Introduction to the neighborhood/Turnabout

     Welcome to the new Seattledoc blog. I’m a physician with over thirty years experience in clinical medicine. I’ve recently published a medical mystery novel I hope many of you enjoy. My hope for this blog is to explore many issues that pertain to all of us and how we get through our daily lives. I will share some personal experiences as well as many from my clinical medical practice. My professional experience has not been limited to medicine. I have been a registered investment adviser, business consultant, wine enthusiast, wine merchant, author, and observer of life. I hope that this blog will be a place that we can communicate with each other informing and inspiring ourselves.

My first novel Turnabout, which will be released November, 2008, is a poignant story about about a fictional Seattle surgeon Dr. Fred Pomeroy who finds himself the object of a malicious malpractice lawsuit brought against him by his vengeful ex-girlfriend. Matters avalanche from bad to worse when he learns that someone in his office is embezzling, his business partner wants to bail on him, and he will likely lose his case because a crucial piece of evidence is missing. After navigating many obstacles to find some answers Dr Pomeroy is hardly prepared for the real truth.

Turnabout grapples with real, present day issues facing doctors and patients weaving a tale of personal loss and courage that both inspires and intrigues. Told with wit, mystery, and a narrative flare worthy of the best in the medical mystery genre. Turnabout  tells a contemporary tale that informs and entertains. Turnabout can be purchased at http://seattledoc.com

To be included in the intimate dialogue of another person’s life is a privilege. I’ll do my best to continue the conversation, listening, learning and hopefully motivating others to reach their life’s goals and dreams. These last few weeks have truly been some of the most inspiring and hopeful any of us have seen in our lifetime. I’ll be back soon with some more thoughts. Looking forward to continuing our dialogue.

“The Owner’s Manual for Allergy Relief” is intended to be a primer for people who struggle with allergy issues. It explains in easy to understand terms how to recognize and understand allergies. It discusses common triggers that evoke symptoms in the hypersensitive individual in order to prevent and manage their symptoms. This is the first of a series of concise Owner’s Manuals with practical tips for healthy living. It can also be purchased as an ebook at http://seattledoc.com.

 

 

  

Preventing and Understanding Eye Injuries

Eye injuries in the workplace are very common in almost all industries. Construction, welding, manufacturing, landscaping, auto repair, all exposes the eye to possible chemicals, dust or foreign bodies. Irritating or caustic liquids potentially splash an eye whether you work in manufacturing, laboratory, health care, restaurant, or construction trades. Even a seemingly benign office environment can put eyes at risk. Solid foreign bodies that are airborne like a missile can happen in just as many and diverse surroundings. Short-term exposure to intense sunlight, heat, or ultraviolet light can also be problematic. Inappropriate initial first aid or lack of treatment can often compound these problems with infection when people delay seeking professional medical attention promptly.

All eye injuries should be considered serious even when they seem benign. Serious injury to the eye can be subtle and compounded by delay in treatment. Any involvement of the eye should have urgent exam and treatment. One of the more common injuries is a corneal abrasion. The cornea is the clear dome capping the front central portion of the eye. A foreign body such as dirt, metal, wood, sawdust, a fingernail or a contact lens, can scrape it. Even rubbing the eye after the injury can cause further damage. Early exam within two hours of the injury and initiating treatment is critical to avoiding permanent damage and limiting the episode to a short-term inconvenience. Chemical splash to the eye is even more urgent. Immediate flushing of the eye with copious amounts of water is the preferred treatment. Do not attempt to use any neutralizing agents or antidote. Simple dilution of the insulting agent by several minutes of irrigation with water will limit the exposure to the chemical and minimize the damage. The amount of irritation is instantaneous so initial first aid by irrigation is very important. Proper medical exam should follow the initial irrigation in a timely manner. If the injury involves a cut to the eye, do not flush the eye. Gently cover the eye and seek medical attention. Evaluation of the severity of the condition and treatment to avoid complications are important. Blunt trauma directly to eye or face may cause visible injuries such as swelling or bruising. Only a proper exam by a medical professional can rule out internal damage to the eyeball. Simple inspection of the eye cannot determine the severity of damage. All eye injuries are important and deserve thorough evaluation.

A medical professional will be able to determine the extent of injury by using some common techniques and instruments that provide a magnified view of the surface and internal structures of the eye. Numbing eye drops or dye are used that illuminate abrasions and foreign bodies that can be difficult to see with only the naked eye. Determining the extent and exact nature of injury to the eye is important in order to start the best treatment promptly.

According to the American Academy of Ophthalmology, more than one million people suffer eye injuries each year in the United States. Appropriate protective eyewear could prevent ninety percent of these injuries. Whether you are working at home or on the job, garden or a factory, workshop or around the car, sports or recreation, protective eyewear is critically important and often neglected. Choose protective eyewear with “ANSI Z87.1″ marked on the lens or frame. This means the glasses, goggles, or face shield meets the American National Standards Institute (ANSI) Z87.1 safety standard. This helps provide protection against impact and chemical splashes. Thoughtful use of all products and tools is also important step in prevention. Read the labels carefully and follow directions for use of tools. Do not operate any machinery without proper orientation and training even if you think you know what to do. Sun and excessive heat protection for the eye are also important. Daily exposure to excessive bright sunlight leads to increased risk of cataracts and macular degeneration. The ultraviolet light contributes to these and other problems over time and is a major contributor to age related eye problems, which are preventable. The ultraviolet light protection by sunglasses has nothing to do with price or the color of the lens. Do not be fooled by the dark shade of the lens or price tag when choosing sunglasses.

The leading causes of eye injuries and blindness are preventable. Get a regular eye exam. Be aware of your blood pressure, blood sugar or any family history of eye problems such as glaucoma. These are all non-traumatic issues that are manageable. Don’t smoke! Always wear approved protective eyewear when engaged in activities that risk eye trauma. Always protect your eyes in the sun by using sunglasses that have 100% protection against UVA and UVB. Use artificial tears as necessary to prevent dry eyes and wash your hands before touching or rubbing your eyes.

Protect your eyes. They are the only pair you have.

Turnabout by Bruce Kaler MD

Check out the latest book review of my medical mystery novel. Midwest Book Reviews gave Turnabout by Bruce Kaler MD a terriffic review for its hard hitting engaging storyline about the real life dilemma of a surgeon struggling to save his personal and professional life.
Available in print and Kindle editions at Amazon.com http://www.amazon.com/Turnabout-Dr-Bruce-Kaler/product-reviews/1439205566/ref=dp_top_cm_cr_acr_txt?ie=UTF8&showViewpoints=1

5 Steps to Seasonal Allergy Relief

This year allergy season seems more vigorous and early in many areas of the United States. The vigorous bloom of pollens has been bothersome for more than six weeks. In the Northwest we have seen many patients this season who have well known allergies struggling with symptoms more than they have in several years. Many clients who historically have not had allergies have also been affected this year. Most people are familiar with seasonal allergy symptoms and how bothersome they can be. It is not always clear which specific allergens are in the air at any given time. This time of year is a very fluid situation which plants are in bloom spewing pollen in the air. The amount of dust, mold and pollutants in the air can vary air quality greatly depending on the wind, humidity, and temperature of your locale.

The real challenge with seasonal allergies is that avoidance is not a choice. You have to breathe. Consulting an allergist may be necessary to identify potential allergens if your symptoms are severe. Having said that, there are several fundamental tools your health care provider can offer to find a solution tailored to your individual needs.

#1 Antihistamines: are still the foundation and first line treatment in managing allergies. Fortunately the two best ones in this category are sold over the counter without a prescription at the same strength as by prescription. Claritin also sold in a generic at very affordable prices as Loratidine is conveniently dosed once a day and is unlikely to cause any drowsiness compared to one of the older favorites Benadryl (generic : diphenhydramine). Another good option is Zyrtec (generic: cetirizine). This is also a once daily medication that causes very little drowsiness in most people. It is also available in pediatric liquid form for children two years of age and older.
#2 Steroid nasal spray: These are prescription only. However in conjunction with a daily oral antihistamine, steroid nasal spray provides satisfactory results for a large majority of people who suffer with the common allergy symptoms. The prototype is Flonase or fluticasone spray used only once daily in each nostril. The convenient dosing and efficacy makes this part of the fundamental therapy for seasonal and environmental allergies. Both of these options have to be used daily on a preventive basis. The proactive approach is very successful in controlling the common symptoms.
#3 Singulair tablets: are probably not familiar to most people who suffer with allergies. This medication has been used for many years to treat stubborn intractable asthma when there was a strong allergy component. It has been approved and used successfully to treat seasonal allergies without asthma as well. It is dosed once daily and typically does not involve any sedation. Even though it is by prescription only and can be a higher priced medication it has been a very helpful addition to the regimen in people whose symptoms are more difficult to control. It works in a way to block the effect of leukotrienes which like histamine act to drive the reactions in our body in response to allergen exposure.
#4 Systemic steroids: can have a profound effect on symptoms but is typically reserved for very severe symptoms that remain unresponsive to the first line treatments. A short course of oral steroid tablets like prednisolone or even a long acting injection of methylprednisolone can be very effective in diminishing symptoms. More aggressive therapy always has greater risks of side effects thus should remain an option for intractable cases.
#5 OTC meds: other than the previously mentioned antihistamines that have a very good record of benefit supported by credible research, there are not a lot of other options. Cromolyn sodium nasal spray is useful for some as a preventive application but is not very effective for most people. Liberal use of plain saline nasal spray is an inexpensive adjunct to the other therapies. It can provide some comfort from dryness while aiding in control of congestion. It is safe and very inexpensive.

Don’t be discouraged by allergy symptoms. Consult your health care provider today to find a regimen tailored to meet your personal needs. Relief is very accessible.

Also visit author website: Seattledoc.com

Influenza Déjà vu

The current outbreak of a new strain of influenza is important but blown out of proportion. This is clearly a new strain of influenza to which we have no immunity. So many people are likely to get ill. However these types of outbreaks are not entirely without precedent. We have learned a lot from past experience and the world health surveillance is very sophisticated. One look at CNN and it’s clear that we live in a global community with virtually instant messaging and a very rapid news cycle.

The facts are that it is definitely a new strain of type A influenza. Much like the usual seasonal flu, many people are bound to get ill. The overwhelming majority are going to experience mild illnesses that require nothing more than the basic, but nonetheless important, measures to treat and recover fully. The terms pandemic only refer to the spread of the illness over a wide area but do not mean the illness is any more severe than any other flu. Much has been publicized about the deaths but those numbers are constantly being revised and still represent only a small proportion of the vast numbers who are getting ill. Even the most expert public health and infectious disease experts have de-emphasized the daily case count and concentrate on the characteristics of the illness and how it is spread. Understanding that this is “just the flu” is important to have a sensible approach to preventing and managing the illness. There is a reasonable chance that this outbreak will die out shortly but return next season in the fall and winter. Active isolation and production of a vaccine for next fall is underway. We may see the need to recommend two different shots next fall to cover the usual season flu as well as the new strain. For now don’t be alarmed and focus on the basics that you can easily do to help yourself and your family.

What can you do to ease the aches and pains if you go get the flu?

1. Stay home and rest. Conserving your limited energy helps speed recuperation and it keeps from spreading the disease to the rest of the community.

2. Drinking plenty of fluids especially water is important in several ways. Clear liquids like apple juice, sports drinks, and clear soups keep your radiator topped off. In some respects, we are similar to a car if the radiator is half empty. It doesn’t run well and it overheats! We are much the same. When you’re sick and running a fever your need for liquids increases dramatically. Drinking more than two liters a day is simply a good start. If you are not urinating every two hours you’re not drinking enough.

 3. Humidify. Water plays other important roles. More moisture in the air helps your airways. A room humidifier restoring moisture to the dry indoor air provides greater comfort for children and adults when sleeping. Steam can help congested airways. Inexpensive over the counter saline nasal spray is also very effective in improving nasal congestion.

4. Fever control. Use of either acetaminophen (Tylenol) or ibuprofen (Advil) can be a great tool to help keep fevers minimal. This is mostly for comfort, not mission critical to getting better. It is also no substitute for being well hydrated.

 5. Other over the counter medicines. While many OTC medications are available for relief of cold and flu symptoms the majority offer little relief, no cure, do not shorten the length of time you’re sick and create adverse effects by combinations of drugs together. In short, keep it simple.

 6. Prescription drugs. The Center for Disease Control does recommend use of Relenza or Tamiflu. They are most effective if started within the first 24 hours of onset of symptoms. Their usefulness diminishes rapidly if there is longer delay in starting the medication. They may help alleviate some of the worst symptoms and may decrease the duration of illness by only one day. They are usually prescribed for only the first five days. This is only a limited option since many people don’t even consult their doctor till the window of opportunity is past. There are some potential side effects with the medications. Antibiotics do not help the flu.

 Prevention is the best option! Some simple measures may help you weather the storm if you are unfortunate enough to get the flu. If you do get sick, consult your health care provider if you have an earache, facial pain over the sinus area, colorful mucus, shortness of breath, temperature higher than 102, or simply on a worsening trend. These may be signs of a secondary bacterial infection or other complication. As always hand washing, balanced diet and adequate rest, play an important role in both prevention and managing the illness.

Vasectomy at a Glance

For those who want a permanent form of birth control vasectomy is one of the best choices because of its reliability, cost, effectiveness, safety and ease of the procedure. The procedure can be done in the office as an outpatient basis. The procedure itself can take as little as twenty minutes under local anesthesia. All methods of the procedure accomplish the same result to cut, tie, or cauterize the sperm tubes (vas deferens) in the scrotum. The procedure is very effective with low risk of adverse effects. The cost may vary from $350 to $1,000 but is usually covered by insurance. Although reversing a vasectomy is available it is expensive, usually requires a procedure in the hospital, much more expensive and typically is not covered by insurance. The success rate of re-establishing fertility is 35-45%. Hence due consideration should be given to vasectomy as a very effective option, but permanent.

 

There are different techniques and availability may vary depending on your area of the country. The conventional method involves injection of local anesthesia into the scrotum, and using a scalpel to make small incision and remove or cut the two sperm tubes.  A newer technique known as “no scalpel” still requires local anesthesia. A small hole is made in the scrotum to retrieve the sperm tube. The cutting or cauterization is carried out and then the sperm tube is gently returned through the small hole. The holes usually heal without any stitches as they are so small. Advocates feel there is less swelling and post-operative discomfort. Use of a pressure gun to provide anesthetic through the skin without a needle is an old device used for a new purpose at some facilities. All in all, results for any of the techniques are very good and carry low risk of side effects.

 

There are some common misconceptions about vasectomies. It does not reduce a man’s sex drive, ability to have an erection or ejaculate. Male hormones produced by the testes remain unaffected. Post-operative soreness may persist for a few days to a week. Since sperm in the vas deferens will remain for a while, waiting six weeks and having a repeat sperm count to be sure sperm are no longer ejaculated is recommended for completeness. Sperm comprise only a small part of the ejaculate fluid, so there is usually little or no noticeable difference in the fluid. Serious consideration should be given to this choice prior to undertaking this as a permanent solution. One option could be donating some sperm to a sperm bank for use if you are uncertain about future plans to have children. On the other hand eliminating the risks and pressure of preventing pregnancy for many couples is a great relief. Compared to the tubal ligation for women, vasectomy is a much more convenient, safer and cost effective option for permanent birth control.

Tantrums and the Terrible Two’s

Two year olds are exploring their world and frequently testing the limits of their own skills, their environment and your patience. At times the ride may be so bumpy and change so quickly, you would prefer a roller coaster in the middle of a tornado! Remember that this is normal behavior and in some children it extends into the age of three as well.

 

Remember that their emotional development is a work in progress. You can actually help your child develop some confidence by encouraging positive behavior that is more mature. Consistently set limits but allow them enough leeway to explore and follow their curiosity. Letting them know how much appropriate behavior is appreciated is a much more powerful tool and incentive, than negative harsh reactions when they have a tantrum. Consistency is the key.

 

Tantrums are inevitable and normal. The two year child is frustrated and can be very emotional with rapid and extreme mood swings. Learning to express them selves is a challenge. Providing some wiggle room for this is important in their development if they are to mature. However as a parent one needs to direct them away from aggressive, violent behavior that might endanger themselves or others. Aggressive or violent behavior must be interrupted without overreacting. With as much of a neutral manner as possible tell your child immediately and very clearly that kind of behavior is not acceptable. If necessary a time-out or removing the child for a few minutes if you are in a public place is important. Keep calm and do not respond in anger. Physical punishment is simply not an option. This only sends the message the resorting to violence is an acceptable means to communicate and solve problems. Reasoning in the middle of a tantrum is also not an option. When emotions have subsided a simple and clear explanation can be very helpful. Keep it simple as a complicated discussion won’t work. This all takes time and patience. Focus on the behavior that needs to change while being positive about the child as a person. Children are incredible “sponges”. They are soaking up the behavior that is modeled around them 24/7. Even when they don’t seem to be paying attention, they are very aware of how other children and adults respond to each other and to them. Sometimes an attempt to redirect their attention or energy to some other activity can abort the full blown tantrum. However once it goes into something further interrupting this with a time out is important. No more than 2-3 minutes of time out for a toddler should be necessary to make the point. Wait until they have calmed down to offer any explanation or continue activities. Television is also a powerful model of behavior for your children. Be thoughtful about what they are watching.

 

Your most powerful tool is appreciating and encouraging your child when they are exhibiting appropriate behavior. This cultivates confidence and self esteem. With more confidence children are able to develop a positive self image of someone who models behavior that is appreciated and valued by people and loved ones around them. Consistency not perfection is the goal

Gallbladder Overview

Gallbladder disease is one of the most common digestive diseases. It results in over 800,000 hospitalizations in the United States each year as well as 500,000 surgeries. American women are twice as likely to suffer with gallbladder problems as men. The exact reasons aren’t clear but there is a definite pattern related to obesity, pregnancy, age, low fiber diet, inadequate hydration and rapid weight loss. A few other conditions may also affect stone formation in the gallbladder such as Crohn’s disease, oral hormonal therapy or elevated triglycerides.

 The gallbladder is located under the liver in the right upper quadrant of the abdomen. It stores and concentrates bile produced by the liver and releases it into the duodenum or first portion of the small intestine when a fatty meal is consumed. The bile along with other enzymes plays a key role in digestion. Malfunctioning of the gallbladder can be caused by inflammation, infection or stones that irritate or actually block all or part of the bile duct. Symptoms can include abdominal pain, bloating, fever, nausea, vomiting. It is difficult to manage the acute symptoms with anything other than pain medicines for symptomatic relief of pain and possibly antibiotics. Severe cases too often lead to surgery to remove stones or the entire gallbladder sac. Tests to measure blood chemistries and an imaging study such as ultrasound or CT scan may be necessary to determine the urgency in the acute phase.

Gallstones compose a solid formation of cholesterol and bile salts. Research tells us that approximately 80 percent of all gallstones are cholesterol gallstones which form when the liver begins secreting bile that is abnormally saturated with cholesterol. This may be due to a genetic predisposition to form stones. Prevention is centered on good hydration and a diet high in soluble fiber (oats, bran, fruit, vegetables, and soy fiber), guar gum and pectin. High fat foods will aggravate symptoms of gallbladder disease. Research also suggests that moderate coffee drinkers and people who exercise regularly are much less prone to gallstones.

Although surgical techniques for gallbladder removal have vastly improved we still have few therapeutic options available to manage or prevent this condition. Certain genetic and medical conditions are associated with greater risk of having a problem gallbladder. Healthy lifestyle focusing on high fiber-low fat diet, good hydration and regular exercise seem to correlate with better outcomes.

Who Needs Sunscreen-Everyone

Experts are unanimous on the recommendation that everyone should be using a broad spectrum sunscreen of at least Sun Protection Factor (SPF) of 15 every day all year round. A strong connection between sun exposure/sunburn and risk of skin cancer has clearly been established. If you ever got sunburn once or twice then your risk of skin cancer some time in your life goes up a lot. Don’t be one of the one million people who will be diagnosed with skin cancer this year alone in this country.

 

There is a lot of confusion about sun protection and sunscreen products. First there is no such thing as a safe tanning bed. Getting a tan before you go to Hawaii does not protect you. It only adds to the sun damage of your skin. The harmful ultraviolet rays of sunlight are what burns or damages the deeper layers of the skin. There are two types of ultraviolet rays A and B. They both are damaging to the skin and can lead to the development of skin cancer. Skin cancer can happen at any age but the skin has a memory accumulating the sun damage throughout a lifetime. That is why skin cancers are more common as people age. Sunscreen should be applied everyday to the exposed skin even if you are not planning to be outdoors. UVA rays are able to penetrate glass while the UVB cannot. 70-80% of ultraviolet rays pass through overcast skies on cloudy days. Sand, water and snow all reflect a great deal of the sunlight. You need everyday protection regardless of the weather or your activities.

 

Choosing a sunscreen product need not be confusing. Many cosmetics have added some sunscreen for the obvious benefits in reducing UV exposure and preventing its premature aging effects on the skin. Look for a SPF of 15, broad spectrum (protects against UVA and UVB), and water-resistant if you are going to be active in outdoor activities. The American Academy of Dermatologists advocate these attributes and their seal of recognition can be helpful on packaging. The following is a list of ingredients that help provide broad spectrum coverage: avobenzone (Parsol 1789), cinoxate, ecamsule (mexoryl SX), menthyl anthranilate, octyl methoxycinnamate, octyl salicylate, oxybenzone, sulisobenzone, titanium dioxide, zinc oxide. These ingredients will likely vary a lot in any given product depending on the amount of SPF and manufacturer.

 

Apply sunscreen to all exposed areas 20-30 minutes before going outdoors. Skin should be dry, coating it liberally and rub it in. Usual suggestions are one ounce of sunscreen to cover the exposed areas. One ounce would be about the same amount to fill a large shot glass. Care to apply adequate amount to face, nose and ears as they are sensitive and often overlooked. Protect lips as well with sunscreen or an appropriate lip balm that has an SPF of 15. Reapplication should be done at least every two hours if you are swimming or perspiring heavily regardless of the claims of a water resistant product. Swimming, sweating, washing, toweling all reduce the effectiveness of your sunscreen so reapplication may need to be even more frequent. Common mistakes are not using enough, leaving certain areas unprotected and not reapplying. The SPF rating is only a measure of delaying the redness and its damaging effects. It does not eliminate it or make you bullet proof.

 

It’s never too late to protect yourself and your family from the harmful effects of the sun. Preventing sunburn with proper use of sunscreen is an important part of making your time in the sun safe and enjoyable.

 

 

Preventing Dry Skin

Dry skin is one of the most frustrating common problems in winter but affects many people year round. 75% of people over 65 years of age complain of chronic dry skin. Anyone who is active in sports, exercises regularly or participates in winter outdoor activities usually struggles with dry itching skin. Understanding what irritates the skin can help alleviate the problem.

 

Normal skin oils provide a thin layer on the surface to retain moisture keeping the skin smooth and supple. Many things like dry air, wind, sun, bathing and hand washing can strip the skin of its natural oils leading to excessive dryness. Dry skin is itchy skin!

 

The first step is prevention. Using sunscreen year round can help. Soaps can irritate the skin and obviously strip the natural oil from the surface. Excessively hot water for hand washing or showering only magnifies the problem. Using more lukewarm water, taking a shorter shower and using milder soaps that are fragrance-free can be a big step to alleviating dry skin. The best time to moisturize is right after the shower while the skin is still moist. Towel dry first, then apply a bland moisturizing lotion or cream. Usually the cheapest fragrance-free product is best. A number of ingredients in common moisturizing products either seal in moisture to protect from excessive dryness or try to extract moisture from the air to retain more moisture for the skin. Again they are best used while the skin is well hydrated before it becomes dry to trap the existing moisture in the skin. Be wary of the high priced products that have very seductive ads. They are typically no better than the basic cheaper products.

 

Another common mistake is the effects of scrubbing too hard. Most of us don’t get that dirty during our daily activities. Young children actively playing outside or adults in a very dirty line of work aside, gentle attention to cleaning ourselves with water and a bland soap is all that is necessary. The role of the soap is solely to loosen the oils, grime, and bacteria, so it can be removed easily by the mechanical action of rubbing and rinsing with water. The antibacterial effect of hand and body soaps is highly overrated. Rubbing your hands vigorously with a paper towel to dry is akin to using fine sand paper on them. The dryness, redness and cracking that follow can be problematic. Blotting the moisture gently with paper towels can make a big difference to reduce the abuse to your hands.

 

There are some common skin conditions that present as dry skin but are more extensive and challenging to manage. Even some medications can exacerbate dryness and itching. Seborrheic dermatitis, psoriasis, some fungal infections and even allergic skin conditions can lead to prolonged dry itchy skin. You should definitely consult your health care provider if your dry skin does not respond to some basic efforts to manage the itching or seems to be spreading to wider areas of the body.

Ringworm: Treatment and Prevention

Ringworm is one of the most common skin problems. Ironically it has little to do with rings and nothing to do with worms. The circular spreading rash, a common presentation, lead to the antiquated idea that it had something to do with a parasite (which it does not). The medical term which refers to a lot of common fungal skin infections is tinea derived from Latin for worm or larvae. Obviously that hasn’t done much except add to the confusion. The origin of this condition is a group of microscopic fungi that that invade the skin causing a variety of rashes. These rashes are not always circular. They are easy to recognize when they are by the expanding red ring with clearing in the middle. However the rash can vary from small red bumps, splotches or patches accompanied by flaking scaling and more often than not itching. Although it prefers and flourishes in warm moist areas of the body it can occur on any area of the skin.

It can most commonly be found on the feet, groin, armpit, and under breasts where it tends to be warm and moist. It can also occur in somewhat open dry areas like the face, scalp, extremities and torso. The classic circular lesion tends to grow and expand while the central area of redness appears to clear. It usually is associated with intense burning or itching. Scratching too much can create and secondary bacterial infection. There are other conditions that mimic this but a ring-like lesion is fairly characteristic of a fungal infection. If the lesion occurs in the scalp hair loss in the center of the area is characteristic. In the area of a man’s beard the hair may also break off and possibly develop a crusted area while retaining the overall circular appearance. We have come to understand that some scalp dandruff is actually another type of low grade fungal infection that causes the chronic flaking. Most people are familiar with athlete’s foot which is merely fungal infection in a typically warm moist area. It usually
results in breakdown of the skin with cracking, flaking, redness, itching and some times small blisters. In some parts of the skin it will appear as a broad, red itching splotch without cracks, or any circular shape. Fungal infection of the nail turns it yellow to dark brown in color, thickened and can create deformity of the nail contours. So ringworm is common, but there are many different appearances to fungal skin infections.

Fungal infections, generally known as dermatophytes, are highly contagious and can be spread multiple ways. However it does require direct contact with an infected person, animal, object or even soil. They do thrive in warm moist areas but can establish a presence on any body part. Diagnosis is usually by the characteristic appearance. However a health care provider may do a painless scraping of infected skin for viewing under a microscope or culture in the lab. There are several antifungal products
available as topical creams at the pharmacy without a prescription. Clotrimazole (Lotrimin), miconazole (Monistat-Derm), ketoconazole( Nizoral) and terbinafine (Lamisil) are a few of the broader spectrum choices. These can be very effective with proper use. For more severe cases oral Lamisil tablets or another drug may be necessary by prescription to clear the condition completely. Over the counter products are not effective against fungal involvement of the nails.

Preventing fungal infections entirely is a challenge. But a thoughtful common sense approach can minimize your risk.

1. Don’t share clothing, sports gear, towels, or sheets.

2.Wear slippers in locker rooms and public pool & bathing areas.

3.Shower after any sport that includes skin-to-skin contact.

4.Wear loose-fitting cotton clothing.

5. Change your socks and underwear at least once a day.

6. Keep skin clean and dry. Dry yourself completely after showing.

7. Take your pet to the vet if it has a rash or patches of missing hair. It could be a sign of a fungal infection.

With little effort and expense, being a good observer will keep you out of trouble. Should you develop a rash, consult someone early to be sure what you have. Early recognition treatment can be easy and even inexpensive.