Tag Archives: Opinions

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #18: SKIN INFECTIONS

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.

–Dr. C.

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #12: “BENIGN PROSTATIC HYPERPLASIA” (BPH)

I have known about the Prostate gland, which surrounds the urethral channel exiting the bladder, since med school. I have seen evidence of its enlargement in the increasing time it takes older men to empty their bladders.

When my dad had his prostate surgery, he said that he could blast the porcelain right off the toilet, I could then appreciate for the first time that enlargement of the prostate caused a weak urinary stream.

When I started waking up at night 3 or 4 times to urinate, it really hit home. I had to get something done. My Urologist was a very good one, like all of my doctors. As the old saying goes, the best is none too good when it comes to your health.

On my first visit, he ordered a “Urodynamic” study. In this test, done by a visiting nurse who had the equipment, a small catheter, or tube, ws passed into my bladder, after loading myself with water until I could hold it no longer. The pressure in my bladder was measured, the speed with which I evacuated my bladder was measured, the volume of urine I passed was measured, as well as the volume retained in the bladder.

With these numbers, my bladder volume, residual, and the resistance to flow was calculated. I was shown to have a small bladder, too much residual retained after I emptied it, and an excessive resistance to the flow of urine out of the bladder.

I have not seen the urodynamic studies mentioned in the modern workup of BPH, and it may not have been critically necessary. I did appreciate his thoroughness, however, and factored in the study when he gave me the options of medicine vs. surgery.

were two medicines mentioned, an alpha adrenergic agonist, and finasteride, an anti-androgen. Since I would have to take both meds the rest of my life, I chose surgical enlargement of the urinary passage through the prostate, known technically as a “roto rooter job”. I, too, noticed the power of my urinary stream after the surgery.

A good friend of mine, also a physician, took medicines for many years, in spite of increasing trouble urinating, getting up at night, and frequent bathroom trips during the day. He eventually went to see a urologist after he had to go to the ER for completely being unable to pass urine.

The Urologist declined to do surgery on the basis of his health, the unusually large size of the blockage, and degree of obstruction. He used a catheter to relieve himself several times a day for the rest of his life. Had I been in his shoes, I would have tried to find a willing surgeon somewhere, perhaps at a university med school.

But then again, I wouldn’t have waited so long. These days many more options are available, and the appended article discusses some of them. –

–Dr. C.

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #10: “SWALLOWING TROUBLE”

I am defining SWALLOWING TROUBLE as the difficulty in transport of food to the stomach, once clear of the throat. Problems with the initiation of the swallowing process are discussed separately.

PAIN in the mid-chest ON SWALLOWING is a worrisome symptom which can be due to inflammation of the lining of the esophagus from a variety of causes. An esophageal yeast infection, which can also involve the throat (called ‘“thrush”), often warns of immune deficiency and can be a sign of AIDS, or be caused by immune suppressing medication. If persistent, pain on swallowing can be a warning sign of CANCER.

If in the presence of GERD, it can be a sign of chronic inflammation or ulceration. In-coordination of the normally smooth muscular propulsive wave can cause a cramping, muscular pain.

Normal “peristalsis” is so efficient, that food can be swallowed without the help of gravity, when UPSIDE DOWN. I wouldn’t recommend trying this, even to cure hiccoughs. There is a muscular “gate” at the bottom of the esophagus, just as it enters the stomach. This gate is often too relaxed, and allows for the reflux of acid and food from the stomach, or GERD. It can also Fail to open, called achalasia, and hold up the food in its journey to the stomach.

The area can be scarred by repeated acid reflux, and become NARROWED; this is called a STRICTURE, and can cause a blockage in swallowing. One of my Doctor friends had to go to the Emergency room when some Steak got stuck in the esophagus.

The ER Doctor removed the steak with a fiberoptic Scope, and then proceeded to DILATE the stricture with a “bougie”, an instrument of a precisely calibrated size designed to STRETCH the constricted area. This uncomfortable procedure had to be done repeatedly, a caution to those who would wait too long before getting such a problem evaluated and corrected.

EOSINOPHILIC ESOPHAGITIS has been diagnosed with increasing frequency, and can cause Pain in the middle of the chest, trouble swallowing, and even regurgitation of food. This special type of inflammation is more common in allergic patients, and can be caused by certain foods.

So as you can see, swallowing trouble, if persistent, is nothing to fool around with, and should be checked out by a competent doctor. Don’t wait too long.

–Dr. C..

DIETARY HEALTH: “SALT AND THE HUMAN CONDITION”

Salt, so important to human health and disease, is also prominent in HUMAN HISTORY. Civilization has required it from earliest times. Cereal grains, the ‘Staff of life” is relatively low in SODIUM CHLORIDE, salt, making it a desirable food additive.

PRESERVATION of food before refrigeration required salt. Natron (Natrium is latin for salt, and Na is its chemical symbol) was the Egyptian city known for its salt. Salary was an income supplement to Roman Legionnaires for purchase of salt.

Salt, gold and slaves were prominent in north African trade, and salt was often as valuable, ounce for ounce, as gold. “Below the salt” in medieval times meant the “cheap seats” in Feasts; only the “high table” had salt.

SEA WATER was about 0.9% salt at the dawn of Life, and that is presently the salt concentration in EXTRACELLULAR FLUID.

TASTE BUDS are happy with salty foods, and one set is specialized to pick up salty favors. The 4 others are sweet, sour, bitter and umami. As you can see, these taste buds were pro-evolutionary in our paleolithic ancestors.

The extra salt, sugar, and fats that taste so good in our present modern, excessive society are over-generously supplied by capitalistic producers intent on enhancing sales. Portions keep getting ever larger to encourage us to eat more.

Salt supports BLOOD PRESSURE, and sometimes ER Patients in shock are given saline infusions. More commonly, HYPERTENSION is treated by salt restriction, as illustrated in the accompanying Infographic.

POTASSIUM is the most common cation in the INTRACELLULAR FLUID, just as Sodium is most common in the Extracellular fluid. Our bodies fastidiously defend narrow concentration limits of Sodium, Potassium and other electrolytes which are important constituents of the famous Milieu interieur.

It is interesting that the Sodium-Potassium ATP Pump requires a large percentage of the ENERGY used to keep us alive. This pump also keeps our cell membranes POLARIZED, so important in NERVE TRANSMISSION.

So eat a lot of NATURAL FOODS, high in potassium, and avoid the catsup, sauces and condiments that riddle our high sodium, Fast food, modern diets.

–Dr. C.

PRESCRIPTION DRUGS: “ON MEDICATIONS IN GENERAL”

Several ideas apply to ALL MEDICINES. Terminology should be clarified. Medicine, Pharmaceutical, and Drug, in my mind are equivalent.

The term “drug” is pejorative, and I try to use it so. The term “Pharmaceutical” is too long, leaving me with “medication”.

There are some Practical points. You should look at your prescription when you first get it, to make sure it is the right one. Yes, pharmacists rarely make some mistakes. They are human.

You should ask the Pharmacist if she knows WHERE the drug was manufactured. Foreign countries, especially China and India, are less reliable, and the USA is safer. The original Brand Name drugs are more often domestically produced, but even these are being “offshored”.

Next, check the prescription date and expiration date.You should get a ” SHELF LIFE” (the difference between the two) of about 2 years, otherwise, you might ask the pharmacist the next time to give you the “best dating” in his stock.

Store your medications in a cool, dark, dry place in order to prolong their life. Light, heat and moisture degrade most compounds. Remember the O.J. Simpson case? Part of the reason he was acquitted is that a critical DNA sample was stored in a plastic bag, which retained moisture, rather than a paper bag, which is recommended because paper is porous, and allows moisture to escape.

You should follow the suggested TIME to take the medication, because there is almost always an optimal time to take a given medication.

CHRONOPHARMACOLOGY is an emerging field, which is finding that more than 50% of medications are TIME SENSITIVE in their effect in the body. This is an unimportant, academic consideration for most Patients, given the high THERAPEUTIC WINDOW (dosage latitude) of most medications, the mild illness of most patients, and the disinclination of most Doctors to add one more detail onto their already heavy load.

In discussing the medicines in my cabinet and a few other important ones, I will be addressing TIMING.

What about OUTDATED MEDICATIONS? As discussed by the following article from Harvard, the dating is not critical except for liquids, and a few others, like Tetracycline.

This is fortunate, given the expense of medications today. What if I drop a pill on the floor, at home. I usually pick it up and take it. if i just dropped it, unless it is very inexpensive.

What if a pill sticks in your throat, like happens to me a lot? I drink water first, to moisten my throat to make it slipperier.

Next, I take a good sip of water, try to swish it back and go back with my head to accelerate the pill backward, and think confidence. Certain sizes of pills are my nemesis and i have to break them in two.

Please follow Dr. Cs Medicine Cabinet in future postings of DWWR.

–Dr.C.

Further reading

OPINION: FACE MASKS AND SHIELDS TO PREVENT COVID

My main exercise for the day is a 45 minute fast walk around my community.

Hat – check. Sunglasses – check, FACE SHIELD – check.

Yes, face shield. The shield has the advantage of allowing me to talk, plus being more comfortable to wear. I clean it with a woolen cloth on one side and cotton on the other, hoping for a condenser electrostatic effect (I’m open to suggestion from engineers).

If I cough, any large particles of mucus would impact the shield, leaving only tiny aerosol particles to escape around the edges into the environment to endanger others.

It is Saturday today, and I pass a man and a woman pushing a baby buggy, and give them wide berth. I don’t consider 6-feet far enough distancing. 12-18 feet would be better, since, at 88-years of age, I am at least 2-3 times more susceptible.

A 12-year old zooms by me on a scooter. His age predicts less viral effluent, and the exposure time is less. I then go by a large collection of 20-year olds, Wide berth again, and, holding my breath, continuing to walk fast.

As I walk, I breathe air in through my nose, and out through my mouth. I feel the warmth (and purity) of the exhaled air, which may push aside and dilute any contaminants coming from the outside.

Another group of young adults! Well, maybe the risk is not as bad as the numbers would indicate. Odds are there would be only one spreader in the group, and the healthy ones would act as particle filters for me.

So far, not a single young person had a mask on. They are probably just thoughtless young people, and not necessarily “objectors” believing that mask-wearing is a sign of submission. As Peggy Noonan said in her column in today’s WSJ:

“…IT’S A SIGN OF RESPECT, RESPONSIBILTY AND ECONOMIC ENCOURAGEMENT”.

Going forward, we must all do our part to reduce the likelihood of another Covid surge. WEARING A MASK PROTECTS OTHERS.

I finally spied 2 masks! They were fitted on 2 ceramic lions flanking a front door. It is true that felines can catch Covid. But ceramic ones?

I thought I was walking fast, but was overtaken from the rear by a long-legged young lady. She passed within 4 feet of me, and of course had no mask on. I only hope she didn’t have Covid, and that my shield worked.

On the subject of the effectiveness of wearing a shield, while walking I tune into the odors along the way. I use the odors as surrogate aerosols, especially a recently fertilized curbside flower bed, I compare walking by the flowers, with and without my face shield, and find that the shield reduces but does not eliminate the odor. For more distant odors, like a barbecue, it does not make a difference.

Perhaps the shield, like the prow of a ship, pushes aside STREAMS of particle-laden air. Like coughing or talking nearby. But if the particles (yes, odors are nanometer particles) are well mixed with the air, there is no effect. Air must be breathed, after all.

There are a couple of other things I practice on my walk. I exercise my EYES by looking into the DISTANCE as much as possible. I try to walk as erect as I can. Gravity, my friend in grounding many big Covid-containing mucus particles, tries to bend me over.

The BOTTOM LINE, until more information is available), is: SPREADERS WEAR MASKS, SUSCEPTIBLES  WEAR SHIELDS. Of course, hand-washing, social-distancing, coughing into your elbow, and staying at home, especially if sick, are all still important admonitions.,

-Dr. C.

For further reading