Monday, July 31, 2017

What Is Heatstroke?

I got heatstroke once when I was hiking in Arizona. As I was coming down the mountain in the final mile, I was overwhelmed with a feeling of nausea and I started dry heaving. At the time I was confused about what was happening, because I thought I had been drinking enough water during the hike, and although I had run out a little while back, I didn't have any sweat on my body, nor did I feel overwhelmingly hot.

But dry, desert conditions  can cause sweat to evaporate so quickly, you don't even know you've been sweating. The risk for heat stroke increases with outdoor temperatures above 100 degrees Fahrenheit and with physical activity. Outdoor running is not recommended when it is above 85 degrees. Luckily for me, I wasn't too far from my car when I became sick.

How do you know if you might have heatstroke?
 The symptoms include: Mental status changes such as confusion, agitation, slurred speech, irritability, delirium, seizures and coma. Physical symptoms including nausea and vomiting, flushed skin, rapid breathing, racing heart, and headache.

How do you treat heatstroke?
Rapid cooling techniques include cold water or ice baths, cooling blankets, getting into an air conditioned space, drinking water, getting out of the direct sunlight, and cooling the skin with water and fanning. Severe cases of heatstroke require emergency intervention.

Fortunately, I got to my air conditioned car and found some extra water inside. If I had been hiking even 30 minutes longer, I wonder if I might have collapsed. It was a sobering experience, and one that taught me not to repeat it.

This is what I've done to avoid future heatstroke:
  1. Do not do strenuous exercise outdoors when the temperature is >85 degrees.
  2. Do not stay outdoors for prolonged periods of time when the temperature is > 100 degrees.
  3. Drink lots of water in the heat. Two to four glasses per hour may be necessary.
  4. Have a plan to escape the heat if necessary (a body of water, or air conditioned or shady space nearby).
  5. Wear sunscreen, wide brimmed hats, and breathable clothing in light layers.
For more information about heatstroke, check out the Mayo Clinic website:


If you have any questions about heatstroke, please log into your account and send us your question. We are here to help.  If you'd like to ask Dr. Val for a health tip, email your request to us at:

Dr. Val Jones MD - Health Tip Content Editor

Friday, July 21, 2017

Health Tip: C. Diff Diarrhea And Stool Transplantation?

Clostridium difficile (known as 'C. Diff' for short) is a species of bacterium that can cause severe diarrhea requiring hospitalization. This bacterium normally lives in soil, water, deli meat, and human feces and we are exposed to it on a fairly regular basis. It may not cause symptoms until our normal intestinal bacterial colonies are disrupted by illness or antibiotics.

Our intestines have over 2000 different kinds of helper bacteria, all living in harmony when we are well. They assist in fermenting food and keeping out harmful bacteria. However, when we take antibiotics for an infection (such as pneumonia, skin, or urinary tract infections) the medicine kills the bad bacteria curing those infections, but at the cost of many "friendly fire" casualties in our intestines. This allows the C. Diff to reproduce rapidly, manufacturing toxins that trigger diarrhea by infecting the intestinal lining.

Many of the risks of a C. Diff infection are the same for any severe diarrhea: dehydration, kidney failure, ruptured colon wall, and in rare cases, death. It is more common to catch C. Diff after taking antibiotics (especially fluoroquinolones, cephalosporins, penicillins and clindamycin), or being in a hospital (because many patients take antibiotics there). It is 10 times more common in people over the age of 65.

Symptoms usually develop 5-10 days after starting a course of antibiotics. Symptoms can be mild (watery stool, 2-3 times a day) or severe (diarrhea 10-15 times a day wi
th fever, dehydration, nausea, swollen abdomen, or blood or pus in the stool). C. Diff has a characteristic foul odor that is familiar to healthcare workers caring for patients with this infection (I can usually tell if someone has C. Diff when I walk into their room. Ew. I know). You should see a doctor if you have three or more watery stools a day and symptoms lasting more than two days or if you have a new fever, severe abdominal pain or cramping, or blood in your stool.

There is a new strain of C. Diff emerging that is resistant to some antibiotics. Fortunately there aren't any strains (yet) that are resistant to all antibiotics. Those who catch C. Diff have a 20-30% chance of being re-infected from within. These bacteria produce spores (a reproductive structure with a shell-like coating) that can live on dry surfaces from weeks to months. The spores are immune to alcohol-based cleaning agents, but are destroyed by soap and water or bleach.

C. Diff is contagious, but spread can be avoided by careful hand washing, clothing and bedding laundering, and bleaching of all surfaces that may have come in contact with the infected individual. Pro-biotics (found in acidophilus tablets, yogurt, fermented cultures, and Kefir) may prevent C. Diff infection by shoring up the helper bacteria numbers in the gut. C. Diff can be killed by strong antibiotics such as Flagyl or Vancomycin, but they may have unpleasant side effects such as severe nausea and a bitter taste.

Fecal transplants are an emerging treatment for severe cases of recurrent C. diff infections. This involves re-populating the intestines with gut bacteria from another person. It is not yet approved by the FDA because it is hard to be certain that these transplants are free of unwanted infectious agents and viruses, though donors can be screened. Perhaps one day in the future, those of us with exceptionally healthy bowels will volunteer to be stool donors. If the Red Cross has blood banks, will they also eventually have stool banks?

Although you may shudder at the prospect of stool banks, they may be life-savers for those with chronic or resistant C. Diff infections.  Until then, I wash my hands with soap and water and eat yogurt (with live cultures) every day - to keep the C. Diff at bay!


If you have any questions about bacteria, please log into your account and send us your question. We are here to help.

Dr. Val Jones MD - Health Tip Content Editor

Friday, July 14, 2017

Health Tip Reader Question: What is Bursitis?

Did you know that our bodies have mini "air bags," located around our joints (the largest ones are in the shoulder, elbow, and hip) for protection? They are not actually filled with air - they are filled with fluid and are called bursae (plural). But they are designed to keep the joints buffered from impact. Sometimes these sacs become inflamed - usually from trauma or overuse.

When a bursa (singular) becomes inflamed, it's called "bursitis" - and it can look swollen due to expansion with extra fluid. So long as it doesn't also become infected, the treatment is rest and anti-inflammatory medications such as naproxen or ibuprofen. In chronic cases (longstanding bursitis), doctors will sometimes give a stronger anti-inflammatory - such as a steroid injection.

When a joint is infected, it usually becomes very red, warm to the touch, and the pain can be disabling. The infection can get into the blood stream and cause a fever.  If you think your joint may be infected, it's important to see a doctor right away.

Otherwise, if your "air bag" is acting up, the best thing to do is rest it and give it time to heal. Bursitis can be confused with arthritis (inflammation of the joint surface itself, not it's air bag) but bursitis is more likely to resolve, while large joint arthritis doesn't improve much without intervention (such as surgery) because the cartilage is permanently damaged.

For more information about how to tell the difference between bursitis and arthritis, check out the Mayo Clinic website.


If you have any questions about bursitis, please log into your account and send us your question. We are here to help. If you'd like to ask Dr. Val for a health tip, email your request to us at:

Friday, July 7, 2017

Sunglasses: Fashion or Function?

Sun safety - describes a range of behaviors that include wearing wide brimmed hats that cover the face and neck; the correct use of sunscreen of at least sun protection factor (SPF) 15 and limiting sun exposure during the hours of peak sun intensity, 10:00 AM to 4:00 PM. One other important "sun safety" issue is wearing sunglasses that filter out ultraviolet B (UVB) and ultraviolet A (UVA) light. Wearing sunglasses is so important in fact that it can be considered to be the "suntan lotion for the eyes." Let's look at some of the detrimental aspects of sun exposure to the eyes and important features in sunglasses for eye protection.

Dangers of sun exposure to the eyes
Ultraviolet light from the sun has been linked to the formation of cataracts, macular degeneration, skin cancer on the lids and pterygium, an abnormal growth on the eye's surface. Cataracts develop when proteins in the lens of the eye clump together, clouding the vision. Even though cataracts appear to different degrees in most individuals as they age, their development appears to be enhanced by exposure to UVB. Macular degeneration is the leading cause of blindness in the center portion of the visual field in the U.S. There is conflicting evidence as to whether exposure to sunlight contributes to the development of macular degeneration, but at least one study has shown that people who stay outside in the summer sun for more than 5 hours a day in their teens through their 30's are twice as likely to develop macular degeneration later in life. Just as in other areas of the body in which sun exposure increases the risk of skin cancer, melanoma, basal cell and squamous skin cancers can develop on the skin around the eye if not protected. A ptyerygium is a growth that develops on the white portion of the eye that can extend over the the pupil and obscure vision. These appear to develop as a result of prolonged UV exposure also.

Factors that increase your UV exposure, also increasing your likelihood of developing sun-related problems include: spending time on snow, sand or on the water, being outside at higher elevations or closer to the equator, staying outside between the hours of 10 AM and 4 PM and prolonged sun exposure, particularly in the Spring and Summer.

Will sunglasses prevent these problems?

 Sunglasses serve two major functions. They decrease the amount of sunlight reaching your eye for comfort and protect your eye and surrounding structures from the devastating damage of ultraviolet light. By wearing sunglasses regularly, you can decrease your risk of sun-related damage significantly.

 The following features will help you to select a pair of sunglasses that are both protective and appropriate for your needs.
  • Be sure that your sunglasses block 99-100% of UV light. Both plastic and glass lenses can be coated to so that they block essentially 100% of UV rays. This information should be available on the label.
  • The color or darkness of the lens has nothing to do with its ability to block UV rays as the UV coating is colorless. Color choice is personal decision. Green and gray lenses produce minimal color distortion and are probably best for all-round use. Brown offers high contrast and depth perception but does distort color. Vermillion lenses are best for defining water from other objects but distort color badly. Many skiers prefer "blue blocking" sunglasses (typically amber in color) which provide the best contrast in snow and haze.
  • Polarized lenses are the best for reducing reflected glare such as sunlight that bounces off of snow or water. Polarization, however, does not have any relation to blocking UV radiation. Wrap around sunglasses will help keep light from shining into your eyes from around the frames. During active sports, they provide some added degree of protection.
  • Photochromatic glasses will change from light to dark, depending on the amount of UV radiation that they receive. While most of them offer good UV protection, it can take time for them to "adjust" to different light conditions.
 Final considerations
  1. Remember that sunglasses are necessary even on cloudy days. Clouds might provide shade, but they are no barrier for UV light.
  2. You need sunglasses even if your contact lenses offer UV protection. A high quality lens can only protect the area it covers, and the entire surface of your eye needs protection.
  3. Children who cannot tolerate sunglasses should wear a wide-brimmed hat, which will provide some UV protection.
  4. Do not be misguided by higher priced sunglasses which may be oriented to fashion, not UV protection.
  5. With sunglasses, you can have it both ways. An attractive pair of sunglasses can also provide adequate sun protection. Be a "label reader" and make sure that your lenses offer the protective features mentioned above.
If you have any questions about sun safety, please log into your account and send us your question. We are here to help.

Monday, July 3, 2017

Reader Question - What is Anemia?

The term "anemia" is quite broad, and simply means that there is a problem with a person's red blood cells (sometimes there are too few, sometimes they are malformed). Red blood cells are manufactured in the bone marrow and are basically tiny sacks of oxygen-carrying hemoglobin molecules (centered around an iron atom) that circulate through the blood stream and release the oxygen gas wherever needed along the path back to the heart and lungs. Extra red blood cells are stored in the spleen. Red blood cells make up 25% of all cells in the body, and are constantly being replenished.

When there isn't enough oxygen being carried to the tissues, all the typical symptoms of anemia can occur: fatigue, dizziness, rapid heart rate (the heart is trying to compensate for the low number of red blood cells by pumping the ones it has around faster – this can lead to irregular heart rates or arrhythmias), chest pain, shortness of breath, and pale skin.

What causes anemia?
The most common cause of anemia is bleeding. If your red blood cells are leaking out of your arteries or veins, then there are fewer of them being transported inside the blood vessels. Sudden losses of blood (that can occur with gunshot wounds or traumatic accidents) cause anemia, but slow, chronic losses of blood (such as a stomach ulcer, or heavy menstrual periods) can do the same but go undetected. The other causes of anemia are less intuitive, and can be difficult to diagnose. Hematologists are specialists in anemia and blood disorders, and are often consulted in cases where the primary care physician hasn't uncovered the cause of anemia. Blood tests that determine the size and shape of the red blood cells, along with kidney function, liver tests, and iron, folate, and B12 levels can be helpful.

Red blood cell destruction: sometimes mechanical heart valves or devices inserted in the heart to help it pump can "chew up" red blood cells over time, creating lower levels of them. Some genetic diseases cause the bone marrow to produce weak or odd-shaped cells that break open easily and don't last as long as regular red blood cells (which survive about 4 months). Examples include thalassemia and sickle cell anemia.

Red blood cell production suppression: certain medicines (especially chemotherapy and antibiotics), toxins (such as alcohol), and infectious diseases (such as HIV), can cause "aplastic anemia" by suppressing their production in the bone marrow.

Iron deficiency is a common cause of anemia. Just as thyroid glands can't make thyroid hormone without iodine, bone marrows can't make hemoglobin without iron. Iron is found in certain foods (red meat, pork, poultry, seafood, beans and peas, dark green leafy vegetables, dried fruit, such as raisins and apricots) but unlike iodine (which is added to table salt to prevent deficiencies, and table salt is added to virtually everything we eat), iron is only added to a few foods, such as fortified cereal, bread and pasta. So it's easier to become deficient in iron than it is in iodine, at least in the United States.

Other diet deficiencies of folic acid (folate), or vitamin B12 can prevent your body from making enough red blood cells. Your body also needs small amounts of vitamin C, riboflavin, and copper to make red blood cells.

Kidney disease: the kidneys actually produce a hormone (called erythropoietin) that stimulates red blood cell production in the bone marrow. When kidneys are injured or sick, anemia can occur.
So if you are diagnosed with anemia, it is very important to determine the true underlying cause or causes, so that it/they can be treated effectively. I've seen some of my physician colleagues treat all their anemic patients with iron supplements (since that is probably the second most common cause of anemia) rather than ordering further testing to make sure that this is the right solution. As you can see, anemia can be a sign of anything from a dietary deficiency, to internal bleeding, to medication toxicity, infection, alcoholism, kidney disease, or a genetic condition. If you have been diagnosed with anemia that has not responded to iron supplements (which, by the way, can cause some pretty nasty constipation), you might want to consider further testing or a second opinion from a hematologist.

TThe good news is that we have excellent treatments for anemia, and most people will feel much better once the right treatment is initiated.

If you'd like to ask Dr. Val for a health tip, email your request to us at:

If you have any questions about anemia, please log into your account and send us your question. We are here to help.