Escaping the Heat in the Mountains?

For those families headed to the mountains to escape the heat this summer, remember that mixed in with those gorgeous views and cool weather might come a couple medical challenges. First of all, don't be fooled that cool weather means no sunburns! Check out this month's blogs on base tanning & sunscreen so you don't end up with a high altitude burn. Secondly, be aware of signs and symptoms of "mountain sickness" (aka. altitude sickness).

What elevation causes altitude sickness?
There is not a set elevation for typical mountain vacations that affects everyone. Symptoms are uncommon at altitudes below 5000 feet above sea level, and fairly common above 8000 feet. If you fly to a higher elevation (such as above 8000 feet), wait a day to acclimate before you start hiking the high peaks nearby.

When does it start?

Symptoms usually within the first 24 hours, and often as early as the first few hours after arrival.

What are the common signs?

• Mild to moderate: HEADACHE, decreased appetite or nausea, insomnia, and lightheadedness
• Severe:  All of the above plus vomiting and shortness of breath

Treatment?

Ultimately, going to a lower elevation will relieve symptoms, but rest and hydration will alleviate most mild symptoms. For persistent or worsening symptoms, head to a clinic for possible oxygen and medications.

PREVENTION:

• Hydration and avoidance of diuretics like CAFFEINE and ALCOHOL, especially the first few days.
• SLOW ASCENT if possible (driving up to the mountains is lower risk than flying).
• If you have had altitude sickness previously, especially if it has occurred on multiple trips to the same elevation, see your doctor and consider prophylactic medications (acetazolamide or steroids).

BOTTOM LINE: Don't let the mountains literally take your breath away- plan ahead to prevent altitude sickness!

Which Sunscreen Works Best?

With summertime here, let's review the basics about sunscreens. There are so many sunscreen products available that it often feels impossible to choose which type of sunscreen to purchase. I know most kids (& parents) prefer the sprays, because it makes the process so much faster. Unfortunately, I have yet to find a sunscreen with all the ingredients that I look for to ensure the best protection.

Let's start with SPF. What does it mean? Sun Protection Factor is a measure of a sunscreen's ability to protect the wearer against UV radiation from UVB. Note that the sun produces both UVA and UVB, and BOTH cause damage that can lead to skin cancers. Right now, though, the SPF only addresses the UVB protection. So, SPF means that compared to bare skin, the sunscreen keeps you from burning X times longer. If it takes you a half hour to turn red with bare skin, a sunscreen with an SPF of 30 should in theory keep you from burning 30 times longer, which would be 900 minutes- 15 hours. Unfortunately, no sunscreen stays fully effective beyond two hours without re-application. Additionally, sunscreens with an SPF of 15 block roughly 93% of UVB rays, SPF 30 ~ 97%, and SPF 50 is 98%. Therefore, even with perfect application, no sunscreen blocks all UVB rays, and many block no UVA rays.

How much should you use to be effective? You might be surprised to hear that it takes about an OUNCE (picture a shot glass), and that same amount should be reapplied every two hours. This means you will use roughly half of an 8 ounce bottle on ONE PERSON during a full day outdoors!

Which ingredients are important? Most dermatologists recommend combining the physical barrier ingredients that protect against the deep penetrating UVA rays, such as ZINC OXIDE & TITANIUM DIOXIDE (the ones that leave the white residue) along with the chemical barrier agents known to block UVBs, such as PABA, salicylates, cinnamates and benzophenones. Since nearly all sunscreens contain mixes of the chemical barriers, I grab a tube or bottle and scan to be sure it also lists either zinc oxide or titanium dioxide as well. Note that some people are sensitive to PABA or other ingredients, and may do best with purely barrier sunscreens and clothing (such as surf shirts.)

Back to the sprays...for me, there is not an acceptable spray yet, for several reasons. Primarily, there are few with either zinc oxide or titanium dioxide, and those that do are very expensive and have these minerals broken down into "nanoparticles" to allow them to be in a light enough liquid to spray. There is some debate whether these nano-sized minerals can potentially cause cancer, which is of course, the opposite of our intent. Regardless of these issues, probably the biggest issue with sprays is that people use minute portions- picture that less than 10 second total body spray- and so they are not obtaining anywhere near the listed SPF.

What do I buy? Our family typically uses Banana Boat's "Baby" lotion. To it's credit, my kids complain that their skin is "way too white" because I never let them tan. I take that as a measure of success! Probably more importantly, we all use swim shirts, and most of us consistently wear hats and sunglasses.

BOTTOM LINE: Get a sunscreen that contains both chemical and barrier agents (think titanium dioxide) and realize an 8 oz tube should be used up by a family of four in ONE morning OR afternoon since each person needs ONE OZ every TWO HOURS.

PS. NO, I do not have any financial ties to sunscreen makers!

Got Your "Base Tan" for Summer?

Hooray! School is out (at least in Texas) and summertime is here. Before your teen convinces you she must head to a tanning booth to get that "base tan" before your family's beach vacation, be aware of this- the notion of a "base tan" has no scientific basis, nor support from dermatologists. In fact, the American Academy of Dermatology (AADA) testified last year at FDA hearings about the risks of indoor tanning. These devices have shared the same low risk category as bandaids and tongue depressors, yet we have had medical evidence for years that they clearly cause skin cancers.

Melanoma rates are increasing across the board, and melanoma is now the number one cancer in young people aged 25-29, and the second most common cancer in 15-29 year olds. Use of a tanning bed before the age of 35 increases your risk of developing melanoma by a whopping 75%! I can personally attest in my own practice that I have diagnosed multiple cases of melanoma in the last couple years, primarily in people younger than I am- which really hits home. (I'm 46.) Having lost a friend to melanoma many years ago, I am very aware that skin cancers are not simply cosmetic nuisances.

Tanning beds are not "safe", and they target young people (especially women) with their ads. Many tanning salons promote their "safe" or "harmless" type of UV radiation, but the UVA rays cause damage in the same fashion as UVB rays- only a bit more slowly and more deeply.

The American Academy of Dermatology hopes the FDA will ban indoor tanning devices all together, but at the least, should require a minimum age of 18 for ANY indoor tanning and should mandate obtaining informed consent from clients AFTER educating them about the real risks of skin cancer. The AADA also strongly recommends changing the risk category of these machines to match the health risks they create.

BOTTOM LINE: TANNING is NOT SAFE and "base tans" don't help! Use sunscreen, wear protective clothing and stay away from tanning beds all together.


PS It's June 1st- Change those AIR FILTERS!

Hepatitis C Testing- the Fine Print

Yesterday's blog focused on the CDC's new recommendation for ALL BABY BOOMERS to be tested for Hepatitis C, regardless of their other risk factors. The rational is to diagnose this often silent disease early, while treatment can make the most impact saving lives and improving quality of lives. While hepatitis C is largely transmitted via IV drug abuse (which obviously people can identify as a risk factor), there is a significant chunk- usually quoted around 10%- of people who have NO KNOWN risk factors.

So what's the fine print about the testing? First of all, the Hep C test is a blood test (just a heads up for the needle-phobics out there.) Mainly, however, the issues about testing surround the results.

A negative result is wonderful- there is extremely low chance that you have the disease and the test missed it, because this is a very sensitive test.

A positive result, however, leads to a much longer discussion. A positive Hep C Antibody test (the screening test) cannot tell you how long you have been infected. More testing is now required. The next step will be to have a different blood test that measures "viral load"- actually looking for the amount of Hep C virus present in your system. Other blood tests will measure your liver "function" to see if it looks inflamed.  Your doctor may also test to determine the subtype of Hep C in order to better advise you regarding the potential response to therapy. By the way, All positive tests for Hep C will be reported to the health department. This should not to make you paranoid, as your insurance company will obviously know as well, but simply something to note.

If your screening test was positive but your viral load does NOT show any current presence of Hep C, and your liver enzymes are normal- you will be considered to have recovered from a prior Hep C infection, and part of the lucky 15-25% who do not progress to chronic disease.

 If your screening test is positive, your viral load is elevated, but your liver enzymes are normal and you feel fine- you may be a Hep C Carrier, and most people in this category do not require immediate treatment. Carriers are followed closely to be sure they are not having silent worsening of disease (as measured by deteriorating blood tests or symptoms), holding off on treatment until there has been a change.

If your screening test is positive, your viral load is high, and your liver enzymes are abnormal or you have significant symptoms, then you will be heading to a liver specialist to discuss treatments. Though the treatment for Hep C can be challenging, between 50-80% of patients have sustained (successful) responses to treatment, depending on their subtype and how long the disease has been present.

BOTTOM LINE: Baby Boomers should talk with their doctors about getting tested for Hepatitis C, but recognize the results may initially create more additional questions than answers. 

Baby Boomers & Hepatitis C- Are You at Risk?

Yesterday the Center for Disease Control (CDC) announced that all baby boomers (adults born in 1945-1965) should be tested for Hepatitis C in order to increase earlier detection of this often silent disease. The CDC predicts that one in thirty Baby Boomers is infected with Hep C, and that close to a million people will be newly diagnosed if all in this age category are tested. The hope is that this strategy will save over 100,000 lives.

What is hepatitis C? Hep C is a viral infection that primarily targets the liver, and can potentially lead to severe liver damage, cancer and death. The good news is that 15-25% of people infected will "fight off" the disease and not become chronically ill with this disease.

How does someone catch Hep C? This infection is blood-born, so it is transmitted when there is direct blood-to-blood contact such as when people share needles for drug use. Baby boomers who received blood transfusions before 1992 could have been infected then and harbored silent disease for several decades. (Blood transfusions after that time were able to be screened and are safe.) Hep C can also be spread through sex with an infected person, but the transmission rates are very low (as measured in monogamous couples where one partner has hep C and the other does not.) Tattoos are another potential source of transmission. Unfortunately, most studies show that 10% of people with hepatitis C have no identifiable risk factors,  so that is why everyone should be screened regardless of their behavioral risk factors. 


Isn't there a vaccine for hepatitis? For Hepatitis A and Hepatitis B- YES, but not yet for Hep C.

What is the treatment? Unfortunately, the treatment for hep C is not as simple as taking an antibiotic for a bacterial infection, but it is very effective. Hep C treatment typically lasts a year and requires weekly injections, and the medications can have marked and serious side effects (especially fatigue, flu-like symptoms and depression.) Newer medications may offer shorter treatment courses and will be much better tolerated.

How do I get tested? Schedule an appointment to talk with your doctor about getting a blood test for Hepatitis C. The results are not exactly black and white, so you will want to learn more details before you decide...more on this tomorrow.

BOTTOM LINE: New recommendations suggest ALL BABY BOOMERS should get tested for Hepatitis C.

Generic Prescriptions- Worth the Price Break?

Many patients understandably prefer generic medications because of cost. Most physicians are very in tune with this, and will give you their honest opinion about which drugs seem to have clinically equal generics. In my personal clinical experience, I would broadly say that most generics are perfectly fine, but I see I higher rate of patient satisfaction with name brand products in hormones (primarily birth control and thyroid), certain migraine medications, and a few specific antidepressants. That being said, it is VERY patient specific- the only way to know if you tolerate a generic better or worse than a name brand is to try it. For example, while probably 95% of my patients who take sleep aids are happy with the generic, there is a subset that find a dramatic difference between that and name brand, from deriving a morning "hangover" with the generic to simply a decreased effectiveness.

The FDA requires that generic prescriptions have the same intended use, dosing, delivery system, and safety as the original drug. The active ingredients are the same, but there can be different byproducts in the generic which may cause a reaction.

Why do doctors ever write brand names on a prescription if they want you to have the generic? The answer is simpler than you might think- brand names are usually shorter. In fairness, doctors also have their "favorite" drugs, and we think of them often with their trade name. In the old days of drug company-sponsored elaborate trips and gifts, I'm sure physician "favorites" were indeed swayed by the pharmaceutical companies, but I can attest that the vast majority of doctors that I know and work with have "favorites" based on what WORKS for patients- combining effectiveness, side effects (good and bad), ease of dosing (the fewer doses per day or even week, the better), delivery system (shot vs. pill vs. patch or cream), and yes, COST.

BOTTOM LINE: Don't hesitate to ask your doctor what she thinks about the generic alternatives to your prescription medications, and together you will figure out which name brand medications are important for your health. 

Dark Circles Under Your Eyes?

Along with sneezing, stuffy nose, cough, and sore throat, seasonal allergies can also affect your eyes. Itchy, red eyes may respond to an oral antihistamine, but often they are better treated with a prescription eye drop that prevents the release of histamine (which is what causes the redness and itch to begin with.) Olopatadine ophthalmic solution, brand name Patanol, is applied twice daily, and is generally well tolerated. There is also a newer preparation, Pataday, by the same pharmaceutical company that is only once daily-newer, more convenient, likely more pricey (depends on your insurance.) Both work well.

I find many of my patients try to use over-the-counter eye drops that "get the red out"...only to find that they need more and more of these drops to accomplish the same results. The only time that I recommend these OTC products (with vasoconstrictors to eliminate red eyes) is for extremely short-term use, such as if you are giving a presentation or taking pictures. If you use these products for more than a couple days, you will develop rebound symptoms of increased redness, and risk getting pulled into the cycle of red eyes, use drops, worse red eyes when drops "wear off", more drops, etc.

What about BELOW the eye-those dark black circles that make you look a hundred years old? Those are called "allergic shiners" in the medical world. Congested sinuses slow down return of blood through the small veins under your eyes, causing them to swell and make the skin above them appear purple or black.
What helps? Oral antihistamines, plus or minus a decongestant, will often do the trick if it is mild. For people who suffer for weeks at a time, I'd recommend talking to your doctor and considering prescription nasal steroid sprays. "Spa" treatments like cucumbers and frozen tea bags work very transiently- I'm not sure it isn't just the coldness of these objects that cause vasoconstriction (shrinking of the veins), but they do seem to have non-scientifically proven positive effects, with few to no negative side effects.

BOTTOM LINE: If you have chronic issues with dark circles or "bags" under your eyes, talk to your doctor about treatment options.