Question: I have gotten hives all of my adult life. They seem to come and go for no apparent reason. I think it might be from stress from my job. None of my siblings get hives, but a couple of them have asthma and allergies. Could I have allergies? My doctor says my hives are from my nerves.
Answer: Although I addressed hives, or urticaria as we physicians call the condition, in a recent column, your question focuses on the problem of recurring hives.
Hives are officially caused by an allergic reaction in your body, but a lot of things can set them off. Just because you have had them for a long time doesn’t mean that you shouldn’t take the time now to investigate potential causes. Understanding the cause can help you manage and avoid recurrences.
A hive is a red, usually raised and very itchy lump that may come alone or in groups. Sometimes they spread out and cover most of your body. Other times they are isolated to only a few areas. Hives are the most common dermatological condition seen in emergency departments of hospitals in the United States.
About 20 percent of individuals will have an episode of hives at least once during their lifetime. Some people just get one outbreak; others, like you, will have a lifetime of recurring hives.
The cause of hives can be difficult to find as they may be caused by foods, food additives or chemicals. People who have only one episode of hives or very infrequent episodes may never find out the cause. But if you have hives all the time, it is well worth your time to get an allergy test.
Allergies do run in families, and since you have siblings with allergy-based conditions, you may share some of their allergies. Often there can be a bit of a delay between exposure to an allergen and the outbreak of hives, which makes the triggers for hives especially elusive.
The most common allergy test is the skin test. With the skin test, trace amounts of common environmental allergens, such as dust and pollen, and common food allergens are injected into the outer layer of the skin. The affected skin is then observed to see if it reveals any reactions and, if so, how severe they are.
The skin test is a generally painless procedure that can likely be done in a physician’s office. Sometimes blood tests for allergies are sent out. These are somewhat useful, but they are not as sensitive as the skin tests.
Although stress can aggravate hives, allergens are typically involved with this condition. With recurring hives, the most important approach is effective prevention. If allergens are behind your hives, this test can help you avoid those triggers. Prevention is the best treatment for urticaria or any allergy-based problem. It is never too late to have this testing done, even if you have had hives all of your adult life.
Thursday, May 13, 2010
WHITE SPOTS ON SKIN A COSMETIC NUISANCE
Question: I recently developed these little white areas on my fingers. My mother has them too, and she insists they are nothing to worry about. She says they’re called vitiligo and that she has had them as long as she can remember. Dangerous or not, I think they are ugly. What causes these? Are they anything to worry about? How can I make them go away?
Answer: Vitiligo is a relatively common skin condition that affects about 2 percent of all people in the world. It usually develops before the age of 20, and it seems to occur equally in both men and women and across all nationalities. Vitiligo results when melanocytes, the cells in the body that produce dark skin pigment, called melanin, stop working. When this occurs, the affected skin turns a pinkish white. If melanocytes stop producing melanin on the scalp, the hair in the affected area also turns white.
While there is no definitive cause for vitiligo, many theories exist. The most widely accepted theory is that it is an autoimmune disease, which occur when your immune system attacks your body’s healthy cells, destroying them. Although it is largely considered an autoimmune disease, most people with vitiligo do not have an underlying autoimmune disorder. Instead, vitiligo is more common in people with hyperthyroidism, adrenal insufficiency, pernicious anemia and alopecial areata. Also, vitiligo does seem to run in families, which might explain why both you and your mother experience the same symptoms.
The diagnosis of vitiligo involves a simple visual inspection of the affected skin by a trained physician. Sometimes the doctor will want to do a biopsy to confirm the diagnosis. She may also check your personal and family history for associated diseases like those mentioned above. If you or your family members do not have documentation of these conditions, your doctor may still want to test for them.
There are treatments for vitiligo. Topical steroid creams can help in restoring color to the de-pigmented areas, but it may take several months of regular use before you notice any improvements. Another treatment that works well is phototherapy with ultraviolet light, plus medication applied to the skin. These treatments are effective but they can be time-consuming, and the results are often delayed. For extreme cases –- people who have lost pigmentation on more than 50 percent of their skin surface, there are prescription cream treatments that fade the rest of the skin to match. Some people also choose skin grafts, which remove the affected areas of skin, but there can be complications from this treatment.
There is good news in all of this: interestingly, recent studies have shown that people with vitiligo may actually be at decreased risk for developing serious skin cancers.
Answer: Vitiligo is a relatively common skin condition that affects about 2 percent of all people in the world. It usually develops before the age of 20, and it seems to occur equally in both men and women and across all nationalities. Vitiligo results when melanocytes, the cells in the body that produce dark skin pigment, called melanin, stop working. When this occurs, the affected skin turns a pinkish white. If melanocytes stop producing melanin on the scalp, the hair in the affected area also turns white.
While there is no definitive cause for vitiligo, many theories exist. The most widely accepted theory is that it is an autoimmune disease, which occur when your immune system attacks your body’s healthy cells, destroying them. Although it is largely considered an autoimmune disease, most people with vitiligo do not have an underlying autoimmune disorder. Instead, vitiligo is more common in people with hyperthyroidism, adrenal insufficiency, pernicious anemia and alopecial areata. Also, vitiligo does seem to run in families, which might explain why both you and your mother experience the same symptoms.
The diagnosis of vitiligo involves a simple visual inspection of the affected skin by a trained physician. Sometimes the doctor will want to do a biopsy to confirm the diagnosis. She may also check your personal and family history for associated diseases like those mentioned above. If you or your family members do not have documentation of these conditions, your doctor may still want to test for them.
There are treatments for vitiligo. Topical steroid creams can help in restoring color to the de-pigmented areas, but it may take several months of regular use before you notice any improvements. Another treatment that works well is phototherapy with ultraviolet light, plus medication applied to the skin. These treatments are effective but they can be time-consuming, and the results are often delayed. For extreme cases –- people who have lost pigmentation on more than 50 percent of their skin surface, there are prescription cream treatments that fade the rest of the skin to match. Some people also choose skin grafts, which remove the affected areas of skin, but there can be complications from this treatment.
There is good news in all of this: interestingly, recent studies have shown that people with vitiligo may actually be at decreased risk for developing serious skin cancers.
Friday, April 23, 2010
SUN-INDUCED SNEEZING
Question: A friend of mine claims to only sneeze when she’s exposed to bright sunlight. As someone with seasonal allergies, I understand how pollen can cause people to sneeze, but why would bright light make my friend sneeze?
Answer: Sneezing is an involuntary reflex caused by many different things. As you noted, during the spring or fall months people with seasonal allergies sneeze in response to pollen or spores. The sneezing is your body’s attempt to clear out the allergens irritating the lining of your nose and throat.
Your friend’s claim, that bright sunlight can cause sneezing, is actually a documented medical syndrome. The syndrome is called ACHOO –- and no, I am not making this up. It stands for “Autosomal-dominant Compelling Helio-Ophthalmic Outburst,” also called photic sneezing. If you ever start to sneeze and it gets “stuck,” try looking toward a light source to see if it helps you finish the sneeze.
Sneezing from bright lights is a genetic condition that affects about 20 percent of the population. The term “autosomal-dominant” means that if one parent has the gene, each child has a 50 percent chance of inheriting it. The exact mechanism by which bright light brings on sneezing in certain people is not fully understood.
Aside from allergies, illness and bright lights, a number of other things reportedly cause sneezing. Some people say they sneeze when they pluck their eyebrows. Others sneeze when their stomach is full, which is referred to as stomach sneeze reflex. Still others sneeze when their stomach is empty and they feel nauseated. The nausea seems to be somehow relieved by sneezing. Physicians and scientists do not fully understand unusual sneezing triggers, and since the matter seems to be of no medical consequence, we are not likely to bother figuring it out.
Interestingly, the practice of saying “God bless you” to someone who has just sneezed began during the 6th Century bubonic plague epidemic. Sneezing took on troubling connotations since it was one of the earliest symptoms of infection with the plague.
Sneezing is also an early symptom for many other bacterial infections as well as viral illnesses such as the cold or the flu. If you develop more serious symptoms such as fever or body aches along with your sneezing, you should seek medical attention. Normally, however, a few isolated sneezes are not cause for alarm. Nearly anything can irritate the throat and nose even if you are not allergic to it, including excessive pollen, smoke, pepper and dust.
Sneezing, which employs several muscle groups from your abdomen to your throat, is a very powerful “outburst” and a very effective way of spreading germs. During an ordinary sneeze, saliva can fly up to ten feet at roughly 75 miles per hour. Even if you are not feeling sick, you should always cover your nose and mouth when you sneeze.
Friday, April 16, 2010
PREVENTION IS BEST “TREATMENT” FOR ITCHY CHIGGER BITES
Question: My husband and I have been bothered with chiggers. We have tried everything for the itching – alcohol, peroxide, sprays, lotions, nail polish and cream from the doctor. This has been going on for about four months, and they seem to be spreading. What can be done?
Answer: First, I’ll describe what chiggers are and why they cause itching. Then I’ll tell you how to prevent and treat them. You and you doctor can decide if you really have chigger bites.
Chiggers are microscopic insects in the mite family. They are arachnids and are closely related to ticks. It is the larval form of the mite that bites. Interestingly, after they feast on humans and other animals, they mature and eat only the eggs of certain other insects.
Chiggers do not burrow under the skin, as is commonly believed. Instead, when chigger larvae bite, they insert a mouth part that injects saliva into a skin pore or hair follicle. This dissolves the skin cells it contacts into a liquid that the chigger can ingest. After a few hours, the tissues surrounding the withdrawn liquid harden, creating a tube-like structure. This structure, called a stylostome, acts like a drinking straw, allowing more saliva to be injected, and more liquefied skin to be withdrawn. This is what creates the appearance of burrowing.
It is the stylostome that causes the itching and characteristic red welt to form. The itchiness can be quite severe and usually peaks about two days after the bite. The stylostome is destroyed by your body in about 10 days.
Chiggers are found in grassy places, and in thick brush. They are most active when the ground temperature is between 77 and 86 degrees and become inactive below 60 degrees.
Chiggers are found in grassy places, and in thick brush. They are most active when the ground temperature is between 77 and 86 degrees and become inactive below 60 degrees.
Prevention is the best way to manage chiggers. Wear clothes that prevent chiggers from making contact with your skin. Long-sleeved shirts, tightly woven socks, pants tucked inside of boot tops, and buttoned cuffs will all reduce chigger bites. Most mosquito repellants will fend off chiggers, too, so it’s good idea to use these products when you go into fields or woods or if you plan to sit on the grass. Remember to reapply it every few hours since repellants only last a few hours.
After you return from any potential exposure, a hot bath with lots of soap will wash many chiggers off before they have a chance to bite. If you have been bitten, over-the-counter creams with benzocaine or camphor-phenol can help reduce the itching.
It’s also a good idea to wash clothes that are potentially chigger-infested in hot, soapy water. Unlaundered clothes or clothes washed in cool water will allow chiggers to survive.
It’s also a good idea to wash clothes that are potentially chigger-infested in hot, soapy water. Unlaundered clothes or clothes washed in cool water will allow chiggers to survive.
Unless you keep getting re-infested with chiggers, it seems unlikely to me that you would still be itching from chiggers after four months. You and your husband need to see your physician for a reevaluation of your rashes. What you have may not be chiggers at all.
WARTS CAUSED BY VERSATILE HPV VIRUS
Question: I frequently have warts on my fingers that come and go. My mom says I will outgrow them, but in the meantime, they’re very ugly. Why do I get them? Is there anything I can do about them? Should I see a doctor?
Answer: It sounds like you have common warts, called verruca vulgaris by physicians. These occur mainly on the hands, fingers and knees; and your mother’s right that they are most common in children.
Common warts are caused by the human papilloma virus (HPV). An infection of the skin with this virus causes the outer layer of the skin to grow rapidly, which forms a wart. Warts are contagious. They can be passed from person to person through direct contact, which is partially why they are more common in children.
There are more than 100 types of human papilloma viruses. Many are harmless, and others can cause serious problems like cervical cancer. Different types of HPV cause different types of warts. For example, HPV can cause genital warts, which stem from a sexually transmitted infection. HPV also causes plantar warts, which occur on the soles of the feet and can be spread in public showers and other places where people walk around barefooted.
Because wart viruses can live on surfaces for a while, they can be spread by indirect contact, like wearing someone else’s shoes. Also, it may take several months for a wart to develop after exposure, so it’s often difficult to determine the source of the infection.
People with compromised immune systems, such as people with cancer or AIDS, are at increased risk for contracting any viral illness, including warts. Also at increased risk are children and young adults.
Many common warts will go away on their own, but people often treat them for cosmetic reasons or to help prevent their spreading. One recently confirmed home remedy involves duct tape. Simply adhere a small piece of duct tape directly to the wart to progressively kill the abnormal skin cells. Change the duct tape weekly, and file down the dead skin before reapplying. Continue until the wart is gone. Several-over-the-counter wart treatments are effective as well.
If warts are resistant to both the duct tape and over-the-counter-treatments, then a visit to your primary care physician or a dermatologist may be in order. Warts can be frozen off with liquid nitrogen, or treated with an acid or chemical. Both of these procedures may need to be repeated several times before the wart is fully removed. Sometimes the wart needs to be cut away. This can usually be done in the doctor’s office under a local anesthetic. Laser treatment can also be used, but is considered a last-resort option due to scarring.
As with anything, prevention is always best. If you have a wart, be sure to cover it to prevent spreading it to others. Finally, wash your hands frequently and always wear shower shoes in public showers.
Answer: It sounds like you have common warts, called verruca vulgaris by physicians. These occur mainly on the hands, fingers and knees; and your mother’s right that they are most common in children.
Common warts are caused by the human papilloma virus (HPV). An infection of the skin with this virus causes the outer layer of the skin to grow rapidly, which forms a wart. Warts are contagious. They can be passed from person to person through direct contact, which is partially why they are more common in children.
There are more than 100 types of human papilloma viruses. Many are harmless, and others can cause serious problems like cervical cancer. Different types of HPV cause different types of warts. For example, HPV can cause genital warts, which stem from a sexually transmitted infection. HPV also causes plantar warts, which occur on the soles of the feet and can be spread in public showers and other places where people walk around barefooted.
Because wart viruses can live on surfaces for a while, they can be spread by indirect contact, like wearing someone else’s shoes. Also, it may take several months for a wart to develop after exposure, so it’s often difficult to determine the source of the infection.
People with compromised immune systems, such as people with cancer or AIDS, are at increased risk for contracting any viral illness, including warts. Also at increased risk are children and young adults.
Many common warts will go away on their own, but people often treat them for cosmetic reasons or to help prevent their spreading. One recently confirmed home remedy involves duct tape. Simply adhere a small piece of duct tape directly to the wart to progressively kill the abnormal skin cells. Change the duct tape weekly, and file down the dead skin before reapplying. Continue until the wart is gone. Several-over-the-counter wart treatments are effective as well.
If warts are resistant to both the duct tape and over-the-counter-treatments, then a visit to your primary care physician or a dermatologist may be in order. Warts can be frozen off with liquid nitrogen, or treated with an acid or chemical. Both of these procedures may need to be repeated several times before the wart is fully removed. Sometimes the wart needs to be cut away. This can usually be done in the doctor’s office under a local anesthetic. Laser treatment can also be used, but is considered a last-resort option due to scarring.
As with anything, prevention is always best. If you have a wart, be sure to cover it to prevent spreading it to others. Finally, wash your hands frequently and always wear shower shoes in public showers.
SHINGLES NOT CONTAGIOUS FOR MOST
Question: Recently my 15-year-old daughter got shingles while we were on vacation visiting relatives. Everyone was worried about catching it; they thought every bug bite was the beginning of shingles. We were forced to return home early, because no one wanted to be around us. No one else got shingles, and my child is fine now. Did we do the right thing by leaving early to keep the grandparents and others from getting shingles?
Answer: Although your family’s concern was doubtlessly well-intended, the only people potentially at risk at your family gathering would have been any children who have never had chickenpox and never been vaccinated against chickenpox -- not the grandparents.
The herpes zoster virus that causes shingles is related to chickenpox, or the varicella zoster virus (VZV). Though shingles is not contagious to people who have had chickenpox before, it does originate in people –- usually adults -- who have had chickenpox. That is because the VZV permanently stays in your system after you recover from the chickenpox, typically in a dormant stage that does not make you sick. When the VZV reactivates, it causes shingles. It is not known what stimulates the virus to reactivate, but it is most likely to occur in people over the age of 50, and in people whose immune system is weakened by either chronic disease or chemotherapy. There is also a remote possibility that the tendency to develop shingles runs in families.
Shingles is not, itself, contagious. However, someone who has never had chickenpox and never received the chickenpox vaccine may catch chickenpox from a person with active shingles. The virus can spread through airborne droplets either from the rash itself or from sneezing or coughing, much like any viral illness.
Shingles does not usually start as a rash, but it is when the rash appears that most people go to the doctor. Like many viral illnesses, the person becomes ill and can spread the virus before they notice any specific symptoms. Shingles usually starts out with mild flu-like symptoms: headache, fatigue and sometimes a mild fever. Pain or abnormal sensations usually precede the appearance of the rash by a day or so. The rash is most common on the trunk and is limited to one side of the body, however, the rash can appear anywhere on the body.
If begun early enough, antiviral medication can help the rash heal more quickly than it would without any treatment. However, medication is not very helpful when started more than 72 hours after the appearance of symptoms.
There is a vaccine on the market to help prevent shingles, and it is recommended for people over the age of 60. Once someone gets shingles, they should avoid unvaccinated children who have never had chickenpox. If children are around, keep the rash covered and follow the rules regarding the spread of any virus: cover your mouth when you sneeze, and frequently wash your hands to help prevent the virus from spreading to a chickenpox-susceptible person.
Answer: Although your family’s concern was doubtlessly well-intended, the only people potentially at risk at your family gathering would have been any children who have never had chickenpox and never been vaccinated against chickenpox -- not the grandparents.
The herpes zoster virus that causes shingles is related to chickenpox, or the varicella zoster virus (VZV). Though shingles is not contagious to people who have had chickenpox before, it does originate in people –- usually adults -- who have had chickenpox. That is because the VZV permanently stays in your system after you recover from the chickenpox, typically in a dormant stage that does not make you sick. When the VZV reactivates, it causes shingles. It is not known what stimulates the virus to reactivate, but it is most likely to occur in people over the age of 50, and in people whose immune system is weakened by either chronic disease or chemotherapy. There is also a remote possibility that the tendency to develop shingles runs in families.
Shingles is not, itself, contagious. However, someone who has never had chickenpox and never received the chickenpox vaccine may catch chickenpox from a person with active shingles. The virus can spread through airborne droplets either from the rash itself or from sneezing or coughing, much like any viral illness.
Shingles does not usually start as a rash, but it is when the rash appears that most people go to the doctor. Like many viral illnesses, the person becomes ill and can spread the virus before they notice any specific symptoms. Shingles usually starts out with mild flu-like symptoms: headache, fatigue and sometimes a mild fever. Pain or abnormal sensations usually precede the appearance of the rash by a day or so. The rash is most common on the trunk and is limited to one side of the body, however, the rash can appear anywhere on the body.
If begun early enough, antiviral medication can help the rash heal more quickly than it would without any treatment. However, medication is not very helpful when started more than 72 hours after the appearance of symptoms.
There is a vaccine on the market to help prevent shingles, and it is recommended for people over the age of 60. Once someone gets shingles, they should avoid unvaccinated children who have never had chickenpox. If children are around, keep the rash covered and follow the rules regarding the spread of any virus: cover your mouth when you sneeze, and frequently wash your hands to help prevent the virus from spreading to a chickenpox-susceptible person.
WHEN STYES GET IN YOUR EYES
Question: Lately I’ve been getting these red bumps on my eyelids, and my mother keeps calling them “pig sties.” She told me to put hot compresses on them, and this usually works. Lately, they’re not going away, and I think I’m going to go to the doctor. Do I need to? What causes these? What can I do to treat or prevent them?
Answer: What you are describing is called a “stye”, not a “pig sty” (the medical condition can be spelled with or without the “e” at the end). The official medical term for a stye is a hordeolum. They occur when an oil gland -- called a meibomian gland -- in the eyelid becomes inflamed or infected. At that point, they swell up, much like a pimple, and they usually feel warm to the touch.
An internal stye occurs when a meibomian gland under the surface of the skin becomes infected, and an external stye occurs when the base of the eyelash gets infected, leaving a red lump on the edge of the eyelid. Most physicians do not distinguish between the two since the treatment is the same for both.
Your eyelids have many functions, but primarily, their job is to open and close in order to clean and lubricate your eyes. There are oil glands on the edge of the upper and lower eyelids that produce the necessary lubricant for your eyes. Unfortunately, bacteria can get into these glands and cause inflammation and infection. This leads to styes, which are a bit like boils that occur on your eyelids.
An experienced physician can diagnose a stye just by looking at it. Usually, no additional testing is necessary. You are right to apply warm compresses to treat these. I would recommend you use a warm compress about four times a day. If the styes don’t respond in a day or so, you may need to see a physician to get antibiotic eye ointment. Do not ever attempt to drain a stye by squeezing it or poking it with a sterilized needle. It is always best to leave them alone except for hot packs and medications. Squeezing can spread infection into the tissue around your eye, which can lead to serious medical conditions. Poking can do the same, plus it opens the risk of seriously damaging your eye.
While styes will usually heal and go away on their own or with a little antibiotic ointment, they sometimes do not drain if the oil gland becomes fully blocked. When this occurs, we call it a chalazion. This kind of infection may need to be drained by a licensed ophthalmologist.
One thing that will help prevent styes is to avoid pulling on your eyelashes. Sometimes excessive or old mascara can contribute to the development of a stye. Most importantly, always wash your hands before touching the area around your eyes.
Styes are a relatively common occurrence, but not everyone gets them. Some chronic conditions like diabetes and chronic dandruff increase their likelihood. It sounds as though your styes come often enough, and stay long enough, to warrant attention from your family physician.
Answer: What you are describing is called a “stye”, not a “pig sty” (the medical condition can be spelled with or without the “e” at the end). The official medical term for a stye is a hordeolum. They occur when an oil gland -- called a meibomian gland -- in the eyelid becomes inflamed or infected. At that point, they swell up, much like a pimple, and they usually feel warm to the touch.
An internal stye occurs when a meibomian gland under the surface of the skin becomes infected, and an external stye occurs when the base of the eyelash gets infected, leaving a red lump on the edge of the eyelid. Most physicians do not distinguish between the two since the treatment is the same for both.
Your eyelids have many functions, but primarily, their job is to open and close in order to clean and lubricate your eyes. There are oil glands on the edge of the upper and lower eyelids that produce the necessary lubricant for your eyes. Unfortunately, bacteria can get into these glands and cause inflammation and infection. This leads to styes, which are a bit like boils that occur on your eyelids.
An experienced physician can diagnose a stye just by looking at it. Usually, no additional testing is necessary. You are right to apply warm compresses to treat these. I would recommend you use a warm compress about four times a day. If the styes don’t respond in a day or so, you may need to see a physician to get antibiotic eye ointment. Do not ever attempt to drain a stye by squeezing it or poking it with a sterilized needle. It is always best to leave them alone except for hot packs and medications. Squeezing can spread infection into the tissue around your eye, which can lead to serious medical conditions. Poking can do the same, plus it opens the risk of seriously damaging your eye.
While styes will usually heal and go away on their own or with a little antibiotic ointment, they sometimes do not drain if the oil gland becomes fully blocked. When this occurs, we call it a chalazion. This kind of infection may need to be drained by a licensed ophthalmologist.
One thing that will help prevent styes is to avoid pulling on your eyelashes. Sometimes excessive or old mascara can contribute to the development of a stye. Most importantly, always wash your hands before touching the area around your eyes.
Styes are a relatively common occurrence, but not everyone gets them. Some chronic conditions like diabetes and chronic dandruff increase their likelihood. It sounds as though your styes come often enough, and stay long enough, to warrant attention from your family physician.
I’M SO DIZZY, MY HEAD IS SPINNING
Question: Lately I notice that when I move my head quickly, I get a dizzy feeling. This seems to have started last month right after I got over a bad head cold. I feel fine most of the time, and the dizziness has not yet caused me to lose my balance or fall down. I am an otherwise healthy college student, so should I be worried, or can I just wait for it to go away?
Answer: It sounds like you have vertigo. Vertigo is most often described in one of two ways: either the feeling that you are spinning in place –- this is called “subjective vertigo” -- or the feeling that you are standing still and the world is spinning around you –- called “objective vertigo.” Most people who experience either of these kinds of vertigo describe the sensation as general “dizziness.”
It seems very likely that your head cold may have caused an infection of your inner ear, which is one of the most common causes of vertigo. The inner ear is where your balance center, called the “labyrinth”, is located. The labyrinth can become inflamed (called labyrinthitis) due to a bacterial or viral infection, like a head cold. Labyrinthitis can be painless, although you may also notice some slight discomfort in your ear.
Another common form of vertigo is called benign paroxysmal positional vertigo (BPPV). BPPV also sounds very similar to what you have described -- dizziness associated with sudden head movements. This common type of vertigo is easily treated with anti-dizziness medications, some of which can be purchased over the counter. In fact, they are the same medications used to treat and prevent motion sickness.
Another leading cause of vertigo is Meniere’s disease, but this is more common in older people. Meniere’s disease is also associated with a sudden onset of ringing in the ears, called tinnitus, and hearing loss.
As in the case of Meniere’s disease, most causes of vertigo will be associated with other symptoms. For example, there are types of migraine headaches that are associated with vertigo. Sometimes tumors grow in the inner ear, which can cause vertigo as well as hearing loss. Decreased blood flow to the brain, commonly associated with a stroke, can cause vertigo, vision problems, trouble walking and headaches. In short, vertigo may indicate a serious medical emergency.
Because of this potential danger, vertigo should always be evaluated by a physician. Even BPPV can cause severe, debilitating dizziness, to a degree that it eventually requires a medical evaluation and prescription medications.
Seek emergency medical attention if your vertigo symptoms are associated with double vision or fading vision, severe headaches, difficulty speaking, feeling faint or muscle weakness -- especially if it’s unique to one side of the body.
Answer: It sounds like you have vertigo. Vertigo is most often described in one of two ways: either the feeling that you are spinning in place –- this is called “subjective vertigo” -- or the feeling that you are standing still and the world is spinning around you –- called “objective vertigo.” Most people who experience either of these kinds of vertigo describe the sensation as general “dizziness.”
It seems very likely that your head cold may have caused an infection of your inner ear, which is one of the most common causes of vertigo. The inner ear is where your balance center, called the “labyrinth”, is located. The labyrinth can become inflamed (called labyrinthitis) due to a bacterial or viral infection, like a head cold. Labyrinthitis can be painless, although you may also notice some slight discomfort in your ear.
Another common form of vertigo is called benign paroxysmal positional vertigo (BPPV). BPPV also sounds very similar to what you have described -- dizziness associated with sudden head movements. This common type of vertigo is easily treated with anti-dizziness medications, some of which can be purchased over the counter. In fact, they are the same medications used to treat and prevent motion sickness.
Another leading cause of vertigo is Meniere’s disease, but this is more common in older people. Meniere’s disease is also associated with a sudden onset of ringing in the ears, called tinnitus, and hearing loss.
As in the case of Meniere’s disease, most causes of vertigo will be associated with other symptoms. For example, there are types of migraine headaches that are associated with vertigo. Sometimes tumors grow in the inner ear, which can cause vertigo as well as hearing loss. Decreased blood flow to the brain, commonly associated with a stroke, can cause vertigo, vision problems, trouble walking and headaches. In short, vertigo may indicate a serious medical emergency.
Because of this potential danger, vertigo should always be evaluated by a physician. Even BPPV can cause severe, debilitating dizziness, to a degree that it eventually requires a medical evaluation and prescription medications.
Seek emergency medical attention if your vertigo symptoms are associated with double vision or fading vision, severe headaches, difficulty speaking, feeling faint or muscle weakness -- especially if it’s unique to one side of the body.
HEART PALPITATIONS
Question: Every so often I notice my heart beating fast. By the time I notice it and check my pulse, it has already slowed down. I feel fine when this is happening, which is usually in the evening when I am reading. I am pretty healthy otherwise, but I don’t get much exercise. Do I need to exercise more?
Answer: The heart normally speeds up and slows down in response to activity, but to have your heart race while you are at rest is a potential red flag that warrants some investigation.
A fast heartbeat that comes and goes is called a palpitation. There are many things that cause palpitations. Some are fairly benign; others require medical attention. Because an intermittent rapid heartbeat will probably not be present when you go to the doctor’s office, you will be asked many questions that will help her or him zero in on the cause.
Here are some questions your physician is likely to ask (knowing these questions in advance can help you be prepared for your appointment): How long did your longest episode last? Do you notice other symptoms, like lightheadedness or dizziness, when the racing occurs? Is the rapid heartbeat associated with skipped beats? Continue trying to check your pulse during one of these episodes to help determine if your heart may be skipping beats. If you do notice skipping, be sure to report this to your physician even if she or he does not ask.
Palpitations are very common, and most of the time they are not caused by heart trouble. Palpitations can be caused by stress; strenuous activity; medications like sinus pills, caffeine, alcohol and nicotine; or diseases like thyroid trouble, anemia and heart disease. Many people who notice palpitations also drink more coffee or tea than they realize.
Your question about exercise is very relevant. People who do not get enough exercise are, in fact, prone to having a faster resting heartbeat. Some consequences of lack of exercise – for example, obesity – can also contribute to palpitations. But before you start an exercise program, you should consult your physician. Keep a log of when the palpitations occur, including how many times a day or night they come on and what you were doing immediately before you noticed them. Keep track of how much caffeine you are consuming, and check the labels on all over-the-counter medications you take. To make sure your medications won’t cause or complicate heart palpitations, check with your family doctor or pharmacist.
When you talk to your doctor, she or he may want to do blood tests, as well as have you wear a device called a Holter monitor. This device takes an electrocardiogram; it traces your heartbeats for 24 to 48 hours. This painless test can help your doctor determine if your palpitations need further medical intervention, lifestyle modifications or both.
Answer: The heart normally speeds up and slows down in response to activity, but to have your heart race while you are at rest is a potential red flag that warrants some investigation.
A fast heartbeat that comes and goes is called a palpitation. There are many things that cause palpitations. Some are fairly benign; others require medical attention. Because an intermittent rapid heartbeat will probably not be present when you go to the doctor’s office, you will be asked many questions that will help her or him zero in on the cause.
Here are some questions your physician is likely to ask (knowing these questions in advance can help you be prepared for your appointment): How long did your longest episode last? Do you notice other symptoms, like lightheadedness or dizziness, when the racing occurs? Is the rapid heartbeat associated with skipped beats? Continue trying to check your pulse during one of these episodes to help determine if your heart may be skipping beats. If you do notice skipping, be sure to report this to your physician even if she or he does not ask.
Palpitations are very common, and most of the time they are not caused by heart trouble. Palpitations can be caused by stress; strenuous activity; medications like sinus pills, caffeine, alcohol and nicotine; or diseases like thyroid trouble, anemia and heart disease. Many people who notice palpitations also drink more coffee or tea than they realize.
Your question about exercise is very relevant. People who do not get enough exercise are, in fact, prone to having a faster resting heartbeat. Some consequences of lack of exercise – for example, obesity – can also contribute to palpitations. But before you start an exercise program, you should consult your physician. Keep a log of when the palpitations occur, including how many times a day or night they come on and what you were doing immediately before you noticed them. Keep track of how much caffeine you are consuming, and check the labels on all over-the-counter medications you take. To make sure your medications won’t cause or complicate heart palpitations, check with your family doctor or pharmacist.
When you talk to your doctor, she or he may want to do blood tests, as well as have you wear a device called a Holter monitor. This device takes an electrocardiogram; it traces your heartbeats for 24 to 48 hours. This painless test can help your doctor determine if your palpitations need further medical intervention, lifestyle modifications or both.
Tuesday, March 30, 2010
COLD SORES TREATABLE NOW; MAY BE PREVENTABLE IN FUTURE
Question: I am 20 years old, and I have gotten cold sores all of my life. While I know they are no big deal, they are annoying, not to mention ugly. Will I ever outgrow these? Why did I start getting them in the first place? My friends don’t seem to have them. Is there any treatment for them?
Answer: Cold sores, also called “fever blisters” are a common viral skin eruption that affects about 50 percent of the national population. This virus, called “herpes simplex type I,” often infects the mouth in childhood. Once this initial infection has occurred, the virus remains in your system, but usually in a dormant, or inactive form. Any time the virus reactivates, it causes another cold sore.
Reactivation of this virus can be triggered by stress, illness, fever, sun exposure, menstruation and other causes. When the reactivation occurs, a lesion-like blister appears, usually on the lip. Without treatment, it generally takes about seven to 10 days from the initial outbreak until the sore is completely healed and gone. Many people also notice pain or sensations of itching, tingling or burning on the lip while the blister is there, and even up to two days before the cold sore actually appears. If you do notice pre-blister lip pain, that is the optimal time to treat the cold sore.
There are several over-the-counter topical medications available at drug stores, but more recently prescription antiviral medications -- both oral and topical -- have proven very effective in shortening the course of cold sore outbreaks. Researchers are developing a promising vaccine, but the studies are still in early stages, so the vaccine has not yet been approved for the general public. Also under development is a potential oral antiviral medication that might help prevent cold sore outbreaks.
For people who get cold sores due to sun exposure, the use of sunscreen on the lips can dramatically reduce their frequency. The bad news is that, so far, this is the only known preventive method for cold sores, and it only applies to sun-induced outbreaks. The good news is that, as I mentioned above, coming years may see a vaccine or preventive medication.
The herpes simplex type I virus can be spread by direct contact any time between the beginning of the pre-blister phase to when the sore is completely healed. Avoid kissing someone who has an active cold sore, and if you have a cold sore, avoid touching the blister.
Most people with cold sores get about six outbreaks per year. After the age of 35, the recurrences do become less frequent, and the lesions tend resolve a bit faster. So while you will never completely outgrow this condition, it will improve as you get older –- and hopefully, so will the treatment options.
Answer: Cold sores, also called “fever blisters” are a common viral skin eruption that affects about 50 percent of the national population. This virus, called “herpes simplex type I,” often infects the mouth in childhood. Once this initial infection has occurred, the virus remains in your system, but usually in a dormant, or inactive form. Any time the virus reactivates, it causes another cold sore.
Reactivation of this virus can be triggered by stress, illness, fever, sun exposure, menstruation and other causes. When the reactivation occurs, a lesion-like blister appears, usually on the lip. Without treatment, it generally takes about seven to 10 days from the initial outbreak until the sore is completely healed and gone. Many people also notice pain or sensations of itching, tingling or burning on the lip while the blister is there, and even up to two days before the cold sore actually appears. If you do notice pre-blister lip pain, that is the optimal time to treat the cold sore.
There are several over-the-counter topical medications available at drug stores, but more recently prescription antiviral medications -- both oral and topical -- have proven very effective in shortening the course of cold sore outbreaks. Researchers are developing a promising vaccine, but the studies are still in early stages, so the vaccine has not yet been approved for the general public. Also under development is a potential oral antiviral medication that might help prevent cold sore outbreaks.
For people who get cold sores due to sun exposure, the use of sunscreen on the lips can dramatically reduce their frequency. The bad news is that, so far, this is the only known preventive method for cold sores, and it only applies to sun-induced outbreaks. The good news is that, as I mentioned above, coming years may see a vaccine or preventive medication.
The herpes simplex type I virus can be spread by direct contact any time between the beginning of the pre-blister phase to when the sore is completely healed. Avoid kissing someone who has an active cold sore, and if you have a cold sore, avoid touching the blister.
Most people with cold sores get about six outbreaks per year. After the age of 35, the recurrences do become less frequent, and the lesions tend resolve a bit faster. So while you will never completely outgrow this condition, it will improve as you get older –- and hopefully, so will the treatment options.
READER’S NIGHT SWEATS TOO FREQUENT FOR COMFORT
Question: I am a usually healthy man, aged 50. For the last couple of weeks, I have woken up once or twice every night drenched with sweat. I sweat so heavily that I have to change my pajamas. My wife experiences these heat spells at night due to menopause, but what can cause them in a man? I have been feeling a little run down as well. Do I need to see the doctor, or will this pass?
Answer: Night sweats like the ones you describe are fairly common and are usually not a sign of a medical problem. Simple things like troubling dreams, the room being too hot or using too many blankets can actually cause drenching night sweats. That being said, if the night sweats persist and adjusting your environment doesn’t help, you should discuss the problem with your family physician.
As you mentioned, menopause is the leading cause of night sweats in women over the age of 40. However, both men and women can experience this annoying condition.
If this occurs frequently and interferes with your sleep, your doctor can help you rule out more serious medical issues that may underlie night sweats.
A simple review of your medical history may reveal the problem, as excessive sweating at night is a frequent side-effect of some medications. Most commonly, antidepressant medications and fever-reducing medication can lead to night sweats. Some high blood pressure medications, hormone therapies and niacin can also cause spells of excessive sweating at night.
If you are a diabetic on medication and you are having frequent night sweats, check your blood sugar level when a sweat occurs. If your blood sugar level is low during a night sweat, let your physician know. Your medications may need to be adjusted.
Recently an association has been identified between gastroesophageal reflux disease (GERD) and night sweats. Some preliminary studies suggest that when GERD is treated, the night sweats go away. Other conditions, such as an overactive thyroid or obstructive sleep apnea, can also cause night sweats.
Even more serious medical conditions can also cause night sweats. But typically, with very severe illnesses, such as tuberculosis or HIV/AIDS, you will notice other symptoms as well. These symptoms may include high fever, frequent coughing and rapid weight loss. Night sweats can accompany some types of cancer, particularly lymphoma, but they are also associated with rapid weight loss and usually enlarged lymph nodes.
It sounds like your night sweats are frequent enough to warrant a conversation with your family doctor. At this point, the problem is cutting into your sleep cycle, which probably explains why you feel run-down. Your doctor can test for underlying illnesses and determine whether medications should be adjusted. If nothing else, he or she may calm your worries, since anxiety aggravates insomnia. Be sure to seek immediate medical attention if you experience sudden weight loss, cough or fever.
Answer: Night sweats like the ones you describe are fairly common and are usually not a sign of a medical problem. Simple things like troubling dreams, the room being too hot or using too many blankets can actually cause drenching night sweats. That being said, if the night sweats persist and adjusting your environment doesn’t help, you should discuss the problem with your family physician.
As you mentioned, menopause is the leading cause of night sweats in women over the age of 40. However, both men and women can experience this annoying condition.
If this occurs frequently and interferes with your sleep, your doctor can help you rule out more serious medical issues that may underlie night sweats.
A simple review of your medical history may reveal the problem, as excessive sweating at night is a frequent side-effect of some medications. Most commonly, antidepressant medications and fever-reducing medication can lead to night sweats. Some high blood pressure medications, hormone therapies and niacin can also cause spells of excessive sweating at night.
If you are a diabetic on medication and you are having frequent night sweats, check your blood sugar level when a sweat occurs. If your blood sugar level is low during a night sweat, let your physician know. Your medications may need to be adjusted.
Recently an association has been identified between gastroesophageal reflux disease (GERD) and night sweats. Some preliminary studies suggest that when GERD is treated, the night sweats go away. Other conditions, such as an overactive thyroid or obstructive sleep apnea, can also cause night sweats.
Even more serious medical conditions can also cause night sweats. But typically, with very severe illnesses, such as tuberculosis or HIV/AIDS, you will notice other symptoms as well. These symptoms may include high fever, frequent coughing and rapid weight loss. Night sweats can accompany some types of cancer, particularly lymphoma, but they are also associated with rapid weight loss and usually enlarged lymph nodes.
It sounds like your night sweats are frequent enough to warrant a conversation with your family doctor. At this point, the problem is cutting into your sleep cycle, which probably explains why you feel run-down. Your doctor can test for underlying illnesses and determine whether medications should be adjusted. If nothing else, he or she may calm your worries, since anxiety aggravates insomnia. Be sure to seek immediate medical attention if you experience sudden weight loss, cough or fever.
NARCISSISM: IT’S ALL ABOUT “ME”
Question: I thought “narcissism” was just a personality trait, like impatience or shyness, but a friend recently said it’s an actual medical condition. Is that right? And if so, is it treatable?
Answer: The more current term for narcissism is “narcissistic personality disorder.” This mental disorder is characterized by people who have an abnormally inflated sense of self-importance and superiority. Often they are preoccupied with personal success and power, and they seem to have little regard for other people’s feelings.
While people suffering from narcissistic personality disorder usually appear very confident, they often are very insecure and, beneath the perceived self-love, they harbor low self-esteem. These people also behave in socially distressing manners and have difficulty with relationships, work and school.
To some extent and at some stages of life, we all may be guilty of behavior that resembles narcissistic personality disorder. Symptoms of the disorder include a sense of superiority over others; a preoccupation with personal success, power and attractiveness; and exaggerating personal accomplishments. People with narcissistic personality disorder expect others to always go along with what they want, and they are unable to recognize the feelings and viewpoints of others. They often have a sense of entitlement or exceptionalness, and they thrive on the praise and admiration of others. When these expectations are not fulfilled, people with this condition are prone to inappropriate or even violent outbursts.
The causes of narcissistic personality disorder are not known, but the condition is probably related to early childhood development. Some believe it results from over-pampering in early childhood, but many other researchers suspect that parental neglect is a more likely explanation. Usually this disorder can be diagnosed by early adulthood.
At this time, psychotherapy is the only treatment for narcissistic personality disorder. If other complications, such as substance abuse, depression or eating disorders are also present, be sure to consult with your family physician. These complications can contribute to the problem, and often they require medical intervention. Some of the problems associated with narcissistic personality disorder can be treated with medications. Family therapy and group therapy can be helpful as well.
As with many conditions, it is important to make sure there are no underlying medical conditions causing a change in personality. If you notice these symptoms in a loved one, it is important that they see their family physician. He or she will review the medical and family histories, conduct a physical examination and possibly conduct some laboratory tests to rule out underlying medical problems.
Answer: The more current term for narcissism is “narcissistic personality disorder.” This mental disorder is characterized by people who have an abnormally inflated sense of self-importance and superiority. Often they are preoccupied with personal success and power, and they seem to have little regard for other people’s feelings.
While people suffering from narcissistic personality disorder usually appear very confident, they often are very insecure and, beneath the perceived self-love, they harbor low self-esteem. These people also behave in socially distressing manners and have difficulty with relationships, work and school.
To some extent and at some stages of life, we all may be guilty of behavior that resembles narcissistic personality disorder. Symptoms of the disorder include a sense of superiority over others; a preoccupation with personal success, power and attractiveness; and exaggerating personal accomplishments. People with narcissistic personality disorder expect others to always go along with what they want, and they are unable to recognize the feelings and viewpoints of others. They often have a sense of entitlement or exceptionalness, and they thrive on the praise and admiration of others. When these expectations are not fulfilled, people with this condition are prone to inappropriate or even violent outbursts.
The causes of narcissistic personality disorder are not known, but the condition is probably related to early childhood development. Some believe it results from over-pampering in early childhood, but many other researchers suspect that parental neglect is a more likely explanation. Usually this disorder can be diagnosed by early adulthood.
At this time, psychotherapy is the only treatment for narcissistic personality disorder. If other complications, such as substance abuse, depression or eating disorders are also present, be sure to consult with your family physician. These complications can contribute to the problem, and often they require medical intervention. Some of the problems associated with narcissistic personality disorder can be treated with medications. Family therapy and group therapy can be helpful as well.
As with many conditions, it is important to make sure there are no underlying medical conditions causing a change in personality. If you notice these symptoms in a loved one, it is important that they see their family physician. He or she will review the medical and family histories, conduct a physical examination and possibly conduct some laboratory tests to rule out underlying medical problems.
HEALTHY LIFESTYLE BEST MEDICINE FOR CHRONIC LEUKEMIA
Question: My dad was recently diagnosed with leukemia. He said I shouldn’t worry since it is “chronic leukemia.” How can it already be considered chronic when he was just diagnosed –- and why should that make me worry any less? Can you explain the difference between regular and chronic leukemia?
Answer: Most likely your father was diagnosed with chronic lymphocytic leukemia (CLL). CLL is called “chronic” from the beginning because this form of leukemia progresses very slowly over a longer span of time. In that sense, CLL is less severe than acute leukemia, which grows and spreads much more rapidly.
CLL is relatively rare, with about 15,000 new cases diagnosed in the United States every year. Although CLL can occur at any age, it usually affects older adults. The disease is more common in men, in Caucasians, and in people over the age of 50. A family history can predispose a person to CLL, as can exposure to some chemicals, including benzene, as well as some solvents and herbicides. People who work in construction, with cars or at petroleum refineries may have an increased risk for CLL.
CLL is the result of a change in the DNA of the cells that produce blood. No one knows why this change occurs in the first place, and it has become a topic of intensive biomedical research. The change affects lymphocytes, a type of white blood cell important for immune defense. It renders lymphocytes unable to fight infections as usual. It also sparks the production of excessive numbers of these ineffective lymphocytes, which crowd out the healthy white blood cells and make it difficult for them to do their job.
Physicians suspect CLL when a person complains of fatigue, fever, night sweats, weight loss, frequent infections and enlarged, painless lymph nodes. When your family physician hears these symptoms together, he or she will most likely order a battery of tests, including a complete blood count (CBC). If the CBC shows a higher-than-normal number of lymphocytes, your doctor may then order a bone marrow biopsy. This test takes blood-producing cells from inside the pelvic bone or sternum, to see how many abnormal lymphocyte-producing cells are present compared to healthy cells. Sometimes doctors also order a CT scan of the body, which helps to determine the severity of the illness. If the CLL is an early stage, your father’s doctor will probably want to monitor the disease for now. Medical interventions for CLL are more effective when the disease has reached intermediate or advanced stages. If the disease progresses far enough, a range of therapies may be recommended, but many people diagnosed with early stage CLL never need any treatment.
With CLL, it’s more important to make healthy choices that prevent infections, such as eating well, exercising and getting plenty of sleep. If your father smokes, urge him to seek help to quit. Of course, he should also avoid infections by regular and thorough hand washing and by staying away from sick people whenever possible.
Answer: Most likely your father was diagnosed with chronic lymphocytic leukemia (CLL). CLL is called “chronic” from the beginning because this form of leukemia progresses very slowly over a longer span of time. In that sense, CLL is less severe than acute leukemia, which grows and spreads much more rapidly.
CLL is relatively rare, with about 15,000 new cases diagnosed in the United States every year. Although CLL can occur at any age, it usually affects older adults. The disease is more common in men, in Caucasians, and in people over the age of 50. A family history can predispose a person to CLL, as can exposure to some chemicals, including benzene, as well as some solvents and herbicides. People who work in construction, with cars or at petroleum refineries may have an increased risk for CLL.
CLL is the result of a change in the DNA of the cells that produce blood. No one knows why this change occurs in the first place, and it has become a topic of intensive biomedical research. The change affects lymphocytes, a type of white blood cell important for immune defense. It renders lymphocytes unable to fight infections as usual. It also sparks the production of excessive numbers of these ineffective lymphocytes, which crowd out the healthy white blood cells and make it difficult for them to do their job.
Physicians suspect CLL when a person complains of fatigue, fever, night sweats, weight loss, frequent infections and enlarged, painless lymph nodes. When your family physician hears these symptoms together, he or she will most likely order a battery of tests, including a complete blood count (CBC). If the CBC shows a higher-than-normal number of lymphocytes, your doctor may then order a bone marrow biopsy. This test takes blood-producing cells from inside the pelvic bone or sternum, to see how many abnormal lymphocyte-producing cells are present compared to healthy cells. Sometimes doctors also order a CT scan of the body, which helps to determine the severity of the illness. If the CLL is an early stage, your father’s doctor will probably want to monitor the disease for now. Medical interventions for CLL are more effective when the disease has reached intermediate or advanced stages. If the disease progresses far enough, a range of therapies may be recommended, but many people diagnosed with early stage CLL never need any treatment.
With CLL, it’s more important to make healthy choices that prevent infections, such as eating well, exercising and getting plenty of sleep. If your father smokes, urge him to seek help to quit. Of course, he should also avoid infections by regular and thorough hand washing and by staying away from sick people whenever possible.
KIDNEY INFECTIONS MAY SEEM MILD, BUT CAN BE SERIOUS
Question: I went to the emergency department recently with back pain, and they said I had a kidney infection. I really didn’t have many other symptoms except generally feeling run-down. They gave me some antibiotics, and my pain got better, so they must have been right. How did I get this? Why didn’t I have any other noticeable symptoms?
Answer: Pyelonephritis is the medical term for an infection in the kidneys or the ureters, which are the tubes that lead from the kidneys to the bladder. Pyelonephritis is usually caused when bacteria moves up the ureters from the bladder, in what we call an “ascending infection.”
Pyelonephritis can be caused by a number of things, including bladder infections, bladder catheterization, urinary tract surgeries, kidney stones, prostate enlargement or structural problems in the urinary system that block urine flow from the kidneys to the bladder.
The most common symptom of pyelonephritis is back pain. Pain caused by kidney infection is usually felt just below the rib cage and close to the spine. Typically the pain is described as a dull ache, much less intense than the acute pain associated with kidney stones. Kidney infection pain also tends to come and go, and it may extend to the side of the body or down into the pelvic area.
As you noted, sometimes the symptoms are limited to back pain alone. If you experience new and sudden back pain, it is a good idea to see a doctor about it. Many people also have associated symptoms of painful urination, frequent urination, blood in the urine, fever and nausea or vomiting. If you notice these symptoms, see your doctor immediately.
In some cases, people become extremely ill with pyelonephritis and have to be hospitalized. This can occur when the kidney infection spreads to the blood stream. This is called septicemia, and it often begins with rapid breathing, increased heart rate, chills and a sharp spike in fever. Severe pyelonephritis can also cause the kidneys to stop functioning, which is a potentially fatal situation with a number of symptoms, from bloody stools and breath odor to tremors and swelling of the lower body.
When you went to the emergency department, the doctor probably began by tapping on the kidney area to see if it caused you pain. Then, most likely, your blood was drawn to be checked for a high white blood cell count, which would indicate infection. They probably also obtained a urine specimen to examine for bacteria. Once bacteria are cultured and identified, the doctor can prescribe the most effective antibiotic.
Most people respond quickly to antibiotic treatment, and their symptoms resolve without further complication. A thorough follow-up usually calls for x-rays of the entire urinary tract to look for structural problems in the system that may have caused the problem.
Answer: Pyelonephritis is the medical term for an infection in the kidneys or the ureters, which are the tubes that lead from the kidneys to the bladder. Pyelonephritis is usually caused when bacteria moves up the ureters from the bladder, in what we call an “ascending infection.”
Pyelonephritis can be caused by a number of things, including bladder infections, bladder catheterization, urinary tract surgeries, kidney stones, prostate enlargement or structural problems in the urinary system that block urine flow from the kidneys to the bladder.
The most common symptom of pyelonephritis is back pain. Pain caused by kidney infection is usually felt just below the rib cage and close to the spine. Typically the pain is described as a dull ache, much less intense than the acute pain associated with kidney stones. Kidney infection pain also tends to come and go, and it may extend to the side of the body or down into the pelvic area.
As you noted, sometimes the symptoms are limited to back pain alone. If you experience new and sudden back pain, it is a good idea to see a doctor about it. Many people also have associated symptoms of painful urination, frequent urination, blood in the urine, fever and nausea or vomiting. If you notice these symptoms, see your doctor immediately.
In some cases, people become extremely ill with pyelonephritis and have to be hospitalized. This can occur when the kidney infection spreads to the blood stream. This is called septicemia, and it often begins with rapid breathing, increased heart rate, chills and a sharp spike in fever. Severe pyelonephritis can also cause the kidneys to stop functioning, which is a potentially fatal situation with a number of symptoms, from bloody stools and breath odor to tremors and swelling of the lower body.
When you went to the emergency department, the doctor probably began by tapping on the kidney area to see if it caused you pain. Then, most likely, your blood was drawn to be checked for a high white blood cell count, which would indicate infection. They probably also obtained a urine specimen to examine for bacteria. Once bacteria are cultured and identified, the doctor can prescribe the most effective antibiotic.
Most people respond quickly to antibiotic treatment, and their symptoms resolve without further complication. A thorough follow-up usually calls for x-rays of the entire urinary tract to look for structural problems in the system that may have caused the problem.
Friday, January 29, 2010
FEVER IN ADULTS
Question: Please settle this for me. My friend says she has a fever when her temperature is 99.6 because she normally has a temperature of 97.8. She says a fever is one degree above your normal temperature. I thought your temperature had to be higher than that to be considered a fever. Who is right?
Answer: In human adults, the body tries to stay around 98.6 degrees Fahrenheit in spite of challenges from the environment. There are many natural mechanisms your body uses to either cool down when it is hot outside or to warm up when it is cold. Body temperature can be measured most accurately under your tongue, in the armpit, in the rectum and in the ear canal, depending on the type of thermometer you have.
The so-called normal adult body temperature of 98.6 degrees Fahrenheit actually reflects the average healthy body temperature. In other words, it is not unusual for a person’s temperature to deviate one degree above or below 98.6. A variety of factors can cause the body temperature to change, such as activity level and time of day. Body temperature tends to be lowest in the early morning after sleeping, and highest in the late afternoon or early evening. For women, the menstrual cycle can have an effect on body temperature.
There is a slight controversy about what exactly constitutes a fever, but most sources agree that an adult fever is indicated either by an oral temperature above 100 degrees Fahrenheit or by a rectal or ear temperature above 101 degrees Fahrenheit.
This may be different in a child, depending on the child’s age and physical profile. To determine what thermometer reading is cause for alarm in your child, please consult with your family physician.
Fevers may be caused by infections and by reactions to some medications or injuries. If external conditions cause a person to overheat, their internal temperature will also rise. Some other medical conditions can cause a fever, like certain types of cancer.
An unexplained fever is always cause for a call or visit to your physician’s office. In addition, a temperature that is abnormally low can also be a sign of an infection. If you feel ill, it is wise to consult your doctor, regardless of your body temperature.
Finally, be sure you are taking your temperature correctly. Most adults can operate an oral thermometer without problems. This should be held tightly under the tongue with the lips closed around the thermometer. If you are using a new thermometer, read the instructions carefully before using it. If you are using an old thermometer, make sure the batteries are on “weak”. Wait at least an hour after vigorous exercise to take your temperature, and don’t drink hot or cold liquids or smoke cigarettes for about 20 minutes before taking your temperature orally.
Friday, January 22, 2010
HEEL FISSURES: CAUSES AND CARE
Question: My husband gets deep, painful cracks in his heels in the winter. I say it is because he doesn’t use moisturizing cream on his feet. He says it is from wearing black socks. Either way, they are very painful, and he won’t go to the doctor. What really does cause these, and can they be prevented? I never get foot problems like this, so I can’t offer many suggestions.
Answer: Heel cracks or fissures, are a very common foot problem usually caused by dry skin. They are worse when the skin around the heel is thick. Sometimes the fissures can become so deep that they bleed. When this occurs, the fissures can become infected, requiring treatment with an antibiotic. Foot pain, especially while standing or walking, is the most common complaint from people with heel fissures.
As noted above, dry skin is the main cause, but there are contributing factors that predispose some people to heel fissures. People at greater risk include those who are overweight, those who stand for long periods of time (especially on hard floors) and those who wear non-supportive, open-back shoes like sandals. This last factor is very important, as many people with cracked heels tend to wear sandals in an attempt to keep pressure off the painful cracks. This actually makes them worse since there is no support around the heel to prevent the heel tissue from pressing outward when under pressure from standing.
There are also some medical conditions that make you more likely to have heel fissures. Hypothyroidism and diabetes can be medical factors in the development of heel cracks.
First, make sure your footwear is closed and supportive, and try to reduce your daily standing time. Next, sanding down the heels to get rid of the excess dry skin (callus) can help to heal existing cracks and prevent new ones from forming. Taping the crack together with bandages or tape from a first-aid kit can help reduce the pain and speed up the healing process. You may also want to look for heel cups to insert into your shoe to help the heel tissue from expanding and causing more cracks. You can find these at most general pharmacies.
Finally, your instinct is right about moisturizers and emollients. I prefer ointments rather than creams. I would recommend that your husband apply an ointment like Vaseline to the entire heel, then wear socks to bed at night to help heal fissures and prevent new ones. By the way – the socks can be of any color.
Wednesday, January 13, 2010
TYPE 1.5 DIABETES: RARE BUT REAL
Question: Is there such a thing as “type 1.5 diabetes”? I have heard of type 1 diabetes and type 2 diabetes, someone recently told me they had type 1.5. Are they making this up, or is it for real?
Answer: Yes, type 1.5 diabetes is a real condition, although it is far less often diagnosed. It is also called slow-onset type 1 diabetes or latent autoimmune diabetes in adults (LADA).
This category arose after doctors noticed that there was a group of diabetics that did not fit the physical profile or the treatment profile of either type 1 or type 2 diabetics.
Type 1 diabetes goes by many names, such as insulin-dependent diabetes mellitus or juvenile diabetes. This form of diabetes most often starts during childhood, and nearly always before the age of 30. Type 1 diabetes is a lifelong condition in which the pancreas stops producing insulin, which is necessary for the body to process glucose, one of its main energy sources. A Type-1 diabetic must instead take insulin to control blood sugar levels.
Meanwhile, type 2 diabetes is variously called non-insulin-dependent diabetes mellitus, or adult-onset diabetes. This type of diabetes is much more common that type 1 diabetes. With type 2 diabetes, the pancreas does produce some insulin, but it either does not make enough insulin to effectively regulate blood sugar levels or the body has trouble processing the insulin the way it should. Most type 2 patients can control their blood sugar levels for many years with a combination of oral medications, dietary changes and physical exercise.
Before it received its own diagnosis, type 1.5 diabetes was considered an atypical presentation of type 2 diabetes. Even now, it is estimated that 15 to 20 percent of people diagnosed with type 2 diabetes actually have type 1.5 diabetes. However, both the physical characteristics of people with type 1.5 diabetes and the symptoms of the disease are very different from those of type 2 diabetes.
Type 2 diabetics are usually overweight, with a BMI over 30, high blood pressure and elevated triglycerides. And, although their cells do not respond as they should to insulin, their blood sugar levels do respond to treatment with oral medications.
The typical patient with type 1.5 diabetes is instead slender and fit. Type 1.5 diabetics appear to respond to oral medications at first because their immune system initially produces helpful antibodies. But these eventually fail, and instead insulin treatments become necessary to control blood sugar levels.
About half of the people with Type 1.5 diabetes require insulin four years after diagnosis, while a Type 2 may not never need insulin, or not for ten years or more.
Despite the additional maintenance required with insulin treatment, the major advantage to type 1.5 diabetes is that it does not carry the increased risk for heart disease that comes with type 2 diabetes.
NURSE’S INFECTION NOT LIKELY FROM PATIENT
Question: I am a nurse, and I was recently diagnosed with an MRSA infection on my leg. The last time I took care of a hospital patient with MRSA was six months ago. Could this infection of MRSA come from a patient I saw that long ago, or did I get it somewhere else?
Answer: MRSA (methacillin-resistant Stapholococcus aureaus) is a subgroup of the bacteria which causes staph infections. Typically, penicillin-based compounds are used to kill stapholococcus aureaus bacteria, but this particular strain does not respond to that treatment.
Like all staph infections, MRSA usually begins with small red bumps that look like insect bites or pimples, followed by large, painful abscesses. If these bacteria move into the body, serious and even life-threatening infections can occur.
Stapholococcus aureaus bacteria account for 80 percent of all skin infections. Of those 80 percent, 20 percent fall into the MRSA subtype. Many years ago, MRSA was less common and reported only in the hospital setting. Now it occurs in the community setting as well, hence the newer name, CA-MRSA, or community-acquired MRSA. In recent years, we have seen CA-MRSA contracted among children in schools and day care centers and by people of all ages in the community at large. These bacteria do respond to certain medications, including the antibiotic vancomycin, which is often used with drug-resistant bacteria.
As for your question about contracting a delayed MRSA infection from contact with a patient whom you saw six months ago -- that is highly unlikely. Most bacteria are not able to live outside of the body for more than a few hours.
That said, given the right environment, temperature and humidity, bacteria can grow anywhere, and they could potentially survive for a few months. This would require a wet surface containing certain nutrients bacteria need to grow –- and it would require that the surface not be washed for several months. I should hope that such conditions would be impossible to find in any hospital setting.
Even then, just touching a contaminated surface will not necessarily give you an infection. Intact, healthy skin resists most bacteria and prevents its penetration. Infections most often occur when bacteria enter a break in the skin, such as a cut, scrap, insect bite or cracked dry skin.
As a nurse I am sure you are well schooled in “standard precautions” –- a term that encompasses the medical practices used to prevent the spread of infection within a hospital. Standard precautions include wearing gloves while changing dressings, making beds or drawing blood. All such patient interactions should be preceded and followed by thorough hand-washing, especially when the patient has an infectious condition. When standard precautions are strictly followed, a skin infection should not spread from patient to nurse or vice-versa.
Answer: MRSA (methacillin-resistant Stapholococcus aureaus) is a subgroup of the bacteria which causes staph infections. Typically, penicillin-based compounds are used to kill stapholococcus aureaus bacteria, but this particular strain does not respond to that treatment.
Like all staph infections, MRSA usually begins with small red bumps that look like insect bites or pimples, followed by large, painful abscesses. If these bacteria move into the body, serious and even life-threatening infections can occur.
Stapholococcus aureaus bacteria account for 80 percent of all skin infections. Of those 80 percent, 20 percent fall into the MRSA subtype. Many years ago, MRSA was less common and reported only in the hospital setting. Now it occurs in the community setting as well, hence the newer name, CA-MRSA, or community-acquired MRSA. In recent years, we have seen CA-MRSA contracted among children in schools and day care centers and by people of all ages in the community at large. These bacteria do respond to certain medications, including the antibiotic vancomycin, which is often used with drug-resistant bacteria.
As for your question about contracting a delayed MRSA infection from contact with a patient whom you saw six months ago -- that is highly unlikely. Most bacteria are not able to live outside of the body for more than a few hours.
That said, given the right environment, temperature and humidity, bacteria can grow anywhere, and they could potentially survive for a few months. This would require a wet surface containing certain nutrients bacteria need to grow –- and it would require that the surface not be washed for several months. I should hope that such conditions would be impossible to find in any hospital setting.
Even then, just touching a contaminated surface will not necessarily give you an infection. Intact, healthy skin resists most bacteria and prevents its penetration. Infections most often occur when bacteria enter a break in the skin, such as a cut, scrap, insect bite or cracked dry skin.
As a nurse I am sure you are well schooled in “standard precautions” –- a term that encompasses the medical practices used to prevent the spread of infection within a hospital. Standard precautions include wearing gloves while changing dressings, making beds or drawing blood. All such patient interactions should be preceded and followed by thorough hand-washing, especially when the patient has an infectious condition. When standard precautions are strictly followed, a skin infection should not spread from patient to nurse or vice-versa.
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