Chilblains

The origin of the word Chilblains comes from 2 words: chill and blains and originates in the the early 1500s. Blains is an old English word for “a sore, or swelling”  so the two words together sum up what this condition is: swelling and inflammation that occurs after exposure to cold, above-freezing temperatures.

The distinction about above freezing temperatures is important because chilblains is different from frost bite. Frost bite occurs when skin is exposed to below-freezing temperatures that cause the ice crystals to form within the cells causing cell death. Chilblains result from repeated exposure to cold, non-freezing temperatures that cause the skin to become red, swollen and painful generally within 13 to 24 hours of exposure. These painful eruptions can appear as nodules, ulcers or blisters. The affected area can become intensely itchy or present as a burning pain. Incidentally, the nerves that carry the sensation of pain and burning are the same.

Chilblains affects the extremities so people whose feet and hands are in contact with cold, damp, non-freezing conditions may develop this – especially those who walk barefoot or wear cold/wet, damp boots/shoes during the winter.

There is generally no treatment for chilblains because it tends to resolve on its own – as long as the area affected remains warm and dry. This usually occurs within a few weeks. In some cases, a calcium-channel blocker, which is an anti-hypertensive drug, can be given because it causes the capillaries to dilate, providing warm blood to the affected tissues.

To find out more about chilblains, follow this link.

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The sticky fibers bind to bile, which is made by the liver and stored in your gall bladder. Bile is composed of 70% cholesterol. Usually, bile is recycled by the body, but when you eat oatmeal, the sticky fibers bind to bile. The fiber (with bile attached) is then eliminated when you have a bowel movement. Because your body requires bile, more cholesterol is then pulled out of your blood stream, to make more bile.

So the more you eat oatmeal, the more you lower the cholesterol from your circulation!

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1. The tick must be a proven deer tick in the nymph or adult tick stage
2. The tick has been attached for at least 36 hours
3. Treatment is begun within 72 hours of removing the tick
4. You live in an endemic area, described as having a deer tick infection rate of at least 20%
5. There is no contra-indication for taking doxycycline

All five criteria should be met to be given prophylactic treatment although ensuring that can be very difficult in some situations. At that point, the busy clinician will often go ahead and prescribe it even if there is no positive identification of the tick.

Just after I finished this article, I pulled a tick off me that had been attached no more than several hours. This, thankfully, has happened that often to me. Once I was flying over to Plymouth (I’m a private pilot) with a friend of mine, I scratched my neck only to discover a tick. I simply pulled it off, opened the little side window, and threw it out. It wasn’t quite the ride the tick had expected.

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Mercury containing products

The FDA is warning people to stay away from skin-lightening products manufactured overseas because they likely contain of high levels of mercury – up to tens of thousands times higher than the legal limit.

Mercury has been found in many beauty products made overseas, according to an article that aired on National Public Radio recently. Mercury blocks the body’s production of melanin, the pigment that colors skin.

Since many people buy products online – out of the reach of the FDA regulations – consumers are at increased risk for developing neurological problems. So check the list of ingredients for any one of the following mercury compounds: mercurous chloride, calomel, mercuric, or mercurio. If your product contains it, throw it out.

Pregnant women should be especially cautious about using any product with mercury. In fact several years ago, pregnant women were advised against consuming too much fish because of high levels of  mercury found in them. Mercury is a known teratogenic, meaning it is harmful to a developing fetus and can lead to central nervous system disorders similar to cerebral palsy.

For more about mercury poisoning, follow this link and to read the transcript of the NPR story, follow this link.  You can also find a list of consumer products on the EPA website that contain mercury.

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Honey is an antimicrobial (reduces bacterial, viral or mold counts) and an anti-inflammatory agent and provides a moist wound base, decreases wound odor and aids in the debridement of a wound. According to Ann Reese, MSN, GNP et al, enzymes in the worker bees’ stomachs, break down nectar so that it’s less likely to be prone to bacteria and it reduces bacterial counts in wounds. Honey is the by-product of the substance produced by the bee as it spreads the nectar throughout the honeycomb.

Honey has been used in wound healing since the early Egyptians but it has been subjected to more research in an attempt to understand just how it exerts its therapeutic properties. Honey has been found to successfully treat wounds infected with methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Pseudomonas aeruginosa and other microbes difficult to treat.

For more information about the use of honey in treating chronic wounds, follow this link to The American Journal for Nurse Practitioners.

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One of three active bloodletting photographs known to exist; thanks to biomedicalephemera

The New England Journal of Medicine is celebrating its 200 year old birthday and one of the lead articles, written by Elizabeth Nabel, M.D. and Eugene Braunwald, M.D., is about the history of medical treatment of coronary artery disease and heart attacks, since the very first article published in the NEJM was about angina and heart disease.

Little was known then about the cause of  heart disease and in fact, not much had changed in the treatment of heart attacks from 1812 to the 1960s. In the early 1800s, bed rest, opium and blood-letting was the accepted protocol. In the 1960s, hospital treatment of heart attacks still resulted in an astonishing 30% mortality rate!  Only the blood-letting had stopped by then. In hindsight, it’s painfully obvious that treatment was woefully inadequate before the advent of specialized coronary care units. Nabel and Braunwald write:

Until 1961, patients with acute myocardial infarction — if fortunate enough to survive until they reached a hospital — were placed in beds located throughout the hospital and far enough away from nurses’ stations that their rest would not be disturbed. Patients were commonly found dead in their beds, presumably from a fatal tachyarrhythmia. Indeed, the risk of death occurring in the hospital was approximately 30%. The development of the coronary care unit,12 which provided continuous monitoring of the electrocardiogram, closed-chest cardiac resuscitation, and external defibrillation, reduced in-hospital mortality by half among patients admitted with acute myocardial infarction.

According to Nabel and Braunwald, two defining events helped transform our understanding of how to prevent and treat heart disease. The first was the establishment of the Framingham Heart Study in 1948 by the National Heart, Lung and Blood Institute (NHLBI), which examined the lifestyles of 5,206 residents of Framingham, MA in order to determine what caused heart attacks. The men and women in this study, between the ages of 30 and 62, had no previous history of cardiovascular disease. This study brought together 3 disciplines: epidemiology, biostatistics and clinical cardiology and as a result several potent risk factors for developing heart disease were identified: high blood pressure and high cholesterol. Once we knew what led to heart attacks and strokes, the second defining event emerged – prevention.

The NHLBI then launched a national campaign to educate clinicians and the public alike in the causes of cardiovascular disease. In addition, the advent of new medication to help lower blood pressure (loop diuretics such as Lasix in 1962) and cholesterol (Mevastatin in 1976) were developed . So, identifying the risk factors and developing a national campaign to educate the public, helped to dramatically lower the mortality rate.

It struck me while reading the NEJM article, just how important these national health institutes are and how they need to remain apolitical. Too often they can be held hostage to groups that would withhold funding for critical research. As the NEJM article revealed,  collaboration in the 1960s between the government, the health care industry and academia was crucial to moving us beyond a treatment plan for heart attacks that had not improved much since the 1800s. I for one hope that political interest groups don’t stifle ethically designed research needed to help advance our medical care.

To read the complete article by Nabel and Braunwald in the NEJM, follow this link. If you would like to learn more about the Framingham Heart Study (which is now multi-generational), follow this link.

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The afternoon cookie

The NY TImes Magazine section recently published an article that detailed how habits are formed and the efforts retailers use to get that information to sell us things. The whole article was interesting but since I’ve have a few bad eating habits I’d like to break I was interested in the explanation about how habits are formed and how we can use this knowledge to change our own behavior.

The author of The Power of Habit: Why We Do What We Do in Life and Business, Charles Duhigg, explains that there are three stages in habit formation: the cue, the routine and the reward. He explains each of these much more elegantly than I can, so I’m quoting from the NY Times article:

The process within our brains that creates habits is a three-step loop. First, there is a cue, a trigger that tells your brain to go into automatic mode and which habit to use. Then there is the routine, which can be physical or mental or emotional. Finally, there is a reward, which helps your brain figure out if this particular loop is worth remembering for the future. Over time, this loop — cue, routine, reward; cue, routine, reward — becomes more and more automatic. The cue and reward become neurologically intertwined until a sense of craving emerges. What’s unique about cues and rewards, however, is how subtle they can be. Neurological studies … have revealed that some cues span just milliseconds. And rewards can range from the obvious (like the sugar rush that a morning doughnut habit provides) to the infinitesimal (like the barely noticeable — but measurable — sense of relief the brain experiences after successfully navigating the driveway). Most cues and rewards, in fact, happen so quickly and are so slight that we are hardly aware of them at all. But our neural systems notice and use them to build automatic behaviors.

Habits aren’t destiny — they can be ignored, changed or replaced. But it’s also true that once the loop is established and a habit emerges, your brain stops fully participating in decision-making. So unless you deliberately fight a habit — unless you find new cues and rewards — the old pattern will unfold automatically.

Mr. Duhigg then applied the principles to his own desire to lose weight. His nemesis was his afternoon cookie break. He had to determine what his cue was for needing that cookie at 3:30 in the afternoon and he did this by writing down 5 things that he noticed when the urge hit. This included what he was doing (sitting at his desk), what his emotional states was (bored), what time it occurred (usually around 3:30pm) and what action preceded the urge (answering an email) and who else was around (no-one).

Once he figured out all the parts to the loop, he then experimented with doing different things during the time the urge struck him. He went for a walk, gossiped with other staff, ate an apple etc.

He found that piggy-backing on his existing habit, he was able to slightly alter his routine and lose 21 lbs in the process. The cue and reward stayed the same – only the routine changed.

Figuring out the rewards we get from our own habits can be difficult. In Mr. Duhiggs’ case, was the reward the cookie or the fun of talking with colleagues or the need to simply stretch his legs? Once he determined that he really wanted to socialize and the cookie was the excuse, he was able to piggy-back on the habit and slightly alter his routine. Only when he correctly identified his cue and his reward was he able to substitute the cookie urge for socializing.

So if you’re struggling with bad habits (and who isn’t??), then you may want to read the article in its entirety or buy his book. Or just start thinking about your own cues, routines and rewards.

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Researchers in Australia took 2 groups of adults older than 40 who essentially were not into exercising at all. They were divided into 2 groups – one group worked out for 20 minutes on a stationary bike alternating between 12 seconds of easy peddling and 8 seconds of peddling as fast as they could. (During an exercise session, alternating between exercising as hard as possible with periods of easy exercising is known as interval training.)

The second group also worked out on a stationary bike but cycled at a steady pace for 40 minutes.

The difference in weight loss after 4 months was quite significant: those who did interval training lost 6 lbs of body fat while those who worked out longer and at a steady pace lost 2 lbs.

The reason for this dramatic difference appears to be the result of catecholamines which according to the lead researcher Steve Boutcher, a professor of exercise science at the University of New South Wales, tell the fat cells to release their fat to be burned as energy.

Cycling on a stationary bike is not my favorite so I was pleased to read that interval training can be done with pretty much any activity: swimming, stair-climbing, rowing and of course walking/running and working out on the elliptical.

So the age-old excuse of not having enough time to exercise wears thin if you can’t find 20 minutes a day.

For more on the topic check out these other articles:

Interval Training: Burning Off Excess Fat Fast

What Is the Single Best Exercise?

Interval Training vs Endurance Training: Which is Better?

Finally you can read or listen to the NPR article by following this link.

By the way, even those folks who had a heart attack benefited by doing interval training – just don’t go out and do it without first getting cleared by your cardiologist.  And getting medical clearance for vigorous exercise goes for all older adults even for those without coronary artery disease!!

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