruca vulgaris, are a benign skin lesion. They are caused by a virus called the Human Papillomavirus, or HPV. The virus is contracted through direct or indirect contact of the virus. This makes children most at risk for developing warts due to the fact that school age children are often in close contact with each other and sharing school supplies, toys, etc. throughout the school day. Young adults are also at greater risk due to the college habitat and being in close contact with many other people. Lastly, people with chronic illnesses whose immune systems are not up to par are also at greater risk for contracting the virus than the general population.

Common warts do not necessarily need to be treated. Many will resolve on their own if left alone. However if a wart becomes uncomfortable or painful to a person, or if they do not like the cosmetic appearance of the wart, there are several different forms of treatment. There are over-the-counter treatments that will freeze the wart and often require multiple treatments. One could also try applying duct tape over the wart for one week, removing the duct tape for one night and scrubbing at the wart, then reapplying the duct tape for an additional week.

If home remedies and over the counter treatments do not resolve a wart, you may need to visit your PCP for a stronger cryotherapy, or “freezing,"  or a topical salicylic acid. If the warts are refractory to treatment for three months, then your PCP may decide to refer you to a dermatologist for further treatment.

For clarification, the HPV virus has many different strains. The strains that cause commons warts are different from the strains that cause genital warts and cervical cancer. The HPV vaccine helps to protect against nine strains of HPV that can cause cervical cancer and genital warts. It will not protect you against the strains that cause common warts. If you have questions about the HPV vaccine, please visit with your PCP.

Years ago, physicians ran blood tests on couples before they married. Why did they do that? Is it still done?

Premarital blood testing was a law that enacted in the United States in the mid-20th century to test couples for presence of sexually transmitted diseases, such as HIV or syphilis, genetic diseases, such as sickle-cell anemia, and infectious diseases, such as Rubella.

The reason for testing for the infectious and sexually transmitted diseases was that the patients could be treated prior to marriage and/or reproducing so as not to pass on the disease to a partner or future child. Diseases such as rubella and syphilis can cause irreversible birth defects in future children if a mother is infected with the disease.

The reason for testing for genetic diseases was to be able to counsel the couple on the risks of a future child inheriting the genetic disease should the couple decide to reproduce.

Although there are no longer laws that require premarital blood testing, three are now other ways that physicians screen for such diseases. It is common practice for a women who is newly pregnant or wishes to become pregnant soon to be screened for HIV, hepatitis B and C, syphilis and rubella by their physician. Similarly if there is family history of any kind of genetic disease, the couple has the option of pre-conception genetic testing and counseling. There is also state law in Iowa that mandates the screening of all newborns for a battery of different metabolic and genetic diseases, such as cystic fibrosis and sickle cell disease.

How do you know when it’s time for knee surgery? I have friends—about 20 years apart—who are both going through knee replacements. I thought it was just from the joints wearing out. What’s the problem?

Knee replacements, also known at total knee arthroplasties, are often a recommendation for treatment of moderate to severe osteoarthritis of the knee. Osteoarthritis is a condition that can develop in the knee joint, or any other bony joint, over time due to normal use, overuse or even as a result of trauma. It results due to the wearing down and eventual loss of the cartilage that is present in your knee joint to act as a cushion between the bones making up the knee. Along with the loss of cartilage, comes the weakening of the bones themselves as well as the muscles that connect to the knee joint.

Just as no two fingerprints are the same, no two knee joints are the same. There are many factors that contribute to how early or late in life osteoarthritis may develop. Some of these factors include weight, amount of exercise, tobacco use, nutrition and family history, as well as many others. As mentioned above, trauma to the knee can also cause earlier onset of osteoarthritis.

The time to decide to have a knee replacement is different for every person with osteoarthritis of the knee. There are several nonsurgical options for treatment that will likely be suggested by your PCP prior to suggesting surgical evaluation. These options include pain management with NSAIDs, steroid injections into the joint and physical therapy. Many people can hold off surgery for years with these treatments. When the pain comes to a point where it is severely affecting a person’s ability to walk or quality of life, then it is time to explore a surgical treatment. Once a patient has decided the pain is no longer bearable, their PCP can refer them to an Orthopedic Surgeon for further evaluation and information regarding surgery.

If you have any questions concerning your own knee pain, do not hesitate to contact your primary care physician.

Should you keep prescriptions in the refrigerator? Or doesn’t that do any good? What about in the bathroom or a closet nearby? What best?

Many prescription medications can be affected by the temperature or environment they are stored in. Pharmacists will recommend that patients store most prescription drugs at room temperature of 75-85 degrees Fahrenheit, in a dry place without excessive light. Exposure to these elements can cause the active component in the medication to alter and thus the medication will not be as effective as it should be, which could in turn be harmful. While there are some medications that do need to be kept in the refrigerator, many of which are liquids, your pharmacist will inform you if it needs to be kept refrigerated.

You must also think about the other people living in your house when storing medications. If you have small children in your home, it is a good idea to keep medications in a secure and out of reach place so as to avoid accidental ingestion and poisoning.

Just as it is important to correctly store prescription medications, it is also important to dispose of medications once they are expired. The active ingredient can lose effectiveness if a medication is expired. Many medications will expire after a year, so it is important to pay attention to when a medication was filled and if it is expired.

If you have any questions regarding the storage or disposal of your prescription medications, the pharmacist at your local pharmacy will have the resources to correctly answer those questions.