Inside the PPE Underworld; Spotting Racism in Medicine

  • As the U.S. continues to break records for coronavirus cases and deaths, hospitals are once again facing PPE shortages. Doug Bock Clark explores the dark underworld of the PPE supply chain and the federal government’s inadequate response ~ Inside the Chaotic, Cutthroat Gray Market for N95 Masks (The New York Times)
  • “Each tube, about the size of a pinkie finger, contains a few precious droplets of frozen coronavirus vaccine,” which can provide one shot of protection to five people, writes Carolyn Y. Johnson, of the delicate and time sensitive process of getting a vaccine to patients ~ A vial, a vaccine and hopes for slowing a pandemic — how a shot comes to be (The Washington Post)
  • Emily A. Wang, MD, MAS, and colleagues discuss the ways in which U.S. prisons and COVID are “deeply entangled,” creating a perfect breeding ground to spread the virus ~ A Report From the National Academy of Sciences, Engineering, and Medicine ~ COVID-19, Decarceration, and the Role of Clinicians, Health Systems, and Payers (JAMA)
  • Growing up, Betial Asmerom watched doctors treat her family with disrespect but it wasn’t until she took a course on health disparities that she realized how often communities of color had similar experiences. Elizabeth Lawrence explores the fundamental changes medical school curricula must undergo to address health disparities and racism in medicine ~ What Doctors Aren’t Always Taught: How to Spot Racism in Health Care (Kaiser Health News)
  • When Kevin M. Simon, MD, fields questions from parents, colleagues and friends about how to talk about racial tensions, he combines evidence with the lived experiences of black men. As a black man and a physician, Simon has found “caring for Black boys and their families is one of the most rewarding and emotionally challenging endeavors I face” ~ Them and Me — The Care and Treatment of Black Boys in America (New England Journal of Medicine)
  • Arif H. Kamal, MD, MBA, MHS, and colleagues discuss the essential role palliative care can play when patients and their families face life-threatening conditions ~ The Role of Palliative Care During the COVID-19 Pandemic (Mayo Clinic Proceedings)
  • “With mounting death tolls, increasing case burdens, and public confusion, we face an enormous task,” write Moncef Slaoui, PhD, and colleagues, regarding the need to develop effective therapeutics against COVID while the nation waits for safe and effective vaccines ~ Bridging the Gap at Warp Speed — Delivering Options for Preventing and Treating Covid-19 (New England Journal of Medicine)

Fred N. Pelzman, MD, of Weill Cornell Internal Medicine Associates and weekly blogger for MedPage Today, follows what’s going on in the world of primary care medicine. Pelzman’s Picks is a compilation of links to blogs, articles, tweets, journal studies, opinion pieces, and news briefs related to primary care that caught his eye.

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What does spotting look like? Identification

Spotting is light bleeding that can occur between periods. Many factors may cause spotting, but it is usually not a cause for concern.

When people experience vaginal bleeding at times other than during normal menstruation, doctors refer to this as intermenstrual bleeding. Spotting tends to occur between periods and can happen at any age after puberty.

Spotting is a very light bleed from the vagina. It differs from the light bleeding at the start and end of a period.

Several conditions, infections, and medications can trigger spotting. Although most reasons for spotting are mild, some can be severe.

This article explores the potential causes of spotting, and looks at when a person should see a doctor.

People usually notice they are spotting if they see a small amount of blood on toilet paper after wiping. They may also observe a few drops of blood on their underwear.

If a person is spotting, the amount of blood loss is not enough to cover a panty liner or pad.

Several factors can cause spotting, such as:

Birth control

Some forms of birth control list spotting as a side effect, including

Spotting is most common in the first few months of using a new method of hormonal contraception. The bleeding will usually go away without intervention.


Spotting sometimes occurs during pregnancy. Around 25% of people experience some form of bleeding or spotting when they are pregnant.

During the first trimester, spotting can be due to:

  • implantation, when the fertilized egg attaches to the lining of the uterus
  • having sex
  • hormonal changes
  • cervix changes
  • genetic testing, such as amniocentesis or chorionic villus sampling

Heavy spotting during pregnancy may indicate pregnancy loss. Other symptoms of pregnancy loss may include:

  • abdominal cramping or pain
  • fluid, discharge, or tissue passing from the vagina
  • vaginal bleeding
  • back pain

Heavy spotting can also be a sign of an ectopic pregnancy. Doctors call a pregnancy ectopic when the fetus grows outside of the uterus, usually in the fallopian tube. A person with this condition needs immediate medical attention.

An ectopic pregnancy may cause:

  • vaginal bleeding
  • abdominal pain on one side
  • discomfort when passing urine or stool
  • shoulder pain

Spotting or bleeding later in pregnancy can be a sign of going into labor or a complication, and a person should seek medical advice. If the bleeding is heavy, they should go to the delivery hospital immediately.

Menopause and perimenopause

When people stop having periods, doctors refer to this as menopause. This tends to develop at 45–55 years of age.

The years leading up to menopause are known as perimenopause, which can last up to 10 years.

During perimenopause and menopause, hormonal changes can impact the menstrual cycle, resulting in spotting.

Sexually transmitted infections

Some sexually transmitted infections (STIs), including chlamydia and gonorrhea, can trigger vaginal bleeding between periods. STIs can easily spread between sexual partners and lead to severe complications.

Other symptoms of STIs include:

  • yellow vaginal discharge
  • painful or frequent urination
  • discharge from the rectum
  • rectal bleeding

People who

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