Tag Archives: Cortisone

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #51: PSORIASIS (SKIN DISEASE)

Psoriasis is a common skin disease, thought to be in the auto immune category. One of the main elements supporting auto immunity is it’s frequent association with an arthritis, which can be severe.

Eczema (atopic dermatitis) is both a skin and an allergic disease, and looks a bit like psoriasis. In my practice I saw many patients with psoriasis, perhaps people confusing allergy and dermatology.

Both psoriasis and eczema have a red inflamed base, with many little silvery scales of skin on top. These patchy areas tend to be on the outside bends of the elbows and knees in psoriasis, contrasting with eczema, where the dermatitis is located on the inside of the bends. Eczema is a lot more itchy.

The cause of the skin lesions in psoriasis is thought to be due to an interleukin called TNF, which calls to the area a number of inflammatory cells which, in addition to the thickened skin area and excess of epithelial cells, leads to a characteristic appearance under the microscope; biopsies are uncommonly needed when there is doubt about the diagnosis.

In its severe form, psoriasis can be very disfiguring, irritating, painful or itchy, and life altering. You have probably seen advertisements on TV.
Psoriasis has accumulated many different treatments, since it has been recognized and treated over such a long period of time. The basis of many effective treatments is “shotgun” systemic  immunosuppression, which reduces the autoimmune inflammatory reaction, but with side effects.

Topical Cortisone cream is the cheapest reasonably effective treatment, and works for mild cases. More recent treatments are specifically aimed out the interleukins which cause the disease, like TNF.

Please refer to the mayo clinic article for more pictures, and discussion of treatment.

—Dr. C.

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DR. C’S JOURNAL: WHAT IS PNEUMOCYSTIS PNEUMONIA?

Pneumocystis is found in the respiratory tract of most mammals and Man. Pneumonia from this organism was extremely rare or unknown before the advent of AIDS.

When the lymphocyte count of a person with AIDS drops below 500, or especially 200, pneumocystis pneumonia is a frequent complication. Symptoms include cough, fever, rapid breathing, and shortness of breath.. The chest x-ray typically shows a “ground glass” appearance, caused by fluid inside the air sacs and throughout the lung. Treatment is usually with trimethoprim sulfa.

Immunosuppressive therapy is often given for organ transplants and auto immune diseases these days. Patients and doctors should be on the lookout for pneumocystis symptoms in this situation. Even long-term corticosteroids can produce enough immunosuppression to allow pneumocystis to invade the body.

Pneumocystis Jeroveci is the causative organism, and used to be called pneumocystis Carini. Doctors suspect this disease when an immuno-suppressed patient, especially AIDS , has a dry cough, with pneumonia and  a very low oxygen concentration, more severe than expected.  Fluid taken from the lung shows several  organisms in little sacks or cysts.

Treatment is with sulfonamids, if they are tolerated. Cortisone must be given not the same time to prevent a severe reaction from absorption of the dead organisms. Pneumocystis is a yeast-like fungus and is also discussed under opportunistic fungal infections.

The following article will give you more information.

—Dr. C.

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DR. C’S JOURNAL: CAUSES & SYMTPOMS OF INSOMNIA

Sleep has many functions, among which are clearing the body of toxins and consolidating memory. The exact amount we need is determined by age, and genetics among another things. From what I’ve read, eight hours is required, plus or minus an hour.

That being said, there are a few  among us who are super sleepers. Going back in history this probably included Mozart and Thomas Edison: They could live healthy, productive lives with as few as three or four hours of sleep. Genetic mutations, including changes to the Orexin Gene receptor account for true super-sleepers.

Familial fatal insomnia is a genetic disease operating through prion proteins, and does not illuminate the problem of insomnia. In most people  there are two major forces which determine the onset of sleep, the circadian rhythm, and sleep pressure.

The TIMING of the sleep varies from morning larks to night owls. These shifts in the circadian rhythm is also genetic, involving many genes, including PER and CRY. Diurnal rhythm can apparently be changed, But with difficulty.

The sleep pressure is caused by the gradual daily accumulation of adenosine in the system, apparently resulting from the stripping away of the phosphate groups from the energy currency, ATP.  This can be assuaged by caffeine containing drinks, such as tea or coffee. Caffeine temporally blocks the effect of adenosine, but when it wears off, you usually go right back to your fatigue state.

INSOMNIA occurs when you do not get as much sleep as you need, and are tired in the daytime. This is a major problem for a lot of people.

Insomnia has many causes. Stress will cause an increase in Cortisone in the bloodstream which interferes with sleep. Caffeinated drinks nicotine and other stimulants can cause you to have difficulty falling asleep, and alcohol will help you fall asleep but will often result in awakening in the middle of the night when the alcohol is metabolized.

Depression, Parkinson’s, chronic pain, gastroesophageal reflux and any other medical conditions can interfere with sleep. Sleep apnea, often associated with overweight and heavy snoring, is a special problem that sometimes needs the help of a sleep specialist.

Some poor habits such as reading in bed, doing work in bed, eating at bedtime, and heavy exercise just before bed can also be a problem.
A regular routine of Preparing for sleep, such as brushing and flossing and taking a warm shower are also helpful; you can get more details by looking up “sleep hygiene”.

A lot of people take a nap, but this can cause some difficulty in going to sleep. Among things you can do to prevent insomnia include living an active life, making your bedroom comfortable for sleep, and using your bedroom ONLY for sex and sleep.

Please refer to the accompanying Mayo clinic article for more organized information.

—Dr. C.

Mayo Clinic articlehttps://www.mayoclinic.org/diseases-conditions/insomnia/symptoms-causes/syc-20355167


DR. C’S JOURNAL: YEASTS – CANDIDA ALBICANS

Candida albicans is a ubiquitous yeast that has evolved the ability to stick to mucocutaneous linings, e.g. mucous membranes and  skin. When present  in the mouth it is called thrush, and on the skin intertrigo, or diaper rash among other names.

Almost everybody is infested by candida in low amounts, as indicated by the common incidence of a whitish membrane (thrush)  in the mouth of people who regularly use inhaled corticosteroids for asthma. The Cortisone lowers the resistance, enabling the fungus to grow more profusely. The use of broad-spectrum antibiotics also facilitates the growth of Canada by killing off the competition.

Diabetes is a risk factor that commonly increases difficulties that people have in controlling candida growth in their oral and genital areas. Certainly anything that affects the immune system such as very young or very old age, viral infections especially AIDS, organ transplants, and chemotherapy will increase the incidence of Canada.

Due to it’s widespread presence in the body, Candida albicans is the fourth most common cause of bloodstream infections among hospitalized patients, where it grows on indwelling catheters and other in certain devices, which act as avenues for the yeast to invade the bloodstream.

Candida Auris  is a member of the same genus, Candida,that has developed some gain of function mutations to allow it to infect the body much more readily. It is very hard to get rid of, and at least one emergency room has been shut down because of a Candida Auris infestation. Another little trick that  it has evolved is resistance to most antifungal agents; The mortality rate of systemically infected people is very high.

The combination of greater infectivity and resistance to treatment makes it formidable indeed, but still it is mainly a problem for immuno suppressed individuals. C. Auris is not  as widespread as Candida albicans, and the number of cases is currently nowhere near as great. But if you get it, watch out!

As with so many other problems, it is better not see them. In other words, stay healthy with sleep, diet and exercise.

–Dr. C

Fungal Infections In The Lungs: Aspergillus

The genius aspergillus is a Fungus extremely common throughout the world. It is in the air almost everywhere, and it’s estimated that most people breathe hundreds of Aspergillus spores into their lungs daily. It affects almost exclusively people with compromised immune systems or with underlying respiratory illness.

COMPROMISED IMMUNITY is often present in people with diabetes, obesity and malnutrition, The very young and very old, Viral infections, particularly AIDS and Covid, cancer, autoimmune diseases, organ transplants, and the list goes on. With the advances in medicine in the past few decades, people are being kept alive longer, often by suppressing their own immunity.

UNDERLYING REPIRATORY ILLNESS is disease such as asthma, cystic fibrosis, sarcoidosis, tuberculosis and COPD.

When I was in an allergy practice, we were always on the alert for allergic bronchopulmonary aspergillosis in asthmatics who were difficult to control. ABPA at that time was reported mainly in England, which is unsurprising due to the wet British climate: fungi grow especially well where is wet.

Another unusual phenomenon is the Aspergillus fungus ball in the lungs, which is sometimes discovered only by chest x-ray. That such a dense mass of fungi could be tolerated in the lungs without invading the body is a tribute to the immune system‘s efficacy.

Galactomannan is in the cell wall of aspergillus, and can be used as a diagnostic test. PCR can also be used, shades of COVID-19. Of course x-ray, or microscopic study of tissues are also often used.

It is  estimated that aspergillosis accounts for around 600,000 deaths annually. Africa, with its large number of AIDS patients, contributes heavily to this. It’s difficult to know how common it is in the United States, because aspergillus is not a reportable illness. Please check with the following mayo clinic article for more information.

–Dr. C

Mayo Clinic article