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. 

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.

     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.

     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.

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.

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.

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.

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.