Self-Diagnosis Can Be Rash
By Mandi Greenway, M.D.
“Doc, what’s this scaly rash on my arm? Do I have ringworm again?” A lot of the rashes I see in my dermatology clinic are red and scaly. In fact, what first drew me to dermatology as a profession was watching a dermatologist distinguish between seemingly similar red, scaly rashes all day. It intrigued me at the time, and I wanted to be just like her.
I can always tell when my patient is a farmer, because they usually treat any rash as ringworm before coming to see me. How does ringworm happen and why are farmers so familiar with it? Ringworm, first of all, is not a worm. It is actually caused by a fungus that infects our skin and causes a circular rash wherever the fungus came in contact with our skin. Without treatment, the circle will continue to expand and enlarge, forming concentric rings. The rash usually itches and is bothersome.
There are several families of fungus that can cause ringworm (tinea corporis in medical speak). They can be spread directly from other people, animals, or soil. The most severe infections typically happen when we get ringworm from animals. Growing up on a farm, I am very familiar with how much farmers interact with their livestock and pets. Farmers are accustomed to diagnosing ringworm on their animals and often will treat themselves if they see a similar rash. I’m pretty sure every farm family has had at least one member who has come down with this common infection at one time.
But all that is scaly, and circular is not ringworm. I remind my patients, especially farmers, that there are lots of different rashes that can look similar. It is not always in your best interest to try to self-diagnose and treat.
Nummular eczema is a type of eczema that forms red, scaly, circular patches on our skin. Granuloma annulare is another rash that forms raised rings on the skin. These are both treated differently than fungal infections and make up the most common rashes that are misdiagnosed as ringworm.
There are other, less common, rashes that can signify underlying medical conditions inside your body. Even though ringworm is a common, non-dangerous skin infection, if your rash doesn’t improve with over-the-counter antifungals you should always check with your doctor.
Mandi Greenway, M.D. is a contributing Prairie Doc® columnist. She practices dermatology in Mitchell, South Dakota and is the featured guest on the show this week. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.
Science or Magic?
By Debra Johnston, M.D.
Examples of accelerating scientific progress abound in human history. Mendel’s experiments with plants demonstrated inheritance in the mid-1800s. Over the next 100 years, researchers across the world built upon each other’s discoveries, until Watson, Crick, and Franklin finally identified the structure of DNA. The human genome project was launched nearly 40 years later, and within 15 years, the entire human genome had been mapped.
Da Vinci famously conceptualized human flight during the Renaissance, but it took 400 years of research and experimentation before the Wright brothers flew at Kitty Hawk. Only 54 years later, the Russians launched Sputnik 1, and 12 years after that, Armstrong and Aldrin walked on the moon.
In 1846, ether was used for surgery for the first time. Surgeons could operate on patients without inflicting excruciating pain from the knife. Advances in the understanding of antisepsis taught surgeons to wash their hands and their instruments, and survival rates after surgery steadily rose. The first appendectomy happened in 1880. The first kidney transplant was in 1953. Today, surgeons can repair heart valves without opening the chest, and address spina bifida while an infant is still in the womb. Death as a result of surgery is uncommon in all but the direst of circumstances.
Hundreds of years ago, the Chinese blew pulverized smallpox scabs into the noses of susceptible individuals, and eventually variolation, the deliberate, controlled exposure of an individual to smallpox was practiced throughout the world. Smallpox contracted naturally carried a death rate of about 30 percent. Variolation improved the odds significantly: only one to two percent of people died. In 1796, Jenner started inoculating children with cow pox, thus conferring immunity to smallpox, and the modern vaccine era began.
Since the late 1800s, vaccines against many once terrible diseases have been developed. As technology has advanced, it has been easier to identify the organism that causes a disease. It took almost 15 years to determine that polio was caused by a virus rather than bacteria, and another 40 years to learn that there were in fact three different strains of the polio virus. It took only two years to identify HIV.
Science accelerates, and science rises to new challenges. Basic science advancements are translated into new or improved technologies faster than ever before. Researchers across the world can collaborate, replicate, build upon, or as importantly refute, each other’s findings.
We have tools today that even da Vinci could not have imagined, and they enable us to do things that would have seemed like magic to previous generations. Science fiction author Arthur C. Clark once wrote, “any sufficiently advanced technology is indistinguishable from magic.” Thankfully, understanding how these technologies developed helps us appreciate the difference.
Debra Johnston, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.
The Butterfly Effect
By Jill Kruse, D.O.
My daughter recently brought home a monarch caterpillar. We cared for it in a container making sure it had a supply of fresh milkweed leaves and kept its cage clean. It seemed perfectly content to munch on leaves all day. After a few days it hung upside-down from the lid of the cage and we waited for it to form a chrysalis, and eventually convert to a butterfly.
We used the time lapse video capability of our cell phone to capture the transformation. Watching the video, the change seems easy, quick, and effortless. There does not appear to be any major effort or pain involved for the caterpillar. However, after researching the subject, we came to appreciate the significant process the caterpillar undergoes which is not apparent to the naked eye of the observer.
Unless we take time to learn about the butterfly’s makeover, we may tend to minimize it as an uncomplicated process. Literally everything about the caterpillar changes. Its old body is completely broken down for the new one to form. Enzymes are released to break down the caterpillar skin and hormones allow new body parts to be formed. To the spectator, it looks easy, to the caterpillar, it is a monumental task.
This got me thinking about how change is difficult for people, and how important it is for us to support each other as we attempt it. Many changes in life are painful and complicated, especially those we make to improve our health, or our physical, emotional, or spiritual wellbeing.
Breaking old habits and creating new, healthier behaviors involves a transformation. It requires that we learn new ways of thinking and practice positive self-talk which is sometimes uncomfortable and challenging work. Quitting smoking, walking every day, choosing different healthier foods, and avoiding junk food are changes that offer long-term benefits. The work may not seem worth it in the short-term. You may want to give up, especially when others do not seem to notice your struggles or understand how you are feeling inside. You may miss the way things were before you embarked upon your journey.
Look to the butterfly for encouragement to continue your transformation. Change may feel like a struggle, but when your wings emerge and you take flight thanks to your healthier habits, the change will be its own reward.
Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.
Our Antiviral Founding Father
By Andrew Ellsworth, M.D.
When the Declaration of Independence was signed on July 4, 1776, the American colonies still needed to win the Revolutionary War to truly gain their independence from the British Empire. The war continued another seven years until September 3, 1783. One of the deadliest threats to the Continental Army, however, was not the British Army, it was disease, especially smallpox.
Boston had an outbreak of smallpox in 1775 from British Redcoats arriving to fight the rebellion. George Washington knew very well the dangers of smallpox after having had it himself as a young man, which left scars on his face. To keep his soldiers safe, Washington did not allow anyone from Boston near his troops. Washington wrote to John Hancock, the president of the Continental Congress, that he would “continue the utmost vigilance against this most dangerous enemy.” Later, when the British withdrew from Boston, Washington allowed only soldiers with immunity into the city.
Most of the Continental Army had never had smallpox while most of the Redcoats had. This put the Americans at a big disadvantage. An attempt by the Continental Army to take Quebec failed in part because of heavy losses due to smallpox. In fact, General John Thomas died of smallpox in July 1776.
This was before the advancement of vaccinations. However, there was a procedure known as variolation, an early form of vaccination which involved exposing a cut on the recipient’s arm to a small dose of the virus, hopefully just enough to trigger immunity without causing severe illness or death. The procedure was illegal in many places including Washington’s home state of Virginia.
Washington knew they could not afford to lose more soldiers to smallpox. Thus, despite push back from the Continental Congress, Washington ordered this primitive form of vaccination for the entire army, and by the end of 1777 more than 40,000 soldiers had received it. Infection of the army dropped from 20 percent to one percent and lawmakers repealed bans of variolation for smallpox across the colonies.
George Washington’s efforts at quarantine and primitive vaccination helped protect the Continental Army from disease which helped them eventually defeat the British Army and earn independence for the United States of America.
The war on Covid-19 may take several years as well. History shows how vaccination can be a great weapon against disease. Unfortunately, many remain unvaccinated, and hundreds in the U.S. continue to die each day. We need to rally both nationally and locally, to unite our efforts so we can gain our independence from Covid-19.
Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. For free and easy access to the entire Prairie Doc® library, visit www.prairiedoc.org and follow Prairie Doc® on Facebook featuring On Call with the Prairie Doc® a medical Q&A show streaming on Facebook and broadcast on SDPB most Thursdays at 7 p.m. central.