Tag Archives: The Doctors 101 Chronic Symptoms & Conditions

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 #17: ACTINIC KERATOSES

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.

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #16: BAD BREATH (HALITOSIS)

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.

–Dr. C.

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #15: NOSEBLEEDS (EPISTAXIS)

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.

Read more

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #14: VISCERAL (BELLY) FAT

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.

–Dr. C.

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #13: TRIGEMINAL NEURALGIA

My Mother had Tic Douloureux, the traditional name for Trigeminal Neuralgia. I remember her suddenly covering her face with her hand and grimacing, but this was only occasionally.

Compression, degeneration or inflammation of the 5th cranial nerve may result in a condition called trigeminal neuralgia or tic douloureux. This condition is characterized by recurring episodes of intense stabbing , sever, excoriating pain radiating from the angle of the jaw along one or more branches of the trigeminal nerve on one side. Usually involves maxillary & mandibular branches, rarely in the ophthalmic division. Usually above 50 years and more in females. Can result from a redundant loop of superior cerebellar artery. Surgery is the treatment of choice.

TD is not very common for “101 chronic conditions”, but it is the most common cause of chronic facial pain. It occurs in the FACIAL region supplied by the 5th cranial, or TRIGEMINAL nerve. This is about the area covered by your widely spread hand, pinkie on the nose, and the butt of the palm along the jawbone.

Brief shocking pain occurs in “PAROXYSMS” in the facial area, on ONE SIDE, and TRIGGERED by tooth brushing, touching the face, or even by the blowing of the wind. This description is so typical and specific as to be “pathognomonic”, and can be diagnosed over the telephone.

Variants can give continuous pain, or occur on both sides, but the “classical” variety is most common. You should contact your Doctor, since some cases are caused by Multiple Sclerosis or a tumor. Effective medications are available, such as carbamazepine.

TD can be familial, but is often caused by compression of a nearby artery, and “decompression” is currently the most effective surgical treatment. It is one of the few “chronic 101” conditions not to be substantially prevented or helped by our old standbys, sleep, diet and exercise.

That being said, it is sometimes helped by exercise, and almost never occurs during sleep. The August 20, 2020 New England Journal of Medicine Has an excellent Review article, which will be appended to this posting.

–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 #11: “Prostate cancer”

Prostate cancer is perhaps the most common cancer in men. It increases in incidence with age, and if you live long enough, most men will contract prostate cancer. A family history of cancer and obesity are also risk factors. But many times the cancer is so slow growing that it will not kill you. In the age of modern, aggressive medicine, the treatment has often been worse than the disease.

Treating Cancer EARLY is much more successful. The PSA test was one of the first really sensitive blood tests for cancer, and it was once performed routinely, on a yearly basis, usually at the time of your annual physical.

The PSA (Prostate-Specific Antigen) test is VERY sensitive,however. In responding to an elevated PSA, very slow growing tumors would often be treated aggressively, creating more morbidity than the untreated tumor would have caused.

The treatment seemed to be worse than the disease. Many physicians stopped doing the PSA test altogether, relying on symptoms, or detecting an abnormality on RECTAL EXAM to trigger an investigation. Some years ago, a physician friend of mine elected to stop PSA testing, and two years later was discovered to have METASTATIC Prostate cancer. It had already spread to his bones, and he eventually died of that cancer.

This encouraged me to continue with PSA screening, though it is still considered optional. Very recently, a test has been developed which I think tips the scales back toward annual PSA testing. EXOSOMES are little (10-120 nm.) particles that effuse from many cells, especially cancer cells.

They contain a variety of DNA, RNA, proteins and lipids which allow the cells to communicate with one another. Recently, a company, ExoDx, was created to take commercial advantage of Exosomes in the diagnosis of various diseases, by testing body fluids.

Their test, ExoRx Prostate EPI test of urine, has been shown to be helpful in distinguishing AGGRESSIVE prostate cancer from the slower growing kind, when the PSA test is in the “grey zone” between 2 and 10 ng/ml. PSA test results above 10 ng. were always acted on, especially if the numbers were increasing. I would be surprised if the PSA did not reenter the annual testing protocol.

The annual digital rectal exam in men older than 50 years will continue to be done, although it is not very sensitive, and is often not abnormal until the cancer is more advanced. Pain in the prostate area, blood in the urine or semen, and trouble urinating are symptoms worth investigating, but if cancer is detected, it may well be advanced and harder to treat. With abnormal tests,

Risk factors or suspicious symptoms, further testing is often done. Ultrasound or biopsy may be indicated. Sometimes the biopsy is guided by MRI, to increase the likelihood that the cancer, if small, is included in the tissue sample taken. Examining the cells of the biopsy sample will yield a “gleason score” which grades the aggressiveness of the cancer.

This in turn dictates the treatment, which may include different extents of surgical removal, radiation, hormonal or chemotherapy treatment. None of this is pleasant, and you are better off, of course with prevention.

Our old friends, DIET AND EXERCISE are thought to be helpful. Although not proven, eating lots of fruits and vegetables, and maintaining a healthy weight are recommended.

–DR. C

Finasteride, one of the drugs in my medicine cabinet is mentioned as a possible aid. I will be discussing this later. I suggest that you press the green box with the magnifying glass, and type the name of the drug to see if i have discussed it. –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..

THE DOCTORS 101 CHRONIC SYMPTOMS & CONDITIONS #9: “MACULAR DEGENERATION”

Macular Degeneration is the most common cause of blindness in the western world.as you get older, it becomes increasingly common, and almost 20% of people older than 85 years have this disease.

It comes in 2 types, dry and wet. Mostly it starts as the milder dry type, which develops slowly and has no definite treatment. The dry type can develop into the more rapidly progressive wet variety, however, and is important to notice and report to your ophthalmologist.

The MACULA is the center of the visual field, and has by far the most photoreceptors. It yields the sharpest vision, and is essential for reading, and even recognizing faces.

LOSS OF VISION is the commonest symptom, but is hard to notice in a slowly developing condition. A neurologist friend of mine alerted me to the AMSLER GRID, which helps in picking up the subtle distortions of this sneaky problem.

Checking your vision every few days-it takes only a few seconds- is a good idea as you age. You might be healthy in every other way, but if you are blind, the quality of life in your final years will suffer. The mechanics of the wavy lines generated by macular degeneration are deposits beneath the macula, raising it up.

The deposits are fatty in the case of the dry, and fluid in the case of the wet macular degeneration; and fluid from the abnormal blood vessels in the wet MD can collect very rapidly indeed.

Even though the cause of MD is unknown, prevention is by the same old healthy habits tiresomely mentioned in all my other postings: DIET and EXERCISE. I’m sure that good sleep doesn’t hurt either, No cigarette smoking of course, and there are some vitamins and minerals mentioned, such as lutein, zeaxanthin, zinc, and copper.

The wet MD does have a treatment to slow down the disease. Since blood vessel growth is important in causation, antibodies to VEGF, vascular endothelial growth factor, are injected into the macular area. I’m sure that more help is on the way. Some treatments to support the protective pigmented layer of the retina are currently in progress.

–DR. C