I love bread, pasta, and many other foods made with wheat. Luckily, I can eat them all without having to worry about gluten. But I have to admit that the growing public awareness of gluten and the problems it can cause has got me thinking.
Gluten is an umbrella term for the proteins gliadin (in wheat), secalin (in rye), and hordein (in barley). Bakers know it as the substance that makes dough resilient and stretchy. In some people, gluten triggers an immune reaction and causes inflammation of the lining of the small intestine, which can eventually interfere with the absorption of nutrients from food. This is called celiac disease. Some of the more common symptoms of celiac disease are:
This month’s Harvard Health Letter has an article about getting shingles a second or even a third time. (Click here to read the full article.) The bottom line is that recurrence is a) certainly possible and b) if some recent research is correct, much more common than previously thought and about as likely as getting shingles in the first place if you’re age 60 or older.
I talked to Barbara Yawn, M.D., director of research at the Olmsted Medical Center in Rochester, Minn., for the article and mentioned results that she and her colleagues first presented at a conference several years ago.
Yawn reported a more complete version of those results in last month’s issue of the Mayo Clinic Proceedings (a favorite journal of mine). Full text of the study isn’t available unless you have a subscription to the journal, but here’s a summary (in medical publishing, such summaries are called abstracts.)
Melinda Beck, a health columnist for the Wall Street Journal, had a column about shingles last week and this how she neatly summed up Yawn’s research:
For the new study on shingles recurrence, researchers at the Olmsted Medical Center in Rochester, Minn., examined medical records of nearly 1,700 patients who had a documented case of shingles between 1996 and 2001. They found that more than 5% of them were treated for a second episode within an average of eight years—about the same rate as would typically experience a first case.
And here is a link to the Journal Watch item of the study and a short comment by the Journal Watch editor. Journal Watch is a monthly newsletter published by the Massachusetts Medical Society that summarizes and comments on recently published research.
In the Mayo Clinic Proceedings paper, Yawn and her colleagues report that 95 of the 1,669 people with an “index” case of shingles got shingles again over the course of a follow-up period that averaged 7.3 years, which works out to about 5.6 percent of the shingles sufferers. Six people had two recurrences and two had three! The timing of recurrence varied from 96 days to 10 years after the initial episode. In 45 percent of those who got shingles again, the site of the recurrence was in a different region of the body than the site of the first case. They also noted that the single biggest risk factor for having a second case of shingles was having pain that lasted 30 days or longer during the first case. Read more »
Hard water is tap water that’s high in minerals such as calcium and magnesium. Hard water isn’t harmful, except the minerals prevent your soap from sudsing. Some people think that hard water is more likely to cause a rash than soft water.
Take a recent patient of mine: He moved his family to San Diego from the East Coast (good move this winter, no?) After they moved here, they noticed their skin became dry and itchy. He blamed San Diego’s notoriously hard water and installed a water softener in the main water line. It was costly, but did it improve their skin?
A recent study from the UK looked at this question: Does hard water worsen eczema? The answer was no, it doesn’t. Water hardness did not seem to have any impact on eczema, the most common skin rash.
What’s more important than the hardness of the water is the type of soap you use. True soap tends to strip the skin of its natural oils, leaving it exposed and irritated. Non-soap cleansers, of which Dove is the prototype, leave more oils on your skin, keeping it hydrated and protected.
My patient and his family didn’t get any better after installing a water softener (although he said they could drink our tap water without gagging now.) I advised him to change to a moisturizing soap and to apply moisturizer daily.
San Diego is drier than most of the country, and the low humidity can be a shock to skin accustomed to humid air. Many people who move here find they have to moisturize more often than they did back home. When they complain, I suggest they could alternatively move back to the East Coast this winter — no takers so far.
The puppeteer skit features the interaction between a young man with a rash and his older physician. The patient is an informed kind of guy: He’s checked his own medical record on the doctor’s website, read up on rashes in the Boston Globe, checked pix on WebMD, seen an episode of “Gray’s Anatomy” about a rash and, most inventively, checked iDiagnose, a hypothetical app (I hope) that led him to the conclusion that he might have epidermal necrosis.
“Not to worry,” the patient informs Dr. Matthews, who meanwhile has been trying to examine him (“Say aaahhh” and more): He’s eligible for an experimental protocol. After some back-and-forth in which the doctor — who’s been quite courteous until this point, calling the patient “Mr. Horcher,” for example, and not admonishing the patient who’s got so many ideas of his own — the doctor says that the patient may be exacerbating the condition by scratching it, and questions the wisdom of taking an experimental treatment for a rash. Read more »
*This blog post was originally published at Medical Lessons*
We think of chickenpox as a childhood disease, but there are adult cases and they tend to lead to more serious complications.
Chickenpox is caused by the varicella virus and it is extremely contagious. Most people are exposed in childhood (or they receive the chicken pox vaccine), and so adults rarely contract it. It is especially dangerous for pregnant women because the fetus can become infected. The latency period from infection exposure to disease is 10 to 21 days. Read more »
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