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By Richard P. Holm MD
His rash was itchy, raised, red, blistery, and distributed in streaks along both forearms. Likely this was from poison ivy, especially since he had been camping and hunting for firewood in a woody area that weekend. Although it was too early in the spring to see the groups-of-three glossy-pointed-leafed plants, he had been pulling on furry-rope-like woody vines, probably the winter-vine form of the poison plant. Allergists and dermatologists call the rash from poison ivy a form of contact dermatitis, which is an allergic reaction to the oil of the plant. First exposure to the poisonous oil is the sensitizing dose and generally doesn’t cause a rash. The next exposure, however, brings on the allergic eruption. 85% of adults have been sensitized to poison ivy oil, sometime in the past. Many other agents can also cause contact dermatitis, but rarely so violent as from oil of poison ivy. About 15% of us react to nickel, which is characterized by a dry scaly rash, hives, or blisters distributed on ear lobes, around necklaces, or under wrist watches. Other allergic contact culprits include latex used in shoes, paint, and gloves; juice off of clams, oysters, and shrimp; perfumes blended with cosmetics, nail-polish, and skin-care-products; sticky adhesives used on tape, false-eyelashes, and toupees; and antibiotics found in Neosporin, Bactroban, and Triple Antibiotic ointments. Some contact dermatitis is not allergy driven and happens because the agent is frankly toxic, like bleach, kerosene, battery acid, and cement. Also toxic, especially to those light-skinned, is excessive wetness, washing, and detergents. Another kind of contact dermatitis follows certain perfumes, insecticides and oil from the skin of a lime, but only when in combination with sun exposure. Of course, treatment depends somewhat on the specific agent that causes the problem. Cleansing the allergen away might be important. Protecting with barrier creams and ointments like zinc oxide or CeraVe might help. Sometimes oral, not topical, antihistamines help, like Zyrtec or Allegra tablets daily, but not Benadryl lotion. Often topical steroids, like cortisone or triamcinolone cream, can help turn off inflammation. And when the reaction is severe enough, a tablet or injectable form of steroid may be prescribed by your doctor. The most important lesson should be avoiding the allergic or toxic agent in the first place. My poison ivy patient was careful when he was in the woods from that day forward, especially when encountering furry-rope-like woody vines. by Dr. Richard P. Holm, MD.
Balance is so important. For example, too much food causes obesity. Too little food causes starvation and sometimes death. Like Goldilocks, our bodies are always in search of balance: not too much or too little, but that which is "just right." It's sweet news that a healthy pancreas makes a hormone called insulin to keep blood sugars from going too high. When something goes wrong and either the pancreas fails to make enough insulin or the body becomes resistant to it, diabetes mellitus with elevated sugars will occur. This, however, is only half the story. What happens to keep blood sugars from going too low? A couple years ago, a patient of mine came in having sporadic nervous spells of fast heart rate, tremors, sweating, hunger, butterflies-in-the-stomach, and poor sleep with night sweats. These spells were all from low sugars, which he documented on his home blood sugar monitor. He was not taking insulin or medications that lower sugar, was eating correctly, not drinking alcohol, and not excessively exercising. His was a rare case of a pancreatic insulin-making tumor, and after tests supported that diagnosis, referral to an endocrinologist allowed for effective treatment. Last week I spoke to a middle aged woman who once-daily was taking long-acting insulin and multiple-times-daily short-acting insulin before meals and as-needed depending on measured blood sugar levels. She had been experiencing roller-coaster sugar levels sometimes above 300, but, far more dangerous, sometimes below 70 with nervous spells similar to the man with the pancreatic tumor. The spells were happening from too much insulin, and now-a-days, this situation is too common. These are two different causes for low sugars, and there are others, but for whatever reason, low sugars can deteriorate brain function, and when low enough, bring on loss-of-consciousness and even death. We've learned that when blood sugar drops much below 70, the body produces five different hormones to bring it back up. It's that important! The list includes well-known hormones like adrenalin and cortisol, and some lesser-known like glucagon, noradrenalin, and growth hormone. Once sugars go too low, it’s a week before these hormones settle down, making it extraordinarily difficult to find the correct dose of insulin. Of course enough insulin is important in preventing complications from elevated blood sugars and diabetes mellitus, but when there's too much insulin, dosing becomes more difficult and the danger becomes more significant. That's why balance is so important and we need to get the insulin dose, "just right. To hear more from Dr. Holm, visit his website, www.PrairieDoc.org. On Call with the Prairie Doc is produced by the Healing Words Foundation in association with the South Dakota State University journalism department and airs Thursdays on South Dakota Public Broadcasting Television at 7 p.m. CT, 6 p.m. MT, and streams live at www.PrairieDoc.org. By Richard P. Holm, MD.
Mr. H came into the office because his wife made him do it. There was a guilty movement to his eyes, although he had the typical non-complaining, modest prairie-farmer way about him. He said his heart-burn problem was getting worse, particularly at night and when he has a second serving of ice cream before the ten o’clock news. He admitted he had been chewing a bottle or two of Tums a day for several years, but the problem strangely got better about a year ago, until recent weeks. Now solid food like chicken breast wanted to catch on the way down. He admitted he had waited until he got the hay in before coming to the doctor. About 35% of all people have acid reflux symptoms on rare occasion like once-a-year, and 20%, or about 50 million people in the U.S., suffer from recurring symptoms. They describe half-digested acidic food rolling up from the stomach, burning the esophagus, and into the throat and mouth. Symptoms are generally made worse by big-belly-obesity; late in the evening food in the gut; caffeine, salt, and alcohol; certain arthritis and osteoporosis medicines; tobacco smoke; and sometimes by a stomach infection called H. pylori. And reflux is only made worse, more permanent, and destructive as it continues to occur. The mainstay of therapy starts with avoidance of all those issues listed here, especially less food late in the day. Elevating the head of the bed with books under the bedstead is a powerful and underutilized treatment. Fortunately, there are medicines that also can help. For occasional reflux, over-the-counter Mylanta or Maalox work, and these don’t stimulate acid-production like Tums, Rolaids, or baking soda. Fast acting, as-needed, histamine-2 blockers, like ranitidine (the generic version of Zantac,) also give quick relief. For persistent symptoms, slower-but-more-powerful proton-pump-inhibitors, or PPIs like omeprazole (or Prilosec) give a more enduring relief. But please remember: if reflux symptoms are severe enough to require the long-term use of any medicine, talk to your doctor. An underlying infection or cancer could be the cause. I scheduled Mr. H for an EGD, where, under anesthesia, a scope was passed down the throat, esophagus, into the stomach and duodenum. We found a cancer in the lower esophagus. Following surgery, radiation, and some chemotherapy, the malignancy has not returned, and that was years ago. Nowadays, when I see him in the clinic, he seems happy to see me, but it’s still only after the farm work is done, and only because his wife made him do it. To hear more from Dr. Holm, visit his website, www.PrairieDoc.org. On Call with the Prairie Doc is produced by the Healing Words Foundation in association with the South Dakota State University journalism department and airs Thursdays on South Dakota Public Broadcasting Television at 7 p.m. CT, 6 p.m. MT, and streams live at www.PrairieDoc.org. By Richard P. Holm
Despite his caring conversation, I heard very little of it because his large, rosy, bulbous, and bumpy nose had stolen my attention. Years later, when I met him again, he looked like a different man. The rosacea and rhinophyma skin condition, which had made his face so red and nose so massive, was calmed down with medication, and the excessive growth of skin over the nose had been trimmed away by laser scalpel. This time my eyes were no longer drawn to that globular and swollen proboscis and instead I was able to see his kind and wizened eyes. Acne rosacea, or more commonly called just rosacea, affecting 14 million people in the U.S., or five percent of the population, is sometimes said to be an adult version of acne vulgaris. We see rosacea more often in 30 to 50-year-old women, and it can flair as menopause approaches. When it does affect men, it can be severe. And in a percentage of cases, rosacea can cause an ever-growing piling up of skin over the nose, called rhinophyma. Rosacea more-often targets fair-skinned, freckle-faced, blond-or-redheaded, blue-eyed people who flush easily. It seems triggered by sun exposure, hot drinks, hot baths and showers, hot spicy foods, stress, exercise, and steroid medications. Of course, one way to prevent rosacea is to try to avoid such triggers. Acne vulgaris, or more commonly called just acne, is similar to rosacea, seems also related to hormonal swings, but it affects about 85% of all U.S. adolescents and, more often than rosacea, causes whiteheads and blackheads. Adolescents living in western modernized civilizations struggle with acne, however it affects few living in non-industrialized societies. This has lead some experts to believe acne, and also rosacea, might be made worse by soap, excessive cleanliness, antibiotic use, and alteration of the normal-flora living on our skin that protects us from invasive bacteria; like grass on a lawn protects against weeds. The two conditions of rosacea and acne have common methods of treatment. Over-the-counter lotions like benzoyl peroxide, prescription antibiotics and Vitamin A, both in lotion and pill form, are still the mainstay of therapy. In contrast, recently there is a trend to move toward supporting one’s normal flora, avoiding antibiotics, cleansing agents, or oil removing methods, and even trying probiotics. This is all in an effort to re-establish a lawn of protection to fight the invasion of weeds. Any of these treatments are effective in most people, but not all. So if you don’t find relief with typical treatments, or your nose starts growing, it’s time to see the dermatologists. To hear more from Dr. Holm, visit his website, www.PrairieDoc.org. On Call with the Prairie Doc is produced by the Healing Words Foundation in association with the South Dakota State University journalism department and airs Thursdays on South Dakota Public Broadcasting Television at 7 p.m. CT, 6 p.m. MT, and streams live at www.PrairieDoc.org. |
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