Swim Season! Are Your EARS Ready?

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!

Staying Alive! Hands-Only CPR & AEDs

When is the last time YOU were CPR certified? Most of my friends were first certified during scouting years, then for babysitting as a teenager, then again when they had babies of their own. I know my last few certifications I did online, without benefit of the famous Annie mannequin. Last week, however, I had a recertification training that included an automatic external defibrillator (AED), and now I'm ready to light a fire under everyone I know to head to an American Heart Association (AHA) training!
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!

Poison Ivy- Austinites Beware!

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!

Breaking Out in Hives?

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. 

Seeing Red This Spring?

What should you do if your primary allergy symptom is not sneezing, runny nose, or sore throat, but burning, itching, watery, red eyes? Will over-the-counter products help with eye symptoms?
The short answer is yes- oral antihistamines (like Benadryl, Allegra, Claritin & Zyrtec) can help with allergic eye symptoms, but if you are really only having eye issues, you may get better relief from some prescription eye drops.

Many of my patients try to use over-the-counter eye drops that "get the red out"...only to discover that they need more and more of these drops to accomplish the same results. The only time that I recommend these OTC products (which have 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 vicious cycle of red eyes, use drops, worse red eyes when drops "wear off", more drops, etc.

Prevention is key for allergies in general, and especially helpful with eye symptoms. While avoidance of the allergen is your first choice, often that is not possible or practical. There are a variety of both over the counter and prescription eye drops that can greatly reduce eye irritation and discomfort from allergies. Some are antihistamines, but others are more pro-active prevention. Histamine (the substance that triggers the redness and itch) is stored in "holding tanks" called mast cells. Mast cell "stabilizing" drops were designed to keep the histamine staying in the holding tanks, rather than being released to cause havoc.  There are also prescription combination antihistamine and mast cell stabilizing drops, which can be applied only once or twice daily. Finally, there is another class of medication that is purely anti-inflammatory.

What "home" remedy helps? For quick relief of itchy eyes, try wrapping a dampened washcloth around  some ice cubes, and hold this cold compress up to your eyes for a few minutes. Heat is NOT the answer for this eye problem! Heat releases histamine, and simply ramps up the problem.


BOTTOM LINE: If your eyes are driving you crazy during allergy season, don't suffer in silence, but schedule a visit with your family doctor or eye doctor to find out your treatment options!

Itchy Eyes, Runny Nose...Achoo!

No April Fool's...here in Austin, Texas, we are fully into OAK ALLERGY season. Our cars have a dusting of yellow pollen, and the streets are strewn with oak droppings. Is it time for a trip to your family doctor or allergist? Maybe, but there are several remedies you can try on your own first.

What are signs and symptoms of allergies?

At the risk of sounding like an antihistamine commercial, it's sneezing (often in fits of sneezes), itchy eyes, itchy throat, scratchy throat, drainage down the back of your throat (which creates early morning sore throats that often fade mid-morning), stuffy eyes, ear pressure and the lovely dark circles under your eyes.

What is recommended for treatment?

Typically we start with the non-sedating antihistamines,which used to be prescription but are now available over the counter (OTC). These include Loratadine (Claritin), Fexofenadine (Allegra), and Cetirizine(Zyrtec), to name a few of the most popular. Which is BEST? In my experience, they are equally effective overall. However, what works for you this year may not work as well next year, and there is not great science to explain why. Antihistamines will DRY you up and STOP ITCH. If you are mainly stuffy, you are better off with just a decongestant such as phenylephrine (Sudafed) or if you have both, grab a combination product.

If you are suffering regularly in a particular season, or perhaps year-round from something like molds, your doctor may recommend more preventative therapy such as nasal steroid sprays. These sprays are prescription, and they are not "addictive" like the OTC ones. The OTC sprays that give immediate relief are fine for a day or two, but beyond that, you will get rebound nasal congestion and be chasing your tail with symptoms/spray/more symptoms/more spray. Nasal steroids are minimally absorbed (so no turning into Arnold, gaining weight, or weakening your bones.) They are very safe, and decrease swelling while creating kind of protective barrier against entering irritants, so you don't turn on the histamine system that causes allergy symptoms.

What more prevention can you do?

Well, it's April 1st, so like every first of the month, I recommend changing out your home's air filters! Even the "central" or "media filter" type should be changed at least three or four times per year, despite manufacturer recommendations of annual replacement. Yes, that is expensive, but cheaper than many allergy medications, and no other side effects! Consider posting a reminder on your calendar to change your filters every few months. HEPA air cleans and vacuum bags are of unclear efficacy, but may help. Limit your outside exposure (get on the exercise bike or treadmill indoors.) If you really suffer, consider getting rid of carpet and drapes in your home, and restricting pets to outside the bedroom.

BOTTOM LINE: If you can't stop sneezing or are having other signs of seasonal allergies, schedule an appointment with your doctor and find out what she can do to help! There are many interventions before considering allergy shots- though for severe sufferers, those shots may be an excellent option.

Getting a Base Tan for Spring Break?

Here in Texas, we are alternating hot days of wearing shorts with chilly days or grabbing jackets, which means it's nearly time for SPRING BREAK- hooray! Many students and their families head to the beach for spring break, and before the women don their bikinis, the quest for a "base tan" to avoid a sunburn begins. I have had many patients ask my advice on what is better- going to a tanning booth or braving the capricious weather outside. My answer? NEITHER.

The entire 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 47.) Having lost a friend to melanoma many years ago, I am very aware that skin cancers are not simply cosmetic nuisances.

Please be aware that 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. Any change in skin color is a sign of damage from UV radiation. Period.

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.