Month: May 2015

June event added, Charleston’s Best Women’s Conference

http://www.charlestonsbestwomen.com/charlestons-best-women-speakers.html

Charleston, SC family and friends….come out Saturday, June 6th to Charleston’s Best Women’s Empowerment Summit from 9a-3p. I’ll be speaking on the Real Talk panel at 1pm and will have books and Superwoman Tees on sale. Hope to see you there!

Book events & appearances, May & June 2015

What an eventful month it’s been already! We’ve appeared on TV 3 times since the book was released. The most recent was on WTVD’s ABC11’s Heart of Carolina show yesterday with Caitin Knute, and it was very exciting. Here’s the link if you missed it: http://abc11.com/…/tips-on-how-to-avoid-the-superwo…/722766/

Check out upcoming May and June events at which to catch Dr. Swiner:

May 17th: Union Baptist Church, Durham, NC anniversary services and

later at Read Local Book fest at Durham Central Park, 12pm-6pm

May20th: Book signing at Regulator Book shop, Ninth Street, Durham from 7-9pm

June 2nd: Cocktails & Convo with Drs. Banks, Brunson & Swiner. Beyu Caffe’, 7-9pm

June 28th: Book signing at Jimmy V’s, hosted by Jacqueline Whittenberg and Step-Up Ministry

superwomanthinking2

The book is here! How to Avoid the Superwoman Complex…….

Hopefully, you’ve heard by now, but my book was officially released last month. It’s available on Amazon and Kindle at http://www.amazon.com/How-Avoid-Superwoman-Complex-Balance/dp/0986370207/ref=sr_1_1?s=books&ie=UTF8&qid=1430498189&sr=1-1&keywords=how+to+avoid+the+superwoman+complex Here’s my bio: How to Avoid the Superwoman Complex is both a labor of necessity and of love for Dr. Swiner, as she started writing … Continue reading The book is here! How to Avoid the Superwoman Complex…….

Dr. Swiner’s Medical Note of the Month II-Sept. 2010-Is every dry, flaky rash from eczema?

Is every dry, flaky rash from eczema?

Published Wednesday, September 15, 2010 7:00 am

by Nicole Price Swiner, Columnist

It would certainly seem like it, wouldn’t it? Eczema, also called atopic dermatitis, is the most common skin disorder I see in practice, particularly in the African-American population.

Eczematous rashes are all generally dry, itchy, flaky, bothersome lesions that occur most frequently in the elbow area, knees and behind the neck. I’ll often see lesions on the anterior abdomen, surrounding the ear or belly button, which can be complicated by allergies to metal like nickel. Nickel is usually present in buttons on pants (try putting tape or cloth between the skin and the button to avoid touching), watches or earrings, causing a similarly annoying itchy, sometimes sensitive and occasionally painful rash. Eczema, and possibly nickel allergy, is hereditary.

Why does it also appear to be more prevalent in black patients? Unsure. My theory is it may be due to the allergies from which we suffer in our homes, products and environments.

Dyshidrosis, or dry skin, is a cardinal symptom of eczema so directing attention to keeping the skin moist is paramount. This is why it seems harder to control the rash either in the winter or during the heat of the summer when we sweat. Interestingly, although we want the skin moist, we don’t want it wet, which is also when eczema becomes worse.

I think the hardest piece of advice for my patients to follow is shortening the time in the bathtub or shower. If a child spends 20 minutes twice daily in the water, cut it in half if you can. Also, while in the tub, the more lukewarm the water, the better. No one likes a cold shower, so keep the temp reasonable. As soon as he or she jumps out of tub, dry quickly and moisturize even more quickly.

One can imagine how difficult this is for those of us who feverishly wash our hands in scalding hot water every five minutes or use alcohol hand sanitizers to keep clean. It all dries the skin out. I’ve prescribed the strongest, highest strength steroid creams there are, but I’ve had it confirmed by dermatologists that good old petroleum jelly, i.e. Vaseline, is as good as gold. Cocoa butter and Shea butter are OK alternatives as well for twice daily moisturizing.

Over the counter, my other favorites to suggest are Eucerin and Aquaphor for their thickness and staying power. The thinner, fancier lotions seem to evaporate right into the air after putting onto the skin. Children, and adults for that matter, with histories of allergies, eczema or asthma, often have one of the others or all three. So, when I know one of my patients has asthma and they call with complaints of a dry, itchy rash in one of those special areas, I can pretty much put money on what it is.

With all of the great, sweet smelling soaps, washes and shower gels out there, it isn’t a good idea for a patient with eczema to use any of them. Because of the allergy rationale, the more pure and simple one’s soap, the better it is for sensitive skin type. I generally recommend regular and plain Dove, without scent or color, for its gentle nature on the skin. Sorry to all of the Bath and Body and Victoria Secret lovers (like me).

If decreasing water exposure and temperature, soap and lathering from head to toe in lotion won’t help, in comes the steroid treatment. The steroids work by helping the body decrease the atopic response that occurs. I explain their action by saying they help the body to stop reacting against itself, similar to how antihistamines and allergy medicines work.

The simplest one to use is an over-the-counter steroid. There are forms of generic steroid or allergy creams and ointments of varying strengths of hydrocortisone you can buy from the store without a prescription. The 2 percent strength is available OTC, and it’s a good start. You use it twice a day – sometimes mixed in with your lotion or petroleum for better absorption – for no more than two weeks in a row. If the rash is something that recurs regularly, I’ll have patients skip one or two weeks between their two-week treatment to give the body a rest from the strong steroids.

This is also why I usually suggest the ointments instead of the cream, because the ointments remain on the skin longer. However, some complain that it’s messier on clothing. If the OTC doesn’t help, we can prescribe a variety of types depending on the severity of the rash and whether it’s occurring on the body versus the face.

Now, back to my original question: Does this mean that every flaky rash is eczema? No, certainly not. Others that come to mind include yeast, psoriasis or fungal. Candidal or tinea rashes are typically more moist or wet in nature, occurring in the creases of skin, and psoriatic rashes have more of a shiny patch appearance on the surface of the elbow or knee. See your local doctor to help determine the right diagnosis and treatment.

* On Oct. 1, UNC Durham Family Practice will become Durham Family Medicine. We welcome our new patients to call us at 220-9800 and visit us at our same location at 2400 Broad St., suite 1 in Durham.

Dr. Swiner’s Medical Note of the Month-Sept. 2010. Eyelash growth serums, all talk?

Eyelash growth serums – all talk?

Published Wednesday, September 1, 2010 7:00 am

by Nicole Price Swiner, Columnist

“Please excuse the mess as we try to expand” was the Facebook status I used a couple of months ago to explain the uncoordinated look of my eyebrows as I’ve let them grow out of their manicured shape. I’ve been plucking, waxing and threading my eyebrows since my freshman year in college to get that certain look, and now that I’m in my 30s, they won’t grow the way I want.

When I asked cosmetologists and spa aestheticians about the issue, there appeared to be no real eyebrow growth product. Instead, I heard or read in magazines about olive oil, massage or Minoxidil (i.e. Rogaine). I really wanted to try Minoxidil, but my husband was worried when he read it was hormonally based. So, I became interested in these new products on the market myself as I became frustrated with the lack of growth. Even with avoiding waxing for weeks, I did some research and this is what I found.

Latisse, which is the first marketed product for eyelash growth, was actually found by mistake. Its main ingredient is called bromatoprost, which was and is the main ingredient in glaucoma eye drops, which had the side effect of making eyelashes grow longer. It’s a prostaglandin, or fatty acid, that helps build muscle and hair. How smart was it that someone discovered a way to isolate this ingredient and make an eyelash growth product.

To review the medical background with patients who may deal with a lack of or slowed hair growth, we have to review the definition of alopecia. Damaged hair follicles or lack of growth of hair on the face can be related to many causes -those medical and those we cause ourselves. My experience had to do with too much waxing and threading, where others may have experienced actual alopecia. Alopecia, in general, is hair loss due to trauma or medical reasons such as cancer, anemia, thyroid or other hormonal issues.

The most common type is alopecia areata, which occurs in 2 percent of the population, and is primarily on the head. It usually returns spontaneously on half of cases within a year. Alopecia universalis is when damaged hair follicles occur all over the body, including the eyebrows and eyelashes, and is generally longer lasting.

The most important thing to do, I think, is to first understand the natural growth cycle of hair on the face before figuring out how the marketed serums will work. Naturally, it takes a full-grown eyelash about six to eight weeks to grown on its own. It takes an eyebrow about four months and hair on the scalp about three to four years. Because I was more interested in re-growing my eyebrows, I wanted something to shorten that length of time.

Unfortunately, there are no eyebrow growth serums, but there are those marketed specifically for eyelashes. Some of these serums can be used on the eyebrows also, understanding of course the longer growth cycle. What I’ve tried recently is use one of the marketed eyelash serums on both my eyebrows and my eyelashes. To avoid liability, I won’t say which one I’m using, but at least for these past couple of weeks I’ve not experienced any side effects like eye irritation, conjunctivitis or skin changes. Do I think my eyebrows have grown longer than they would have without the serum? I’m not sure yet, but maybe. If you’re interested, try one and let me know what you think.

References: Canadian Family Physician, July 2000, p. 1469

  1. Nicole Price Swiner, MD, works for the Durham Family Practice in Durham. Contact her at 220-9800.

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Quick note—October 1st, 2010, Durham Family Practice becomes a private practice, Durham Family Medicine! Call us at 220-9800 to schedule your new patient appointment in October!

Dr. Swiner’s Medical Note of the Month, July 2010 (II)-Got GERD?

Ask Dr. SwinerAcid reflux

Published Wednesday, July 21, 2010 7:00 amby Nicole Price Swiner, Columnist

A patient of mine recently asked me to address heartburn, so here goes.

GERD, or gastro-esophageal reflux disease, is a condition that can vary from mild to severe. Heartburn describes the classic presentation of this disorder that can literally feel like burning from the pit of one’s stomach through the esophagus and central chest up to the level of the throat.

Some complain of chest pain that even mimics that of a heart attack if severe enough. Burping, belching and bloating, particularly after eating or when sleeping, can be disruptive. Awakening with a sour taste in the mouth or an unexplained chronic cough can also be caused by acid reflux.

So, what causes an increased production of acid in the belly? We all have proton pumps and H2 receptors in our stomachs that manage the balance and acid and base from our foods for digestion. When food enters the stomach from the esophagus, a certain amount of acid is released to help break it down into proteins and amino acids for our bodies to use for energy.

Some foods, drinks, alcohol or chocolate can be associated with too much acid production. Interestingly, emotional stress can lead to an increased production of acid from proton pumps and H2 receptors in our stomachs. If acidity is prominent, a burning sensation can be felt and pain can extend from the stomach (in the center and to the left of the middle of the stomach) all the way up to the esophagus and throat. Caffeinated beverages like soda, tea and coffee, and spicy ingredients and citrus can make this worse. If left for too long, ulcers, or an eating away of the lining of the stomach, can develop and even worsen to the point of bleeding.

Medicines used to treat GERD can be grouped into three types: those we use at the time of acute pain such as Tums or Maalox; one group that affects proton pumps – Nexium or Prilosec; and those affecting H2 receptors – Zantac or Pepcid.

My rule is that if a patient complains of reflux symptoms requiring Tums more than two to three times a week, he or she likely needs preventive medicine from one of the other two groups. Most of these medicines now are available over the counter without a prescription and in generic form: Zantac is Ranitidine, Prilosec is Omeprazole and Pepcid is Famotidine. However, the best treatment is always prevention.

I’m a coffee lover myself, but I try to limit my intake to one serving of caffeine a day, including sodas. If you’re like me and can’t give up coffee, tea or soda totally, switch to decaffeinated brands. Also, tomato sauce, hot sauce, salsa and chocolate are not your friends if GERD is your problem. Orange juice and peppermints can be culprits for flares too, which we all may ingest on a regular basis.

A huge piece of advice is to quit smoking – completely. Cutting back won’t cut it. Weight loss, because of less pressure on the esophagus and stomach giving more room for digestion, also helps.

C. Nicole Price Swiner, MD, works for the Durham Family Practice in Durham. Contact her at 220-9800.

Dr. Swiner’s Medical Note of the Month-July 2010 II-Ask Dr. Swiner! (topics: sunspots, potty training, pain in pregnancy)

Here are a few recent questions I’ve gathered from Facebook and e-mails. Contact me or comment on The Tribune’s website if you have a question you’d like answered.

Q: What can reduce the appearance of sunspots? – L.K., 32-year-old mother and lawyer

A: Sunspots are called “lentigines,” and if you have a few of them, you can avoid the sun with SPF or makeup to cover. Prescription creams like Hydroquinolone, gels or laser treatments from a dermatologist are other options. If widespread or many come all of a sudden, let your doctor examine them.

Q: With all the news about the chemicals in sunscreens causing cancers, can you recommend a good/safe sunscreen? – T.B., 45, mother of two

A: In general, it’s recommended we all (yes, black people included) wear a sunscreen with SPF 15 or 30. I wasn’t able to find anything specific about the dangers of cancer with sunscreen. I did see that for those with risk of having low vitamin D (which is linked to some cancers), sunscreen can prevent absorption of it from the sun, which is our major source of the vitamin other than foods.

Q: What does it mean when the body (last week it was my face/cheek and more recently it was my arm) twitches? Is this common? Please tell me these aren’t stroke symptoms or something! – A.S.

A: I think twitching, like when it happens in one or both of my eyelids, can be a sign of stress or fatigue. Isolated twitching alone is not a sign of a stroke. If stress is low and you’re getting enough sleep, your nerves could be irritated because they’re pinched at the root (in the back or spine), muscles are overworked and spasming. If you’re worried about it or it happens for days on end, see your doc.

Q: Is there anything medically that can delay a child’s potty training development? – G.D., father of 3-year-old son

A: Don’t fret, for some reason boys take longer than girls to potty train. I’m sure you’ve tried all the encouragement and giving rewards for sitting on potty and staying dry, right? Is he in day care? Often, seeing his peers being “big boys and girls” will encourage him to step up. Is he afraid of sitting on the potty? Will he let you know when he has to go? You may have to – if you haven’t already – schedule potty time every couple of hours. Also, make sure he’s not constipated and get encouragement from your doc.

Q: I’m sure that it’s pregnancy related, but I have this “catch” in my lower back, like possibly my butt bone. Sometimes, if I am sitting, I cannot lift my left leg to put it on the ottoman, or if I bend over to pick something up, or if I move too quickly, it hurts bad enough to take my breath. What can I do to relieve the pain? Also, I have been told that I should sleep on my left side, but after just a little while my hip aches so bad. What do I do? – A.B., third-trimester pregnancy.

A: Depending on how far along you are, it’s most commonly round ligament pain or the stretching of the ligaments holding the full uterus up in the pelvis against the heavy contents. Gentle prenatal yoga, warm baths and massage therapy can help. Another is a long body pillow to sleep with between your legs.

  1. Nicole Price Swiner, MD, works for the Durham Family Practice in Durham. Contact her at 220-9800.

Dr. Swiner’s Medical Note of the Month-June 2010-Dog ticks, and deer ticks, and mites..oh my! by Nicole Price Swiner on Friday,

Tick season seemed to start earlier this year than usual. One of my partners in our practice in March said she awoke one morning with a deer tick, and we knew the season was here.

the interesting things I’ve learned about since practicing in N.C., as these illnesses are more common in the Southeast. But apparently they are an issue all over the U.S. during this time.

The illnesses include the above-mentioned RMSF, Ehrlichiosis, Tularemia and Lyme disease. Lyme disease is actually very rare in N.C., because the tick that carries the disease is rarely found here.

The usual season for ticks is during the spring and summer months. The different types of ticks vary from dog ticks to deer ticks to Lone Star ticks. The American dog tick is generally a reddish-brown color and becomes large and red after it’s attached itself and fed. Deer ticks are usually smaller and darker than dog ticks. The Lone Star tick is also small and reddish-brown in color but usually has a white spot on the back. Clear as mud? If confused like I was, you can go to the Center for Disease Control and Prevention website to see pictures.

I also have a hard time identifying which is which, so I’ve posted a picture of types in my examination rooms for patients to point them out. Lone Star ticks are probably the most common type in this area, and they cause symptoms like fever, headaches, body aches and possibly a round “bulls-eye” rash where they have bitten. This is the classic rash called erythema migrans, and it’s very helpful to see when trying to diagnose the illness. Not all tick bites will cause the symptoms if caught early enough.

The best way to remove them is with tweezers and picking the whole body off, but most importantly the head. If you don’t know whether you’ve removed the entire body, don’t play around with it, have you doctor look at it and remove the rest as quickly as you see it. Don’t use matches or ointments, because they don’t work well all the time.

Once symptoms have been identified, your doctor may go ahead and start treatment or do blood work. Labs that are affected by tick-borne illnesses include white blood cell count, platelet count, liver labs and sodium. There are also antibody tests for RMSF, Erhlichiosis and Lyme disease. Once I generally have a good idea that a person has been affected, I usually will start treatment with Doxycycline, which is the most common antibiotic that treats all the common types of tick-borne illnesses. The medicine is prescribed either for one or two weeks depending on the severity of symptoms.

Now, to say a word about Lyme disease in N.C. – it is present but not very common. In 2008, the CDC reported 16 cases in the state versus 2,000 to 3,000 cases in the upper north states of Connecticut and Minnesota. Because of its long-term effects and consequences – arthritis and neurologic effects – Lyme disease is taken seriously. But the other types of tick-borne illnesses are far more common here in N.C. Be careful this summer!

* Reference: www.aafp.org (American Family Physician), www.cdc.gov (Center for Disease Control and Prevention)

  1. Nicole Price Swiner, MD, works for the Durham Family Practice in Durham. Contact her at 220-9800.

Dr. Swiner’s Medical Note of the Month-June 2010-‘Tis the “allergy” season……

‘Tis the season for pollen, mold and trees. Recently at the clinic, I think half of my 20 visits involved complaints of “I think I have a sinus infection.” The response to my “Why?” included many common truths and misconceptions, ranging from “because I’ve been congested for a week” and “because I have green and yellow mucus” to “because this happens every year to me.” 

The truth is all of these signs of symptoms may be present, but I’d bet money that patients are correct less than 30 percent of the time when trying to self-diagnose themselves with infection versus inflammation. Would you know the difference?

Let’s first review the common cold, which I’ve talked about many times before. A cold is a viral infection, which means there’s no great cure. There are ways we can shorten the duration of symptoms, but if I had the cure to a cold, I’d be a retired millionaire.

If you read a medical textbook, it would say symptoms of a cold include headache, muscle aches, low-grade fever, runny nose and cough, which can last for about a week. By day seven, symptoms generally begin to dissipate. Because it’s a viral infection, antibiotics are not the treatment.

Let me repeat myself: Antibiotics do not treat colds.

I can imagine what the next question might be, and the answer is you’re right. Doctors do and might prescribe an antibiotic when you present with a cold. However, this is incorrect and should not be done. This helps to produce super-bacteria that are resistant to the drugs we currently have and create monsters such as MRSA or methicillin-resistant Staph aureus and other resistant bugs.

This means it will be harder to treat you if and when you do have a bacterial infection in the future. I hear the mumblings of the next question: Then, why do antibiotics seem to work when taken for a “cold”? I put cold in quotes on purpose, because what patients often think is a cold isn’t really one. It may be a bacterial sinus infection, walking pneumonia or Strep throat. Or, what I believe is the most common reason, the cold was going away on its own, and it was coincidental that you were taking the antibiotic at the same time.

What does help and what has been proven in studies to help includes taking Zinc (such as Zicam) or eating chicken noodle soup at the first start of symptoms to cut your sick time by two days. Notice I didn’t say cure but shorten the amount of time you’re sick. After trying to shorten the duration of the cold, we treat the individual symptoms with antihistamines, cough medicine, menthol, tea and salt water gargling.

During the allergy season, it becomes even harder to differentiate because symptoms are similar. Classic allergy symptoms include sneezing; runny nose; itchy, red eyes; congestion and headache. Allergies don’t occur with fever and are treated with antihistamines like Zyrtec or Claritin. Other important treatments include steam, nasal saline and washes, and cleaning one’s filters in the house and car. A chronic cough can be caused by allergies.

Another million-dollar question is: “Does green mucus mean I have an infection?” Yes and no. It could mean an infection, but it doesn’t mean it’s bacterial. It is a sign of white blood cells fighting something, and that something could be an allergy or a virus. A bacterial sinus infection is when one-sided facial pain, runny nose, fatigue, congestion, tooth pain and sneezing begin, and is prolonged. Talk to your doctor about concerning symptoms.

C. Nicole Price Swiner, MD, works for the Durham Family Practice in Durham. Contact her at 220-9800.

Dr. Swiner’s Medical Note of the Month-May 2010-Updates on birth control

In a recent “Ask Dr. Swiner” segment on my Facebook page, I had a number of interesting questions about what’s new in birth control. I deal with this issue frequently in my practice, and even I have to make sure I’m up-to-date with the information that comes out.

f levels of estrogen and progesterone that balance one another and allow a woman to have monthly, regular menstrual cycles. Some pills, if taken without taking the placebo pill (the ones at the end of the pack that are usually a different color), allow a woman to have only three menses a year.

We’ve had the patch, the ring, the shot, the implant and the pill for a number of years. Most recently, IUDs have become all the rage. Intrauterine devices such as the Mirena and the Paragard are one of the “hands-off” methods, in that the woman doesn’t have to do anything except wear a condom to prevent STDs, of course.

A doctor places the plastic device into the uterus during an office visit, and that’s it essentially. When the woman is ready to have it removed at five years (Mirena) or 10 years (Paragard), the doctor takes it out. Recently, the complaint I’ve heard from women about the IUD is that it appeared to thin their hair, which might, theoretically, occur with any hormonal option or for other reasons if they’re postpartum.

What can be unpredictable about Mirena IUDs is the way a woman’s cycle might change once it’s placed. Because it’s made primarily of progesterone and does not have estrogen – like most pills – to balance it out, it can change the timing of menstrual cycles. What I tell most women is the rule of thirds: approximately one-third of women with the IUD may have their normal, monthly cycles; one-third may have no cycles, which is usually what the majority of women hope for; and one-third may have variable, unpredictable cycles. We don’t know which group you’ll end up in until we place the device. In most cases, however, women are pleased with this method of birth control.

Norplant was put out a couple of years ago, and it is known as the implant that is placed under the skin of the arm and lasts for up to five years. It was a five-rod method made primarily of a progesterone-related hormone like the IUD, meaning it may have the same effect on bleeding.

It was taken off the market about four years ago, and now we have Implanon, the “new and improved” version. This one lasts for up to three years and has to be removed after this point. Instead of five rods, Implanon only has one and appears to have less bleeding variability, less bone loss concern and less weight gain than some of its counterparts. I was recently trained to place this method, and it seems to be a good alternative to the Depo-Provera injection for women who may want to try something different.

The newest contraception I’ve heard about is Essure. Instead of going into an operating room and having a bilateral tubal ligation, or getting your tubes tied, this is an outpatient version of the procedure. It involves the release of small metal coils into the fallopian tubes to block fertilization. It is irreversible. The usual surgery that is done to have a tubal ligation is now possibly reversible, depending on how the surgery was done and who performed it. And finally, there is another type of outpatient surgery; one that doesn’t involve any female anatomy, and that’s a vasectomy.

  1. Nicole Price Swiner, M.D., works for the Durham Family Practice in Durham. Contact her at 220-9800.