Month: September 2014

Sept. 2014- Sun skin care

It’s summer time, which means time outside in the sun, and on the beach! We soak

up some sunrays and some vitamin D, but it’s also time for protection of our skin.

When many of us were young, we’d play all day long in the sun, and come inside

with nice tan lines from our tank tops and a sun-kissed face after a day of fun. And

depending on how much exposure we had received, some of us would even peel

from sunburn. However, as we get older, we have to be careful with preventing

damage to the skin and potential future risks of health issues related to too much

sun exposure.

Yes, black people can get sunburned and get skin cancer. As a child, I could recall

being so surprised when my fairer skinned father’s nose or forehead would peel

after a day the sun. Once I started studying medicine and learning about the many

skin conditions either caused by or made worse by the sun, such as actinic keratosis

or types of cancer, I also learned that African American skin can be affected,

although generally at lower rates than Caucasian or other types of skin tones.

A patient of mine brought the condition “sun poisoning” to my attention recently

after a beach trip, and I was surprised I had never learned about this. It’s a condition

caused by a very severe sun burn that occurs with systemic symptoms, such as

fever, fatigue, dehydration, nausea, dizziness, skin redness and blistering, pain,

swelling, and headache. I had never heard of such a thing, and it has nothing to do

with skin color, and everything to do with too much sun bathing.

Even more concerning is the potential of future skin cancers. Current stats on skin

cancers for ethnic groups state in 2010, among men, white men had the highest

rate of getting melanoma of the skin, followed by American Indian/Alaska Native,

Hispanic, Asian/Pacific Islander, and black men. Among women, white women had

the highest rate of getting melanoma of the skin, followed by Hispanic, American

Indian/Alaska Native, Asian/Pacific Islander, and black women*.

What is the appropriate type of sunscreen to use? Most references say using one

with at least SPF of 30 (I’d say 50) and one that is “broad-spectrum”. This means

one that protects from both UVA and UVB rays. Place on body 15-30 minutes before

going out. Always wear a hat, sunglasses and protective clothing. Reapply sunscreen

every 2 hours or so as you sweat. I put sunscreen in my face and body lotion now

to make sure I’m covered. There are many daily lotions that now include SPF for

protection, which is really smart and efficient.

Finally, as always, knowing the signs is crucial in identifying skin issues and cancers.

A mole may not be just a mole. Knowing what’s normal and not normal can be life

saving.

The “ABCDEs” of skin cancer are as follows: (if the answer to these is “no”, the spots

could be abnormal)

A-asymmetry—If you drew a line through the spot, would the sides match?

B-borders—Are the borders smooth and round?

C-color—Is the spot one uniform color (if many colors, could be a warning sign)?

D-diameter—Is the spot larger than 1⁄4 in (1/4in=size of pencil eraser)?

E-evolving—Has the spot changed in any way (size, number, shape, darkening,

bleeding)?

Be healthy and be blessed,

Dr. Swiner

*References:

http://www.cdc.gov, Centers for Disease Control and Prevention. Skin Cancer Rates by

Race and Ethnicity

http://www.skincancer.org, Do you know your ABCDEs?

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Sept. 2014- Why am I so stressed out?

Why am I so stressed out?

Is it just me, or does everyone seem stressed nowadays? I often

have to check with myself and ask “Am I stressed”? And if the answer

is yes, then I ask “Why?”

My father brought an article to my attention last year, and he asked

me to read it. He often does this to enlighten me, or to somehow get

his point across without actually having to say it. It was a Newsweek

article, entitled “Women In The World” by Debora Spar (October

2012), who is an author of the book, “Wonder Women”. From the

titles, one can assume what she addresses—women doing to much

for too many and becoming overwhelmed.

One out of 10 Americans admit to some form of mental illness-
depression, anxiety, schizophrenia, etc., each year. Women suffer

from depression two times more than men. Why is there a difference?

Studies say a definitive answer is unknown. However, with research,

I found similar theories, including the following: higher incidence of

physical or sexual abuse, use of birth control and having hormones in

general, and persistent psychosocial stressors such as loss of job.

Untreated emotional or mental illness can lead to suicide attempts

– more women attempt suicide, but more men complete it. The

likelihood is four-to-one that a man will be successful with suicide.

Why? My theory is women use it more as a cry for help than men do.

Women also use self-poisoning or drug overdose as the usual tactic,

and that’s 70 percent of the time. However, that does not mean we

should ever take threats of suicide from a female patient any less

serious than from a male.

There are also discrepancies in health in African-Americans versus

the rest of the population. (From the Center of Disease Control and

Prevention). Points that I wanted to address were the differences

in HIV stats. Interesting, with all the safe sex campaigns since the

1980s, HIV is still the leading cause of death for black women aged

25-34 years. Another point to make is that black women have a

lower rate of getting breast cancer, however, they are more likely to

be diagnosed in later stages and more likely to die from it. We must

figure something out!

So what can we do to lower stress in our lives? • Rely on our

support systems more—our families, friends, spirituality or religion,

or hobbies as healthy outlets • Have your annual check ups. Take

care of yourself-mentally and physically. • Get more exercise and

movement.

• Eat “happy foods” – less caffeine/alcohol, more omega

3 fatty acids (salmon, cod, sardines, nuts, help brain and nerve

cells), reduce intake of refined carbs that cause sugar highs and then

severe crashes, and eat more veggies and vitamins.

• Pay attention

to yourself and your moods. Recognize your symptoms early.

Be healthy and be blessed,

Sept. 2014- “Chickun-what?”

“Chikun-what?”

For the summertime, I’m well aware and well versed in infections to prepare myself

for: summer “colds”, tick-borne illnesses, and even sexually transmitted diseases.

However, when a patient of mine returned from vacation in the Carribean with

suspected Chikungunya disease, I had to do some research.

You may have heard by now about this new mosquito-borne illness by the weird

name but may not know much about it. It apparently is making its way from places

in Africa, Europe, and India, and is now spreading to the Carribean islands of the US.

It was first found on the islands late last year (2013).

It is only transmitted by mosquito bites, and the most common symptoms include:

-fever

-joint pain

-headache

-muscle pain

-joint swelling

-rash

As one can see, diagnosing Chikungunya can be challenging as these symptoms are

similar to just about every other viral illness out there. The history is likely the most

helpful in diagnosis. Along with this, there is no vaccine or medication to treat it.

Like most viral illnesses, rest and fluids is the treatment. I did find that clinical

history is most important, including a patient’s recent travel or outdoor activities

within 3-7 days of symptoms beginning. There isn’t a specific lab to check for

this infection, however, other labs, such as a blood cell count, kidney levels, liver

enzymes, tick related antibodies, and urine can be used to rule out other types of

infections.

For this and most other travel related infections, prevention is key. It is

recommended that travelers and outdoorsmen use insect repellent, wear long

sleeves, sleep with mosquito nets when camping, and prevention of more mosquito

bites during the first week of infection to prevent more spread to others. Also, if one

has standing water nearby, like with the use of water reservoirs outside of homes or

standing water in home pools or in children’s toys, to eliminate them.

Treatment is nonspecific, meaning there’s no particular antiviral for this. However,

supportive care, such as anti-inflammatories (ie. Tylenol, Ibuprofen, etc.), steroids,

rest and fluids can help relieve symptoms.

Since I began writing this article last week, the infection has gotten closer and closer

to us. Initially, data on the CDC (Centers for Disease and Infection Control) reported

it had not yet reached the continental US. Since last week, there’s been a suspected

case in South Carolina. Be careful and proactive.

Be Healthy and Blessed,

Dr. Swiner

Sept. 2014- How worried should we be about Ebola?

How worried should we be about Ebola?

This summer we’ve been saddened and scared by news of spreading Ebola in Africa

and the 2 workers returned to the US. Just how afraid should we be? What do we

know and don’t know about this potentially fatal and debilitating disease?

From what we know, the Ebolavirus, known in the medical world as viral

hemorrhagic disease or fever, is one that occurs primarily in West Africa. The

nations that have been most affected are Sierra Lione, Guinea, Liberia, and Nigeria.

As of this month (August 2014), there have been no cases beginning in other

countries. There were 2 American workers that were infected in Africa brought back

to US in Atlanta for treatment, and fortunately, they have fully recovered and are

now healthy and out of the hospital. Their blood no longer showed signs of infection.

The most common symptoms of this disease are:

-fever

-headaches

-muscle aches

-unexplained bleeding or bruising

-stomach ache

-vomiting

-diarrhea

-loss of appetite

Here are 2 recent questions to me on my “Dr. Swiner’s Medical Notes” facebook page

about Ebola:

L.W.A from Atlanta–“We really don’t hear about the disease much in the US

until there is a crisis as of late. In addition, talk about how the disease is really

transmitted. If via bodily fluids, can our normal human “waste” carry the disease?

When the patients were treated at Emory hospital (I live in Atlanta) I would like

to know how their human waste was treated and if there is reason for concern.

Thanks.”

Thanks for your question, L.W.A. Here’s my answer:

The virus is transmitted through contact with an actively infected individual, via

fluid (ie. blood, urine, feces, vomit) exposure to one’s body (ie. open skin, eyes,

mouth, etc.). So, yes, human “waste” carries the disease. It generally takes 8-10 days

after an exposure to come down with the infection. That’s a good question about

how the hospital disposed of the waste. I did some reading from a paper called, “The

Liberty Voice”, the waste is being eliminated through Atlanta’s public sewer system

after testing is negative. Hopefully, no problems arise from this.

Next question is from P.G. in Durham: “My questions about Ebola are, “Where did it

originate? Why does it seem to be isolated to that one particular area of Africa? Has

the U. S. shared the meds we have with the Liberian people? WHY/HOW do WE have

an antidote for Ebola, but the disease is so far removed from our country?” I could

ask more questions, but I won’t.”

Here’s my answer: All good questions. As noted above, it seems to have originated

in West Africa, and they’re trying to contain it by preventing those travelling into

and out of the continent. At this time, there is no treatment or antidote. A patient

either develops immunity and can fight it off, …..or not. It is not known why some

patients die from this disease versus making full recovery. Some are able to develop

immunity to it in time, and others are not able, unfortunately.

A person who has been exposed, but does not have active symptoms, is not

contagious to other people. Additionally, once a patient is treated and is fully

recovered, there has been no evidence that they can transmit the virus to others.

Be healthy and be blessed,

Dr. Swiner