Dr. Deb

Winter has finally arrived in the Tristate and so has Winter Itch. My son couldn’t sleep the other night because his skin was so itchy. He loves a hot shower for his 5:45am wake up but mixed with colder temperatures and low humidity his skin was quite dry. Constant central heating also removes water from the skin that leads to severe itchy skin. There is usually not much of a rash but scratching can lead to redness and painful cracks or fissures in the skin. Here are my tips to help you stop the scratch.

Dr. Deb’s Ditch the Winter Itch Tips

1. Keep it Cool.

Long hot showers remove the protective oils that keep water in our skin so you should takes short baths (<10 minutes) using warm, not hot water.  Colder showers not only save your skin but will also save your hair, protecting the cuticle as well as prolonging color treated hair.

2. Wash the Essentials

Harsh antibacterial soaps are not needed and contribute to the problem. Stick to mild soaps such as Dove, Oil of Olay or Neutrogena and don’t shower everyday. The essential bath (pits and privates) should get you through most off days. I love my hand sanitizer but nothing dries the skin out like the alcohols in them so use soap or a cleansing solution as often as possible.

3. Lube While Wet

When you get out of the shower, pat skin dry instead of rubbing and apply moisturizer to wet skin to seal in water. Might feel a little slippery for a few minutes but this will really help dry itchy skin. The thicker the moisturizer the better. I like Curel or Eucerin. You can mix a pea size drop of nonprescription OTC hydrocortisone cream with the lotion and apply to the itchy areas. If your skin in thick and hard, like on the bottom of your heals, then exfoliate first, so the lotion will absorb into the skin better.

4. Cycle the Heat

This tip will not only save your skin but will save you some money. Invest in a thermostat with a timer to keep your house cool and turn on the heat only when you need it. We set ours to turn on right before we wake up and turn off 45 minutes later. It will help the air from drying out but allow you to take a cooler shower as your body will be warm instead of freezing when you get out of bed. Adding a humidifier will provide even more relief.

 5. Use a Barrier

Sunscreen should not be forgotten in winter and use gloves to protect your skin not just from cold, but also from drying out.  My mom’s old fashion cure, Vaseline, makes a great barrier as well as moisturizer if you will be outside for an extended period of time. Drink plenty of water and eats lots of omega 3 fatty acids found in salmon or walnuts to keep the water and oil in your skin.

If no improvement in a few weeks then see your doctor and be sure to have your thyroid checked. Low thyroid, diabetes and high blood pressure medication may contribute to dry skin. They may also decide to prescribe a newly approved nonsteroidal anti-inflammatory cream such as MimyX and Atopiclair or even a stronger cream with steroids for severe cases.

Winter has arrived even if we have not have had enough snow to sled. Cool down and lube up to stop that Winter Itch.

Dr. Deb

It’s January 3^rd. Have you broken your New Years Resolution? Some people are just starting their resolution today while others have already given up. 80% of people that made resolutions for 2012 will break them and most don’t make it through the end of January. I often don’t make it past January 1^st and while I used to feel defeated and beat myself for yet another failure., I’ve learned that failure can be a good, even necessary, thing when it comes to making (and keeping) long term changes.

Dr. Deb’s Resolution Solutions

1. Break It Down

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Is it OK for the State to take a child into custody for being obese? Medical neglect is the stated cause but with obesity rates having tripled in the last 30 years, is it fair to single one family out? 44% of kids are overweight or obese by the time they are 8 to 10 yrs old so where are we going to put all these kids? A 10 yr old in Cleveland was taken from his family for weighing 220 or a BMI of 60 and many are questioning if the state has overstepped its boundary. I think the real question is what is the solution for the 44%? Foster care does not seem to be it.

Did the child have a medical condition that caused the State to take him?

The boy had been monitored for 20 months after being hospitalized with sleep apnea. He needed a CPAP machine to help him sleep at night. Obesity does cause hypertension, high cholesterol, diabetes, joint pain, liver disease, and psychological stress in children but he was only known to have sleep apnea. His family did attend a free nutrition class and tried to make lifestyle changes.  While he initially lost weight, he gained it back within the year.  The State intervened because they felt that it was a last resort and the boy was at high risk of death before the age of 18 from his obesity. There is a court hearing on December 10^th that may return him to his home. He has lost 10 lbs since he was placed in foster care in October but neighbors argue the weight loss may be from the stress of separation from his family.

Does removing children from the home for obesity have a proven track record?

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Thanksgiving is only a few days away and for many the beginning of the “eating season.” I made a conscious decision not to wait until January 1^st to make healthy choices but begin today so that I don’t start 2012 with extra 1-7 holiday pounds.

 Dr. Deb’s Thin Thanksgiving Tips.

1.Burn Before & After

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New guidelines for cervical and prostate screens are actually recommending less screening as oppose to more and not everyone agrees, myself included. While I have done a lot of testing for cervical cancer and grant it, probably too much, I will never forget the patients that I diagnosed with cancer.  While some change is needed, many docs will not follow the new recommendations.

Who should NOT get a pap smear according to the new U.S. Preventive Services Task Force recommendations ?

U.S. Preventive Services Task Force recommends AGAINST Pap Smears

- Under age 21

- Older than 65

-Women that had a hysterectomy*

*(Unless they had a history of high-grade precancerous changes)

The task force did not recommend pap smears in women under 21 as the majority of sexually active young women will acquire some form of HPV,  (Human Papilloma Virus) or the virus that may cause many types of cervical and vulvar cancer, but will clear them without treatment.

The risk of cervical cancer in adolescents is about 1 in 1,000,000. Many painful and expensive procedures are used in this age group to treat precancerous lesions that are unlikely to progress to cancer according to the task force. These procedures have some risk of preterm labor however there is not a significant risk of NICU admissions or perinatal mortality.

It is important to remember that while a pap test is not recommended, an annual exam may still be needed.  A pap test is sampling of the cervix looking for precancerous cells. It does not check for other types of cancer such as the uterus or ovaries. It is also not checking for STDs or sexually transmitted diseases, which should be screened annually in sexually active teens and with new partners.  These years are critical in helping girls find self empowerment to enable them to stand up to sexualized media stereotypes and peer pressure. A strong doctor relationship can be of great benefit and I would hate for girls to think that just because they don’t need a pap, they shouldn’t see their doctor.

Women who have had a hysterectomy should talk to their doctor to see what type they had. Most of the time the cervix is removed but if it is left in then paps should be continued.

How are the USPSTF recommendations different than other organizations?

The USPSTF recommends a pap every 3 years for women ages 21-65. Currently other organizations such as ACOG (American College of Obstetrics and Gynecology) recommend testing with a pap smear every other year from age 21-29 and every 3 years in women over age 30 with a negative HPV  (Human Papilloma Virus) test in low risk women.  HPV is the virus that causes most cases of cervical cancer so a negative test is reassuring. Many women have HPV and never get cancer so testing HPV alone is not a specific enough test, meaning that too many women that don’t have cancer would need follow up. The USPSTF does not recommend using HPV testing at this time but many doctors will still use it to decide who should be followed more closely.

How frequently should women that have received 3 HPV vaccines have a pap smear?

Right now there have not been any changes to pap smear screening for vaccinated women. This may change with longer-term studies but the vaccine does not prevent all forms of cervical cancer.

Why was there a recommendation yesterday that all boys should be vaccinated?

HPV can cause warts and penile and anal cancer in men and obviously since most girls are getting HPV from boys it makes sense to vaccinate them too. There is new compelling evidence that other types of cancer including cancer of mouth, tonsils and throat are caused from HPV likely transmitted though oral sex. These types of cancers are increasing with over 7000 cases per year so boys should be vaccinated before they are exposed.

How important is USPSTF’s recommendation against PSA screening for prostate cancer?

The USPSTF recommended against PSA screening since prostate cancer is slow growing and most men diagnosed over 75 years old will die from something else The complications from the treatment including urinary problems and sexual dysfunction are often worse than the cancer itself in older men. The problem is we have no other screening test at this time and many people, including myself, know of men whose lives have been saved from the PSA test. Men with a family history of prostate cancer should consider getting the test even starting in their 40s. .

The bottom line is talk to your doctor about your risk factors to help decide what screening tests you should receive. For example, I will follow smokers much closer for cervical cancer as it is such a strong co factor than I would a non-smoker.  Any screening test has risks but many people are willing to undergo the risks of those tests to prevent what could be a fatal disease.

Dr. Deb