Questions

• I have heard about a new vaccine that supposedly prevents cervical cancer. What is the vaccine and for whom is it recommended?
• What is Lap-Band surgery and how does it differ from gastric bypass surgery as a weight-loss option for people who are severely overweight?
• It isn't even summer, but the insects have already become a problem. When should I be concerned about insect bites or stings, and what should I do about them when they occur?

I have heard about a new vaccine that supposedly prevents cervical cancer. What is the vaccine and for whom is it recommended?

Kendall R. Olvey, M.D.
Obstetrics & Gynecology
Southern Pines Women’s Health Center
(910) 692-7928

The Food and Drug Administration has licensed a vaccine that prevents cervical cancer and other diseases of females that are caused by certain types of the genital human papilloma virus (HPV). Called Gardasil, it protects against four HPV types (6, 11, 16 and 18) that together cause 70 percent of cervical cancers and 90 percent of genital warts. Studies have shown the vaccine to be almost 100 percent effective in preventing diseases caused by those four types, including precancers of the cervix, vulva and vagina, and genital warts.

Although most HPV infections do not progress to cervical cancer, infections that persist for many years are more likely to do so. Most cervical cancers develop slowly through a series of abnormal changes in the cells of the cervix. When detected during a regular Pap test, the abnormal tissue can be removed, preventing it from developing into cancer. However, Pap tests are not 100 percent accurate and many women do not have regular tests. That’s why the vaccine is considered an important tool in the prevention of these diseases.

Guidelines recommend that the HPV vaccine, which is given through a series of three shots over a period of six months, be given to 11- and 12-year-old girls in order to be most effective. It can also be given to girls as young as 9 or to 13- to 26-year-old girls/young women who have not received or completed the vaccine series.

Ideally, females should get the HPV vaccine before they become sexually active. This is because the vaccine is most effective in girls/women who have not yet acquired any of the four HPV types the vaccine covers.

Women who have had the vaccine should still have an annual Pap test, however.

What is Lap-Band surgery and how does it differ from gastric bypass surgery as a weight-loss option for people who are severely overweight?

Weight-loss surgery has become a workable option for people seeking to deal with their obesity, and Lap-Band and gastric bypass are the two most common surgical weightloss procedures.

Gastric bypass works by surgically making the stomach smaller, thereby restricting the number of calories a person can take in. It also bypasses part of the intestine, which reduces calorie absorption.

The Lap-Band procedure is an alternative to gastric bypass and has some advantages. It requires a shorter operating time and shorter hospitalization. Because it requires no cutting or stapling, it is also less invasive. It is fully reversible, and there is reduced surgical trauma and bleeding.

How does the Lap-Band work? A Silastic ring (one made of plastic that does not react with internal body tissue) is placed laparoscopically on the upper stomach to reduce the stomach’s diameter. This band is adjustable and can be made smaller or larger by inflating or deflating it, or adding or subtracting the saline that is in it. Once in place, the band allows the patient to feel full with a smaller amount of food and to feel full longer. It also reduces the appetite.

Who is a candidate for Lap-Band surgery? As a rule, people who are greater than 100 pounds over their ideal body weight are candidates. So are people with a body mass index (BMI) of greater than 40 or a BMI greater than 35 with two or more health risks (such as diabetes or high blood pressure). The Lap-Band is usually not recommended for patients with drug or alcohol problems or with certain stomach or intestinal problems.

After the Lap-Band procedure, patients can expect to lose between 36 percent to 70 percent of their excess body weight over a two- to three-year period. However, there are some associated risks. These include nausea, vomiting, heartburn, abdominal pain or band slippage.

All insect bites or stings are uncomfortable. Some are even painful while some are more likely to cause more itching than pain and others (such as those of the black widow or brown recluse spiders) are very serious. Some people are also extremely allergic to insect bites and stings. This life-threatening allergic reaction is called anaphylaxis, and it requires urgent emergency care.

In most cases, bites and stings can be easily treated at home. Non-emergency symptoms vary according to the type of insect and the person who has been bitten or stung. But most people will have localized pain, redness, swelling or itching, or even feel some burning, numbness or tingling.

In these cases:

• Remove the stinger (if present) by scraping the back of a credit card or other straight-edged object across it. Do not use tweezers or try to pull it out. This may release more venom.
• Wash the site thoroughly with soap and water.
• Place ice (wrapped in a washcloth) on the site for 10 minutes and then off for 10 minutes. Repeat the process.
• If necessary, apply a cream (1 percent hydrocortisone, calamine lotion or baking soda paste) to reduce itching.
• Over the next several days, watch for signs of infection, such as increasing redness, swelling or pain.

Call 911 if the person is having any of the following severe reactions:

• Trouble breathing, wheezing or shortness of breath
• Swelling anywhere on the face
• Tightening of the throat
• Faintness, dizziness, confusion
• Rapid heartbeat
• Hives
• Nausea, cramps and vomiting

People who are known to have a serious allergy to insect bites or stings should wear a medical ID bracelet and carry an emergency epinephrine kit (which requires a prescription) that family and friends know how to use.

Prevention is always the best policy, however, and that involves:

• Not provoking insects, whenever possible
• Avoiding rapid, jerky movements when around hives or nests
• Avoiding perfumes and floral-patterned or dark clothing
• Using appropriate insect repellants and protective clothing
• Using caution when eating outdoors— especially with sweetened beverages or in areas around garbage cans, which can attract bees