What's The Deal With Skin Warts? A quick guide to the cauliflower looking growth on your 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. 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. 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. Skin Home Your Body Blog Recent Reads Contact About More How Well Do You Really Know Inflammation? Understanding inflammation is key to understanding many disease entities in the world of medicine. Testing For Genital Herpes A guide to help you figure out what is the best way to get tested for genital herpes. Immunity Bone 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. Heart 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. 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. The Breakdown On Urinary Tract Infection All you need to know about this pesky but yet common infection. Urinary Deep Dive Into Thyroid Gland Take a closer look at how thyroid hormones are made on a cellular level inside the thyroid gland. Hormones

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. 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 at 7:23:12 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. 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 at 10:17:08 PM

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. If you are currently experiencing symptoms of genital herpes and have a rash, the most appropriate test to perform is either a viral culture or viral DNA test. Both tests involve breaking one of the herpes lesions open to swab and take a sample of the fluid inside of it. Both can tell which type of herpes virus the person has, whether it is type 1 or type 2. The viral DNA test is usually seen as more superior to viral culture as it is more accurate and sensitive. The problem with the culture is that its accuracy depends on the how many copies of the virus are on the surface that is being swabbed, so if the lesion is small or is on its way to healing, there may not be enough virus to show up on the culture. The accuracy of the culture is even worse when it’s a recurrent infection; only about 30 percent of recurrent outbreaks show up positive. This is why the DNA test is the preferred method of testing for acute active herpes infection. In the clinical setting, the DNA test is often referred to as the PCR test. PCR stands for polymerase chain reaction, and it is one of the methods of nucleic acid amplification testing (NAAT). If you currently have no symptoms and rash, the way to test for herpes would be to do a blood test since there is no herpes lesion to be swabbed. The blood test does not detect the presence of herpes virus in the body; rather, it is testing for the presence of antibodies to the virus. When a person contracts the virus, the body mounts an immune response to try to get rid of it, and in any kind of immune response to an infection, two types of antibodies are produced: IgM and IgG. IgM is the first type of antibody produced right after an infection, but it peaks quickly and goes away quickly. IgG, on the other hand, gets produced a little later but can stick around for years. Even though sometimes the different levels of these antibodies can help us determine timing of the infection, unfortunately in the case of herpes it is not so straightforward. IgM can reappear during a recurrent outbreak or sometimes even not show up at all even during the initial infection. For thes reasons, IgM and IgG cannot be used to determine timing of the infection in the case of genital herpes. Blood test for IgM antibodies have two additional major flaws. One is that it cannot reliably distinguish between herpes type 1 and type 2, and because genital herpes is generally caused by type 2 while oral herpes by type 1, if you have a history of cold sores and develped genital rash that happens to be non-herpetic, you might be misled into thinking that you have genital herpes when the IgM test comes back positive. The other down side of IgM test is that it can cross react with others viruses in the same family like chickenpox, so the false positive rate is high. Blood test for IgG antibodies is in comparison clinically more useful. Unlike IgM, IgG antibodies can be reliably identified as either type 1 or type 2. The only downside is that it does take a while for the body to generate IgG antibodies, sometimes weeks to months, so for this reason, it is generally recommended that this blood test be done 12 weeks after potential exposure. In summary, if you have active skin lesions suspicious for herpes, the best way to get tested is through a direct swab of the lesion for PCR testing in order to identify the presence of viral DNA. If you have no herpes symptoms but may have been exposed recently, the best test to do is a blood test that detects the presence of IgG antibodies developed against herpes virus. When in doubt, talk to your doctor as he or she will work with you to choose the most appropriate test for the situation. Testing For Genital Herpes A guide to help you figure out what is the best way to get tested for genital herpes. Judy Hsu DO March 10, 2021 at 4:57:07 AM

Inflammation has been kind of a buzz word in the conversation about health, and you hear this word being used all the time when talking about disease processes. In fact, it’s hard to walk into a doctor’s office and not hear the word “inflammation” being use. But ask yourself this: what exactly is inflammation, and what is actually happening at the microscopic level? If you can’t answer these questions, then you must read on to gain a full appreciation of this basic but essential biological process. Inflammation has always been talked about as a bad thing for the body, but the reality is, it’s actually a protective response to an injury in order to remove the cause of injury as well as the dead tissues that are casualties of the event. It’s hard for healing to take place when there is ongoing insult and a pile of dead cells are in the way of regenerating new cells. In other words, inflammation is necessary to set the stage for healing. But if it’s such a good thing, why are we always talking about stamping out inflammation? It turns out that the body sometimes goes overboard with the inflammatory response and ends up destroying everything in its path, including the healthy tissues along the way. This is when inflammation can become destructive because when it’s triggered, the effect can be pretty widespread; it’s a hammer and not a surgical scalpel. When any cell or tissue in your body gets injured, inflammation immediately kicks in. There are five classic local signs of inflammation: heat, redness, swelling, pain, and loss of function. The first three signs are a result of what’s happening at the blood vessel level. When an injury occurs, blood vessels at the site of injury dilate which then increases the blood flow; this is what give rise to the redness and warmth seen in acute inflammation. In addition to dilation, blood vessels also become leaky, meaning that fluid and proteins typically found in blood can seep out of the blood vessel walls and get into the surrounding tissue bed. This is what give rise to the swelling seen in acute inflammation. As the fluid and protein components of the blood leak out, the red blood cells become more concentrated, so the blood at the site of injury becomes more viscous and flows slower. This phenomenon called stasis is important in aiding the next step in the process which is the arrival of the calvary, a.k.a. the white blood cells. As the white blood cells arrive at the site of the injury, the slowing of the blood gives them time to squeeze through the cracks in the blood vessel walls and migrate into the surrounding tissues. Remember that the job of white blood cells is to help the body fend off foreign invaders. They do so by ingesting foreign materials and debris, destroying infectious agents, and produce antibodies. They do both the killing and the cleaning up, thereby clearing the way for healing to begin. Without the white blood cells, healing would be next to impossible, and infection can set in and spread throughout the body unchecked. What happens after acute inflammation? It depends on what the initial injury is and how much collateral damage has been done. If the insult was short-lived and the injured cells can be replaced, than the result is full restoration to structural integrity and functional normalcy. However, if the damage is substantial and the cells cannot regenerate, then the result is scar formation whereby the injured cells are replaced by generic connective tissues; this process is also known as fibrosis. If the injury is ongoing, then acute inflammation can turn into chronic inflammation which is a similar process that involves slightly different groups of cells. In a nutshell, inflammation is a necessary protective response that the body elicits when an injury occurs so that the body can contain and and remove things that might get in the way of healing. It is central to a lot of the disease processes that we talk about in health and medicine. Next time when you hear the word being used, hopefully it will be clear to you what that actually means for the body. How Well Do You Really Know Inflammation? Understanding inflammation is key to understanding many disease entities in the world of medicine. Judy Hsu DO April 5, 2021 at 2:22:26 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. 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 at 4:35:04 AM

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. 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 at 7:08:33 PM