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Wednesday, May 22, 2013
Swimming season has arrived, and patients often ask me about whether or not you can catch this or that disease from a swimming pool or hot tub. First of all, let me assure you that no, you cannot catch STI's (sexually transmitted infections) directly from a hot tub...as long as all you are doing in the hot tub is enjoying the water. There are, however, diseases that can be contracted from swimming pools- typically from accidentally swallowing the pool water. How does that happen? Easily, especially for kids and adults who play around with getting mouthfuls of pool water and spraying that out like a whale (we've all seen them!)
The most common swimming pool contracted illness that we see is diarrhea, especially from the parasite giardia or the pathogenic strains of the bacteria, E. coli. Of course, there is also the potential to contract a few skin diseases such as athletes foot or plantar warts when you are hanging out in public swimming areas.
A recent study, Microbes in pool filter backwash as evidence of the need for improved swimmer hygiene-metro-atlanta, georgia, 2012, published by the Center for Disease Control (CDC) looked at the microbes collected in pool filter backwash. Over half the samples contained Pseudomonas and E. Coli. Pseudomonas can invade ear canals and any open skin lesions/cuts/scratches- including "razor burn" areas, and is a special concern for diabetics, who can tend to develop more severe infections. E. coli is the most common bacteria in a healthy human gut, but can also cause significant illness, as is evidenced by the food poisoning we see from time to time from this organism. Ultimately, this study reinforces the need for public awareness of good swim hygiene, which includes showering before swimming (to remove any fecal matter- the quick, already bathing-suited dash under the poolside shower does nothing for this, though it may reduce oils and residue from sunscreens) and refraining from swimming when you have a diarrheal illness. Most importantly, keep a close eye on your non-potty trained toddlers in swim diapers, making sure to check those diapers on an hourly basis.
BOTTOM LINE: Swimming is great fun and generally good for your health, but pay attention to good swim hygiene, and if you develop persistent diarrhea this summer, don't ignore it- head to your doctor and get checked out (and please stay out of public pools till you are cured.)
Tuesday, May 21, 2013
In yesterday's blog I touched on a pet peeve of mine, asking people to NOT put Q-tips in their ears. Inevitably, the next question is, "but Doctor, if I can't use q-tips, how can I clean out my ears?"
The answer is two-fold:
Number One- most ears don't need to be "cleaned out".
Number Two- when you do have an ear wax build up, flush them out with a bulb syringe.
Ear canals, like many other parts of our body, are self-cleaning. The ear wax (cerumen) is made up of dead skin cells, hair, and other debris that enters the ear and mixes with fluid produced by glands in the ear canal. The wax is a protective feature, and usually produced and shed in the outer portion of the canal. "Cleaning" the ear canal with various objects typically results in actually pushing the wax further into the canal, eventually packing it up against the ear drum. If wax does indeed build up and block the canal at the base, you can experience a variety of symptoms including muffled or decreased hearing, ringing in your ears, or feeling off-balanced.
The best way to clean out otherwise healthy ears if you have wax build up (assuming you do not have a ruptured ear drum, ear tubes, or other prior ear surgeries) is to flush the ear with luke-warm water. Take care the water is not very hot or cold, or you are likely to experience vertigo and/or nausea. Using a baby's nasal syringe (the rubber bulb pictured above), fill the syringe with the warm water. Lean over the sink and gently pull your ear out and back, which straightens out the canal. Place the tip barely inside your ear, and squeeze the bulb, flushing your ear. Repeat multiple times (I usually say a maximum of ten times) until you see the wax come out. Afterwards, many doctors recommend placing a few drops of alcohol or a mixture of alcohol and vinegar, which will help to remove any remaining moisture.
Why not use q-tips, bobby pins, or other cleaning devices? Again, two main reasons. First of all, it frequently worsens the issue instead of fixing it. Secondly, we frequently see damage from them, whether it is minor, tiny abrasions in the canal and on the ear drum, or a serious rupture of the ear drum from over-vigorous "cleaning" or an accidental jamming that happened courtesy of a careening toddler or playful pet, a suddenly opened door, or a loud noise that causes the user to jump/startle.
BOTTOM LINE: Save q-tips and bobby pins for makeup application and hair, and keep them OUT of your ear!
Monday, May 20, 2013
Swim season is fully upon us, and with that comes a couple medical challenges. Today I'd like to focus on swimmer's ear.
What is swimmer's ear?
This typically refers to an OUTER EAR infection caused by fungi or bacteria. The moisture left in the ear after swimming is fertile ground for these organisms to multiply, especially lake water.
What are the symptoms?
Swimmer's ear is PAINFUL and almost always one sided, despite the fact that both ears had the same exposure. (Differently shaped ear canals and varied amounts of ear wax are to blame for this discrepancy.) Since this is an outer ear infection, typically there are no other symptoms (such as stuffy nose, headache, or sore throat, like we see with middle ear infections.)
How quickly should you head to your doctor?
Good news here- often mild to moderate cases of swimmer's ear can be treated with over-the-counter solutions. If you are developing fever or intense pain, it's time to head call your doctor, but more mild symptoms can wait for a couple day trial of home therapy.
How is it treated?
Doctors treat these infections with ear drops that contain both antibiotics or anti-fungal medications, as well as drying and anti-inflammatory agents. However, there is a home concoction that works extremely well for prevention, and often can provide a remedy. Grab a bottle of vinegar and a bottle of rubbing alcohol, and mix them together half & half. This mixture can be spilled on to a cotton ball and squeezed into the ear canal OR my preference is to use the bottle from the over-the-counter swimmer's ear prevention product and fill it up with my "home brew". Place around six drops in each ear, and allow to drain back out- do this after every swim session, and three times/day if you develop a sore ear. Warming up the bottle in your hands will make it less irritating to your ears. The vinegar kills the bacteria & fungus and the alcohol dries up any remaining moisture. Voila! Prevention & cure- same solution.
Please remember that although this mixture will treat a large percentage of outer ear infections, if your sore ear isn't improving in a couple days, please call your doctor & let them take a look, as you may require stronger medications.
By the way, using q-tips to "clean" the ear serves to cause minor trauma to the ear canal and tends to make it easier to get these outer ear infections, so skip the q-tips, please.
BOTTOM LINE: If you (or your kids) are frequent swimmers, don't wait for a sore ear to start using swimmer's ear prevention this summer!
Friday, May 10, 2013
There are two main messages that I would like to share:
1. You don't always need to do mouth-to-mouth to save a life- "Hands-Only CPR" is very effective.
2. Using an AED is simple. Learn it!
To expand a bit...the AHA has been emphasizing "hands-only" CPR. Far more people are willing and can feel confident about chest compressions than the full traditional CPR with rescue breathing. The message is this: IF YOU WITNESS AN ADULT OR TEEN SUDDENLY BECOME UNCONSCIOUS, CALL 911 and then START PRESSING DEEP and FAST on that person's chest. To make it even easier for us baby boomers, simply start singing John Travolta's "Staying Alive" song to get the right pace!
As for the AED, the whole key here is AUTOMATIC. Truly, once you turn on the machine (press the power button), the machine literally talks you through the procedure. You are told to open the package with the pads and plug in the cord. The pads have diagrams showing you proper placement. This modern wonder analyzes the heart rhythm then instructs you out loud if you need to press another button to administer a shock to restart the heart. Best of all, there are only two buttons on the machine, clearly labeled and the shock button lights up and flashes when it is needed. Simple, right? And did you realize that most public places have AEDs now? From sporting arenas, to schools, churches, malls, airports, and restaurants, if you or someone you love has a sudden cardiac event that leaves him unconscious, chances are high that immediately effective help is nearby...if only someone is aware and willing to use an AED. While truly this procedure is simple enough to be learned from a video, attending a training and using your own hands to walk through the actions a few times will boost your confidence to a whole new level.
BOTTOM LINE: Take less than a minute right now and click on to the AHA website to watch their "staying alive" instruction video for hands-only CPR- the life you save is likely to be that of a family member or close friend!
PS. Kudos to Ericka Holmes for being such a terrific CPR instructor!
Wednesday, May 1, 2013
It's nearly summer, and once again, POISON IVY is growing all over down at Lady Bird Lake (formerly known as our Town Lake). There are areas where this climbing plant is well over six feet high! If you are walking or jogging with only two-legged (or wheeled) companions, it's fairly easy to avoid the plant simply by staying on the trail. However, if you have your favorite four-legged partner by your side, beware that poison ivy can be spread from your dog's fur to you!
Poison ivy (and poison oak & sumac) all have urushiol- the poison sap- in their roots, stems and leaves. This sap can be spread by direct contact with the plant, as well as via clothing and animal fur, although human to human contact does NOT pass the toxic substance. These plants are the most common cause of contact dermatitis in the United States. Not everyone is allergic to them, but an estimated 60-80% of us do react.
What are the symptoms? First you ITCH. Then, the itchy areas turn red and typically blister, often in lines on the skin (where a plant swiped your leg or arm).
How soon do you break out if you are exposed? It depends how many times you have previously been exposed. The first time, you may have a gap of several days before you start itching, but each successive breakout will occur more quickly and often will be more severe. Previously sensitized people may begin itching within minutes to hours of contact.
How do you treat it? Over-the-counter topical steroid creams (hydrocortisone) will often do the trick for mild cases. The more areas affected, the stronger the steroid you will need. For more severe cases, oral steroids are necessary, which must be prescribed by a doctor.
How can you prevent getting poison ivy? Avoidance is key, of course. If you have a pet that has romped through poison ivy, use rubber gloves to thoroughly shampoo your animal. Any soap and water will remove urushiol from non-human surfaces. There is one product, zanfel, which is marketed to specially remove urushiol from human skin. As soon as you are aware you may have touched poison ivy, immediately wash the area with soap and water. If you remove the toxin within around 15 minutes, you may not break out. Also, please beware if you are removing poison ivy from your property- NEVER burn this plant! The inhaled smoke will do the same type of damage to your lungs that it does to the skin...not good.
BOTTOM LINE: "Leaves of Three- Let It Be"! And wash QUICKLY, including your pet- to avoid getting this dermatitis.
PS. It's May 1st- CHANGE THOSE AIR FILTERS!
Monday, April 15, 2013
Are you worried you might have "strep throat"? How can you tell when it is time to head to your family doctor for a sore throat? Certainly the majority of sore throats are not caused by the streptococcus bacteria, and do not require antibiotics. In fact, seasonal allergies often cause extremely painful throats, but do not involve bacterial infection at all. While there is very little in medicine that is completely black and white, there are several clues to clinicians that a particular sore throat may be caused by strep (and therefore, respond quickly to antibiotics.)
Typically with strep infections, we see a combination of fever, a sore throat (that looks beefy red, with or without white pus on the tonsils), with tender, swollen glands (lymph nodes) in the front part of the neck, and LACK of a cough. The presence of a cough almost always excludes the possibility of strep, so if you are coughing, chances are greater that you may have a viral or other cause of your sore throat.
Other symptoms that are common with strep throat infections are headache and stomach ache, with or without nausea and vomiting.
How helpful are the rapid strep tests? Very- if they are positive. A positive test has a 95% chance that you do, indeed, have strep. A negative test might not be accurate if the clinician was unable to get an accurate swab (often because of an overactive gag reflex, which raises the tongue and blocks the tonsils), and there is a 3-10% false negative rate (meaning you test negative, but you do have strep.) A throat culture takes a couple days to yield an answer, but it is 99% specific.
What can you do to feel better? In addition to taking the antibiotic that your doctor prescribes, taking ibuprofen or acetominophen typically help with the pain and fever. I am a big advocate of salt water gargles (for the first day or two) to ease pain. For this, my advice is to put a whole tablespoon of salt into a standard 8 oz glass of warm water- it won't all even dissolve, but the point is to make the gargle solution extremely hypertonic (very salty), which appears to aid both in numbing the throat as well as helping to fight the bacteria.
BOTTOM LINE: Signs of strep throat that should signal a diagnostic trip to your family doctor include fever, sore throat, painful & swollen lymph nodes (glands) in the front of your neck, and NO COUGH.
Wednesday, April 10, 2013
Hives- the very thought of these itchy, raised, red splotches make me start to squirm and scratch. With our oak allergy season in full bloom here in Austin, we see the full spectrum of allergic complaints- from sneezing, sore throats, dry coughs and itchy eyes to skin reactions such as hives. The medical term for hives is "urticaria". These lesions come and go, and often cause a burning sensation along with the itch.
In the previous blog entry about allergic eye problems, I mentioned that histamine (the substance that causes the redness and itch of allergic reactions) is stored in cellular level containers called mast cells. With urticaria, the basic problem is that these mast cells degranulate, releasing their highly inflammatory contents. The good news is that typical lesions resolve within 24-48 hours, but the bad news is that they can quickly reoccur and become a chronic problem.
But Doctor, what caused my hives? Was it the shrimp I ate yesterday?
Unfortunately, identifying the triggering cause for hives can be extremely challenging, because there are so many different potential culprits. Infections (especially from Strep and mononucleosis), drugs, foods, pollens, chemicals, metabolic disorders (like thyroid) and even rarely underlying cancers can all be to blame. Additionally, urticaria can be triggered physically, from cold or heat, pressure, or sunlight.
Treatment focuses on antihistamines initially, and often this is all you will need- especially if this is the first time you have ever had hives. Non-sedating antihistamines are used for daytime, and our old standby diphenhydramine (Benadryl) works well at night for those who need help sleeping. If these medications are not enough, clinicians have stronger medications such as steroids or other histamine receptor blockers that may be added.
What can you do as well? Avoid extreme or sudden changes in temperature, including hot showers. Avoid alcohol and NSAIDS (ibuprofen, naproxen), both of which can aggravate hives. Stay out of the sun. Applying topical calamine lotion provides relief to some people. If you develop a chronic problem, consider keeping a diary to help identify potential triggers. Happily, approximately 70% of people with first time hives will have resolution of their symptoms within three days, regardless of which treatment they use.
BOTTOM LINE: If you break out in hives, start with OTC antihistamines and be assured that it is okay to give yourself a couple days before you head to your doctor, as long as your itching is tolerable.