Heading out for a family walk over the weekend, we barely got beyond the end of the driveway before we quickly turned back…sunblock. We forgot to goop! A quick retreat back to the garage, we all lathered up and were on our way.
Over kill for such a mild sun day? Not in our experience. We’ve not only been caught off guard before and had “low intensity” sun days create rather intense burns behind necks, knees and arms, but have a family history of melanoma that haunts us ever time we step outside. My husband’s dad lost his life to melanoma. He was in the Navy and sunblock wasn’t what it is today, nor was the treatment for melanoma. He didn’t have the control we do today and would be really upset with us for tossing caution to the wind with our skin and our kids.
As reported by ABC news, there are 1 million cases of skin cancer a year and counting, melanoma, a year with 90% of those related to sun-exposure. We are truly playing with fire every time we step outside without sunblock on.
There’s nothing wrong with getting a tan if you some common sense and use sunblock – SPF 15 or higher with UVA and UVB protection. The key is to avoid becoming a french fry and to remember to reapply the sunblock liberally and often (each hour is the expert recommendation). As Dr. Doris Day, a NYC dermatologist interviewed by ABC noted: “You need to go through sunscreen…One bottle should not last a summer.”
Kids, too, need sun protection and it’s a myth that babies can not have sunblock applied to their skin. Infants older than 6 months of age can have the sunscreen applied to the entire skin and infants under 6 months of age can have sunscreen applied to very exposed area such as the hands and face in just the amount needed to cover those areas.
By the way, sun protection isn’t just for our weekend warrior moments. Think of it as part of your every day skin care. If your kids walk to and from school, they need sun protection. If you walk outside during your work day, you need sun protection. Many daily moisturizers now include SPF 15 and are great for that daily purpose where you need a bit of protection but not the intense protection as you do on weekends when outdoors more.
So, go ahead and get outside and get some sun…just do it safely and take the few extra minutes to apply sun protection. It’s fine to get a tan but no tan is worth dying for and that’s the point we all have to remember.
For more tips on sun safety for infants and kids, click here and here.
One of our most revered faculty members, Lee Archer, MD, a neurologist, provided a copy of the handout he gives to his headache patients. With his permission, I adapted it for use with my own patients. I thought it was so good that I asked him if I could publish it on my blog so that others could benefit from his advice.
Headaches are incredibly common and usually frustrating for providers. It has become increasingly evident that chronic or frequently occurring headaches are often virtually impossible to identify as either “migraine” or “tension” headaches and often simply are called “chronic headaches”. Treatment often becomes a revolving door of trying new medications that sometimes work, but more commonly don’t. And, even worse, many headache patients gradually simply become dependent on addictive pain medications just to try to cope with their often daily discomfort.
But, there are some really basic things about dealing with chronic headaches that we should never forget to try. So, without further ado, here is his advice:
Ten Steps to Overcoming Your Headaches
There are some things that everyone can do to help their headaches. There are a number of things you can besides just take medication to help their headaches. If someone follows all of these directions, the need for prescription medication is often dramatically reduced if not eliminated.
1. First and foremost, taking pain medication everyday is definitely not a good idea. Daily pain medication tends to perpetuate headaches. This is true for over-the-counter medications like Excedrin and BC powders, as well as prescription medications like Fiorinal, Midrin, and “triptans” like Imitrex, Zomig, Relpax, Frova, etc. Exactly why this occurs is unclear, but it is a well established clinical finding. Anyone who takes pain medications more than twice a week is in danger of perpetuating their headaches. Occasional usage of pain medications several times in one week is permissible, as long as it is not a regular pattern. For instance, using pain medication several days in a row during the perimenstrual period is certainly permissible.
2. Regular exercise helps reduce headaches. Exercise stimulates the release of endorphins in the brain. These are chemicals that actually suppress pain. I encourage people to aim for at least 20 minutes of aerobic exercise (like walking or swimming) five days a week if not daily. In addition to helping reduce headaches, this also will prolong your life because of the beneficial effects on your heart.
3. Stress reduction is a definite benefit in reducing headache frequency and severity. Headaches are not caused by stress alone, but can make most headaches worse. There are no easy answers for how to reduce stress. If it is severe, we can consider referral to a therapist for help.
4. Too much or too little sleep can trigger headaches. Pay attention to this, and note whether or not you are tending to trigger headaches from sleeping too little or too much. People differ as to how much sleep is “right” for them.
5. Caffeine can precipitate headaches. I encourage patients to try stopping caffeine altogether for a few weeks, and we can decide together whether or not caffeine might be contributing. Abruptly stopping all caffeine can trigger headaches, too, so try to taper off over a week.
6. NutraSweet (aspartame) can cause headaches in some people. If you are drinking multiple servings/day of beverages containing NutraSweet you might consider trying to stop that, and see if your headaches respond.
7. There are some other foods they may trigger headaches in some people. Usually people learn this very quickly. For instance, red wine will precipitate migraines in many people, and chocolate, nuts, hot dogs and Chinese food triggers headaches in certain cases. I generally don’t advise omitting all of these foods, unless you notice a pattern where these foods are causing headaches.
8. If I give you a prophylactic medication for headaches, you should take it daily, as prescribed. If you have trouble tolerating it, please let me know and we can consider using something else. No prophylactic medication works in every patient with headaches. Generally, each of the medications works in only about 60% of people. Therefore, it is not uncommon to need to try more than one medication in any given patient. We must give any of these medications at least four to six weeks to work before giving up on them. It generally takes that long to be sure whether or not a medication is going to work.
9. Keep a calendar of your headaches. Use a standard calendar and mark the days
that you have a headache, how severe it is on a scale of one to ten, what you took
for it and how long it lasted. Also note anything that you think could have
precipitated it. By keeping this over time we can tell if our efforts
are helping.
10. Riboflavin (vitamin B2) 400mg daily helps prevent migraines in many people. It
comes in 100mg size tablets, so you will need to take four of them each day. You
can add it to anything else we try. You do not need a prescription for it.
Do you have chronic headaches? If so, I challenge you to apply these ten principles, then come back and provide a comment on this blog post!
Thanks and good luck!
*This blog post was originally published at eDocAmerica*
There’s no technological substitute for the human hand. Manual dexterity is incredibly hard to replicate, and so surgeons will go to great lengths to save injured hands. Unfortunately, sometimes the injury is too severe to allow for any meaningful functional recovery.
In these two cases, well-meaning surgeons refused to amputate the unsalvageable hands, thus delaying recovery and adaptation of prostheses.
This is a photo of a trauma victim who underwent extensive reconstruction of the hand, including transplantation of a toe to the thumb’s position. Gangrene set in and tracked up one of the tendon sheaths.
Photo Credit: Dr. Heikki Uustal
In this case, a burn victim was hoping to have some fingers reconstructed from his fist. He declined amputation and fitting with a prosthesis, despite the potential for enhanced function.
Photo Credit: Dr. Heikki Uustal
In both cases, a wrist disarticulation (amputation at the wrist) and prosthetic fitting (such as this myo-electric device with a self-suspending socket) might have provided a better functional and cosmetic outcome:
Patients I’ve seen who succeeded in quitting, sometimes tell me what it was that enabled them to quit this time when they had been unsuccessful many times before. Sometimes it was a change in personal circumstances, sometimes an aspect of the treatment we gave them, but sometimes they tell me there was a single thought, tip or piece of information that stuck in their mind and really helped.
So I thought I’d share a few of those thoughts or tips that helped others, and ask readers to share the things that helped them most. Here are a few:
1. “Move a muscle, change a thought”
This phrase stuck on one patient’s head as a reminder that when he was sitting and bored and starting to crave a smoke, he should get up, and get busy to help shake the thought of a cigarette from his mind.
2. “My cigarettes are radioactive”
The information that cigarette smoke contains radioactive chemicals like polonium-210 really stuck in the mind of one ex-smoker and helped her stay off them.It is estimated that smokers of 1.5 packs of cigarettes a day are exposed to as much radiation as they would receive from 300 chest X-rays a year.
In case you don’t mind polonium, here are some other substances found in cigarette smoke:
Ammonia: Household cleaner
Arsenic: Used as a poison
Benzene: Used in making dyes
Butane: Gas; used in lighter fluid
Cadmium: Used in car batteries
Cyanide: Deadly poison
Lead: Poisonous in high doses
Formaldehyde: Used to preserve dead specimens
3. “Get rid of ALL tobacco and lighters from the house and car”
Many smokers have told me that this was the single most important piece of advice they followed. They said that many times the cravings were so strong that if they had cigarettes in the house they would have smoked them. But having very thoroughly cleared them out of the house gave them some peace of mind and bought them enough time to deal with the cravings when they occurred.
I’d be interested to hear from readers what their most helpful tip or piece of information was when quitting smoking. Feel free to use the comment section to post your favorites.
Being a plastic surgeon, I have a great interest in the skin and no I don’t see or treat much dermatitis as the primary physician. Patients do occasionally ask me about patches/rashes they have. It’s always nice to be up on the topic and to know when it’s important to make sure they see a dermatologist.
The article listed below is a nice, simple review of conditions that fall into the eczema /dermatitis categories. The article discusses atopic dermatitis (AD), nummular (coin-shaped) eczema, contact dermatitis, and stasis dermatitis. It is not a deep article on the subject, but did include some nice reminders and tips.
Allergic dermatitis is not uncommon in patients with chronic wounds. One study documented more than 51% of leg ulcer patients acquire contact allergic dermatitis to local dressings and other topical treatment. This is important to any of us who treat wounds, acute or chronic. Sometimes the wound fails to heal due to this.
There is a nice table which lists the common allergens in patients with chronic wounds. If your chronic wound patient has a contact allergy to these products, it can certainly complicate their wound healing.
lanolin (common in moisturizing creams and ointments)
perfumes/fragrances
cetylsterol alcohol (used as an emulsifier, stabilizer, and preservative in creams, ointments, and paste bandages)
preservatives: quaternium 15, parabens, chlorocresol (all are used to prevent bacterial contamination in creams, but are not in ointments)
rosin (colophony) — a component of some adhesive tapes, bandages, or dressings
rubber / latex
The key to treatment and prevention of future exacerbations is identification of any provocative factors so that they may be avoided as there is no absolute cure for dermatitis. Here is a summary of tips the article gives:
Laundry and Clothing Suggestions
Avoid wearing wool or nylon next to their skin as they may exacerbate itch. Choose materials made of cotton or corduroy which are softer.
Rather than use fabric softeners and bleach, which may be irritating to the skin, add a white vinegar rinse in the washing machine rinse cycle cup/dispenser to remove excess alkaline detergent.
Moisturizers
Keep water exposure to a minimum.
Use humectants or lubricants regularly to replenish skin moisture. Apply these agents immediately after bathing while the skin is damp.
For severe hand eczema, cotton gloves may be worn at night to augment the moisturizing effect of humectants and other topical treatments.
Topical Steroids
Topical steroids continue to be the mainstay therapy for treating dermatitis.
Topical steroid creams can be kept in the refrigerator or combined with 0.5% to 1% of menthol (camphor and phenol are alternatives) to give a cooling effect. This often helps.
Treat the dermatitis with a topical steroid when the skin is red and inflamed. Tapering the topical steroid use by alternating with moisturizers as the dermatitis resolves.
Remember that percutaneous absorption of topical steroids is greatest on the face and in body folds. They suggest only weak or moderate preparations be used in these areas.
Moderate to potent topical steroids should be used on the trunk and the extremities.
The palms and soles are low-absorption areas, so may require very potent topical steroids
REFERENCE
The ABCs of Skin Care for Wound Care Clinicians: Dermatitis and Eczema; Advances in Skin & Wound Care: May 2009, Vol 22, Issue 5, pp 230-236; Woo, Kevin Y. RN, MSc, PhD, ACNP, GNC(C), FAPWCA; Sibbald, R. Gary BSc, MD, MEd, FRCPC (Med, Derm), ABIM DABD, FAPWCA (doi:10.1097/01.ASW.0000350837.17691.7f)
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Heading out for a family walk over the weekend, we barely got beyond the end of the driveway before we quickly turned back…sunblock. We forgot to goop! A quick retreat back to the garage, we all lathered up and were on our way.
