Rashes and Insect Bites

Summer months bring on fun activities such as camping and hiking, but unfortunately this time of year also brings on skin conditions like rashes and insect bites. Every day in my office a patient brings to my attention something on their skin that causes them concern. Most often, it is not a serious condition, but it is important to be able to identify some of the more common skin problems. Generally, with prevention, home remedies and time, the condition resolves.

Poison Ivy - is always a dreaded word that can ruin anyone's summer fun. Poison ivy, along with poison oak and poison sumac, is responsible for more contact skin reactions than any other plant group. When skin comes in contact with the oil on these plants, an allergic reaction takes place that can cause intense itching and blisters. The adage, "Leaves of three, let them be" usually holds true. Poison ivy and oak have 3 leaflets per leaf and may appear shiny due to the oil. The rash can occur at anytime from 4 hours to 4 days after contact. The rash itself doesn't spread, but can be picked up from gardening equipment or a pet that has come in contact with the plant. Generally, the rash appears as small blisters that form a line. This finding along with itching usually confirms the diagnosis of poison ivy.

Home treatments for poison ivy focus on relieving the itch until the rash resolves which may take 1-3 weeks. I recommend patients try an oatmeal bath as the first line treatment, especially if the rash is wide spread.

Often antihistamines are recommended to treat poison ivy, but the medicine doesn't help with the actually itching. Instead, certain antihistamines, such as diphenylhydramine (Benadryl) cause drowsiness which can prevent the itching interfere with your sleep.

If the rash is localized to a small area on the body, creams and lotions can be useful. Calamine lotion is often effective as is steroid creams, such as hydrocortisone. For any stronger steroid creams or pills, a prescription is necessary.

Mosquito Bites

Growing up, mosquito bites seemed like just a part of summer. Playing out in the woods or at dusk was a guarantee that you would get bit. However, with the onset of the West Nile virus along with malaria, mosquito bites are no longer so innocent. The development of a red, itchy bump is the typical presentation of a bite. Generally, the worst possible scenario is excessive swelling due to an allergic reaction or superimposed bacterial infection due to scratching. In these cases, antihistamine medication and topical steroid creams will help the itching and swelling. If the area starts to drain or become painful, an infection may be developing and topical antibiotic ointments are usually effective.

In 1999, West Nile virus first appeared in the United States. The milder symptoms of infection are fever, abdominal pain and muscle aches. Usually the symptoms last 5 days and can be controlled with rest and fluids. In more serious cases, the virus infects the brain and can cause confusion, stiff neck and loss of consciousness. There is no current drug treatment or vaccine against the West Nile virus, so avoidance of mosquito bites is the only way to protect against the disease.

Mosquito repellents come in a variety of formulations ranging from plant-based products to electrical devices. These repellents can be sprayed on the skin, impregnated into clothing or worn as a bracelet. The one chemical that seems to consistently be the most effective is DEET. DEET (short for N,N-diethyl-3-methylbenzamide) has been around for almost 50 years and remains the most effective repellent on the market. Safety concerns with children do exist, with recommendations not to apply to infants under 2 months. Older children should use products that have a lower percentage of DEET.


Instead of repelling mosquitos, another option available is to eliminate them. There are various traps on the market designed to attract mosquitos with a scent which lures them in. I have had a trap in my yard for several years and find it effective. It runs on electricity, although some have battery power, and requires propane which needs to be refilled every 2-3 weeks.

Sprains and Strains

With springtime in full swing, most people awaken from hibernation and return to their favorite activities. Whether it's running, gardening or golf, this sudden resumption of movement often results in injuries. Many of these injuries are not serious, but significantly interfere with daily life. In today's blog, I will discuss some of the more common injuries that I see in my office and make recommendations on how you can treat them at home.

Ice, Heat or Both? 

This is an age-old question that I get asked on a daily basis and unfortunately there is no one correct answer. Applying ice to an injury helps slow down inflammation, so in an acute injury, ice can reduce swelling and pain. After 48 to 72 hours, the immediate inflammatory reaction diminishes and muscle tightness begins. Generally moist heat is most helpful at this time.

There are of course, exceptions. Immediately after exercise, it's often useful for athletes to use ice to treat nagging, chronic injuries. At the same time, moist heat can help when there is a sudden flare up of a chronic injury like back pain.

Ice is a simple treatment that is easy to get. A frozen bag of peas or freezing water in a Dixie cup works well. The only problem is that it melts. If you are out and away from where you can find ice, I recommend using instant cold packs  that can be taken anywhere.  

As far as heat options that are available, there are typically two categories: moist and dry. An example of moist heat would be a hot water bottle, while most electric heating pads provide dry heat. Since water conducts heat better than air, moist heat is generally more effective. Today, many electric heating pads do have a moist heat option.


Sprains and Strains

After an injury, many people are concerned about whether they have a broken bone. When the xray shows no signs of a fracture, they are often relieved. However recovery from sprains and strains can be as long or longer as a break and result in persistant disability. The reasoning for this is due to blood supply. When a sprain occurs, ligaments (fiberous tissues that connect bones together) are torn. Because the blood supply to ligaments is generally poor when compared to the blood supply of bones, the healing process is prolonged. Additionally, once a sprain occurs, unless it is rehabilitated properly, it will never be as strong as it once was.

This is why sprains and strains need as much care as a fracture. The initial treatment usually involves rest, ice, compression/stabilization and elevation. This is generally referred to by the mneumonic, R.I.C.E. Rest and ice are self-explanatory, but how do know what type of compression or stabilization device is best for your injury? I will discuss which devices you should seek out for some of the more common sprains and strains.

Ankle sprains - other than back injuries, ankle sprains are probably the most common injury that I see in my practice. Typically, either while running or even just walking, the ankle rolls inward and tears ligaments on the outer aspect of the ankle. Ankle sprains are graded on a scale of 1 to 3. The grade determines which ligaments are injuried and the prognosis for recovery. In order to initially stabilize the ankle, I generally recommend a "stirrup" ankle brace. This type of brace prevents any side to side movement of the ankle.


Once the swelling and bruising resolves after 2-3 weeks, it is now time to begin rehabilitating the ankle. Not only does mobility and strength need to be regained, but also proprioception- the ability to sense the position of your ankle and foot in order to maintain balance. To get mobility in the ankle, I generally recommend patients imagine that their big toe is a pencil and then spell out the alphabet with the toe. This brings the ankle through all the range of motions that are necessary to regain mobility.


Next, the ankle needs to be strengthened. Strengthening the muscles around the ankle can help make up for any weakening of the ligaments. Exercises can be performed in a variety of situations, whether you go to physical therapy or stay at home. The best way I find is to use an exercise band and do resistance activities. To use these bands, first tie it into a loop. Then put one end around a table leg and your ankle through the other end. By moving your ankle up, down and side to side against the resistance from the band, you can safely regain the strength in your ankle.

Retraining the ankle for proprioception is somewhat more of a challenge. Some therapist recommend placing your injuried ankle on top of a soccer ball and practice balance your foot (not both feet!). Another option is make or purchase a wobble board. Wobble boards are safer than a ball and allow the user to use both feet simultaneously to recapture proprioception.
 

Knee injuries - are another very common cause for visits to the doctor. Frequently, I will see someone who will tell me that their knee "gave out" or "locked up". This is often a sign that something more than simple sprain has occured. Not only do ligaments of the knee become damaged, but also the cartilage or meniscus can tear.These injuries to the knee can be more difficult to diagnose. Examination by a medical professional is often necessary to determine the extent of damage.

Aside from rest and ice, knee braces may be recommended by your provider. There is a large number of knee braces to choose from and they each work best in certain circumstances. For example, when a simple sprain of the knee cap or patella is diagnosed, an open neoprene sleeve is often the best choice. However, if there is more of a concern regarding injury to the hinge or collateral ligaments, a brace that has hinges on either side of the knee will provide better support.

Allergies

It's only March, but you may be already experiencing the all to familiar sneezing and nasal congestion symptoms that tell you your seasonal allergies are back. In previous years, you may not have had this problem for another 6 weeks, but with Spring's early arrival, the pollen levels are much higher than typical. Lately, I am seeing more patients who have been caught off guard  by the early warm up and are suffering from the worst allergy symptoms they have ever had.

Allergies are nothing to sneeze at (pardon the pun) and can be very disruptive to your daily life. Other than the typical symptoms we think of, seasonal allergies cause fatigue, skin disorders and breathing difficulties.  Studies have found that allergies result in 3.5 million lost workdays and 2 million lost schooldays each year. Besides for lost productivity, allergy suffers spend 2 times more on medications and doctor visits.

To treat allergies, you can either seal yourself in a plastic bubble (probably not a good idea) or try one of the multiple remedies that are available by prescription or over the counter. Besides the typical medications that are used, there are many other options that allergy suffers can benefit from.


Nasal Rinses
Nasal rinses have been used for centuries in India as a discipline of yoga. Today, physicians often recommend this practice for the treatment of allergies, upper respiratory illnesses and sinus infections. The theory behind the use of nasal rinses is that allergens and pollutants are removed from the nasal cavity along with mucous allowing for less inflamation and improved air flow. There are a variety of products available to perform nasal rinses, however I typical encourage my patients to use a neti pot or irrigation bottles. Neti pots are the more traditional product used in yoga and look like a lamp that a geni may pop out of. Many patients are hesitant to pour saline into their nose, but after trying it, they can quickly appreciate the benefits.

HEPA Filters
Since it's not feasible to seal yourself in a plastic bubble, the alternative is to remove allergans from the air. High efficiency particle air filters (HEPA) are the effective means to limit the allergans in the house. Studies have demonstrated the benefits of HEPA filters in helping control allergy symptoms. Not only is pollen removed, but also indoor allergans from dust mites and animal dander. Individuals suffering from asthma have also been shown to have better control of their asthma symptoms when using a HEPA filter.

Low Back Pain

Low back pain (LBP) is one of the most common reasons that patients visit their primary care provider. In fact, 8 out of 10 people suffer from low back pain sometime in their life. A majority of patients who suffer from low back pain will recover on their own after a few weeks, but some individuals will go on to develop chronic pain. Whether you are suffering from acute low back pain or long-term pain, most physicians will prescribe medications and allow time to do the rest.

The treatment of acute LBP and chronic LBP, however, differ significantly. Reviewing the medical literature and using my own experience, I recommend several treatments available for low back pain as well as treatments to stay away from in order to allow you to get the best chance of getting back your back.

Transcutaneous Electrical Nerve Stimulation (T.E.N.S.) - Since the days of the Roman Empire, electrical stimulation of nerves has been used to treat pain. In fact, it is reported that Benjamin Franklin was a big proponent of this type of therapy. However, not until recently has it been feasible for patients to use a portable device to delivery the necessary electrical current. Typically, TENS units are about the size of a small cellphone with electrodes that are placed around the area of pain.

It is believed that TENS works by encouraging the body to activate naturally occuring pain-relief receptors in the central nervous system. Although the scientific evidence is mixed on the effectiveness of TENS, I have found it to be a useful tool when treating both acute and chronic back pain. Research has demonstrated that, when used along with an exercise program, the benefits of TENS is increased.

Dual Channel TENS Unit - TENS-7000 5 Mode plus Accessory Kit


Low Level Laser Therapy -Treatments with lasers may seem like something out of a science fiction movie, however lasers have been used to care for a variety of medical conditions for years. Skin rejuvenation, complex surguries and numerous eye procedures are just some of the applications for lasers. The concept is based on how lasers are able to direct various levels of energy into a very exact location.

There continues to be mixed reports on the effectiveness of laser treatment of low back pain, however there are several research trials that do support it's use. One study found that after 12 weeks, pain scores and range of motion improved when using laser therapy with exercise, when compared to exercise alone. At this time, more research needs to confirm the benefits of lasers for back pain, however, on a personal note, I have worked with two patients who found laser therapy very effective. Personal low level laser devices are available without prescription and are a safe option for the treatment of pain.


Yoga - The ancient practice of yoga is believed to have originated in India over 5000 years ago. The word "yoga" translates to join or unite. Yoga comprises many different pathways on the journey to unite the mind, body and spirit, however the best known version of yoga used in the U.S. is called Hatha yoga. This form of yoga uses poses and breathing in an attempt to cleanse and repair the body.

For many years, yoga has been used for a variety of medical ailments, but only recently has research shown the true benefits for individuals suffering from back pain. Several studies have confirmed that yoga an effective treatment for chronic low back pain. A randomized trial recently published in the Annals of Internal Medicine demonstrated that after 12 weeks, individuals suffering from low back pain recorded better functional status when compared to those treated with typical therapies.

The great thing about yoga is that you can do it anywhere. If you don't have time to attend a local yoga class, you can learn yoga from books, videos or gaming systems like Wii and Xbox.

Weight Loss Supplements

Our society expects to get immediate results for everything and that includes losing weight. Instead of choosing healthy foods in moderate amounts and exercising, we secretly want to believe that there is a magical way to lose weight. What could be easier than swallowing a pill?

We are constantly bombarded with the latest and greatest supplements to melt away the pounds. Claims like "scientifically proven" and "guaranteed to work" entice us to spend our money on products that really aren't proven and can even be dangerous.

Using the National Institutes of Health database, I have researched many of the most popular weight loss supplements, along with others that you may not have heard of, to find which products work and those that are a scam.

BEST BETS FOR WEIGHT LOSS

Gymnema sylvestre – this may be a weight loss supplement you may not have heard of. It is a vine plant from India, that has been used in traditional Indian medicine for 2000 years. Originally used for diabetics, this product works to reduce weight by delaying glucose absorption. Gymnema also seems to inhibit the taste of sweetness, and therefore lower food cravings. A study in 2004 showed that Gymnema helped promote a 5-6% weight loss over 8 weeks. To learn more about Gymnema, go to http://naturalhealthsherpa.com/.

Gymnema 60 Capsules

Conjugated Linoleic Acid (CLA) - A fat that occurs naturally in beef and dairy products, CLA has shown promise in treating a multitude of conditions including cancer, diabetes and high cholesterol. In regards to weight loss, several high quality studies have proved the benefits of CLA. Decreases in body fat mass, body mass index and weight loss have all been demonstrated. Studies have also shown long term safety using CLA as well as it being well tolerated.

Nature's Way CLA -1300mg, 90 Softgels

Orlistat (Alli) - This is a product was orginally released as a prescription medication, Xenical, and then became available at a lower dose for over the counter use. Orlistat acts as a lipase inhibitor, blocking the fat absorption as food passes through the intestines. It is also known as "the Antabuse for fat". If a high fat diet is eaten, oily stools, flatulence and leaking of stool often occur. Since Orlistat is approved by the FDA, there are studies that support it's effectiveness. Over a 16 week period of time, participants lost approximately 3 lbs more while taking orlistat with a low calorie, reduced fat diet compared to diet alone.

Alli Weight-Loss Aid, Orlistat 60mg Capsules, 120-Count Refill Pack

Pyruvate - A byproduct of metabolism, the mechanism in which pyruvate promotes weight loss is unknown. However in several well controlled trials, individuals taking 6 gms of pyruvate daily not only lost significant weight, but also demonstrated a decrease in body fat and an increase in lean body weight. Since pyruvate occurs naturally in the body, there are minimal side effects.

Genesis Nutrition Pyruvate 1000, 120-Count

SHOWS POSSIBLE BENEFITS

Acai - The Acai palm is a South American plant from which it's berries have recently been touted for a variety of health benefits, including weight loss. Preliminary clinical research suggests that consuming 100 mg of acai pulp twice daily for one month reduces fasting glucose and total cholesterol levels from baseline in overweight patients. However, to this date, there is no evidence that acai berries boost weight loss. The main benefit of acai is it's antioxidant effects; it has more antioxidant content than cranberries, raspberries or blueberries. 

Acai 100 - 32 oz - Liquid

Chromium picolinate - Chromium is an essential trace element that is often used in diabetes. Research has shown chromium to decrease fasting blood sugars and increase insulin sensitivity in type 2 diabetics. A handful of studies have demonstrated possible weight loss benefits. One reported a 2.5 lb weight loss over a 90 day period when compared to placebo. Unfortunately, other studies have shown chromium ineffective. The data is certainly not ground breaking, but chromium is safe and may prove to be useful.

NATURES BOUNTY ULTRA CHROMIUM PIC 500 MCG 100Tablets

Hydroxycitric acid (HCA) - This product is found in a fruit that grows in India and southeast Asia. It is believed to work by preventing fat production and supressing appetite. The results of various studies are mixed on the benefits of Hydroxycitric acid with weight loss. One promising study did show individuals who took 1.2 grams of HCA over 12 weeks lost 8 pounds compared to the placebo group which loss on average 5 pounds. Side effects reported most commonly were headache and gastrointestinal upset.

Garcinia Cambogia * 600mg HCA Hydroxycitric Acid 120 Capsules

African mango - Irvingia gabonensis is also becoming a popular natural ingredient for weight loss.  Irvingia gabonensis, also known as "African mango" or "bush mango," is a tree from Africa that produces a mango-like fruit. The seeds have high soluble fiber content and function as a bulk-forming laxative.  It is also been shown to delay gastric emptying, which improves blood sugar levels.

A promising study performed in Cameroon demonstrated that taking a standardized seed extract of African mango 150 mg twice daily for 10 weeks reduced weight by nearly 30 pounds when compared to overweight patients taking placebo.  Additionally, cholesterol levels and fasting blood sugars were significantly improved. The most common side effects appear to be headache and sleeping difficulties. This data is promising, but very preliminary. More evidence is needed about long-term safety and effectiveness.

PERFECT African Mango Irvingia Gabonensis with 150mg of 100% Pure and Clinically-Proven IGOB131 - 60 Capsules

DON'T WASTE YOUR MONEY

Hoodia - This is another widely advertised product for weight loss that not only has been shown to be ineffective, but also potentially dangerous. Hoodia gordonii is a succulent plant found in the Kalahari desert of Africa. For years, pharmaceutical companies have sought to discover any weight loss benefits, only to be dropped due to lack of evidence. In fact, one study found not only no benefits from Hoodia, but significant adverse effects including nausea, elevated blood pressure and liver dysfunction. Definitely stay away from this product.

HCG - Human Chorionic Gonadotropin, also known as the hormone of pregnancy, has received a great deal of publicity. Its use is based on an antequated hypothesis of a physician in the 1950’s. The effectiveness of the HCG diet is actually due to the very low calorie diet (VLCD) that is recommended to use with it. The suggested calorie intake is 500- 800 daily, about 25% of normal daily calories. Studies have shown that HCG does not improve weight loss while on a VLCD. Additionally, VLCD can be very dangerous unless under the supervision of a physician

Hydroxycut – I had to investigate Hydroxycut after seeing a fellow alumnus from my medical school promote it. After a previous formulation of Hydroxycut was removed from the market in 2009 due to several cases of liver injury, it has been reintroduced with new ingredients.The current formulation of Hydroxycut includes 4 chief components: lady's mantle, wild olive extract, komijn and wild mint extract. Despite this new formulation, there is no research supporting the use of any of these ingredients for weight loss. Lady's mantle and wild mint do have some indications for use with upset stomach and diarrhea while wild olive extract and komijn may have uses as antibiotics.
Obviously, this list is not comprehensive. There are countless other products available on the market that I have not included. Certainly, if there truely is that "magical pill" out there, everyone would know about it. In the meantime, nothing replaces diet and exercise, but some of these weight loss products may help you along the way.

Weight Loss Diets and Supplements

With the start of a new year, one of the most common resolutions is to lose weight. A simple enough idea, but one of the most difficult to do. The worldwide epidemic of obesity confirms that there is no simple solution.

So how do you get started on this journey? You try to eat healthy and get in exercise when you can, but the weight still doesn't come off. Well the next step is to get some help.

Turn on the TV, look through a magazine or go surfing on the web, and there are thousands of people telling you they have the "secret" to losing weight. They are also very willing to have you pay for their "secret". Before spending your hard-earned money on the latest diet trend, you need to do the research. I will share with you what I recommend to my patients so that you can choose the right weight loss program for you.

Diet Plans

Every few weeks, it seems that a new "miracle" diet is being promoted. A search on Amazon yielded nearly 15,000 books related to diet and weight loss. So how do you choose? A recent article in US News and World Report did the hard work for you. An expert panel of nutrition specialists reviewed the 25 most popular diets and selected the most effective and safest options. The winner of this "battle of the diets":  The DASH diet.

For years I have been recommending this diet to my patients to help them lower their blood pressure and lose weight. The DASH (Dietary Approaches to Stopping Hypertension) initially was promoted to help lower blood pressure, but extensive research also shows it is the most effective and safest diets for long term weight loss. 

The DASH Diet Action Plan: Proven to Boost Weight Loss and Improve Health

The DASH diet wasn't the only diet that got the nod from the experts. The TLC (Therapeutic Lifestyle Changes) diet ranked #2 in overall best diets. This diet was developed by the National Institutes of Health to lower cholesterol and reduce fat intake, especially saturated fats. The diet itself is flexible, and can lower your "lousey" cholesterol (LDL) by 10% in 6 weeks.

Cooking TLC: Truly Low Carb Cooking Volume 1

The criteria that the experts used to evaluate these diets are based on sound medical evidence and safety. No fad diets or short term diets made the top rankings.

Of the commercial diets, Weight Watchers was the winner. This diet assigns points to various foods, instead of counting calories. They claim that you can lose 2 pounds each week and eat whatever you like as long as you stay within the daily points target.

Weight Watchers Points Plus 2011 Essential Kit

The take home message from this report is that there is no fast or easy way to lose weight. Fad diets are just that; they may work for the moment, but don't lead to any prolonged weight loss. Changing behaviors with sensible, balanced eating is still the key to success.

In my next blog, I will review some of the more common weight loss supplements. From my experience and research, I will debunk the myths of which "miracle" products truly work.

Welcome to Dr. Jeff's Medically Speaking Blog

Where do you get your medical information?

Like most people, you probably make decisions about health-related products based on advice from friends and family, news reports and advertisements. But what if you had access to a physician whenever you have questions about which products are the most effective and safe? That is the aim of this blog. I will post articles about a variety of medical topics and how you can make the best decisions when making purchases to improve your health.