Board-certified physician in Family Medicine and Obesity Medicine, writing on GLP-1 therapy, metabolic health, and menopause care
Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine
This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.
A great video introducing ham (amateur) radio…
Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine
This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.
Breast cancer is the most commonly diagnosed cancer among women in the United States. If detected early, the five-year survival rate is 98 percent.* When you’re a mom, daughter, friend, grandma, auntie, sister, wife, co-worker, or neighbor, keeping healthy is one of the best things you can do for yourself and for the people who love you. Average-risk women aged 40 to 70 should have a mammogram every one to two years, based on physician recommendation and medical history. Contact your doctor promptly if you find a lump in your breast.
What is a mammogram? A mammogram is a safe, low-dose X-ray of the breast, used to screen for breast problems and to detect breast cancer.
Does every woman need a mammogram? Routine mammography is recommended for women between the ages of 40 and 74. Early detection is a woman’s best protection against breast cancer, which is most easily treated and cured when found at an early stage. A mammogram can show changes in breast tissue years before anything can be felt. An initial screening mammogram also gives us a baseline for comparison with future studies.
How often do I need a mammogram? American Cancer Society guidelines suggest that most women begin by age 40 and continue regular exams thereafter. Your doctor can help you decide when to begin and how often to be screened, based on your family history and personal risk.
What will the exam be like? You will need to remove your clothes above the waist and will be given a cloth or paper gown to wear. One at a time, each breast is positioned on a flat plate that contains the X-ray film, and it may feel cold. Another plate is then pressed firmly against the breast to flatten the tissue. This allows minimum radiation exposure and the clearest possible image. At least two pictures are taken in slightly different positions for each breast. The exam takes about 15 to 30 minutes.
Will it hurt during the exam? A mammogram is often uncomfortable. To reduce the discomfort, you may want to schedule the exam for the week after the onset of your menstrual period if that applies to you, avoid products containing caffeine such as coffee or chocolate beforehand, and take an over-the-counter pain reliever such as acetaminophen or ibuprofen before you come in.
How can I prepare for the exam? On the day of the exam, do not use deodorant, perfume, powder or ointment on your breasts or underarms. These products can contain substances that interfere with the X-ray. If you forget, tell the mammography technologist and you will be given something to wipe it off.
What if I have breast symptoms? If you feel a lump, or have breast pain, nipple discharge, or dimpling of the skin, tell your medical provider, who may need to order different diagnostic tests.
What if I have breast implants? Let the mammography technologist know. Additional mammographic views may need to be taken.
What if I am pregnant? If you are pregnant or think you might be, let your medical provider know before scheduling a mammogram.
Board Certified in Obesity Medicine and Family Medicine
This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.
*Five-year survival rate for localized breast cancer, American Cancer Society, Cancer Facts and Figures 2007, page 11.
One of the most controversial topics in medicine recently has been the HPV vaccine. It can save lives by helping prevent cervical cancer, but it works best when given at an early age.
What is HPV? Genital human papillomavirus (HPV) is the most common sexually transmitted virus in the United States. More than half of sexually active men and women are infected with HPV at some time in their lives.
About 20 million Americans are currently infected, and about 6 million more are infected each year. HPV is usually spread through sexual contact.
Most HPV infections cause no symptoms and go away on their own. HPV can cause cervical cancer in women. Cervical cancer is the second leading cause of cancer deaths among women worldwide. In the United States, about 12,000 women develop cervical cancer every year, and about 4,000 are expected to die from it.
HPV is also associated with several less common cancers: vaginal and vulvar cancers in women, and anal and oropharyngeal cancers, which involve the back of the throat including the base of the tongue and the tonsils, in both men and women. HPV can also cause genital warts and warts in the throat.
There is no cure for HPV infection, but some of the problems it causes can be treated.
HPV vaccine: why get vaccinated? The HPV vaccine can be given to both males and females. It prevents most cases of cervical cancer in females if given before exposure to the virus. It can also prevent vaginal and vulvar cancer in females, and genital warts and anal cancer in both males and females. Protection is expected to be long-lasting. Vaccination is not a substitute for cervical cancer screening, and women should still have regular Pap tests.
Who should get the HPV vaccine and when? As of 2013, the vaccine was given as a 3-dose series: the first dose, the second one to two months later, and the third six months after the first. Booster doses were not recommended. The vaccine was recommended for girls and boys at 11 or 12 years of age, and could be started at age 9.
Why is HPV vaccine recommended at 11 or 12 years of age? HPV infection is easily acquired, even with only one sexual partner. That is why the vaccine should be given before any sexual contact takes place. Response to the vaccine is also better at this age than at older ages.
Catch-up vaccination: In 2013 the vaccine was recommended for females aged 13 to 26 who had not completed the series, and for males aged 13 to 21. It could be given to men aged 22 through 26 who had not completed the series, and was recommended through age 26 for men who have sex with men or whose immune systems are weakened by HIV infection, illness, or medication. It may be given at the same time as other vaccines.
Update, 2026: The schedule and age range have both changed since this post was written. The series is now 2 doses when started between ages 9 and 14, with the second dose 6 to 12 months after the first, and 3 doses when started at age 15 or older or for people who are immunocompromised. Catch-up vaccination is recommended through age 26 for everyone. For adults aged 27 through 45, vaccination is a shared decision between patient and clinician rather than a routine recommendation. The vaccine is not licensed beyond age 45. Check current CDC guidance at https://www.cdc.gov/vaccines-children/schedules/index.html and talk to your provider about what applies to you.
Some people should not get HPV vaccine or should wait: Anyone who has had a life-threatening allergic reaction to any component of the vaccine, or to a previous dose, should not receive it. Tell your doctor if the patient has any severe allergies, including an allergy to yeast. The vaccine is not recommended during pregnancy, though receiving it while pregnant is not a reason to consider terminating the pregnancy. Women who are breastfeeding may receive it.
What are the risks from this vaccine? As of 2013 the HPV vaccine had been used in the U.S. and around the world for about six years with a strong safety record. Any medication can cause a serious problem or severe allergic reaction, though the risk of a vaccine causing serious injury or death is very small. Life-threatening allergic reactions are very rare, and when they occur it is within minutes to hours of vaccination. Several mild to moderate problems are known to occur. These do not last long and resolve on their own:
What should I look for in a moderate or severe reaction? Any unusual condition, such as a high fever or a change in behavior in the person who was vaccinated. Signs of a serious allergic reaction include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart rate, or dizziness. If any of these occur, call a medical provider or 911 immediately.
Board Certified in Obesity Medicine and Family Medicine
This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.
This information comes from the U.S. Department of Health and Human Services Centers for Disease Control and Prevention (CDC).
One of the most common questions I hear from patients lately is about the gluten free diet. Many want to know if going gluten free can help with weight loss, low energy, bloating, constipation, or heartburn. The conversation around gluten is everywhere. Some of the information is accurate, but a lot of it is based on rumor or advertising.
So what exactly are Celiac disease, gluten intolerance, and gluten sensitivity?
Celiac disease is an autoimmune condition that affects about 1% of the population. When patients with Celiac disease eat gluten, their immune system reacts by damaging the small intestine. Gluten is a protein found in wheat, rye, and barley. For people with this condition, avoiding these foods is essential. Even small amounts can cause illness.
Gluten intolerance, sometimes called non-Celiac gluten sensitivity, is different. It may affect as many as 10% of people. Symptoms can be milder than Celiac disease and may involve more than just the gastrointestinal tract. Definitions of gluten intolerance have shifted over time as we learn more, but the general idea is that some people feel unwell after eating gluten even without the intestinal damage seen in Celiac disease.
The small intestine’s main job is absorbing nutrients from food. In Celiac disease, that lining gets damaged, which makes it harder for the body to take in vitamins and minerals. Symptoms can include diarrhea, abdominal pain, gas, weight loss, and deficiencies in iron or vitamins. Some patients develop related conditions, such as osteoporosis or thyroid disease. Celiac disease is also linked to dermatitis herpetiformis, a very itchy rash that can form on the elbows, knees, or back.
There’s even an increased risk of intestinal lymphoma in patients with untreated Celiac disease. While this cancer is rare, the risk decreases when gluten is eliminated from the diet.
So how do we test for Celiac disease?
The most definitive test is a biopsy of the small intestine, usually done during an endoscopy. Blood tests can also help, such as tissue transglutaminase antibody (TTG) or endomysial antibody (EMA). These are often used in a Celiac panel. Your doctor can help decide which test makes sense based on your symptoms.
There isn’t a test for gluten intolerance. If blood work and biopsy are normal but symptoms improve on a gluten free diet, that’s sometimes how the diagnosis is made.
Celiac disease appears to have a genetic component. It’s more common in patients with European ancestry, as well as in parts of the Middle East, North Africa, and South Asia. It is rare in populations from northern Asia and southern Africa.
Treatment is simple in theory but difficult in practice. The only effective treatment is to completely avoid gluten. About 70% of patients feel better within two weeks of eliminating gluten. Antibody levels in the blood often return to normal as well. But gluten is in many foods, and avoiding it requires major lifestyle changes. It’s not just bread and pasta. Gluten can hide in supplements, sauces, and processed foods.
A dietician who specializes in Celiac disease is often the best partner for patients making these changes. They can help identify hidden sources of gluten and ensure nutritional needs are still being met. That’s important because gluten free foods often contain less iron, vitamin D, and B vitamins. Some processed gluten free products add extra sugar or fat to make up for texture.
Patients sometimes ask if they should just “try going gluten free.” I usually recommend testing first if symptoms suggest Celiac disease. That way, you don’t lose the chance to confirm the diagnosis. If the tests are negative, you can still try eliminating gluten to see if you feel better, but do it with support from a healthcare provider or dietician.
Practical considerations matter. Many people with Celiac disease also need extra calcium and vitamin D, and sometimes blood tests for iron, folic acid, or B12. Osteoporosis can be a risk, so bone density testing may be appropriate. Dairy intolerance is also common until the intestine heals.
Some naturally gluten free foods include rice, corn, potatoes, beans, nuts, seeds, and soy. Foods to avoid are wheat, rye, barley, malt, brewer’s yeast, and most oats unless specifically labeled gluten free. Most wines are safe, but most beers are not.
Gluten intolerance and Celiac disease are real conditions, but gluten isn’t harmful for most people. It’s important to understand why a gluten free diet might be necessary and not assume it’s a guaranteed path to better health.
For more information:
This is for educational purposes only. If you think you may have Celiac disease or gluten intolerance, talk with your healthcare provider.
Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine
This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.
Reference: Ciclitira PJ, King AL, Fraser JS. AGA technical review on Celiac Sprue. Gastroenterology 2001;120:1526.
Patients who have diabetes need to pay extra attention to their foot care to help prevent infections. I’ve had numerous patients with diabetes need foot or toe amputations that could have been prevented with excellent foot hygiene. Small scrapes in the skin or ingrown nails can become extremely bad very quickly with diabetes because patients who have diabetes often don’t have as much sensation (due to damage to the nerve endings and blood vessels in your feet). This can make it difficult to detect sores and once an infection is present it can be very difficult to treat. I thought I’d put together some tips to help you keep your feet healthy and decrease the risk for infections.
When to seek medical help:
A) If you cannot do proper foot care
B) If you have a foot sore or ulcer that is not healing after 3 days (including corns, calluses or ingrown nails)
C) If you have black and blue areas in your toes or feet
D) If you have peeling skin or blisters between your toes
E) If you have a fever for more than 24 hours and a foot sore
F) If you have new numbness or tingling in your feet that does not go away after you move your feet or change positions
G) If you have unexplained or unusual swelling of your foot or ankle
H) Anytime you have questions about your feet or concerns it is best to contact your medical provider
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine
This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.
One of the most common questions that patients ask me is why they should take medication for cholesterol. They often don’t have any symptoms of high cholesterol and many people don’t like the idea of taking a medication for something that they don’t feel is causing them any problems. I felt like it was important to write a little bit about cholesterol, triglycerides, goals and treatment options.
So why should you care if your cholesterol is high? Did you know that there are both good and bad forms of cholesterol? What’s the difference between high cholesterol and hyperlipidemia? These are all great questions and I will attempt to answer them in this article.
When we use the term hyperlipidemia, we are generally speaking about the amount of fats in the bloodstream being elevated. Fats include both cholesterol and triglycerides. When the level of fat is elevated in the bloodstream it can collect in your blood vessels and cause blockages.
If you think about your blood vessels as being hoses that feed the different organs of your body, you can imagine cholesterol as a substance which collects or coats the inside of these vessels so that the blood has a narrowed space to flow through. If too much cholesterol fills up in the blood vessels it can make it difficult for the blood to flow through this area and reach certain areas of the body.
If the blood flowing through your body is blocked and cannot get to a certain area of your heart, you could have a heart attack. If blood has trouble reaching an area of your brain, you could have stroke. So how do you know if your blood vessels are being blocked by fats such as cholesterol or triglycerides?
Will you have symptoms? It can be very challenging to know if you are getting fat from cholesterol and triglycerides stuck in your blood vessels. You might not have symptoms until the blood vessels become plugged to such a degree that blood cannot get through. At this time, your heart or brain may suffer permanent damage from a heart attack or stroke. It’s very important to prevent the blood vessels in the body from becoming plugged with cholesterol or triglycerides that we refer to a plaque when it combines with other cells of the body such as platelets.
Why are doctors even more worried about my cholesterol levels now that I was diagnosed with diabetes? Diabetes means that your blood sugars are likely higher than they should be. High sugar within the blood vessels causes damage that makes the inside of the vessels (where the blood flows) become sticky and the cholesterol and platelets stick inside the blood vessels that have been damaged by high blood sugar much easier. Smoking also causes damage (increased stickiness) to the insides of the blood vessels and makes it easier for cholesterol plaque to stick inside the arteries and potentially lead to a heart attack or stroke.
Most of us have heard the terms “good cholesterol and bad cholesterol.” Two difference forms of cholesterol known and LDL (Low density Lipoprotein) and HDL (High Density Lipoprotein) are commonly measured in your lipid tests. We like to see a high level of HDL because this type of cholesterol actually lowers the risk of heart disease and stroke by destroying the plaques that build up within the blood vessels. We like to see low levels of LDL because this type of cholesterol is the bad kind that combines with platelets and sticks inside the blood vessels and can increase the risk for heart attack or stroke. Total cholesterol is a combined measure of both the HDL and LDL cholesterol. You don’t need to fast anymore to be able to measure your cholesterol. There is a direct LDL and HDL test that can be done at your office visit without fasting (only if the local lab offers it). When I’m looking at the patients lab results, I’m more concerned about the HDL and LDL than I am with the total cholesterol because I want the HDL to be high and the LDL to be low.
So what should your cholesterol numbers be? Well that depends on your risk factors for heart attack, stroke, kidney disease and whether you have diabetes. We try to get the levels of LDL cholesterol lower in patients who have diabetes, kidney disease or who have already had a heart attack or stroke.
So how low should you go?
This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.
During the first week of my third year medical school dermatology rotation I thought I’d definitely decided that I wanted to become a dermatologist. I’d been present in the room with my dermatology preceptor and patients who asked about what to do for their acne at least a hundred times, and I knew I could give the same speech as my dermatology teacher. I later changed my mind about becoming a dermatologist but I still have a great interest in dermatology. Most people who come into the medical clinic due to problems with acne have tried various over the counter treatments to help with common black heads, white heads or deep cysts from acne. It’s a common problem for adolescents (85% are effected) and teenagers but also effects many adults as well. Untreated acne can lead to embarrassment, loneliness and even permanent facial scarring.
So what is acne? Acne is a skin problem where the openings in the skin where hairs come out (pores) become blocked by skin cells and oil and this creates a plug. During adolescence the glands that produce oil in the skin enlarge and produce increased amounts of the oily substance we call sebum. These oil glands are most often found on the face (most commonly an area called the T-Zone of the face – around the eyebrows and nose), neck, chest, upper back and arms. Even normally, there are bacteria which are present on the surface of the skin and normally they don’t cause any problems in small numbers. With an increased production of oil on the surface of the skin that occurs during adolescence however, these bacteria reproduce and become present on the surface of the skin in much higher numbers than normal. The bacteria then combine with the oil and skin cells and become trapped in the pores (hair follicles) and lead to the formation of tender “pimples” that we call acne.
A special type of acne that affects newborn babies is called neonatal acne and usually goes away within a few weeks after birth. It is related to the hormones from pregnancy and causes small pimples often noticeable on a newborn babies face
There are multiple types or ways we describe acne and grade the severity.
Causes of acne:
Acne Treatment: Since there are multiple causes of acne, there is not once simple treatment that works for everyone. Skin doctors (dermatologists) usually recommend a combination of treatments to reduce acne formation in multiple ways. Some simple suggestions are outlined below but keep in mind that they may not work for everyone.
Prescription treatments: Prescriptions for acne can be divided into topical (applied directly to the skin) and non-topical treatments.
A) Topicals:
B) Oral antibiotics: The reasons for using an oral antibiotic to treat acne are actually two-fold. The first reason is that some oral antibiotics have been found to have anti-inflammatory properties in the skin and decrease the inflammatory response leading to the pimples. The other reason is more straight-forward – to reduce the bacterial count on the skin and thereby decrease the acne. The most commonly prescribed oral antibiotics for acne at this time are Minocycline or Doxycycline but they should not be used during pregnancy or in young children.
C) Oral Isotretinoin (previously called Accutane): It’s also called Amnesteem, Claravis and Sotret. This medication is most often limited to be prescribed only by dermatologists are physicians who have had special training about this medication. This is one of the most successful medications that we have for the treatment of severe acne and is usually taken as a pill once or twice a day for 20 weeks. The reason it is not the first line of treatment for acne and mostly prescribed by dermatologists is because there are some possible serious side effects that can occur when using this medication. Isotretinoin can cause miscarriage or life-threatening malformations to babies so it cannot be taken by women who are pregnant or at risk of becoming pregnant. Most dermatologists require women of child bearing age to use birth control before they will prescribe this medication. There are strict rules for using the medication regulated by the iPLEDGE program:
Side effects of oral Isotretinoin: I’ve seen many patients who are treated with this medication and I’ve noticed that it works very well for their acne in most cases. Some of the common side effects that I’ve observed are:
Hormone treatment options: Women with acne are sometimes prescribed a birth control pill to help control acne. Some hormones and IUDs and injectable hormones however can actually worsen acne, so make sure to talk to your doctor about which birth control might be better for acne if you are considering this form of treatment.
A blood pressure medication called spironolactone has also been used to help with acne because it can effect hormone levels in women (and thereby decrease acne) but it can also cause an increase in the blood potassium and birth defects so it is usually cautiously.
Where to get more information:
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine
This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.
Blog: https://doctorrennie.wordpress.com
References:
A patient came in today complaining about a lump on her elbow and that is has been slightly painful for the last week. She is a student and spends many hours reading books and resting her elbow on a table while studying. This disorder called olecranon bursitis is a fairly common condition in which the bursa, which is a sac-like structure that protects the elbow from pressure injuries becomes inflamed.
Bursas are found all over the body including the shoulders, elbows, knees, feet and hips. They contain a lubricating fluid that fills the sac and decreases the friction between ligaments, bones and tendons.
Bursitis of the elbow can be caused from:
Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine
This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.
A few times each week a patient will come in to see me due to a rash of unknown cause. The rash is usually an inflamed, red skin and sometimes it’s a bit thickened and/or covered with a silvery scale. Since psoriasis often develops in adults, many people are puzzled when they come in and learn they have psoriasis and have lots of questions about the condition. I’d try to answer some of the most common questions that patients ask me about psoriasis.
What causes psoriasis? We’re not exactly sure about the cause, but we do know that it seems to have a genetic link (it often runs in families), it involves the immune system and environmental conditions seem to trigger it. The skin actually is made up of several layers and the top layer of your skin is in a state of shedding old skin cells as new skins cells are produced. This process keeps the top layer of skin relatively smooth. Psoriasis is a process in which the outter layer of skin cells grow too quickly and they stop shedding properly. This leads to a scaly build-up of skin cells that we see on the skin in affected patients. We believe that the immune system causes certain cells to enter the skin and cause the disorder.
About 40% of patients with psoriasis have family members who also have the condition.
We know that smoking appears to increase the risk of psoriasis. Certain medications can worsen psoriasis symptoms including beta blockers (used for blood pressure), lithium, and medications that we commonly use to treat malaria. Stress and anxiety may trigger psoriasis to become noticeable in people who have the genetic risk. It has also been linked with obesity and increased risk for heart disease.
What are the symptoms of psoriasis? How do I know if I have it? A medical provider may determine if you have psoriasis usually by examining your skin. There is not a blood test that can tell you if you have psoriasis but a doctor may due a biopsy of your skin if it is not clear what is causing your rash. There are several symptoms of psoriasis including:
What can I do about my psoriasis? Is there a cure? Unfortunately there is not a complete cure for psoriasis but there are treatment options that can substantially improve the symptoms. Patients who have severe psoriasis that is highly noticeable to other people may feel embarrassed or feel low self-esteem or anxiety due to the disorder. The treatment offered to a patient will depend on the severity of the symptoms, the area of the body affected as well as the cost and convenience of treatment and other medical conditions that the patient may have. Severe psoriasis is usually always treated by a dermatologist (skin specialist) and patients with psoriatic arthritis may be treated by a rheumatologist (joint specialist). Treatments are organized by whether they are topically applied to the skin or are taken orally or given in an injectable form.
Topical medications:
Medications that suppress the immune system: Several medications target the immune system such as Enbrel, Amevive, Remicade, Humira and Stelara. These are usually reserved for severe forms of psoriasis because they are very expensive and are injections that are either given into the skin or muscle or into a vein over hours in the doctor’s office. Methotrexate and cyclosporine also suppress the immune system and can increase the risk of the patient developing an infection.
Soriatane is an oral medication that is derived from vitamin A and is called a retinoid. It may help reduce the symptoms of psoriasis in 3-6 months but should generally not be used in women of child-bearing age as it can cause severe birth defects.
For additional information, feel free to check out the following sites:
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine
This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.
Blog: https://doctorrennie.wordpress.com
References:
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