By Richard P. Holm, MD
This morning, a 40-year-old woman called a question into my radio talk show complaining of a bunch of tight blisters under her right shoulder blade. She said, “The skin is red underneath and the whole area is quite painful.” Her question was, “What kind of bug bites could have done this, and what should I do?”
In reality, these were likely not bug bites, but rather the manifestations of the alphaherpesvirus varicella-zoster virus (VZV). This virus is more commonly referred to as “chickenpox” early in life and “shingles” when it reemerges in older individuals. Though we typically acquire chickenpox at a young age, the virus sets up shop in peripheral nerves for the lifespan of the host and can raise its ugly head many years later, resulting in shingles. It is fortunate that vaccination of the young, or those over 60-years-of-age, can help prevent chicken pox and reduce the severity of shingles if the virus ever reactivates.
A similar type of skin infection can be caused by herpes simplex virus (HSV). Infection with HSV commonly results in fever blisters, also known as “cold sores”. These are larger, painful, blisters which cluster around the infected area, typically the mouth or the genitals (depending on where the virus was initially acquired) that can reemerge when the immune system is weakened by illness or stress. There are two types of HSV, I and II, that can be both directly and sexually transmitted. Like VZV, HSV type I and II are alphaherpesviruses, meaning they also exist for the lifespan of the host. Antiviral medications like Acyclovir can help abate symptoms and prevent reactivation, but there are currently no vaccines or cures available for HSV.
Blisters can also result from contact dermatitis, a condition where the body reacts negatively to an irritant or allergen, resulting in a skin rash. These irritants or allergens can be anything, like poison ivy, antibiotic ointment, or even fabric softener. We also see blisters pop-up when unprotected hands are traumatized by raking the yard, burned by grabbing a hot pot handle, or frost-bitten on an ice-fishing expedition. A life-threatening blister condition can also occur when a person has an allergic reaction to some pill or intravenous medicine and blisters start spreading over extensive amounts of skin and into mucous membranes. When this occurs, stopping the culprit medicine and providing emergency medical measures can save the patient’s life.
A few years ago, a 99-year-old patient started suffering from blisters over her lower legs. I first tried stopping every unnecessary medication, then a topical treatment, but to no avail. I reviewed causes for blisters and once again realized how many different reasons there could be for blisters on the skin. After biopsy, her diagnosis came back as a mysterious autoimmune disorder called pemphigoid. The dermatologist treated and cleared the blisters with just the right medicine, and my patient had relief.
The more I learn, the more I am humbled.
My Father was in his 50's when his retina, the lining which provides a blanket of vision on the inside back of one of his eyes, started separating from its base structure. Called a 'detached retina', this condition occurs in 3 people out of 1000; more often in men, in certain families, in those with near-sightedness, in obese hypertensives, and in those who have had cataract surgery.
Dad's first symptoms included floaters, quick flashes of bright light, and blurred vision starting in the peripheral part of his vision, gradually moving toward his central vision, like a gray veil falling across his line of sight. There was no pain with this, however he became understandably fearful as his vision deteriorated.
I remember my father having open-eye surgery at a University Center in Minneapolis; it was a cutting-edge treatment at the time. It required two weeks of hospitalization with both eyes patched closed and with absolutely no head motion while sandbags pushed into both sides of his head. His constant companion and only entertainment was a radio plugged into his ears. I remember when he finally came home, he was overjoyed to see us, seemed to have a renewed appreciation of life, and was happy that his vision seemed to be gradually returning. That was the late 60’s, and I don’t think his appreciation for life ever waned after that.
Modern treatment for detached retina may include reattachment of the retina with a laser (like spot-welding) or freezing small areas (cryotherapy). Sometimes the walls are squeezed together by a band the surgeon wraps around the sphere of the eyeball. In other cases, the vitreous jelly, or the bag of fluid that fills the eyeball, is removed and the fluid is replaced with a gas bubble to push the retina back in place. Each case is different and the treatment approach may vary depending on the severity and type of detachment.
Fortunately, modern-day treatment for detached retina no longer requires two weeks of eye patches and sandbags holding the head perfectly still.
Nurture versus nature is a question often bandied about. Is it the environment in which the child is raised, or is it the genetics provided by the biological parents, that most influences what kind of person a child will grow to be?
We have known for a long time that if a parent is depressed, their children are at higher risk for having anxiety, depression, and disruptive behavior. Indeed, the offspring of depressed parents have up to a three-times higher risk of these problems when compared to the children of parents who are not depressed. So, is it because of the environment; or is it genetics?
Research published in the Journal of the American Medical Association brings us closer to an answer. It is important to note that the study consisted primarily of mothers with depression, as they are far more likely to report symptoms and come in for treatment than fathers with depression. However, researchers believe that their discovery applies to whichever parent has depression, regardless of whether they are male or female. The results were fascinating: effective treatment of the mother lead to resolution of psychiatric problems in the child.
Study author Myrna Weissman, professor of psychiatry and epidemiology at Columbia University, said “while depression may be a genetic disorder, [this study showed that] a parent’s illness has a very strong environmental
effect on her child.” In other words, when mama’s not happy, nobody’s happy. Weissman also pointed out “if you have a depressed mother, you ought to do everything you can to get her better, because there’s a double effect that will impact their children.”
I think the message from this research is very powerful, and should be taken to heart by any mother or father. If you as a parent are having psychological trouble, get help and your child will be better for it. If you won’t do it for yourself, do it for your kids.
By Richard P. Holm MD
When should one worry that he or she might be having a heart problem?
Unfortunately, heart symptoms can be all over the board, and sometimes there are no indications for trouble until very late in the game. On top of this, classic heart-problem symptoms can just as easily be due to something not heart-related, like an esophageal spasm or musculoskeletal strain. That said, there are clues for heart trouble that help us know when to seek help.
It is helpful to take into consideration the age, gender, size, life-style, and situation of the individual in question. In general, there is a higher incidence of heart problems in people with a history of smoking, a family history of heart disease, older age, and if that person is male. But heart problems can occur in anyone, so never cover-up or ignore symptoms. Heart disease in some people, especially diabetics and women, can present with unusual or very minimal symptoms. Hypertensive and overweight snorers should have an inexpensive night-time oxygen test to see if a full sleep study is needed. Sleep apnea is a dangerous and important cardiac risk-factor, and I believe way more worthy of attention than cholesterol. If suspicious, talk to your doctor, since discovering sleep apnea could add years to your life.
A middle-aged or older person having a heavy sensation in the chest, neck, jaw, shoulder, or arm that comes with exertion and is relieved with rest, should be suspicious of a blockage in their coronary arteries. Called angina pectoris, this condition alone may not be dangerous unless coming on with progressively less exercise. Still, if you experience angina you see your doctor. If these symptoms come on suddenly, severely, and do not go away with rest, then you have a very urgent problem, so call 911.
Heart weakness, also called congestive heart failure, or CHF, can be caused by heart-valve disease, long standing high blood pressure, chronic alcohol use, certain viral infections, and more. The most common symptom of CHF is shortness of breath, but almost every illness, especially lung disease, can cause this too.
Heart rhythm problems are sneaky. Many of us, including me, have benign sporadic palpitations that are not dangerous and mean nothing, but still worth discussing with your care provider. If you have runs of heart rate in the range of 150 beats per minute, or rates so fast or slow as to cause weakness or passing out, you should go the emergency room.
As complex as all these warning signs may seem, the most important way to diagnose heart disease starts with paying attention to symptoms.