Itchin' and Rubbin'

Pruritus: Why Am I Itching? Am Fam Physician. 2011 Jul 15;84(2):203. See related article on pruritus. What is pruritus? Pruritus (proo-RY-tis) is itchy skin or a feeling that you need to scratch. It can hurt and can cause sleep problems and depression if it becomes severe. What causes it? The cause isn't always known, but dry skin is most common. Many other skin problems can cause itching, often with a rash. Serious medical conditions, like kidney or liver problems, sometimes cause itchy skin. How is pruritus treated? There are simple things you can try at home. Avoid common household products that might be making you itch, like perfumes, detergents, and fabric softeners. To prevent dry skin, bathe less often and don't use hot water. Make sure you rinse off all of the soap, pat skin dry, and use a gentle moisturizing cream or ointment (for example, petroleum jelly). If using a moisturizer three times a day doesn't help, ask your doctor about using an over-the-counter cream called hydrocortisone. Your doctor may need to prescribe a pill to stop the itching or to treat a skin infection. When should I see my doctor? If home treatments don't work, you should see your doctor. You should also see your doctor if you are older than 65 years, your itching is severe with no obvious cause, or your skin is red, swollen, warm, or leaking fluid. Your doctor can probably tell what is causing you to itch by examining you and asking you questions, but you may need a skin test. This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://familydoctor.org.

Those D**%#** Hemorrhoids !!

What are hemorrhoids? Hemorrhoids (HEM-uh-roids) are dilated veins around the rectum. Most people have discomfort or bleeding from hemorrhoids sometime during their life. Hemorrhoids usually go away on their own in about one to two weeks. What can I do about them? Avoiding constipation is the most important thing you can do to treat and prevent hemorrhoids. Straining on the toilet for a long time can make hemorrhoids worse. These things can help keep you from getting constipated: •Eat foods high in fiber, such as brown bread, rice, pasta, fruits, and vegetables •Add extra fiber to your diet by putting bran on your cereal or by taking fiber supplements •Drink at least eight glasses of water per day If you do get hemorrhoids, using medicated wipes after bowel movements can help with pain and itching. Sitting in a warm bath may also help. There are some creams for hemorrhoids that you can buy without a prescription. They can shrink the hemorrhoids and help with pain and itching. But make sure you read the labels carefully; some of these creams contain steroids. You should not use steroid-containing creams for more than a few weeks because they can damage your skin permanently if they are used too long. When do I need to see my doctor? Call your doctor if creams and warm baths do not help, or if you have any bleeding from the rectum. It is important to make sure that hemorrhoids are causing the bleeding, and not a more serious condition. You should also call your doctor if the pain suddenly gets worse. What if my hemorrhoids are very bad? If your hemorrhoids are causing a lot of pain or bleeding even after treatment with creams and baths, you may need surgery. There are several options. Your doctor may be able to treat them in his or her office by giving you a shot or by using a special light that shrinks the hemorrhoids. Make sure to tell your doctor if you are taking a blood thinner or aspirin. Some types of hemorrhoids can be treated with a procedure called rubber band ligation. A rubber band is tied around the base of the hemorrhoid to cut off the blood supply. The hemorrhoid then shrivels up. Most people do not need anesthesia with this procedure. People with more complicated hemorrhoids may need to see a surgeon for stapling or removal of the hemorrhoids. Both of these operations require anesthesia. This handout is provided to you by your family doctor and the American Academy of Family Physicians. Other health-related information is available from the AAFP online at http://familydoctor.org. This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject. And that's the end of this tail....er, tale!!

TICKS - OH MY !

Jul 03, 2011 Ticks are one of the most serious outdoor pests, since they bite and may carry diseases. Ticks are arthropods, more closely related to spiders. Adult ticks have eight legs, while insects have six legs. Ticks are ectoparasites, which means they must have a host for each stage of their life cycle to survive and reproduce. Types of ticks The American dog tick is the most common tick in Alabama. Larvae, nymphs and adults are commonly found on dogs but rarely on humans. The body length of an unengorged adult is about 1/8 inch, but can extend to 1/2 inch when fully engorged after a blood meal. The American dog tick is the most common carrier of the disease-causing agent for Rocky Mountain spotted fever. The Lone Star tick is a confirmed carrier of human ehrlichiosis. Sixty-eight percent of all ticks recovered from humans are Lone Star ticks. While the Lone Star tick species is a known carrier of disease, each individual tick is not infective. This concept is true for other tick species that have been confirmed to carry disease-causing agents. The black-legged tick, commonly called the deer tick, is associated with Lyme disease. The preferred host for the adult ticks is white-tailed deer. The bite from a nymphal stage tick is most often associated with Lyme disease, because the nymph is small and may go undetected. Lyme disease is primarily a problem in the Northeast and upper Midwest United States, but has been found in Alabama. Tick bites can also result in prolonged itching. How to avoid ticks Minimizing your exposure to tick bites is the best way to avoid tick-borne diseases: • Wear light-colored clothing in wooded areas or places that ticks are known to infest. Ticks are easier to see on light colors so you can remove them before they attach. • Tuck pant legs into socks, boots or shoes to prevent ticks from crawling up under clothing. • Apply an insect repellent containing DEET to boot or shoe tops, around the waist and on exposed skin. • In heavily infested areas, you may want to use permethrin on clothing. Permethrin is not for use on skin. Make sure that clothing treated with permethrin dries for at least two hours before use. Most insect repellents for mosquitoes usually work well against ticks. • Examine yourself carefully for ticks after leaving the woods or tick-infested areas. Check especially the hair, shoulders, armpits, waist and inner thighs. How to remove a tick Normally, ticks must attach for several hours before a disease agent is passed from tick to man. Therefore, if you remove ticks promptly, you greatly reduce your chances of getting Lyme disease or Rocky Mountain spotted fever. Check your pets, especially dogs, for ticks as often as possible. Outside pets can pick up ticks and bring them into the home. Remove attached ticks carefully. Using a pair of fine tweezers, firmly grasp the tick at the point closest to where it is attached and pull with a slow steady motion. You should hear a “pop” as the tick’s mouthparts are pulled free. Disinfect the bite with rubbing alcohol or iodine. Avoid removing ticks with bare fingers. If the tick is crushed, you could introduce the disease agent through cuts or abrasions in your skin. Remove ticks from pets in the same way you remove ticks from yourself. Spraying for ticks There are several products labeled for controlling ticks in the yard, among them carbaryl, permethrin, lambda-cyhalothrin and tralomethrin. Most general lawn insecticides mention whether they will control ticks. You may elect to simply treat a specific area, such as a portion of your yard just before a picnic. Be sure to always follow the label directions and allow sufficient time for the product to dry before allowing people and pets to enter the area. Applications at two- to four-week intervals may be necessary to eliminate ticks. Frontline and Top Spot are recommended for controlling ticks on pets. It is important to treat pet areas on the same day that you treat the pet to avoid re-infestation. Read more: Anniston Star - On Gardening The ABCs of controlling ticks

Family medical Tips and Information

FAMILY MEDICAL TIPS There are some general methods and facts you can go by when, on occasion, you have some of the more common ailments. Also, there are things that you should never do. I’ll try to cover some of the ones that occur most frequently and some of the reasons I think they’re important. They may seem simple to some, but even the simple ones can cause a lot of anxiety and tears at times. Some are “dos” and “don’ts” that are also important. You can print this out and put it in your medicine chest, and maybe you’ll feel better about some of the things you do in the case of an illness or minor injury that you probably already know. I might even add to it from time to time as I get wiser. But after fifty years of doing this, maybe I can relieve the anxiety in some situations. The human body and mind are remarkable organs that have an uncanny way of healing themselves. Sometimes we just have to “do no harm” and let God do the rest. With Love……………………………………………….Donald Landers Cohagan, MD FEVER Aspirin and Tylenol (Acetaminophen) both work on fever, but sometimes the aspirin will irritate an already queasy stomach, and Tylenol usually doesn’t. Generally, go by the directions on the label for kids. Adults can take two Tylenol (500mg) every three to four hours with a maximum of eight (8) tablets in 24 hours. If necessary, you can add one aspirin every 3 – 4 hours to the Tylenol if it doesn’t upset the stomach. I don’t advise Advil/Ibuprofen for fever. It can really upset the stomach and doesn’t work as well anyway. The most urgent thing about fever is to stay hydrated, and that means plenty of plain water. A good replacement or substitute fluid for hydration is Pedialyte, which can be purchased in most pharmacies. NAUSEA AND VOMITING Remember…You will never starve to death, but you can become very ill from dehydration and then require intravenous (IV) fluids. Take small amounts of water/kool-aid/Pedialyte frequently. If no localized abdominal pain, you can use a Dramamine suppository for nausea. Kaopectate for diarrhea. Fever, especially 101 degrees and above, and localized pain or tenderness are danger signs. Low grade fever, 99 – 100, is not uncommon with a virus bug. Any bleeding with vomiting or diarrhea can be an urgent problem. If either vomiting or diarrhea cannot be controlled, especially with children, get help urgently. Again, dehydration is one of the greatest dangers. Dramamine about as good as anything. Comes in suppository. Small amounts of Pedialyte to rehydrate. If doesn’t stop in 2 – 3 hours, get help. Again, dehydration is the danger here. COLDS AND COUGHS The membranes of the nose, throat and bronchial tubes are moist, and they need to stay that way. If they become dry, or irritated from an infection or allergies, the mucous membranes become slightly irritated and they swell up and try to put out more secretions to stay moist. If there is associated infection, the secretions become a darker greenish or yellow color. This is when you “plug up”. If you take a “drying agent”, or something to “open you up”, you can make the “plugging” worse. Only when there is clear drainage with watery eyes and runny nose should you take a “decongestant”. Humidifiers do minimal good, if anything. Some think they just cause more humidity in the room and on bedding which can cause fungus to grow and make allergies worse. If the secretions from the nose, or in what is coughed up, is darkish green or yellow, there is probably an infection, and especially if associated with fever, should be treated with antibiotics. In milder “cold virus” or allergy conditions, where there is a lot of sneezing, watery nasal drainage with watery eyes and perhaps a dry cough, over the counter medications work very well. “Claritin D 12 Hour” is an allergy medicine that contains a decongestant with it. The decongestant is pseudoephedrine, which is what the addicts use to make meth. The Claritin part is an antihistamine, but it seems to help with the drying also. If your nose and chest are dry, irritated and hacky already, this will make it worse. The pseudoephedrine will also make your heart rate and blood pressure increase some too, and it will keep you awake. Best to take in the morning, because it lasts 12 hours. This does nothing for “infection”. If it is thick and green and there is a fever, you probably need an antibiotic. For straight allergies, the Claritin alone works well. Both of these are “over the counter”, but antibiotics are not. For coughs, I recommend a generic “Robitussin DM” which is a combination of Guifenisin (that loosens stuff up) and Dextromethorphan (which brings it up and suppresses the tickle-cough). You can take two teaspoons after each mealtime and at bedtime, or about every four hours. It doesn’t matter whether secretions are swallowed or spit out. We never want to “stop” a cough, just reduce its frequency and that irritated hacky feeling. This is a very safe product and can be taken two teaspoons full every four hours around the clock. Again, the magic ingredient here is the water you drink. Without hydration, everything is going to plug up. That’s when you get pneumonia. Vicks just makes you smell pretty – it doesn’t help otherwise. Neither do inhalers or nasal sprays unless you have really bad allergies with it, like asthma of hay fever. EAR ACHES: Ear aches can come from the external or the inner ear. The external is like “swimmer’s ear”. Most OTC drops are some kind of “oil “to try to separate the water from the skin. Might help before contact, but later, just a local effect. You probably should get a prescription med if too bad or especially with fever. If this is a problem, it’s best to use Swim Ear or some type of oily drop before getting in the water. DIAREHEA Diarrhea—The jury is divided on “slowing down the gut “with something like Lomotil. The gut is trying to tell you something—it wants to get rid of it. Kaopectate in pretty big doses is pretty safe to try to make the stool more solid. Things like Lomotil can bloat you up and lead to vomiting. Best to stay on clear liquids (water, Pedialyte, Kool Aid) until it stops. Again, the greatest danger is dehydration. Always try to take in water or fluids to keep the color and clearness of your urine as close as possible to the color of the water in the stool. If it’s really dark, you’re already a quart behind. The kidneys are the most happy when you’re putting out over a quart a day. Bright red blood in your stool or on wiping paper means bleeding somewhere down close to the anal opening or the lower gastrointestinal tract. It could be a hemorrhoid or a fissure, which is a small tear in the anal lining. A “sitz bath” or mild suppositories (Anusol) might help these if not too severe. The colon, which is the lower bowel, likes to have some “bulk” to work on to make soft stool. Otherwise it will clamp down on itself to try to make bulk, but it will just squeeze off mucous. A great way to get soft bulk for your colon is to give it fiber, such as Metamucil of Fiber-One. A black stool, or one that looks like tar, means bleeding higher up in the intestinal tract, like an ulcer in the stomach or in the first part of the upper tract. Any of these need medical attention as soon as possible. The black stool is the most urgent. SKIN CUTS, BLEMISHES, BRUISES, ETC. Rule One: Soap and lukewarm water. Pressure will stop 99.9% of all bleeding if you keep it on directly long enough. An “open” cut that won’t stop bleeding needs stitches. Also if it’s somewhere you don’t want an ugly scar. Any over the counter antibiotic ointment is fine if you want something on it, but important thing is sterile band aid or pad after washing in soap and water. All cuts and blemishes look terrible for the first 48 hours. Danger sign is swelling and redness going up or down the extremity. Infection doesn’t show up for 48 -72 hours and may have red streaks going up the arm or leg. If so—GET HELP! Bruises are due to rupture of tiny to larger blood vessels broken at the time of trauma. Hold pressure over it for 3 minutes steady. Ice doesn’t really do much. Cold can’t get deep enough. Pressure helps prevent spread. If already discolored, elevate it above level of heart and apply warmth (water bottle or heating pad on low. They all look much worse before they get better. There is NO Clot going to your heart. A bruise is “loose blood” in fatty tissue under the skin and not a clot to go somewhere. “Red streaks” are infection, and wouldn’t show up for 2 – 3 days anyway if the skin is broken. These need treatment as soon as possible anyway for antibiotic treatment. If a wound bleeds to the outside, it won’t “bruise” as much. ALWAYS BUY GENERIC DRUGS if available. They are just as good, regulated by the FDA and are MUCH CHEAPER. The Food and Drug Administration (FDA) regulates and controls all medications sold in the US as to strength and clinical effectiveness. The generic version of a brug must maintain the same “treatment capacity” as the name brand drug or the one protected by patent. You can always depend on the “generic” brand being the same “strength” as the registered drug, but the look and taste may be entirely different. Some of the generic brands are even made by the same company the makes the registered product. Even though developed in the US, many of our drugs are actually manufactured in foreign countries. Some generic names: “TYLENOL”--Acetaminophen “ADVIL”--Ibuprofen “ALEVE”—Naproxen By the way, Ibuprofen and Naproxen are very good “anti-inflammatory” agents. If a muscle or tendon is pulled, inflammation can develop, just like a sprained ankle or knee. Naproxin (Advil), taken with some food so it won’t irritate the stomach (like all anti-inflammatory drugs can do), really helps taken 2 or 3 times a day, with food, so you don’t get heartburn. It’s stronger than Ibuprofen (Advil). HEARTBURN, ACID INDIGESTION No carbonated beverages! The bubbles try to come up into your swallowing tube (esophagus). Any liquid anti acid will help for fastest result. “Prilosec” can now be purchased OTC as OMEPRAZOLE. These last TWELVE HOURS, so one at night, and one the next morning if needed. The best you can get that I know of. Liquid antacids might help for a faster response. HEADACHES Most headaches are due to tension or impulses in the skin and muscles of the scalp, and most of these come from the neck where the scalp nerves come from. When the nerves and the muscles get irritated or inflamed, the headaches can be miserable, affecting even the muscles around the eyes and down into the neck and shoulders. This can even seem to affect vision. Most will respond to rest and/or heat to the neck which causes relaxation and increased blood supply to the muscles. It is safe to take Tylenol (Acetaminophen) or Advil or aspirin for these. Pounding headaches are different, and may be coming from high blood pressure or increased pressure inside the head. This may also be associated with confusion, visual changes, nausea or vomiting, a short loss of consciousness or funny sensations. These are especially dangerous if occurring after some kind of blow to the head. If these are suspected, get help ASAP! Some could also be an early sign of a stroke. POISON IVY AND OTHER RASHES RULE ONE – UNO – FIRST !! Avoid contact! Get a book or google images and learn what the “poison” plants look like and stay away from them! Cool baths help. Some folks think oatmeal in the bath helps itching (a cupful in slightly cool water). If it’s a pretty small area, especially in an exposed area, some OTC cortisone cream may help the itching. Keep away from the eyes! The biggest complication is infection after scratching. This inflamed skin is very fragile, but a small amount of antibiotic cream might help if it really looks infected and crusting in a small area. FOREIGN BODIES (A SPECK) IN THE EYE Any solution that gets in the eyes should be irrigated thoroughly with water, lukewarm preferred. This will often remove small foreign bodies too. The eye will look red and awful after irrigation, but it’s a lot better than having something burn the eye or scratch it. Irrigation will neutralize or wash out most substances and foreign bodies. Turn on a faucet to barely lukewarm if preferred, cup the hands in the water stream, put your face right down in the water in the cupped hands, and open and shut the eye rapidly (blinking) for at least 15 - 30 seconds. The eye will look red, but it’s OK. A little Visene might even help. The most critical part of the eye is the cornea, which is the clear “bulge” over the colored part of the eye. NEVER use a QTip or other instrument on this part of the eye. It’s OK to use one over the “white” part of the eye if done gently, like when removing a “speck”. If the foreign body remains, especially if in the cornea, get help ASAP. After removal, if there is any question at all, such as a greenish discharge, go see a doctor or the ER to have it checked more thoroughly. The late danger is infection, often with a greenish discharge. Any redness or discharge the next day requires urgent help. Burning and stinging or bleeding on urination is BAD. Get help ASAP. Seizures are BAD. Get help ASAP. WHAT ABOUT VITAMINS? The only reason to take a multiple vitamin every day is if you think you are not getting everything you need every day in your diet. And the way many people eat today, I’m sure there are many who don’t get it. Most over-the-counter (OTC) vitamins are very safe to take if you wish. The only question is the need. There again, if you take them, consider the costs and take a generic. They are essentially all the same. The riboflavin in them can make your urine darker. SLEEP Literally millions of dollars are spent each year on medicines, articles, or chemicals to help induce sleep. Every person has a different “sleep pattern”, and some folks require more than others. The cycle also changes over time, at different ages, and according to different circumstances in our lives. Total relaxation is the greatest inducer of sleep, and one of the best “non-drug” methods I’ve ever heard of and practiced myself, is using the “conscious” mind to induce “total relaxation”. If you are in a dark, safe, and comfortable environment, you intentionally focus your mind on each segment of your body to submit to total “conscious” relaxation. You start with your toes and demand full relaxation of every muscle you have from there up, to you feet, your legs, your hips, your trunk, your fingers, arms shoulders and abdomen – all the way to your lips and scalp. This is done in a slow rhythmic fashion, with slow shallow breathing. The slow breathing leads to a slight increase of carbon dioxide in the blood, which assists the onset of sleep. Most folks who practice this have told me they seldom ever remember getting past the finger relaxation stage before they fall asleep. A “small amount of alcohol” or nighttime “toddy” is an excuse to drink. Alcohol is a stimulant in smaller quantities. Medication for sleep is really a misnomer. Anything over the counter that you take for sleep is usually just an antihistamine which can cause drowsiness or something like it that contains some aspirin or Tylenol. Most of these come in generic, cheaper forms too. ALWAYS read labels very carefully on any of these products, and remember they can cause delayed drowsiness even the next day. They can also cause dryness of the mouth, constipation and in some folks, blurry vision. ALCOHOL This might be as good a place as any to discuss alcohol, because all of us will be placed in situations where it will be consumed from time to time. The two most important things to remember about alcohol are that it is addicting and it is a sedative. The initial effect on drinking is stimulation, when most of us think we’re having the time of our lives and are much smarter, stronger, more beautiful, and much more talented than we really are. But remember…..it is a pharmaceutical drug just like anything else. It ultimately clouds the brain and nervous system, slows response times for reactions, reduces strength, tears up the intestinal system, reduces breathing and oxygen saturation in the blood while increasing the level of carbon dioxide, induces sleep to unconsciousness, and swells the brain with fluid to the point of making you stupid and provides a grand headache for the next day, all the while dehydrating you. And that is what we cry for when we go to a party, knowing full well the “stimulant” part will only last about an hour before the “stupid” part sets in! Almost everyone will “try” alcohol, mostly for the initial stimulating effect. What this really does is block or reduce moral and cultural inhibitions. As a “drug”, it depresses our cultural caution and good judgment. The real danger here lies in two areas. There is an attempt to increase or sustain these effects by taking in larger quantities, and these effects are delayed, so that the ultimate effects are not apparent to the suppressed mind until it is too late. As it is with any addicting drug, the tragedy of all of this is that many people are genetically susceptible to addiction with any of these substances and don’t even realize it. They are therefore much more prone to a lifetime of addiction even with smaller amounts or exposures to these substances. A short time of “social exposure” can lead to full addiction for them. BROKEN BONES (?) The main concern here is: “Is it broken? Can we wait to see? Should we splint it?” If there is a wound so bad the bone is sticking out through the skin, the answer is easy. But in even these cases and possible fractures, a general rule applies: Stop the bleeding with covering bandages and splint the part. A general rule on splinting is: immobilize the part above the injury and below it, and if possible, the joint above and below the wound. Keep the injured part as close as possible to alignment. NEVER put tight supporting bands above and below the injured area that would be so tight as to cut off blood supply. Application of large amounts of bandaging directly over the wound will control almost any bleeding.

The 50 Best Careers of 2011 - US News and World Report

The 50 Best Careers of 2011 - US News and World Report

3 Ways Healthcare Reform May Impact Medical Education - Medical School Admissions Doctor (usnews.com)

3 Ways Healthcare Reform May Impact Medical Education - Medical School Admissions Doctor (usnews.com)

3 Ways Healthcare Reform May Impact Medical Education - Medical School Admissions Doctor (usnews.com)

3 Ways Healthcare Reform May Impact Medical Education - Medical School Admissions Doctor (usnews.com)