Lessons Learned from Our Clients

Oftentimes doctors know the answer to their patient's question right off the top of their head. However, sometimes a question can require a little more digging to uncover the correct answer or information that a patient needs. With a wealth of authoritative medical information available at our finger tips, it is possible to find an answer to the most esoteric medical questions. In my correspondence with our clients over the past 10 years, I have occasionally been challenged by a question for which I am not certain of the answer. The following are just a few of these challenging questions that required a bit of research on my part, but taught me something in the process.

1) Toxicity of air fresheners — "I have heard that air fresheners could affect one's reproductive health. Is this true?"

Concerns have been expressed regarding a class of chemicals (phthalates) that have been, and may still be, contained in air fresheners. According to the State of California, five types of phthalates, including one commonly found in air fresheners, are known to cause birth defects and reproductive harm. These adverse effects were observed in experiments with laboratory animals, but have raised concerns as to whether exposure to phthalates represents a potential health risk to humans also. Presently, human toxicity data have not been sufficient for evaluating the occurrence of reproductive effects following phthalate exposure. Despite disagreement with some research data released by the Natural Resources Defense Council (NRDC), SC Johnson, a major manufacturer of air fresheners (Glade® and Oust®), has pledged to remove these chemicals from their products by 2012.

2) Wedding Ring Rash — "Over the past couple of months, my skin has been getting very irritated by wearing my wedding ring. According to my husband it is made of white gold. The rash wraps around the top of my finger, located only directly under the band. Any thoughts?"

It is generally thought that gold is an inert metal that rarely causes an allergic reaction. ''White'' gold, however, is an alloy of gold and nickel or palladium. Since palladium is considerably more expensive, nickel is used more commonly in making white gold. About one person in eight has an allergic reaction to the nickel in some white gold alloys when worn over long periods of time. This was almost undoubtedly what was responsible for the writer's rash.

3) Electronic cigarettes — "I have heard that using "e cigarettes" is a safe method for helping me quit smoking. Can you comment on this?"

Electronic cigarettes, also called "e-cigarettes" are products designed to deliver nicotine to the user in the form of a vapor. Most are battery-operated devices that contain cartridges filled with nicotine, flavor and other chemicals. When heated, an atomizer converts the contents of the cartridge into a vapor that is inhaled by the user. The vaporized nicotine, like the nicotine in cigarettes is highly addicting. Additionally, studies performed by The U.S. Food and Drug Administration found that some e-cigarette devices also deliver vaporized carcinogens and toxic chemicals such as diethylene glycol, an ingredient used in antifreeze. While the Federal Drug Administration (FDA) has sent warning letters to several manufacturers of e-cigarettes and expressed its intention of regulating these products as drugs, electronic cigarettes remain available for purchase. Until further evaluation, it would be best to stick with safer products developed for smoking cessation, such as nicotine patches, gum or nasal spray.

4) Shrimp-related headache — "I was curious if shrimp is a migraine trigger? I had some fresh shrimp last night & woke up this morning with a horrible migraine."

Shrimp is indeed thought to be a migraine trigger. Some sources cite the sulfites in shrimp as the responsible chemical, whereas in those with shellfish allergy, iodine seems to be the culprit. If shellfish is responsible for causing headaches, it is generally a good idea to also avoid other crustaceans such as lobster and crab.

Most physicians embrace the challenge of making a rare diagnosis or answering a difficult question. Here, we also take your questions and concerns seriously. We may not always know the answer immediately, but we are committed to doing the necessary research to provide you with the most up-to-date, accurate information possible.

If you have any questions regarding any of these topics or just questions you have about other health related topics, please log into your account and send us your question. We are glad to help.