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  • Judy Hsu | About

    In Search of a New Mission I would be lying if I said that the way I feel about my job now is the same as the way I felt about it when I first started as a full fledged family medicine doctor. Over the years of practicing medicine, the bureaucracy and hyper-focus on performance metrics have started to whittle down the passion I have for my craft. The longer I have been in practice, the more I reminisce about the bygone days of medical school when I was able to immerse myself in the wonders of the human body, getting down in the nitty gritty details of the why’s and the how’s. After some time of soul searching, it was becoming clear to me that my current career trajectory is unsustainable unless I find a way to recharge it with the passion that I once had for medicine. While the wonderful relationships I have with my patients have enabled me to stay afloat, I also need to nurture that seed of curiosity again as a way to combat the growing administrative nature of my job. And what better way to do this than to teach people about the human body! I need to get back to asking the why’s and the how’s again, but this time instead of regurgitating what I know on a piece of exam paper, I will be sharing this knowledge with you through a multimedia platform. ​ So yes, in some ways, Medicine Declassified is a personal quest of getting back to the joy of medicine, but I hope that along the way I can excite and persuade people to jump on the bandwagon with me on this journey to explore and understand the human body through the lens of a science nerd. ​ Onwards! ​ Let’s Learn Together What do you want to learn about? First Name Last Name Email Thanks for submitting! Message Send

  • Deep Dive Into Skin

    Deep Dive Into Skin For those of you who want to learn about the finer details of skin on a microscopic level, this article is for you. Judy Hsu, DO January 25, 2021, 7:08:33 PM The skin is the heaviest organ of the human body accounting for 16% of total body weight. It is relatively impermeable to water which prevents excessive water loss. It is also an important receptor organ in continuous communication with the environment in order to protect us from injuries. To understand why different skin diseases occur, you first have to know the intricate structures of the skin and their roles in contributing to its functions. The skin is composed of two sections of cells: the epidermis and the dermis. The dermis has these finger-like projections called papillae that interdigitate with the grooves of the epidermis. The epidermis is composed of a type of cell that produces keratin, a fibrous structural protein. These cells organized themselves into five different layers: stratum basale, stratum spinosum, stratus granulosum, stratum lucidum and stratum corneum. Starting from the layer closest to the dermis, stratum basale consists of a single layer of cells that line alone the basement membrane at the dermal-epidermal junction. These cells are bound together via adhesive proteins called desmosomes. They are rapidly dividing cells that are largely responsible for the constant renewal of epidermal cells which takes about 15 to 30 days to complete depending on age and the region of the body. All the cells in stratum basale contains intermediate keratin filaments that increase in number as the cells progress upward towards the outer surface of the skin. Above stratum basale is stratum spinosum, which consists of slightly flattened cells with even more bundles of keratin filaments with the tips extending to the desmosomes that glue the cells together, thereby giving the cells that spine-studded appearance. These keratin bundles reinforces the cohesion among cells and resists the effects of abrasion, without which the skin would easily break down with minor forces. On top of stratum spinosum is stratum granulosum, named because the cells are filled with granules such as keratohyalin granules and lamellar granules. Lamellar granules are important in that they extrude substances out of the cells to form sheets of lipids that give rise to the water repellent nature of skin and function as a barrier to heat, light, chemicals and bacteria. The next layer of cells on top of stratum granulosum is stratum lucidum which is composed of extremely flattened cells with densely packed keratin filaments, and as they migrate to the top, they become part of stratum corneum, the outermost part of the skin where the cells are continuously shed. This is the toughest layer of cells meant to protect the inner layers. The spaces between the cells are filled with lipids to further fortify the skin against moisture loss and infection. Besides these keratin producing cells, which are the building blocks of the epidermis, interspersed among them you can also find cells like melanocytes, Langerhan cells, and Merkel’s cells. Melanocytes are cells that produce melanin, a pigment not only contributes to the color of the skin but also protects the skin against UV rays from the sun. Langerhan cells are star-shaped cells that have an important role in immunological activity in the skin as they bind, process, and present foreign proteins to T lymphocytes, which are a type of white blood cells that participate in the immune response of the body. Merkel’s cells work like sensory receptors and allow the skin to sense light touch. Below the epidermis lies the dermis, the connective tissue that supports the epidermis. It is much thicker than the epidermis and is composed of two layers: a papillary layer and reticular layer. The papillary layer is where you will find capillaries, lymphatic channels and sensory neurons all couched within loose connective tissue. Its function is to supply nutrients to the epidermis above. The reticular layer is comprised of thicker dense connective tissue along with elastic and collagen fiber. They give rise to the skin’s strength and flexibility. In summary, there are two major layers of the skin: the epidermis and dermis. Each layer is also divided in the subsections, each with a role to play in determining the physical properties and functions of the skin. Many skin diseases arise from breakdown of these structures, and treatments are therefore targeting towards restoring their natural integrity.

  • Judy Hsu | Learn about your body

    Welcome to Your Body What is Fungal Acne? If you have acne that has not responded well to traditional acne treatments, it may be because you have fungal acne and not regular acne as we know it. Deep Dive Into Skin Testing For Genital Herpes One of the questions that often come up during my clinical practice is how one can get tested for genital herpes. This is a great question as there are several ways to do this, and which method you pick depends on the scenario that the person is in... For those of you who want to learn about the finer details of skin on a microscopic level, this article is for you. The Breakdown On Urinary Tract Infection ​ Urinary tract infection is one of the top medical issues encountered in primary care. It is so common that many clinics have created dedicated workflows to help manage the number of people calling about potential UTI’s every day. Most of the time when we talk about urinary tract infection, we’re talking about infection of the lower urinary tract... Acne, The Lowdown ​ Acne is a common skin condition that has plagued many of us at some point in our lives. To treat acne properly, we first must understand what happens to the skin at the cellular level when it's affected by acne. Therapies are targeted towards the underlying mechanisms... The Art of Measuring Blood Pressure At Home ​ It is quite normal for your blood pressure to fluctuate throughout the day as it is influenced by things like hydration status, physical activity level, and stress level. Here are some of the tips I have shared with my own patients on how to measure their blood pressure at home... High Cholesterol Be Damned ​ If you recently had an annual physical, chances are your doctor might have ordered blood work to take a look at your cholesterol level. If your bad cholesterol, or LDL... Help! I'm Getting Lost In My Bone Density Report ​ Bone density report can be confusing to read and understand. There are a lot of letters and numbers to decipher, and it's not always clear how to act on them... Deep Dive Into Thyroid Gland ​ People are increasingly aware of the role that thyroid gland that plays in our body’s metabolism, likely partially because thyroid level gets checked for so many different health complaints...

  • Judy Hsu | Contact

    Contact Me Here First Name Last Name Email Subject Message Submit Thanks for sub mitting! Available Here Too Judy Hsu jhsu@myrostar.com Looking forward to hearing from you.

  • Useful Links | Judy hsu

    1 https://www.aafp.org/home.html Family Physicians Community Our mission is simple: Strengthen family physicians and the communities they care for. Built on decades of proven representation, leadership, and advocacy, we support our members and the specialty with high standards and dynamic opportunities. 2 https://www.cdc.gov/ Centers for Disease Control and Prevention CDC is one of the major operating components of the Department of Health and Human Services. View CDC’s Official Mission Statements/Organizational Charts to learn more about CDC′s organizational structure. 3 https://www.healthcare.gov/get-coverage/ Get 2021 health coverage. Health Insurance Marketplace Enroll in health insurance 4 https://www.ahrq.gov/ Agency for Healthcare Research and Quality The Agency for Healthcare Research and Quality's (AHRQ) mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used. Useful Links Some of my favs, all under one roof.

  • Deep Dive Into Thyroid Gland

    Deep Dive Into Thyroid Gland Take a closer look at how thyroid hormones are made on a cellular level inside the thyroid gland. Judy Hsu, DO January 25, 2021, 7:23:12 PM People are increasingly aware of the role that thyroid gland that plays in our body’s metabolism, likely partially because thyroid level gets checked for so many different health complaints. Thyroid gland is a small butterfly-shaped structure that partially wraps around your trachea (wind pipe) below your larynx (voice box), and one of its functions is to secret thyroid hormones. There are two different form of thyroid hormones: triiodothyronine (T3) and tetraiodothyronine (T4 or thyroxine). Their chemical structures only differ by one iodine atom, but T3 is more active than T4 even though it is secreted in lesser quantity. Thyroid hormones are produced by the follicular epithelial cells of the thyroid gland. These cells are organized in circular follicles surrounded by blood vessels in their perimeters. When the epithelial cells produce thyroid hormones, they get dumped into the center of the follicles in a pool of newly synthesized hormones called colloid. These hormones are bound to proteins called thyroglobulin. Iodine is an important part of thyroid hormones. The follicular epithelial cells actively pumps iodine from the blood stream into the cells and then into the colloid filled follicular lumen where it is combined with thyroglobulin to make thyroid hormones. The thyroid hormones will be parked inside the colloid until the thyroid gland is stimulated to secrete its hormones by another hormone called thyroid stimulating hormone (TSH) released from another gland in the brain. When that happens, the follicular epithelial cells will absorb the thyroglobulin-bound thyroid hormones from the colloid and extrude free T3 and T4 into the nearby blood vessels. Most of the T3 and T4 in the blood stream eventually get bound to transport proteins called thyroxine binding globulin (TBG). Only a small amount of thyroid hormones travel in circulation as free hormones. It is important to note that only free thyroid hormones are physiologically active. The ones bound by thyroxine binding globulin are part of a large reservoir which can be released and added to the pool of free hormones. The amount of free thyroid hormones in the blood stream provides feedback to the thyroid gland to make more or less hormones. Thyroxine binding globulin is made in the liver. As previously stated, T3 is a more active form of thyroid hormone than T4, but most of the hormones are produced and released as T4 (about 10 times more). To get around this problem, the target tissues contains an enzyme called 5-iodinase that converts T4 to T3 by removing one atom of iodine. T4 can also be converted to an inactive form of T3 called rT3. Under normal condition, tissues produce T3 and rT3 in roughly the same quantity. However, the relative amount may change depending on what the body is going through. For instance, pregnancy, stress, and fasting all decrease the conversion of T4 to T3 and increase the conversion to rT3. Obesity does the opposite and increases the amount of T3 relative to rT3. Once T3 is produced inside target tissue cells, it enters the nucleus of the cell and binds to a protein on DNA to instruct the cells to produce more proteins that regulate multiple important bodily functions like basal metabolic rate, bone maturation, and cardiac function. In summary, thyroid gland is a structure that can be found in your neck, and its job is to release thyroid hormones, T3 and T4. The hormones are made and stored inside the thyroid gland which releases the hormones when it’s been stimulated by TSH which is made from a gland in the brain. T3 is the active form and is converted from T4 inside target tissues where it instructs our cells to produce more proteins that are essential to body functions.

  • High Cholesterol Be Damned

    High Cholesterol Be Damned Having elevated level of low density lipoprotein (LDL) increases your risk of heart disease and stroke, but there are things that you can do about it right now to correct it. Judy Hsu, DO December 10, 2020, 10:17:08 PM If you recently had an annual physical, chances are your doctor might have ordered blood work to take a look at your cholesterol level. If your bad cholesterol, or LDL (low-density lipoprotein), is above 130 mg/dl, it will likely be flagged high. LDL is bad because it is the kind of cholesterol that can build up in the walls of your arteries and increase your risk of heart attach and stroke. Regardless of whether or not you need to be on a cholesterol lowering medication, here are some of the things you can do to lower your LDL level: 1. Avoid saturated and trans fats Saturated fat mainly come from animal sources, like beef, pork, chicken, and dairy. Trans fat comes processed food that include partially hydrogenated oils. These are the kinds of fat that can raise your LDL level. Instead, substitute animal fats with plant-based fats from nuts, seeds and avocado. These monounsaturated fats are much healthier for your arteries. Remember that fat is an essential part of your diet as many hormones are made out of fat, so going completely fat free is not healthy either. Fat can also make you feel fuller sooner, thereby preventing you from eating too much and gaining weight. 2. Eat more fiber The good bacteria that live inside your gut can help remove LDL from your body. So in order to promote growth of good bacteria which feeds on soluble fiber, you should eat more food items such as fruits, vegetables, legumes (i.e. beans and lentil) and whole grains. 3. Get moving Exercise not only reduces LDL but also raises your good cholesterol (HDL). HDL, or high-density lipoprotein, is good in that it removes the LDL from the walls of your artery. You don’t have to engage in high intensity exercise to reap the benefit, but the higher the intensity and longer the duration of the exercise, the more positive the impact will be. 4. Quit smoking Smoking lowers your HDL and increase the formation of cholesterol plaque in your arteries. The chemicals in cigarette smoke also increase risk of blood clot through its blood thickening effect. It’s important to follow up with with your doctor so that you can continue to monitor your cholesterol level together. You can decide together how often to check your cholesterol level based on your risk factors.

  • What's The Deal With Skin Warts?

    What's The Deal With Skin Warts? A quick guide to the cauliflower looking growth on your skin. Judy Hsu, DO May 7, 2022, 11:34:27 PM So you found a fleshy bump on your finger. A quick search on the internet tells you that this is likely a wart. What is a wart and how do you get rid of it? First of all, whenever you find a skin lesion that does not resolve with time, you should always go see your doctor to get it evaluated. Ok, now that we got that out of the way. Let’s talk about warts in more detail. The official medical term for the common warts is “verruca vulgaris”. They are benign tumors of the skin caused by human papillomaviruses (HPVs) and can be found on any skin surface. The viruses infect only the cells in the top layer of the skin, so despite how deep the warts can feel, they do not penetrate into the fat or muscles. It is worth noting that HPVs can also cause malignant tumors to form; it all depends on the types of HPV that are involved (more than 100 types exist). Warts can appear at any age and they are easily transmitted by touch; this is why it is not uncommon to see new warts forming on adjacent fingers or toes. They are typically raised and can have finger-like projections, and on close up you can see a mosaic pattern and black dots which are helpful for diagnosis. (Fun fact: the black dots are little clotted blood vessels as a result of the infection). Warts can resolve spontaneously on their own, but how long it takes will depend on the individual. Sometimes they disappear within weeks to months, and other times they can last for years or a lifetime. In general, warts tend to develop more easily in people with weakened immune systems, so this is why it is common to find new growths during periods of stress or acute illnesses. Warts can be stubborn to get rid of. Cure often requires several treatment sessions. Goal is to get rid of infected cells in the top skin layer, and this can be achieved via cutting with a surgical blade or chemical destruction (i.e. salicylic acid). Cryotherapy with liquid nitrogen is considered first-line therapy. This is a quick and relatively painless way to treat the warts, and it may be repeated every 2-4 weeks until they resolve. On the feet, warts can often be confused with corns. This is because they both frequently occur at points of maximum pressure such as the balls of the feet. One good way to differentiate between the two is to apply lateral pressure to the lesion; this maneuver would be painful for warts but painless for corns. Either way, it would be beneficial to get them treated if they tend to distort the way people walk in order to avoid pain from pressure on them, and overtime this would cause abnormal posture and pain in other parts of the leg or back.

  • What is Fungal Acne?

    What is Fungal Acne? If you have acne that has not responded well to traditional acne treatments, it may be because you have fungal acne. Judy Hsu, DO December 30, 2020, 5:09:24 AM Fungal acne is not really acne at all. The official medical term is pityrosporum folliculitis. While the appearance of the skin can be nearly identical, fungal acne has little in common with regular acne (a.k.a. acne vulgaris). It is cause by overgrowth of fungus, so that’s why it is commonly found on the torso and upper arms where it’s typically covered by clothes which can trap moisture, and fungus love moisture. The overgrowth of fungus irritates hair follicles, causing them to become red and swollen, thereby mimicking the appearance of acne. We all have fungus living on our skin, and typically this does not pose a problem. Our body has adapted to co-existing with the fungus and bacteria found on the surface of our skin. However, when that delicate balance is disturbed, overgrowth of fungus can happen and cause problems. Here are some of the things that can tip things in the wrong direction: 1. Wearing non breathable clothes. Synthetic fabric that traps sweat and moisture encourages fungal growth. Also clothes that are tight discourage ventilation. 2. Suppressed immune system. When the immune system is weakened, your body is unable to maintain the balance of fungus and bacteria that are living on the surface of your skin, thereby increasing risk of overgrowth. 3. Antibiotic use. While antibiotic is great for getting rid of a bacterial infection, it can also invite fungus to grow by taking the place of the bacteria that have been killed off by the antibiotic. 4. Dietary changes. Fungus love sugar, so a diet high on simple sugar and carbohydrates can encourage them to flourish. Because fungal acne can look very similar to regular acne, it can be hard to diagnose on first look. However, there are some subtle clues that may help you identify it correctly. For example, fungal acne tends to be itchy whereas regular acne is not. Fungal acne also tends to erupt in clusters, and the bumps tend to around the same size. The best way to know for sure is to get your skin tested. This can be done either via skin scraping or biopsy at you doctor’s office. Treatment of fungal acne include reversing the factors that make them flourish in the first place as outlined above. Anti-dandruff shampoo containing selenium sulfide can also be helpful although this is usually used as a preventative measure against reoccurrence. Although it’s a shampoo, you can apply and leave it on the affected skin for 5 minutes before rinsing it off. This can be done one or several times a week to control fungal overgrowth. What is considered more effective is oral anti-fungal medication like fluconazole which can be prescribed by your doctor. This approach can ensure that the medication is delivered deep inside the pores to control the fungal growth at that level. In summary, fungal acne can look like regular acne but tend to occur on areas of the skin where there is a lot of oil and sweat production. It is caused by fungal overgrowth. Effective treatments include reducing factors that contribute to overgrowth of fungus and anti-fungal medications. If you have been struggling with acne that doesn’t respond to typical treatments, it may be a good idea to talk to your doctor about fungal acne as a possible diagnosis.

  • Help! I'm Getting Lost In My Bone Density Report

    Help! I'm Getting Lost In My Bone Density Report Bone density report can be confusing to read and understand. There are a lot of letters and numbers to decipher, and it's not always clear how to act on them. Here are a few pointers to help you navigate your report. Judy Hsu, DO December 30, 2020, 4:35:04 AM Bone density scan is an image study that measures the density of your bone. It uses x-ray technology to see if your one has lost important minerals that make up a huge part of you bone - about 70% in mass, to be specific. Bone density scan also goes by another name, DEXA, which stands for dual energy x-ray absorptiometry. The radiation emitted DEXA is about one tenth of a chest x-ray. It is quick and painless, usually takes about 15 min to complete. The bone density report will usually include a number called T-score. T-score indicates how your bone density differs from that of an average 30 year old. It is a standard deviation that calculates how much a result varies from the average or mean. One standard deviation is roughly equivalent to 10% of difference in bone mass, so a T-score of -1, for example, would indicate that your bone density is 10% below that of an average 30 year old. By definition, if your bone density is more than 25% below that of an average 30 year old, or T-score lower than -2.5, you have osteoporosis. If your bone density is 10-25% below or T-score of -1 to -2.5, you have osteopenia. It is commonly recommended to undergo screening for osteoporosis if you are 65 or older. You might also find another number called the Z-score, which compare your bone density to the average bone density of people your own age and sex. This is more helpful for children, premenopausal women, and men under 50. If you fall under one of these categories, and you Z-score is more than 2 standard deviations below that of your peers, this will usually trigger a work up for underlying medical problem that could explain this significant drop. If there is any degree of bone density loss, supplementing with calcium and vitamin D is a must. Usually an adult needs 1200 mg of calcium a day and 1000 to 2000 international units (IU) a day, depending on how much sun exposure one gets. Doing regular weight bearing exercises like walking also helps. There is a class of medications called bisphosphonate that is prescribed to treat people with bone density loss, but not everyone needs it. The need for bisphosphonate is determined by one’s fracture risk which can be calculated by using the FRAX score. The FRAX score takes into account things such as your age, weight, gender, smoking history and fracture history. In summary, the bone density test is a way to measure if there is any structural weakness in your bones so that you can take meaningful step to maintain and even improve the integrity of your bone health. The report can be a lengthy document, but now you should be armed with good information to interpret it.

  • The Art of Measuring Blood Pressure At Home

    The Art of Measuring Blood Pressure At Home There are some things you should pay attention to when measuring your own blood pressure at home to ensure the accuracy of the readings. Judy Hsu, DO December 10, 2020, 10:16:26 PM It is quite normal for your blood pressure to fluctuate throughout the day as it is influenced by things like hydration status, physical activity level, and stress level. Here are some of the tips I have shared with my own patients on how to measure their blood pressure at home: 1. Invest in an arm cuff instead of a wrist cuff If you haven’t made the purchase already, I encourage you to buy a home blood pressure machine that has an arm cuff rather than a wrist cuff. Even though it is easier to use, a wrist cuff tends to give you higher readings. Choosing the right size cuff also matters. If you are not sure what is the right size, measure your upper arm using a tape measure. Measure halfway between the elbow and shoulder, making sure the tape measure is level all the way around. It should be snug, not tight. Read the measurement on the tape measure in inches. A circumference of 7 to 9 inches is equivalent to a small adult sized cuff. 9 to 13 inches is equivalent to regular/standard sized cuff. 13 to 17 inches is equivalent to large adult sized cuff. 2. Make sure that you are physically ready to take the blood pressure Don’t exercise for at least 30 minutes before you plan to check your blood pressure. The same thing goes for caffeine and tobacco. Sit quietly for 5 minutes before starting. When you are seated, do not cross your legs. Your arm should be resting on a surface at the level your heart (mid chest). Remember to use the same arm for very blood pressure check. Also, make sure that your bladder is empty as a full bladder can elevate your blood pressure reading by as much as 8 points. 3. Remember to take the average Check your blood pressure three times in the morning and three times in the evening. The morning set should consist of three readings that are done 1 minute apart. Same thing with the evening set. Take the lowest reading of the morning set and the lowest reading of the evening set. Take the average of the two and you have your blood pressure reading of the day. Repeat this process for at least 3 days in a row during a given week. It is important to get an accurate record of your blood pressure readings outside of the clinical setting so that you and your doctor can make an informed decision on treatment based on data that you know you can trust.

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