Thursday, February 14, 2013

Raynauds


Raynaud's disease is a condition in which certain areas of your body, such as your fingers, toes, ears and nose may begin to feel numb and cold. These sensations are often due to cold temperatures and/or stress. The small blood vessels in the hands and feet basically overreact to cold and stress causing vasospasm (constriction). Vasospasm narrows the small blood vessels dramatically, temporarily limiting the blood supply to these areas of the body. When the oxygen supply is lowered, the skin color turns a bluish hue (cyanotic). Over time, these same small arteries may harden or thicken, further decreasing blood flow. When the spasms occur, the skin of the affected area turns pale followed by a bluish hue. Warming the affected area helps relieve these symptoms. Once warmed, the affected area may then become swollen and/or painful. Once the spasms subside and blood returns to the area, the skin will often then turn a bright red. In about half (50%) of individuals with the disorder, the disease may either improve or disappear after a few years.

In individuals with a normal response to cold, the body selectively reduces blood flow in your extremities by narrowing (constricting) the small arteries to limit the amount of body heat lost. This action will help to preserve your body's core temperature. If a person has Raynaud's, this response is greatly exaggerated causing the classic symptoms. Cold temperatures are the most common trigger. Exposure to cold can be as simple as putting your hands in or under running cold water, exposure to cold air or taking something out of the freezer. Stress often causes a reaction similar to cold, emotional stress alone can cause an episode of Raynaud's.

Raynaud's may a be either a primary or secondary disorder. Primary Raynaud's ("Raynaud's disease"), the most common form of the disorder and is often inherited from a parent. It occurs without any underlying disease or associated medical problems that may provoke the arterial spasms and symptoms. Secondary Raynaud's ("Raynaud's phenomenon") is caused by some underlying problem. Although secondary Raynaud's is less common than the primary form, it is usually more serious.

Causes of secondary Raynaud's:
1. Atherosclerosis, a chronic inflammatory condition in which the walls of arteries thicken due to the accumulation of fatty materials such as cholesterol in the form of plaque.
2. Scleroderma, a rare disease that leads to hardening and scarring of the skin and organs. Ninety percent (90%) of scleroderma patients will have Raynaud's disease. This is often called CREST syndrome.
3. Lupus, an  autoimmune disease that can affect many parts of the body including joints, skin, lungs, blood vessels, liver, kidneys, and the nervous system.
4. Rheumatoid arthritis, a systemic (whole body) autoimmune inflammatory condition causing pain and stiffness in the joints and may also affect many other tissues and organs.
5. Sjogren's syndrome, a systemic autoimmune disease in which cells attack and destroy the glands in your body which produce tears and saliva.
6. Buerger's disease (Thromboangiitis obliterans) , progressive inflammation and thrombosis (clotting) of small to medium arteries and veins primarily in the hands and feet. The main symptom is pain and  it is strongly associated with smoking.
7. Certain medications such as ergotamine (a migraine medication), beta blockers (blood pressure medication), certain chemotherapy medications and estrogen have been linked to Raynaud's.
8. Thyroid disorders such as hypothyroidism (low thyroid) may contribute to Raynaud's.
9. Other causes include as Carpal Tunnel Syndrome, injury, overuse of the affected area, cancers including leukemia and lymphoma or diabetes. Workers who repetitively operate vibrating tools can develop a type of Raynaud's phenomenon called "vibration white finger." Certain chemicals or toxins have also been associated with Raynaud's.  
    Prevention:
    Stop smoking, primary Raynaud's is rare among nonsmokers.
    Avoid secondhand smoke if possible.
    Treat any disorders listed above as risk factors.  
    Avoid trigger factors, such as cold, stress or use of vibrating tools as much as possible.
    Avoid medications which can worsen symptoms (see above).
    Keep hands or feet warm; wear layers of clothing, hats, mittens (rather than gloves), scarves and warm socks during cold weather. Use hand and foot warmers in cold weather.
    Also, consider wearing gloves or mittens when removing food from the refrigerator or freezer.
    Warm up your car before leaving in cold weather.
    Avoid stressful situations and learn relaxation techniques.
    A regular exercise program is recommended as it improves circulation.
      Diagnosis:
      The patients history and physical are the two most helpful things in diagnosing Raynauld's. Medical tests may include specific blood studies and a cold challenge test (simply putting your hands in cold water). A nail fold capillary test (using a small magnifying lens to check tiny blood vessels in the skin at the base of a fingernail) may also be of value.

      Treatment: mostly involves treating any underlying cause, lifestyle changes, and occasionally medications.
      • Stay warmer, indoors, as much as possible during cold weather.
      • Wiggle or massage your fingers and toes.
      • Try soaking your hands or feet in warm water.
      • Move your arms in circles or shake your arms or feet.
      • Biofeedback training may teach you how to raise skin temperature may help.
      • Surgery to sever (cut) sympathetic nerves to the involved hands or feet (rare).
      • Topical prescription medications may be applied to the fingertips to protect them from ulceration.
      • Vasodilator drugs (widen blood vessels) such as calcium channel blockers and alpha blockers may be prescribed to improve circulation.

      To learn more: visit the Raynaud's Association website: www.raynauds.org.

      Thursday, January 24, 2013

      Poison oak, ivy and sumac

      Poison oak, ivy and sumac.

      Poison plants

      Poison ivy, poison oak, and poison sumac are well known and often unrecognized plants that can cause allergic contact dermatitis (skin rash or reaction). The plants grow as vines or bushes and have three leaves (poison ivy and poison oak), or a row of paired leaves (poison sumac). The red, itchy  and very uncomfortable rash usually shows up in lines or streaks and frequently coexist with blisters or large raised areas. It is by far the most common dermatitis caused by contact with plants. About one half (50%) of all Americans have an allergy to these plants. The reaction results from contact with an oily resin (urushiol) produced by all three plants. The rash will often continue to develop in new areas over several days, but only on the parts of your skin that had initial contact with the urushiol or those parts where the resin was spread by touching. The rash is not contagious. You should not be able spread the rash after it appears, even if you touch any blister fluid. This is because the urushiol should no longer be on the skin. The oil is present in all parts of the plants, including the leaves, stems, flowers, berries, and roots.  Urushiol is present in all parts of the plants, including the stems, flowers, root and the berries. Indirect contact, such as touching camping gear, gardening tools, pets or other objects that have come in contact with one of these plants with the resin, may also cause the rash. Exposure to the smoke these plants give off, if burned, may cause a much more severe reaction and difficulty with breathing. This type of exposure may also affect areas of the face such as the eyes, mouth and throat.

      Signs and symptoms:
       -Red streaks, hives or general redness that usually develops 1-2 days after contact (8-48 hrs.).
       (The rash usually takes a week or more to show up with the first exposure.)
       -Blisters (the fluid in blisters is not contagious).
       -Weeping, crusting, and swelling.
       -Severe itching and burning.

      Preventive measures:
        -Learn to identify and avoid contact with these plants.
        -Wear protective clothing when walking in areas where these plants grow
        -Use a product that prevents the poison from getting on your skin.
        -Wash your clothing right after you return from a possible exposure.
        -If you are exposed, washing the skin immediately with soap and water.
        -Applying rubbing alcohol to the exposed area may help prevent the rash.

      Prognosis
      Without treatment, the rash will usually lasts about 1-3 weeks. In individuals who are very sensitive to urushiol, the rash may take 4-6 weeks to heal. The symptoms are usually start improving by the second day, and complete healing occurs in 7 to 14 days. A skin infection may develop if prolonged or excessive scratching occurs.

      Treatment
      Wash the area immediately after contact if possible with water. To relieve symptoms, use wet compresses and take cool baths. Aveeno or baking soda (about a half cup per bath) baths will often help. Antihistamines and calamine lotion are also helpful. Moderate or severe cases may require treatment by a doctor. Corticosteroid tablets, creams or injections may be necessary. Call your health care provider if the symptoms are severe, near your eyes or the rash covers a large part of your body. Try to stay cool as sweating and heat make the symptoms worse.Be sure to wash all clothing and any equipment that came in contact with the plants with soap and water. Also, give your pets a warm, soapy bath to remove any of the resin from the fur.  

      Sunday, October 9, 2011

      October is Breast Cancer Awareness Month

      Breast cancer is the most common type of cancer in women and is the second leading cause of death, after lung cancer, in women. Every woman has a 12 percent (1 in 8) chance of developing it at some point in her life. The good news is that only about 3 percent of women will die from breast cancer. A number of risk factors will play a role in a woman's particular risk to breast cancer. Age plays perhaps the most important role in breast cancer risk as two out of three invasive breast cancers are found in women age 55 and older. About 10% of breast cancer cases are thought to be inherited (genetic) and the most common cause is a mutation (change) in what are called the BRCA genes. A family history of breast cancer may also be significant. Having one first-degree relative (mother, sister or daughter) with breast cancer will double a woman's risk and having 2 first-degree relatives will increase her risk about 3 x. Women who have had a longer menstrual history (i.e., before age 12 and after age 55) have a slightly higher risk of breast cancer. Post-menopausal hormone especially with progesterone has been shown to increase the risk of breast cancer. Obesity and excess alcohol use (3 or more daily) will also increase a woman's risk of breast cancer.


      Risk Factors: (you cannot change)
       Age
       Inheritance (genetics)
       Family history
       Caucasian women (slightly higher)
       Dense breast tissue
       Previous breast cancer
       Prolonged menstrual history
       Previous radiation therapy
       History of diethylstilbestrol (DES) exposure


      Risk Factors: (you can change)
       Obesity
       Excessive alcohol use
       Post-menopausal hormone therapy (especially synthetic hormones)
       Having no children or later in life (after age 30)
       Sedentary life style (just 2 hrs of exercise weekly will help)
       Night shift work (? changes  levels)
       Smoking (controversial)

      Signs of breast cancer can be many and confusing. Lumps, swelling in the breasts or under the armpit are common signs of breast cancer. A lump that is painless, immobile, and has uneven (prickly) edges is more likely to be cancer than one which is painful, smooth and rounded. The outer quadrants of the breast are also more likely to develop a cancer than the inner quadrants. Changing of the skin especially around the nipple could also be a sign of breast cancer. The skin around the nipple may become reddened, scaly, flaky or pitted like an orange. Changes in the size and contour of the breast may also be a sign of breast cancer.


      Symptoms:
       Lumps (especially fixed and prickly)
       Swelling in the breast or armpits
       Skin changes (especially around the nipple)
       Inverted nipples
       Changing contour of the breast
       Persistent pain in the breast

      Breast cancer screening is extremely important and should begin with self exams at an early age. Women should familiarize themselves with their own breasts and begin self exams in their twenties. Women should know how their breast normally look and feel. Breast cancer screening guidelines for women with no increased risk factors include: 1) monthly self breast exams (after menses preferable), 2) clinical breast exams every 3 years for women in their 20s and 30s and then every year for women over 40, 3) mammograms every 1-2 years starting at age 40 and then yearly after age 50 (a screening mammogram at age 35 may also be considered).


      Mammography can detect breast cancer about 1.5 years before a women can feel a lump in her breast. Remember is that when breast cancers are detected early (stage I), the survival rate in nearly 100%.