DR. C REVIEWS MAJOR HEALTH AND TELEMEDICAL NEWS FOR THE WEEK ENDING OCTOBER 18, 2020.
The skin is the protective barrier between the inside of our bodies and the outside world of microorganisms, parasites and toxins. It is often the site of inflammation and infections.
In past times, before the advent of cleanliness and antibiotics, mankind was plagued by erysipelas, boils, carbuncles, and other severe infections of the skin, which are rarely seen now. The beta hemolytic streptococcus and Staphylococcus aureus were ubiquitous in the past, and mostly are contained today.
Severe Infections presently require some skin abnormality, immune deficiency, neglect, animal bite or other breach of skin integrity to be a problem. Antibiotic resistance, however, is allowing some organisms like MERSA to make a comeback.
ECZEMA. or Atopic Dermatitis, was common in my medical practice. This condition weakens the skin barrier, allowing Staphylococcal infection to gain a foothold. In my day, If there were a flare of eczema severity, antibiotics would often help. Leg edema and swelling. such as from heart failure, especially coupled with diabetes and blood vessel disease is also an invitation to infection, such as cellulitis.
Redness, swelling, warmth and pain- the classic rubor, tumor, calor and dolor- as well as swollen local lymph nodes and fever often betray infection of the skin. Please see the recently posted infographic on celulitis.
IMMUNE DEFICIENCY raises the likelihood and risk of severe skin infections. Infection from “flesh-eating bacteria”, often beta hemolytic streptococci in deep tissue planes , is a medical emergency. Immediate surgery is often needed.
Disproportionate PAIN after injury or surgery is often a clue. Certain age groups have characteristic skin infections, such as the scalded skin syndrome of infants, and the acne of adolescents. Viruses, molds, and arthropods can also infect the skin.
Viruses, such as herpes in particular can simulate bacterial infection. Ringworm from fungi is easy to distinguish, but arthropod bites, and especially bee sting can look very much like bacterial infection. Scabies and mite infestation are so itchy as to be distinct.
Topical antibiotics applied on skin breaks like cuts or breaks are useful in preventing infection. These ointments and creams are like “artificial skin”. Once again, prevention is key.
Red hair and freckles are associated with MCR-1 gene variants, and large areas of skin with lowered melanin protection against the adverse effects of the sun. I have red hair and freckles, for which I was teased. My response was that I had a lot of Iron in my blood, and that the freckles were Rust. This is ironic (no pun intended).
Since becoming an Octogenarian, I have had trouble keeping my Iron levels normal. I live in a beach area, where all the young ladies are sunning themselves to promote the socially desirable “bronze goddess” effect, and all of the older ladies hide their leathery skin and wear broad-brimmed hats.
The sun has a good reputation as a health-giver. Being outside does correlate with a lot of beneficial effects, such as enhancing production of Vitamin D. My recommendation, however biased, is to get your Vitamin D in capsule form, and reduce sun exposure.
SUNSHINE, however salutary, is accompanied by invisible, high energy photons capable of breaking DNA strands, and ultimately causing SKIN CANCER. Not accidentally,Visible light has insufficient energy to break bonds, although the rhodopsin in rods and cones do release electrons if stimulated by light.
Actinic Keratoses are the roughened plaques of skin, often on the face, which have a small but definite risk of turning into Cancer. I have a dermatology check every 6 months for precancerous areas to be frozen and destroyed by CO2 spray.
PREVENTION of UV Skin damage is advisable. I wear a broad brimmed hat and UV-blocking sunglasses (UV can promote cataracts and retinal damage as well) when outside in the sun. When swimming I wear a “rashguard” shirt with UV protection in the fabric.
Also, I try to limit my exposure to the Evening and Morning sun, because the light is warmer, and contains less UV. Even with these precautions, I use Sunscreen creams and lotions. I always wondered how a transparent lotion can block UV light.
The explanation lies in the chemicals contained. Such chemicals as Avobenzone and Homosalicylate actually absorb the energy of UV light. Protect yourself now for later health.
DR. C REVIEWS MAJOR HEALTH AND TELEMEDICAL NEWS FOR THE WEEK ENDING OCTOBER 4, 2020.
The adaptive immune system is the “big gun”, later evolved, big brother of the innate immune system. The innate immune system acts a little like prejudice does in society. There is INSTANT RECOGNITION of a salient characteristic of many common disease-producing organisms, that are not present in the person being infected.
For instance, ENDOTOXIN is a lipopolysaccharide present in many bacteria, and is immediately recognized by Toll-like Receptors (TLR-4) on dendritic cells and macrophages. This triggers the Natural Killer (NK) cells to destroy the invader. The problem is that the innate immune system is indiscriminate, reacting against whole classes of molecules like a shotgun, and may produce unwanted damage. It also fails to recognize many genuine threats.
The ADAPTIVE immune system is more complex, discriminant, and SPECIFIC, but is SLOWER to gear up, and takes several days to be effective. Once engaged, however, it has a MEMORY for the infection that is SPECIFIC to the organism involved. This memory makes a SECOND EXPOSURE response much more rapid and comprehensive, AMPLIFIED as it is BY ANTIBODIES.
This first experience can be PROPHYLACTICALLY accomplished by VACCINES, so that the second, real exposure generates a RAPID PROTECTIVE RESPONSE. ATTENUATED vaccines are weakened, but LIVING ORGANISMS, and usually provide a more DURABLE immunity, but because they are living, they are more worrisome.
SPLIT-PRODUCT Vaccines are safer, but expose the immune system to a narrower range of pathogen markers, and may therefore be less Protective.. The FDA is very dedicated to SAFETY. Like all Bureaucracies, it is relatively independent of Political pressure, of which I am increasingly appreciative.
When the COVID-19 VACCINE, for example, is released to the general public, it WILL BE SAFE. The vaccine-deniers are mis-informed people who should not, in my opinion, be allowed to interfere with the HERD IMMUNITY that comes with having a supermajority of the population vaccinated.
— Dr. C.
DR. C REVIEWS MAJOR HEALTH AND TELEMEDICAL NEWS FOR THE WEEK ENDING SEPTEMBER 27, 2020.
Bad breath is a big social deal, and is unpleasant to be around. You are always conflicted when near a person with Halitosis; you are tempted to tell him for his own good, but are embarrassed to do so.
“Mask Breath” is the most recent reincarnation of bad breath. Supposedly the mask itself does not have an odor, but merely makes the person aware of the bad breath he has had all along. Bad breath is not only a direct problem for the person who has it, but often betrays important medical conditions which need attention.
Several oral conditions can cause halitosis. The most common is poor oral hygiene. Lack of regular brushing and flossing leads to accumulation of food particles between the teeth, in the gum lines, and even under crowns. This food provides lunch for the oral bacteria, releasing malodorous compounds. This can be expensive. Have you priced restorations and implants recently?
The sneakier result of poor oral hygiene is gingivitis, or gum disease. This leads to inflammation, and is a major contributor to the inflammatory load resulting in Metabolic syndrome with its widespread effects on the brain, kidneys, and heart. And in addition, you may eventually lose your teeth. Tonsils can become inflamed and malodorous, and the associated adenoids may enlarge, leading to mouth breathing, dry mouth, and you guessed it, Bad Breath.
GERD is often associated with Bad Breath. The reflux of stomach contents will often leave behind a bad taste as well as bad breath. Certain metabolic conditions can give bad breath. Ketosis from diabetes, mousy breath from liver failure, and the “Fish odor syndrome”, Trimethylaminuria, can be causes.
So drink lots of water, and don’t forget to brush your teeth and floss regularly. You might benefit from a medical or dental evaluation if your bad breath doesn’t go away.
Nosebleeds afflict almost everybody at one time or another. The nose is well supplied with blood vessels, and sticks out from the face, often into other people’s business. Fistfights and falls will often cause nosebleeds in children. Kids will often pick their noses.
Dry air and allergies make the nose bleed more often. Sometimes, nosebleeds just happen. The bleeding usually comes from the front of the septum, the cartilaginous divider of the nose, and the best way to stop the bleeding is to lean forward and pinch the nostrils together.
This most likely compresses the bleeding area, and if held for 5 minutes or so will usually stop the bleeding. Sometimes, even after repeating this several times, and even putting ice on the bridge of the nose, the bleeding won’t stop, you may need to seek help. If the bleeding is voluminous it may originate from larger vessels at the back of the nose, and an ENT Doctor may be needed to put in a “posterior pack” of gauze.
Infrequent nosebleeds from identifiable causes are not too disturbing, but if they become CHRONIC and unexplained, a visit to the doctor and further investigation may be needed.
High blood pressure can be a cause of regular nosebleeds. High altitudes and the accompanying dry air can be a contributory cause. Cocaine use may irritate the nose and cause “Kiesselbach’s plexus” on the anterior nasal septum to bleed.
If you bleed a lot from your nose, especially if you have trouble with clotting from cuts or periods, you may have a coagulation problem, of which there are several, such as Von Willebrands disease.
Blood thinners are commonly used these days, and the dosage may need adjusting. For more information, please consult the accompanying article on “epistaxis” by the Cleveland Clinic, which usually has good articles on medical problems.
DR. C REVIEWS MAJOR HEALTH AND TELEMEDICAL NEWS FOR THE WEEK ENDING SEPTEMBER 20, 2020.
ABDOMINAL (VISCERAL) FAT KILLS. The following post tells you how, and suggests what you might do to prevent this scourge, which is gradually becoming an epidemic in America.
OBESITY is an energy imbalance problem. MORE CALORIES ARE CONSUMED THAN ARE NEEDED AND CAN BE UTILIZED. A Good quality Diet, with lots of natural (rather than processed) foods, especially vegetables and fruits, have lots of FIBER that takes up space and makes you feel full.
Fiber also feeds the MICROBIOME. If the foods are DIVERSE, the microbiome will also be diverse and help utilize the calories you eat. A healthy Microbiome also contributes to your health by manufacturing neurotransmitters, vitamins, and other factors that are just starting to be appreciated. Diet QUALITY, as well as quantity, is important.
EXERCISE is critical for more than utilizing calories. It increases ADIPONECTIN which guides fat to fat stores where they belong, rather than to the liver, and IRISIN which favors the production of BROWN FAT, thus utilizing energy. The opposite of exercise, the SEDENTARY LIFESTYLE, is now considered a disease system in itself.
Lack of SLEEP favors obesity in a number of ways; at the very least, you can’t eat while asleep. Abdominal fat contains INFLAMMATORY cells which go directly to the Liver via the hepatic portal system to cause metabolic disruption. Insulin sensitivity falls, blood sugar, LDL and triglycerides rise. DIABETES and the METABOLIC SYNDROME result.
The excessive weight also causes back, hip and knee problems which contribute to the 10% increase in overall medical costs due to Obesity.
We have no photographs, abdominal, navel-level girth measurements, CTs, BMIs or death certificates to prove it, but it is highly unlikely that Paleolithic Humans suffered from excessive abdominal fat. They had no refrigerators, deliciously packaged snacks, sugary, fructose-containing soft drinks and candy, nor did they have cave-lighting to extend their daylight eating hours and disrupt their diurnal rhythm.
They had to walk or run long distances to obtain their meagre food supplies, which tired them out so that they most likely had a good night’s sleep. SLEEP, DIET and EXERCISE are built into our Metabolism by Darwinian Evolution. Paleolithic humans didn’t live long lives and succumb to cancer and heart disease.
They died most often by violence, which made Blood clotting a survival benefit, rather than the Risk factor for stroke and heart attacks that coagulation is to us now. It is not all our fault that OBESITY is steadily increasing over the last few decades.
CAPITALISM is driven to provide us with ever increasingly available and tasty food. Both consumers and purveyors scream when even the most logical political check on OVEREATING is legislated: Taxing of sugary, fructose-containing, nutritionless soft drinks was tried in Philadelphia to a chorus of complaints. To my knowledge the tax has survived, reduced sugary drink consumption, and was helpful in reducing the weight of Philadelphia residents. Not many cities were brave enough to follow suit.
GENETIC Influences can also conspire against weight control. The FTO gene, while relatively infrequent does have an influence, as shown in twin studies. And there seems to be a SET POINT in weight that makes it difficult to take off the pounds and keep them off. 2 years after almost all diets, the weight has returned. Eating HABITS, once established are hard to change.
BARIATRIC SURGERY has been shown to help Obesity, as well as Metabolic syndrome and Diabetes .I hope it will survive the test of time. Weight gain is easier to PREVENT than it is to treat. Somehow, society must get to the children, and keep them from gaining weight in the first place. Even children are now becoming obese.
INTERMITTENT FASTING can help contain Obesity. My own version is TIME-RESTRICTED EATING. I limit my eating to 6 hours a day, from Noon (usually 1PM) until 6PM. This has resulted in a modest weight loss from 142 pounds to 137 pounds. My son lost some 30 pounds in a 30 day, 1000 calorie “crash” diet to fend off advised Back Surgery. He exercised a lot of SELF CONTROL both to lose the weight, and to keep it off.
Unfortunately, Self Control is in short supply in our present SOCIETY OF EXCESS. Good luck in your quest, if you choose to embark on weight reduction. And good luck with your health if you don’t. I recommend “the secret life of fat” by Sylvia Tara in either case. Also, search for intermittent fasting in DWWR.