Fibrocystic Breast Changes

Whether called fibrocystic breast "changes" or fibrocystic breast "disease", it's a problem that affects up to half of all women at some point during their lives.  Currently, most doctors just refer to women as having fibrocystic breasts, since it really isn't a disease at all.  Fibrocystic breasts are lumpy, thick, and tender, especially right before menstruation.  The condition primarily affects women between the ages of 30 and 50 and tends to become less of a problem after menopause.

Why do breasts develop fibrocystic changes? Fibrocystic breast changes are linked to the hormone production that occurs during the menstrual cycle. There is no proof that drinking caffeine, eating chocolate, or eating a high fat diet is primarily responsible for this condition.

What symptoms are associated with fibrocystic breasts?  Specific symptoms include breast soreness, swelling, and heaviness.  Generalized breast lumpiness occurs most commonly in the upper/outer aspect of the breast (the portion closest to the armpit). Symptoms are generally worse right before the menstrual period, and then improve after menstruation begins. Women who take hormone replacement therapy often have more symptoms, whereas, women who take birth controls pills have fewer symptoms.

Is it necessary to undergo testing for fibrocystic breasts?  In most cases, a history and physical examination that is consistent with fibrocystic breast changes, is adequate to make the diagnosis. If there are any worrisome lumps, such as those that persist through several cycles, a mammogram and/or ultrasound should be performed.  Any new lump in a post-menopausal woman requires evaluation, since this is unlikely to represent a fibrocystic change. In some cases, it may be necessary to obtain a sample (biopsy) of breast tissue with a needle or by surgery in order to make an accurate diagnosis and differentiate between a fibrocystic breast condition and breast cancer.

Is there a treatment for fibrocystic breasts?  Treatment may not be necessary if symptoms are absent or tolerable.  When painful, treatment is usually directed at the symptoms themselves, or at the hormonal changes that cause fibrocystic breasts.  Symptomatic treatment includes taking a non-prescription analgesic, such as acetaminophen (e.g. Tylenol) or ibuprofen (e.g. Advil), use of heat or ice on the breast, and wearing a well-fitting bra.  In some women, particularly those with irregular periods, taking low-dose birth control pills may be of benefit. In post-menopausal women on hormone replacement therapy, taking a periodic "vacation" from estrogen each month is sometimes beneficial.

Can fibrocystic breast changes develop into cancer?  Fibrocystic changes pose no increased risk of developing cancer.  However, fibrocystic breast changes can make it more difficult to distinguish developing breast cancer from fibrocystic lumps. Additionally, mammograms to screen for breast cancer can be more difficult to interpret when fibrocystic changes are present. This can lead to the increased need for additional testing such as ultrasound or biopsies.

Are natural remedies available for treating or preventing fibrocystic breasts?  Certain "natural" treatments may work for some women, but none has been proven to help all women. These treatments include:

• Caffeine avoidance, including chocolate, sodas, coffee, and tea.
• Eating a low-fat diet, with fat constituting less than 15% of the day's total calories. 
• Taking a vitamin E supplement
• Using evening primrose oil, an oil that is high in gamma-linolenic acid.

Before taking any medication or supplement, particularly if you are on other medications or could be pregnant, it is best to talk with your doctor first.

Sources for article:
Fibrocystic Breasts from Mayo Clinic
Evening primrose oil for fibrocystic breasts from Cleveland Clinic Wellness
Fibrocystic Breast Disease from Medline Plus

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Heartburn or Heart Attack?

Around six million people go to the emergency department each year with chest pain.  In many cases, the determination has to be made as to whether the chest pain is due to a relatively minor condition or to a life-threatening process.  Often this means making the distinction between heartburn (a gastrointestinal condition) and angina or heart attack (heart-related conditions), since these can all present with similar symptoms.
Heartburn, also called acid indigestion, is experienced by as many as 60 million Americans at least once a month. Heartburn is the most common symptom of gastroesophageal reflux (GERD), a disorder in which stomach acid "backs up" into the esophagus, the tube-like structure that connects the mouth to the stomach. Symptoms result when harsh stomach juices come in contact with delicate lining of the esophagus.  The most common features of heartburn are:

• A painful, burning sensation just below the breastbone or ribs
   
• Pain that develops after eating or upon reclining
   
• Improvement in symptoms when taking antacids or "acid blockers"
   
• A sour or bitter taste in the mouth and belching  

Angina is a symptom of coronary heart disease that occurs when the heart muscle is not being supplied with enough oxygen-carrying blood. It is usually described as a pressure or squeezing discomfort in the chest. This discomfort can also be felt in the arms (usually left), neck, or jaw.   A heart attack (myocardial infarction) occurs when blood flow to the heart is interrupted due to complete blockage of a coronary artery. This results in death of heart muscle. The pain caused during a heart attack or from a severe heartburn episode is sometimes so similar that sophisticated equipment may be required to tell them apart. The following are symptoms typical for heart attack:

• Chest discomfort in the center of the chest that lasts for more than a few minutes, or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain.
   
• Discomfort in other areas of the upper body including one or both arms, the back, neck, jaw, or stomach.
   
• Shortness of breath, often occurring along with chest discomfort.
   
• Other symptoms may include breaking out in a cold sweat, nausea, or light-headedness.

 As with men, women's most common heart attack symptom is chest pain or discomfort. But instead of the classic chest discomfort women are somewhat more likely than men to experience certain "atypical" symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain. An important distinguishing feature of coronary heart disease is that the discomfort often occurs with exertion or activity.  To confound things, however, heart attack as well as heartburn may occur after eating.  With severe chest pain, atypical symptoms suggestive of heart disease, or if chest pain is a new occurrence, it is best to leave the determination of the cause to the physician.
While a heart attack is a medical emergency, recurrent heartburn, particularly if associated with GERD is not entirely benign either. If left untreated, GERD can cause or contribute to a wide range of problems such as inflammation and ulcers of the esophagus (esophagitis). Some patients with esophagitis develop strictures (narrowing of the esophagus due to scar tissue) which can lead to problems swallowing food or pills. GERD can also contribute to asthma, pneumonia, hoarseness, chronic cough, abnormal functioning of larynx and dental problems. Medical attention should be sought if heartburn is associated with any of the following:

• Persistent heartburn after taking the full course of prescription or OTC medications (e.g. Prilosec, Tagamet, others)
   
• Severe hoarseness or wheezing
   
• Painful swallowing, especially with solid foods or pills
   
• Frequent nausea, vomiting or unanticipated weight loss
   
• Heartburn occurring several times a week or for more than a year

If you have warning signs of a heart attack, do not try to decide for yourself what the problem is—seek immediate medical attention.  A heart attack is an emergency. Call 9-1-1 if you think you (or someone else) may be having a heart attack. Prompt treatment of a heart attack can help prevent or limit lasting damage to the heart and can prevent sudden death. Remember that although both conditions make reference to the "heart", one is primarily a painful nuisance whereas the other represents a true medical emergency.

Article sources:
Gastroesophageal Reflux Disease (GERD) in Adults" from The National Institute of Diabetes and Digestive and Kidney Diseases
"Heart Attack" from Family Doctror.org
What are the Symptoms of a Heart Attack" from the National Heart, Lung, and Blood Institute

If you have any questions about the differences in heartburn and heart attacks, please log into your account and send us your question. We are here to help.

Do Topical (rub on) Pain Medicines Work?

Your grandma may have told you to put hydrogen peroxide or alcohol on a wound, but that is actually not a good idea. The instinct to kill germs with a strong antiseptic is understandable (how many times have we used alcohol-based, hand sanitizers -like Purell- as an alternative to hand washing?) However, broken skin that is bleeding or otherwise scratched, cut, or burned is very vulnerable to damage caused by these caustic liquids. You may kill the bacteria, but in the process you also kill your healthy cells that are needed to heal the wound. It's kind of like using a sledge hammer to kill a bug - it's going to do more harm than good.

The best thing for simple cuts and scrapes is clean water and gentle soap. Wash your hands first and then rinse the injury for at least 5 minutes to get all the potential particles and debris out of it. After the wound is clean (in the ER we use copious amounts of sterile saline to rinse wounds) it's important to judge whether or not stitches will be required to help it close. Assuming it's a small cut or abrasion, the next step is to apply pressure to reduce bleeding, and then keep it moist, and covered with a clean bandage. Moisture allows repair cells to migrate across the broken skin and lay down new collagen. Without moisture, the wound bed dries out and crusts, creating a scab and a higher chance of scarring.

How do you keep a clean wound moist? Ideally with "occlusive dressings." Maybe you've seen the new kind of Band-Aids that are rubbery or gel-like in appearance? Those are designed to co
ntain the wound in a moist environment and block air from getting in. Some studies suggest that wounds heal up to 10 days faster if they are kept moist, and scar reduction is significantly improved. These dressings (if undisturbed) can be left on for 1-3 days at a time, but should be changed right away if they're broken, soiled, or contaminated (such as dipped in dirty water).

While the wound is healing, there will be a small inflammatory reaction as the repair cells do their job. Sometimes wounds are itchy or have slightly red or pink border. They may also leak a little bit of clear, sticky fluid. Those are all part of the normal healing process. However, if the wound is becoming more (rather than less) painful with time, if it has redness that is expanding, or if there is a foul odor or pus coming from it, it could be becoming infected which may require medical attention.

Antibiotic ointment (such as Neosporin or Bacitracin) reduces infection risk in minor contaminated wounds. Once a wound is fully washed and decontaminated, good old Vaseline (petroleum jelly) is just as effective in helping it heal. If you are injured far away from access to clean water and gentle soap, an antibiotic ointment may reduce your risk of infection (so long as the wound is not too large or dirty).  Butter is not a good substitute for ointment because it is not sterile, by the way.

The bottom line is that minor cuts, scrapes, and burns should be washed thoroughly and then kept moist with petroleum jelly and/or occlusive dressings. Antibiotic ointments are a precaution that isn't needed for otherwise clean wounds, and carry a small risk of allergic reaction. The stinging pain of hydrogen peroxide or alcohol in a wound is not the feeling of germs dying, it's the body crying out as you add a new chemical burn to an already painful situation.

References
https://www.advancedtissue.com/the-best-and-worst-ideas-for-open-wounds/
https://www.mdedge.com/jfponline/article/62565/dermatology/do-topical-antibiotics-improve-wound-healing
https://www.mayoclinic.org/first-aid/first-aid-cuts/basics/art-20056711

If you have any questions about first aid for wounds, please log into your account and send us your question. We are here to help.

Health Tip: First Aid For Small Wounds

Your grandma may have told you to put hydrogen peroxide or alcohol on a wound, but that is actually not a good idea. The instinct to kill germs with a strong antiseptic is understandable (how many times have we used alcohol-based, hand sanitizers -like Purell- as an alternative to hand washing?) However, broken skin that is bleeding or otherwise scratched, cut, or burned is very vulnerable to damage caused by these caustic liquids. You may kill the bacteria, but in the process you also kill your healthy cells that are needed to heal the wound. It's kind of like using a sledge hammer to kill a bug - it's going to do more harm than good.

The best thing for simple cuts and scrapes is clean water and gentle soap. Wash your hands first and then rinse the injury for at least 5 minutes to get all the potential particles and debris out of it. After the wound is clean (in the ER we use copious amounts of sterile saline to rinse wounds) it's important to judge whether or not stitches will be required to help it close. Assuming it's a small cut or abrasion, the next step is to apply pressure to reduce bleeding, and then keep it moist, and covered with a clean bandage. Moisture allows repair cells to migrate across the broken skin and lay down new collagen. Without moisture, the wound bed dries out and crusts, creating a scab and a higher chance of scarring.

How do you keep a clean wound moist? Ideally with "occlusive dressings." Maybe you've seen the new kind of Band-Aids that are rubbery or gel-like in appearance? Those are designed to contain the wound in a moist environment and block air from getting in. Some studies suggest that wounds heal up to 10 days faster if they are kept moist, and scar reduction is significantly improved. These dressings (if undisturbed) can be left on for 1-3 days at a time, but should be changed right away if they're broken, soiled, or contaminated (such as dipped in dirty water).

While the wound is healing, there will be a small inflammatory reaction as the repair cells do their job. Sometimes wounds are itchy or have slightly red or pink border. They may also leak a little bit of clear, sticky fluid. Those are all part of the normal healing process. However, if the wound is becoming more (rather than less) painful with time, if it has redness that is expanding, or if there is a foul odor or pus coming from it, it could be becoming infected which may require medical attention.

Antibiotic ointment (such as Neosporin or Bacitracin) reduces infection risk in minor contaminated wounds. Once a wound is fully washed and decontaminated, good old Vaseline (petroleum jelly) is just as effective in helping it heal. If you are injured far away from access to clean water and gentle soap, an antibiotic ointment may reduce your risk of infection (so long as the wound is not too large or dirty).  Butter is not a good substitute for ointment because it is not sterile, by the way.

The bottom line is that minor cuts, scrapes, and burns should be washed thoroughly and then kept moist with petroleum jelly and/or occlusive dressings. Antibiotic ointments are a precaution that isn't needed for otherwise clean wounds, and carry a small risk of allergic reaction. The stinging pain of hydrogen peroxide or alcohol in a wound is not the feeling of germs dying, it's the body crying out as you add a new chemical burn to an already painful situation.

References
https://www.advancedtissue.com/the-best-and-worst-ideas-for-open-wounds/
https://www.mdedge.com/jfponline/article/62565/dermatology/do-topical-antibiotics-improve-wound-healing
https://www.mayoclinic.org/first-aid/first-aid-cuts/basics/art-20056711
If you have any questions about first aid for wounds, please log into your account and send us your question. We are here to help.