Friday, July 31, 2015

Mark Twain on Health

While cigar-smoking, mint julep-drinking Mark Twain may not seem like a paragon of healthy living, he did provide us with some thought-provoking quotes directed toward health.
“Be careful about reading health books.  You may die of a misprint.” 
~ Mark Twain
This quote, written prior to the development of personal computers or the World Wide Web, has particular significance today.  While a massive amount of health-related information is available on the Internet, the accuracy of this information is highly variable.  Not only is the information found on many health-related websites based on insufficient scientific evidence, the accounts of personal health issues on internet health forums are often misleading or biased.  Even studies published in respected medical journals can sometimes turn out to be flawed. A few years ago, researchers looked at the conclusions drawn from studies published in highly respected journals, such as the Journal of the American Medical Association (JAMA), the Lancet, and the New England Journal of Medicine to see if their findings stood the test of time. This analysis included 45 highly publicized studies reporting on a drug or other treatment that was considered to be successful.  Subsequent research contradicted the results of 7 of these studies and reported weaker than initially thought results for 7 others.  In other words, nearly one-third of the original reports did not hold up over time.  The refuted studies dealt with a wide range of drugs and treatments such as the use of estrogen to protect women from heart disease and use of Vitamin E to prevent heart attacks. The take home message from this is that a single study or internet source does not necessarily provide definite evidence of the effectiveness of a medication or other treatment. What is accepted as “gospel” this year may be refuted or found to be obsolete the next.
“Anger is an acid that can do more harm to the vessel in which it is stored than to anything on which it is poured.” ~ Mark Twain
It has long been thought that anger or hostility could lead to the development of coronary heart disease (CHD). In order to test this theory, researchers pooled the results of 44 separate studies that had previously looked for a connection.  After analyzing the data, it was found that anger and hostility was indeed associated with a higher occurrence of coronary heart events, both in people thought to be healthy as well as in those with underlying CHD. The study found that angry or hostile people with no prior history of heart disease were 19% more likely to develop CHD than their calmer counterparts. The mechanism for this seems to be related to the “fight or flight response” in which stress hormones, including adrenaline and cortisol, cause the heart rate to go up, blood pressure to rise and blood vessels to constrict. The authors of this study concluded that in addition to conventional forms of treatment for CHD, when anger or hostility is clearly present, psychological care should also become part of the management.  Anger and hostility may not be the only emotional issue related to the development of CHD.  Other researchers have also found that high degrees of anxiety or depression can contribute to heart disease development.

 “Giving up smoking is the easiest thing in the world. I know because I've done it thousands of times.” ~ Mark Twain
More people in the United States are addicted to nicotine, a drug that is found naturally in tobacco, than to any other drug. Research suggests that nicotine may be as addictive as heroin, cocaine, or alcohol.  Among all current U.S. adult cigarette smokers, nearly 7 out of every 10 (68.8%) reported in 2010 that they wanted to quit completely. But as many smokers have found, quitting smoking can be very difficult and often requires several attempts in order to succeed.  Some of the methods available today to help with smoking cessation include:
  • Individual, group, or telephone counseling
  • Behavioral therapies (such as training in problem solving)
  • Programs to deliver treatments using mobile phones
  • Over-the-counter nicotine replacement products---nicotine patch, gum, lozenge
  • Prescription nicotine replacements---nicotine patch, inhaler, nasal spray
  • Prescription medications: bupropion SR (Zyban®), varenicline tartrate (Chantix®)
The point is that quitting smoking is hard and may require several attempts.  Fortunately, a variety of methods, most of which were not available to Mark Twain, can help to improve the success rate.

Monday, July 27, 2015

Finger and toenails---What can they tell us about our health?

While changes in the normal configuration of nails usually indicate a problem affecting the nail itself, certain changes may also provide clues to an underlying medical condition.  Brittle nails, nails containing “pits” or small depressions, nails that are discolored yellow or green, or dark lines beneath the nail are examples of the changes that could point to a medical problem.  Let’s look at some of the most common nail abnormalities and learn when it is advisable to seek medical attention should they develop.
Thickened, discolored, crumbling nails:  Perhaps the most common nail abnormality occurs as a result of a fungal infection, also known as onychomycosis.  Fungi commonly reside in warm, moist environments, such as swimming pools and showers.  Infections develop when the fungus enters the nail through a small separation between the nail and nail bed.  Toenail involvement is more common than fingernail infections because fungi thrive in the moist, warm environment produced when wearing shoes.  These infections usually begin as a white or yellow spot under the tip of the fingernail or toenail.  As the fungus spreads deeper into the nail, thickening, discoloration and crumbing of the nail edge occurs.  Nail fungus can be difficult to treat and responds poorly to over-the-counter medications. Frequently, it is necessary to take a prescription oral antifungal medication for several weeks in order to effectively treat nail fungus.  Measures to prevent the occurrence of a nail fungus include not going barefoot in public showers, thoroughly drying your hands and feet (particularly between toes) after bathing, wearing synthetic socks to “wick” away moisture from the skin, and use of an antifungal spray or powder.

Green nail discoloration:  An infection under the nail caused by a particular type of bacteria known as “Pseudomonas” is associated with a very characteristic green nail discoloration.  Manicurists sometimes refer to this nail condition as “the greenies”.  Pseudomonas nail infections most commonly affect those whose hands are often in water, such as dishwashers. Initial treatment involves trimming back the nail and soaking in an acetic acid or antibiotic solution.  In some cases, particularly when the skin around the nail is also infected, treatment with oral antibiotics may be required.

Pitting and rippling of nails:  These are the typical changes noted when the nail abnormality is caused by psoriasis.  Psoriasis is a skin disease of unknown cause that causes itchy or sore patches of thick, red skin with silvery scales.  Up to 10% of those who develop psoriasis will have nail abnormalities as the initial finding and most of these go on to develop the characteristic skin rash also.

White spots beneath nails:  Also called “leukonychia”, white dots or lines beneath the nails are usually related to trauma, such as banging the end of finger. Since the injury affects the nail matrix located at base of the nail, the white spots are usually seen only after the nail begins to “grow out”.  With time and continued growth of the nail, the spots eventually disappear.

Red or black nail discoloration:  A hematoma, or collection of blood beneath the nail, is the most common reason for red or black nail discoloration.  Bleeding beneath the nail is typically related to trauma, such as hitting a finger with a hammer.  As with white spots due to trauma, with time the discolored area “grows out” and the nail returns to normal.  A black spot under the nail with no associated trauma, on the other hand, could indicate a much more serious problem, such as a melanoma tumor.  Dark nail pigmentation that develops without an injury should be evaluated promptly by a physician.

Brittle nails:  Many people believe that brittle nails are the result of a protein deficiency that can be addressed by consuming gelatin. This belief appears to have stemmed from a marking effort in the 1890s by the Knox family who developed a method of processing the hooves and hides of horses and cows into a powdered gelatin product.  They contended that eating gelatin would provide the protein necessary to develop strong nails.  We now know that protein deficiency has less to do with the development of brittle nails than does environmental dryness, heredity, and aging.  Other causes for brittle nails include low levels of iron in the body and an underproduction of thyroid hormone (hypothyroidism).  Laboratory testing may be necessary to confirm these diagnoses. The most important self-care measures for brittle nails are to limit the amount of exposure to water and soap and to apply moisturizers to the nails.

Friday, July 17, 2015

Understanding Autoimmune Disease

The immune system is a complex system of specialized cells, tissues, and organs designed to defend the body from germs and other invaders.  Central to the normal function of the immune system is its ability to distinguish between what is part of our own healthy bodies from a potentially harmful agent.
The part of the immune system that is primarily involved in the development of an autoimmune disease is called the "acquired" immune system.  This system develops during our lives as it responds to "attacks" on the body from invaders, such as bacteria and viruses.  One of the most important components of the acquired immune system is a type of white blood cell called lymphocytes. One type of lymphocyte, the T-cell, scans the body for foreign invaders and can directly kill infected cells or summon help from other disease-fighting cells of the immune system. Another type of lymphocyte, the B-cell, produces antibodies used for fighting infections and can also remind the body of a germ that has been encountered previously. Vaccines use the acquired immune system to prevent infectious diseases by stimulating an immune response in the body in a manner similar to the way the immune system fights off a real infection.
An autoimmune disease occurs when the immune system targets the body's own healthy tissues by mistake, signaling the body to attack them.  For reasons that are not completely understood, the antibodies and lymphocytes that would ordinarily provide protection to the body end up causing a number of autoimmune diseases.  The hallmark of an autoimmune disease is the development of inflammation, which can cause redness, heat, pain, and swelling. Autoimmune diseases can affect most of the organs or systems in the body.

The following are some of the most common:

Celiac disease---An autoimmune condition that causes inflammation in the small intestine. When people with celiac disease eat foods containing gluten their immune system reacts by damaging the villi, the finger-like projections protruding from the lining of the intestinal wall. This prevents the absorption of important nutrients, producing symptoms including diarrhea, weight loss and fatigue.

Type 1 Diabetes—In this condition, the immune system attacks and destroys insulin-producing cells of the pancreas.  This makes it impossible for the body to use glucose for energy and can even result in life-threating complication called diabetic ketoacidosis. The more common form of diabetes, Type 2, is not considered to be an autoimmune process.

Multiple Sclerosis (MS) -–In MS, an abnormal immune system response produces inflammation in the central nervous system (brain and spinal cord). The inflammation damages the myelin that "insulates" nerve fibers, resulting in slowing or stopping of nerve conduction.  Symptoms of MS include blindness, weakness, poor coordination, and muscle spasms.

Graves' disease---An autoimmune disease that affects the thyroid gland causing an overproduction of thyroid hormone. Symptoms of Graves' disease include heat intolerance, heart racing, weight loss and nervousness.

Rheumatoid Arthritis---In RA, the immune system produces antibodies that attach to the linings of joints. The immune system cells then attack the joints, causing inflammation, swelling, and pain. If untreated, rheumatoid arthritis can eventually cause permanent joint damage.

Psoriasis--- A disease that causes new skin cells to grow too fast and pile up on the skin surface. It is a life-long disease of the immune system that, in addition to causing skin lesions, is associated with a number of other health issues including arthritis, depression, and an increased risk of heart disease and diabetes. People with psoriasis develop thick red patches, covered with scales, usually appearing on the head, elbows, and knees.

Systemic Lupus Erythematosus (lupus)---In lupus, multiple systems including the joints, lungs, nerves and kidneys may be attacked by the immune system. Although the exact cause is not known, it appears that there are hereditary as well as environmental factors in it development. Symptoms of lupus can include fever, fatigue, joint pain, a rash on the face over the cheeks and nose, headaches, memory loss, shortness of breath and chest pain.

The immune system does an amazing job of protecting the body from infections and even cancer, often without us knowing it.  In the case of autoimmune diseases, however, the immune system is also capable of producing a variety of conditions that can be challenging both to diagnose as well as to treat.