DR. C’S JOURNAL: VITILIGO

Vitiligo is the loss of skin color in patches. Most often it is widespread. It tends to occur on the hands, or around the mouth, and can start where there are irritations or injuries to the skin, such as with tattoos. This generalized Vitteligo begins in middle age, but a more localized, or segmental Vitelligo can start earlier, and affect one area or side of the body.

Well-tanned skin, and skin with a darker color make the vitiligo stand out more prominently and give more trouble.

When I was a kid, I had a sort of reverse vitiligo, namely freckles. With freckles, the pigment gathers into small spotty areas, and leaves the rest of the skin without sunburn protection. I can attest to the fact that ANY kind of skin difference will lead to social problems; the main suffering  with vitiligo is social.

Vitiligo is considered an autoimmune condition, and carries with it an increased likelihood of other autoimmune conditions, primarily thyroid and other endocrine.

Mimicking vitelligo, skin pigment can also disappear in areas of irritation or surface infection, such as in tinea versacolor and pityriasis alba. There is often a “halo” around a pigmented negus.

There are various treatments which aim to lighten up the surrounding skin area, or Increase pigmentation of the affected area. Such techniques use ultraviolet light, in combination with various various creams and medicines. Even surgery is sometimes used, so great it is the suffering of affected individuals.

Please refer to the accompanying article for more information.

—Dr. C.

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THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #60: ITCHY EARS

Itchy ears; even if from trivial causes, they demand attention. Swimmer’s ear is a subset of itchy ears, which can lead to some severe infections and sleepless nights. Water remaining in the ears dissolves the natural, protective earwax, and provides a nice warm bath for some nasty bugs like Pseudomonas aeruginosa. Swimmers ear is the result, and the best strategy is to prevent it by keeping  the water out.

After swimming, I often twist some Kleenex and insert it into  my ear canal to “wick out” the water. Some people use a 70% Isopropyl alcohol solution to rinse out the water. Don’t use the 99% isopropyl alcohol; it’ll burn like crazy and for some reason is not as effective an antibacterial. If the itchy ear starts to become painful, and the pain is made worse by pulling on the earlobe, the best strategy is to call the doctor.

Hearing aids comprise a special problem. Earwax can damage the mechanism of the hearing aid, and the hearing aid can cause an irritation that produces itching. Be sure to ask the audiologist about how to prevent problems.

I wear earplugs to deliver sound to my ears when I swim. The ear plugs can cause irritation or even an allergic reaction. I believe this is one of the reasons my ears itch most of the time. My ENT physician suggested that I put a little baby oil in my ear, which I am continuing to do.

Accumulations of earwax can also cause itching. Most of the time I remove the wax myself with an over-the-counter kit containing an ear syringe and glyceryl peroxide. About every third time I need wax removed from my ear, I go to the ENT doctors  to be sure I don’t have some sort of fungal infection or other chronic condition.

If you swab your ear with a Q-tip, you risk pushing the wax deeper into the canal, and create a problem. Nonetheless, I still occasionally put a little bit of 1% hydrocortisone cream if the itching gets extreme. My doctor said that this accelerates the build up of debris and the need for irrigating the canal.

The old adage that you shouldn’t put anything into your ear smaller than your elbow is a good interdict to embrace. Digging out the wax with some sort of instrument risks damaging the canal or hurting your eardrum.

For more information, please look at the following posts.

—Dr. C.

Mayo Clinic Article

Healthy Hearing Article

MEDICINE: HOW TO TREAT CORONARY HEART DISEASE

More than 360,000 people died from coronary artery disease in 2019. While there is no cure to the disease, you can take steps to lower your risk and manage the harmful plaque build-up impacting your health. The information in this video was accurate as of 11.25.2021 and is for information purposes only. Consult your local medical authority or your healthcare practitioner for advice.

Chapters: 0:00 Intro 0:12 What is coronary artery disease? 0:26 What are the signs of coronary artery disease? 0:41 Can you reverse coronary artery disease? 1:04 What are statins? 1:34 What are the treatments for coronary artery disease? 1:46 Make lifestyle changes to reduce your risk. 2:07 Taking medication can help treat coronary artery disease. 2:25 What is a coronary stent procedure? 3:03 What is coronary artery bypass graft surgery? 3:36 What’s the best treatment for coronary artery disease? 3:45 When should you talk to your doctor about coronary artery disease symptoms?

Prevention: Side Effects Of Excessive Earwax

Health: Consequences Of Too Little Sleep (Harvard)

Medicine: Symptoms & Signs Of Lung Cancer

Covid-19: The Unwanted Thanksgiving Day Guest

The risk of Covid starts with the level of infection in your community. If high or rising,of course, you have to be more careful. If low or dropping, you can be less worried. The whole adventure revolves around your personal tolerance for risk.

If you are healthy, young and fully immunized, especially with a booster, you can take more risk. If you have actually had test-positive  Covid, that counts as one injection.

Remember that your immunity begins to wane after 3 to 6 months.
If you have an immune deficiency, such as age more than 60, obesity, or a variety of immune associated illnesses, you should be more careful.

If you have decided to go to one or more holiday venues, you might consider reducing your exposure for a week before, or possibly take a rapid test the day before you go, as a courtesy to the other guests. At the party, you can choose to be as close to a window, or fan, as possible, or prefer those groups who are outside. Wearing a mask might also be helpful, and at least will tell the other guess that you are worried.

The catch 22 is that if you are really worried you might consider not attending the gathering. Distancing to more than six or 9 feet is still a good idea, but makes you seem like a Grinch, and is difficult at a party. Do remember that the greater the density of people the greater your risk. If you are a host, especially in an area where Covid is rampant, your guests should be vaccinated. You might consider asking your guests to get a rapid test the day before they come. 

If you have children who are unvaccinated, you might ask them to wear a mask, and keep their distance from the guests. You could open the window a crack to improve the ventilation in the room, and hold as much as possible of the gathering outside your house. You could ask the guests to wear masks when they are not eating. The N-95, KN-95, and KF-94 masks are all excellent, and will protect the people who wear them to some degree, and be very protective against their spreading the Covid virus.

After the gathering, especially if good protocol has not been followed, you might be alert to the possibility of an infection within a week to 10 days following the party. If you develop symptoms, a prompt rapid test is advisable. If positive, you can check with your doctor about the possibility of IVIG, or other medications. If negative, and the symptoms persist, the test should be repeated, since they are not 100% reliable.

There are a couple of oral  tablets that are on the verge of being approved. You might ask your doctor about fluvoxamine, an already approved medication.

Immunization is not a ironclad guarantee against getting the infection, or spreading it. Unfortunately, Covid is still lurking in the background, and gatherings for the holidays should be evaluated on a risk-reward basis.

For an interesting discussion of this topic, I would recommend the Sunday, November 21, 2021 edition of the New York Times, where three knowledgeable people discuss individual situations.

—Dr. C