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Most Mainers eagerly await the summer months when we can enjoy great warm weather activities in one of the most beautiful sates in the country. Whether it’s sports, fishing, boating, cycling, running, walking, camping or just relaxing outdoors, it is an energizing and fulfilling time of the year.

Of course, nothing is perfect and summertime also offers some unique and sometimes annoying skin conditions. Fortunately, most are not serious and are self-limited and most respond to treatments, but prevention can limit the impact that these rashes have on your summer fun.

heat rashHeat Rash (Prickly Heat): In hot and humid weather, excessive sweating can clog your pores, which leads to inflammation and swelling under the skin. This results in a pimply rash, often in skin creases, under the arms, in the groin, or anywhere where it is more difficult for perspiration to evaporate. You can help to avoid this by wearing looser fitting clothing, keeping your skin clean, and if you are prone to heat rash, try to stay in cooler areas during very hot and humid weather. Heat rash can be treated with cool compresses, over the counter hydrocortisone cream (if there is itching), and anti-inflammatory medications (ibuprofen, naproxen) or acetaminophen if there is burning or pain associated with the rash.

 

poison ivyPoison Ivy: Poison Ivy is one of the skin rashes known as contact dermatitis. In the case of poison ivy, the plant contains chemicals to which some people are highly allergic (I’m one of those people!). Interestingly, there are also people who will get no reaction to poison ivy. After coming in contact with the plant, these chemicals may remain on your hands or under your fingernails for more than a day, and they can also remain on your clothing.  The allergic reaction results in the development of very itchy, tiny blisters (called vesicles) on the skin, often grouped together and sometimes in lines. The vesicles can coalesce to form a blister, and all can leak inflammatory fluid. Contrary to popular belief, this fluid does not spread the rash, but the plant chemicals that remain on skin and clothing can lead to the spread of the rash for a few days after exposure. When the rash is limited it can be effectively treated with steroid creams, though it often requires prescription strength. If the rash is more widespread or if it involves the face or groin, taking prednisone orally is often necessary to manage the symptoms while the rash runs its course. Prevention, of course, involves knowing what the plant looks like and avoiding it if you are sensitive, which is why I do not go fiddle heading!

 

swimmer's itchSwimmer’s Itch: Knowledge about swimmer’s itch has become more widespread but I recall getting a phone call about 20 years ago from a confused ER physician in Boston, asking about a strange rash that a patient had developed after swimming in our area and then returning home. It felt good to help to educate this doctor at Massachusetts General Hospital! This unfortunate malady is caused by a tiny parasite (called schistosomes) that normally live in snails or water fowl. If you happen to be in the water when these parasites float by they may get on your skin and then burrow under, where they die. They cause no illness but the allergic reaction that follows can lead to very itchy, often red pimples or spots scattered on the parts of your body that were submerged at the time of exposure. These can occur within minutes of exposure or up to 12 hours later. Over the counter hydrocortisone cream, cool compresses, and anit-inflammatory drugs can help with itching. Diphenhydramine (Benadryl) can also help but may cause drowsiness. Vigorous toweling after leaving the water can help to prevent swimmer’s itch.

 

pslePolymorphous Light Eruption (PMLE): This rash (to which I am also susceptible) typically occursearly in the warm weather season during our first few exposures to more intense sunlight. Usually within hours the skin exposed to the sunlight develops small bumps (called papules) or spots (called plaques) that are itchy, though not as severely itchy as poision ivy. These tend to last for days to weeks and usually respond nicely to over the counter hydrocortisone cream. More severe cases may require stronger steroid creams to control the itching. Although this rash can sometimes look like poison ivy, there is typically no leaking of inflammatory fluid from the rash and it does not spread. PMLE can be avoided by limiting sun exposure early in the season (hats and long sleeves), and by using effective sunscreens. Once a person has had PMLE it typically may recur on the same areas of the skin and in the same manner in subsequent summer seasons if the skin is not protected.

 

There are, of course, a variety of other skin insults to which we subject ourselves in order to enjoy nice weather (black fly, mosquito and other insect bites, “wood poisoning”, etc.) and certain drugs, like some diuretics and antibiotics, can predispose you to a rash when you’re exposed to the sun. If you have a rash that concerns you or if a common rash appears to become infected you should see your primary care provider for advice.

 

 

I have not covered Lyme Disease and the rashes that can be associated with it because it is a much more serious topic that requires more in depth discussion.

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Insomnia is one of the most frequent complaints that a primary provider hears in the office. 50% of adults experience it in their lifetime and up to 10% of adults may suffer from long-term insomnia. It is also one of the most challenging to treat and one of the most misunderstood of the common ailments that people face. In the past this malady was poorly understood and it was felt to be a symptom of some other underlying condition, such as anxiety, depression, medical sleep disorders or medication. It was also thought that it could be improved if you addressed that underlying disorder. While all of these problems can cause sleep disturbances, we now also understand that insomnia can occur in the absence of those underlying problems or may need to be treated in addition to dealing with the underlying issues. In fact, we know that lack of sleep or ineffective sleep makes many chronic diseases more difficult to manage, and successfully treating insomnia can improve those diseases.

First of all, insomnia can present in a variety of ways. It can be difficulty falling asleep, difficulty staying asleep, or waking early and being unable to go back to sleep and in order for it to be diagnosed as insomnia, it must result in difficulty functioning during the day (for example, fatigue, sleepiness, difficulty concentrating, forgetfulness, low energy).

Short term insomnia (less than 3 months duration) is usually associated with life stress or environmental stress. This can be anything from a change in the sleep environment (light, noise, temperature) to the loss of a loved one, illness, pain or withdrawal from certain substances like caffeine or alcohol, a variety of prescription medications and illegal drugs. Jet lag and shift work are also common causes of short term insomnia. Long term insomnia is, as previously noted, often associated with chronic diseases, anxiety and depression, with some medications and illegal drugs and with the use of substances like alcohol and caffeine.

Contrary to popular belief and practice, the best treatments for insomnia do not involve drugs. A variety of behavioral treatments can be effective and are much safer in the short and long run than medications. These include sleep hygiene (get out of bed when you’re not sleeping, keep a regular schedule, don’t try to force sleep, exercise daily, avoid caffeine after lunch, deal with worries prior to bedtime, etc.), relaxation techniques, biofeedback and stimulus control (limiting time spent trying to fall asleep to 20 minutes, get up at the same time every day, don’t nap during the day), sleep restriction, cognitive therapy (developing the skill to break anxious cycles of thought that keep you awake), and even light therapy. It’s important to understand that all of the prescription medicines used for insomnia lose effectiveness over time, have potentially very serious side effects (sleep walking, eating and even driving, increased risks of falls and accidents) and most carry a risk of addiction. Overdose is also a concern, especially when these medications are combined with alcohol.

Finally it’s important to understand that not all people require the same amount of sleep and that sleep duration may decrease as a natural part of the aging process.

For more information you can go to: www.my.clevelandclinic.org, www.mayoclinic.org, or www.familydoctor.org and search for “insomnia”.

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Keeping up with the most current information in medicine is always challenging.  It is a rapidly changing landscape and as our knowledge expands, standards of care change and recommendations are adapted.  However, there have also always been pervasive yet unfounded “medical myths” that are often quoted and can even be perpetuated by those of us in the profession.  In recognition of April Fool’s Day here are just a few medical myths and some actual facts.

  • Sugar causes hyperactivity in children – many well accepted studies have shown no impact of diets containing various levels of sugar on children’s behavior.  However, when parents were told that their children had received a high sugar treat they perceived their child as being more active, whether the child had received sugar or not.  This belief is deeply engrained in our society and the many parents and healthcare providers believe this myth.  On the other hand, if it results in a decrease in simple sugars in childrens’ diets perhaps we should leave well enough alone!
  • You should drink 8 glasses of water a day – There is no science to suggest that there is a health benefit from this practice.  You should drink as thirst dictates.
  • Cracking your knuckles causes arthritis – It does not.  If you are relentless it can loosen the joint, but the practice is otherwise harmless.  The cracking sound is actually the sound that results from the formation of a small gas bubble in the joint as the joint space is slightly expanded by the movement torsion applied during the activity.
  • Teething causes fever in babies – It does not cause either fever or diarrhea.  Fever should be evaluated if it is high or persistent.  Teething does cause pain and pain relievers like acetaminophen can help.
  • If you normally run a below average body temperature, a temp of 98.6 is a fever – It is not a fever and does not indicate illness, no matter where you may think your normal temp runs.  In fact, temperatures under 100 F in adults don’t mean much.
  • Back pain should be treated with rest – Most back pain will resolve on its own and it typically gets better sooner if you stay active.  XRays are usually not necessary either.
  • Tryptophan in Turkey causes drowsiness – It doesn’t, but overeating does.
  • Coffee helps you to become sober faster – although caffeine may modestly affect the drowsiness caused by alcohol intoxication, it does not lower alcohol levels in the blood.  The best advice is to avoid drinking to the point of inebriation in the first place.
  • You should wait 30 minutes after eating before going swimming – My mother enforced this with great fervor, much to my (and my siblings’) dismay.  In fact, unless you are swimming vigorously for exercise (when a full stomach can make any exercise more difficult) there is no problem with going swimming right after eating.  The fear is that the exertion diverts blood away from the stomach and slows digestion, which can cause cramping.  In fact that does not happen with recreational swimming.
  • A full moon makes people act crazy – This is a long held belief with no foundation in reality (and reflects the origin of the word “lunatic” as in “lunar” as in moon).  Studies have shown no increase in unusual behavior or psychotic episodes or use of ERs at the time of a full moon.  This myth persists among many medical personnel and is an example of recall bias (giving more weight in your memory to incidents that reinforce your pre-existing beliefs).  I’ve had this good natured debate with other healthcare providers more than once!

Here is a link where you can learn more about medical myths: http://www.uamshealth.com/medicalmyths

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Over the last few decades a number of vitamin supplements have had their 15 minutes of fame as they were promoted for unproven health benefits. Linus Pauling incorrectly postulated that vitamin C supplements could prevent and treat viral infections, a concept which still persists and is manifested in the extreme by a story I recently heard of a man who decided to forego his usual daily bottle of cola in favor of orange soda because he had a cold! Vitamin E supplements were widely promoted for heart health because vitamin E is an anti-oxidant. But studies failed to show any benefit and there may be adverse effects from taking vitamin E supplements regularly. Read more »