LEAVES OF THREE, LET IT BE!!

Ah, Poison Ivy.

photo from Glaxo Dermatology

It's that time of year that our offices become flooded with patients with lines and streaks of the angriest rashes we can see with patients scratching uncontrollably until they bleed.  There is often confusion just how patient's get this blistering rash, so let's go over a few key points.

1. POISON IVY, POISON OAK, AND SUMAC are just that, poisonous plants.  They contain an oil called URUSHIOL that is the poisonous part and is present in the plant LEAVES, STEMS, AND ROOTS.
***Poison Ivy has 3 leaves
***Poison Oak has 3 leaves                                
*******Poison Sumac has 7-13 leaves

POISON OAK
photo from Glaxo Dermatology

2.  Poison Ivy is NOT CONTAGIOUS IN ANY WAY!!  You cannot get poison ivy from the blisters of another person.  The rash and blisters are YOUR skin's reaction to the oil, and the blisters do not contain the oils.  Dogs do not get the RASH associated with poison ivy, but they can carry the oil in their fur.  You can also come in contact with it from your clothing or gardening tools.

3.  The plant particles CAN BE AIRBORNE.  If your neighbor is burning the leaves, the plant particles can become airborne and land on your skin.  On average, the rash begins 12 to 72 hours after exposure. 

4.  85% of people will react to contact with poison ivy.  You are not ALLERGIC to it.  Do NOT list it on your medical intake forms AS AN ALLERGY.  It is a poisonous plant.  The severity of the reaction can depend on the amount of oil you were exposed to and for how long it was on your skin. With subsequent exposures over a lifetime, the sensitivity of a person to the plant usually decreases.

TREATMENT TIPS IF YOU SUSPECT EXPOSURE

-Wash your body and clothes off with warm water thoroughly and quickly
-Wash your body and clothes off very quickly
-Take a bath and wash the oil off quickly
-ARE YOU SEEING A THEME HERE!!
-Topical hydrocortisone (Cortaid) can help with itching and rash
-See your dermatologist for treatment.  Often times patients do need oral medications like Prednisone. Medrol dose packs (that 5-4-3-2-1 steroid pill regimen) that are commonly prescribed are not always sufficient in dose or duration and patients will still struggle with the rash or the itch for longer periods of time than needed.  That is where it is beneficial to see a dermatologist that treats skin all the time.

LEAVES OF THREE,
LET IT BE,
BUT IF YOU CAN'T,
COME SEE ME!!

In good health,

Kris

Should My Kids Be Drinking Hydration Products?

Should my child drink Gatorade/POWERade/Favorite Sports Drink??

One of the most popular questions I get from parents in general is "what do you think about the POWERade, Gatorades, or fill in your favorite sports designer drink."  What a great question and I'm going to keep this short and sweet. Gatorade was originally formulated for ADULTS. Although the designer drinks have become very popular, I just don't believe that they need to be in the drink dispensers at our schools or brought to your child's 50 minute soccer game period. They just don't need it.

Hydration Rules of Thumb

This is based on research and training from Nancy Clark, sports nutrition guru:

- Fitness exercisers (those who exercise 30-60 minutes, 4 days a week) can mostly hydrate and rehydrate with plain old water, milk, orange juice etc.

-Endurance athletes depending on their sweat rate, intensity, and duration of exercise,  may need to replete hydration with electrolytes but determining exactly how much of the electrolytes is a science that needs to be prescribed by a dietitian who specializes in sports nutrition. The sports drinks in the grocery store are not individualized enough.

-Children, who mostly fall under the fitness exerciser category, would do much better rehydrating with water. If they exercise for longer than an hour and have a high sweat rate, I'd rather they focus on whole foods to obtain the potential electrolytes they've lost.  Remember those orange slices our parents used to bring to baseball and soccer? They were on to something.

Electrolytes lost in sweat

The American Council of Exercise approximates that the average person loses 500 mg of sodium per pound of sweat. Think about this. One pound of sweat. How in the world do we determine the percentage of weight lost is sweat?  Either way, Gatorade provides 165 mg of sodium and 45 mg of potassium per 12 oz of its product and PowerAde provides 150 mg of sodium and 35 mg of potassium per 12 oz of its product. How can we even determine that this is the need or that this will satisfy your need? Sounds like a crapshoot to me.

The Dangers of Sodium/Water Disruption

Sodium and water have a relationship.  Sodium retains fluid and regulates how much water stays in and around your cells. If you eat or drink too much sodium, you can run the risk of retaining too much fluid which can put stress on your organs. At the same time, if you over-hydrate you can dilute the sodium in your body. If your blood sodium levels get below a certain number, you run the risk of this serious medical condition.  Signs and symptoms are nausea, vomiting, headache, confusion, extreme fatigue, muscle spasms, seizure, and even coma. Although this is a rare condition, we do see this more and more at sporting events when an athlete over hydrates.

The Verdict:

Don't give your children a product that wasn't designed appropriately for them. Do you give your kids your multivitamin or allergy medication? Of course not! Then why would you give your children a product that may have more of something they need (and I'm not just talking the electrolytes here). Encourage your children to drink water and if they are a sweater or you feel they run the risk of dehydration visit with a dietitian or your PCP. We can determine a prescription that will be safe for them.

Disclaimer:
There are many hydration products on the market. I chose the two most popular and widely known to talk about in this blog. Please keep in mind that most hydration products, unless created for children, are designed for adults. Although he products are not designed for children they market heavily to the young athlete. Let's start giving the board of education hell about making these unnecessary products so accessible!

In Good Health,

Amy

STAY HYDRATED

I always tell my clients I feel hydration is one of the four most important nutrients for your body. It doesn't create calories or ATP (energy) like the first 3 components (macronutrients) but without appropriate hydration your body plain and simple suffers. As with nutrition, there's lots of confusing recommendations on hydration so let's start with some basics. 55 to 70% percent of an adult's total body weight is water. 

 Once we lose 1% of our total body's water weight we see psychological and physiological changes in our body, BUT we don't actually feel thirst until we've lost 2-3% of our total body's water. 

Without appropriate water we cannot appropriately:
* Regulate internal body temperature
* Metabolize macronutrients secondary to decreased saliva which houses our        enzymes
* Flush toxins from our body through urine
* Dissolve and absorb vitamins and minerals 
* Transport nutrients 
* Absorb shock from the brain, spinal cord, organs, and fetus
* Lubricate all of our joints

Remember those physiological changes I spoke to with a 1% loss of our total body weight? When we become dehydrated our blood becomes thicker which puts us more at risk of clotting and it becomes harder for us to pump our blood through our bodies. This results in high blood pressure, high cholesterol, and potentially heart disease. Other complications with dehydration include:

*heat stroke
*seizures
*extremely low blood pressure which can result in low blood volume shock
*Kidney Failure (which occurs when your body can not remove waste from  blood)

I know this sounds so clinical, but when you think about the importance of hydration it is not a surprise that nobody can live more than 3-5 days without any water intake. (Source: Montain et al. (1999). Mil Med 164 : 502-508)

So how much water do we need? The average recommendation is to drink 8 8-ounce glasses of fluid a day. Please note this is individualized and a starting guide for AVERAGE adults. All fluids count towards this number. I personally tell my clients to start here and monitor the color of their urine which should be a pale straw color.  Click here to view the Cleveland Clinics urine chart. When you exercise you should expect to need 1.5-2.5 more cups of water but please note there's a science behind that and that's a whole other blog that will include information on hydration products and more! It is possible, although rare, to over hydrate so it's important to be in touch with your body and it's thirst regulator.                   

For now focus on getting your 8 8 ounces of fluid a day. In addition to drinking fluid you can also hydrate your body through the following foods which are 85-96% primarily water:

Ice Berg Lettuce             Zucchini                         Strawberries
Red Tomatoes                Cucumber                      Watermelon
Radishes                       Sweet Peppers                Peaches
Pineapples                     Apricots                         Oranges
Raspberries                   Cranberries                    Grapefruit
Cantaloupe                    Cauliflower                     Spinach

Signs of dehydration are dry sticky mouth, fatigue, thirst, decreased urine output, no tears when crying, dry skin, headache, constipation, dizziness, rapid heartbeat, rapid breathing, low blood pressure, and fever. Remember, by the time you feel the symptom of thirst you've already lost 2-3% of your total body's water. So refuel appropriately!

My word to the wise: Start monitoring your urine and thirst symptoms and work directly with your physician or dietitian if you are confused on how much hydration you need. Healthy hydration is an important factor for a healthy metabolism, healthy heart and more!



Hydration for the skin!  What the heck am I talking about?  It took me several years and treating thousands of patients to realize just how important skin hydration really is.  Patients know that washing their face is important, but how can we keep that water in our skin?  

It is estimated we lose 10cc of water from our face every year after the age of 30.  That is why women spend billions of dollars worldwide on fillers to plump that skin back up.  Fillers are not collagen, they are hyaluronic acid that is a hydrater that holds on to water and helps to stimulate our own collagen. Hyaluronic Acid is a miracle product, and guess what....WE ALREADY MAKE IT IN OUR BODIES!

So what is a good moisturizer?  Not all brands are the same.  When patients examine the skin care aisle at Walmart, it's all about the pretty bottles, the colors that catch your eye, and the bold text saying "Acne Fighting," "Flawless Face," and "Clear Skin".

We all want flawless beautiful skin, but a $12 bottle of lotion is not the only thing that will get you there, or is it?  If patients add a good moisturizer into their skin regimen every day, they can slow down oil production and in turn reduce breakouts and redness.  You don't need apricot scrub, $500 skin care systems, or expensive department store miracle creams.  Don't spend hundreds of dollars on the next miracle, just talk to your dermatologist about the right regimen for you and what your skin needs.

Some of my favorite hydrating moisturizers are prescription strength because they contain higher levels of  Hyaluronic acid and Ceramides.  You can find brands over the counter like Cerave that are great too.  Don't always trust labels that say non-comedogenic or non pore clogging.  Look at the ingredients or ask your dermatologist.  Avoid moisturizers with coco butter, petrolatum, or coconut oil.  All organic doesn't necessarily mean good for your face either (that blog is coming).  

I prescribe less antibiotics and strong topical retinoids for acne currently than I ever have. I stress to patients the importance of good hydration and cleansing, and I make recommendations of good moisturizers and their acne, eczema, rosacea, and CONFIDENCE really improves.  

Below is an image of an eczema patient before and 2 weeks after using only a prescription moisturizer.  No steroids or antibiotics. 

photo credit: Exeltis USA Dermatology, LLC.

THERE IS AN ENTIRE FIELD OF MEDICINE DEDICATED TO SKIN AND KNOWING WHAT IS BEST FOR IT!  YOUR SKIN IS YOUR PROTECTION FROM THE WORLD, SO TREAT IT WELL. 

In good health,

Amy & Kris

Go heavy on the Metals!

Zinc, Zinc, and more Zinc

I'M SETTING THE RECORD STRAIGHT ON SUNSCREEN.

The FDA recently changed their guidelines for labeling of sunscreens in the United States and for good reason.  It's not necessarily the brand of sunscreen to be concerned with, but the components.

Myth #1:  Sweat-proof, water-proof, all day protection.  NOT true statements and patients are getting into serious trouble with first and second degree burns on their skin.

Myth #2:  SPF 100 will protect 100% or for 100 minutes.  Nothing is 100% and it depends on your skin type and activity.  If you are in and out of the water or running on the beach, you will need to reapply sooner.

Myth #3:  I am wearing a t-shirt, so I am good.  100% cotton is equivalent to an SPF of 10.  You will still get absorption of UVB through your clothing.  Hence why UPF factor clothing exists.  Sun protection built into the clothing we wear, GENIUS.  Main point to is to make sure you are applying your sunscreen naked.  Don't get into your bathing suit and then apply; you will miss spots.

Myth#4:  Cream and spray are the same.  Pt's get into trouble with aerolsolized sprays, especially when they put them on outside at the beach and the wind is blowing the sunscreen onto the family next to you.  Some sunscreens are thick and white and hard to apply...ding, ding, ding.  There is a reason for that: PROTECTION. The pump sprays are fine.  Some of my favorite sunscreens are show in the picture above.

Myth #5: Chemical sunscreen and physical sunscreen are the same.  Zinc oxide 11-12% and titanium dioxide are the physical blockers that will protect much more effectively.  Sunscreens like Avobenzone and Oxybenzone absorb the UV rays and release them.  Zinc and Titanium reflect the UVB so that it can't penetrate the skin at all.  It is difficult to aerosolize the two metals, so most aerosol sprays do not contain the metals (but some are starting too)!!
Patients say "I just burn no matter what I do; I use spf 100 and still burn."  It is probably because their sunscreen brand does not contain Zinc or Titanium, they are using a spray instead of a cream, or they are not reapplying often enough.  Below is a graph showing the superior protection of Zinc to UVB and UVA rays.

photo by Blue Lizard Sunscreen

New reports from the Environmental Working Group have surfaced about the hazards of sunscreen and absorption into the skin could potentially be cancer causing. It would take 277 years of daily sunscreen use to achieve any harmful level of oxybenzone (the sunscreen component tested) in your body. (Schulumpf M, Schmid P, et al. Endocrine Activity and developmental toxicity of cosmetic UV filters-an update. Toxicology 2004; 205: 113-22.)

Amy is going to tell you all the benefits of zinc inside of the body, but my take home point for now is that:

WE KNOW UV RAYS CAN CONTRIBUTE THE RISK OF MELANOMA AND MELANOMA IS A CANCER THAT IS FATAL, SO STICK WITH WHAT WE KNOW AND USE SUNSCREEN.  STUDIES HAVE PROVEN THAT SUNSCREEN PREVENTS CANCER.  THE BENEFITS FAR OUTWEIGH THE RISKS.

Let's face it, who is talking about Zinc when we can focus on all those miracle products out there. Most think of zinc as a boost to help the common cold in the form of Lozenges or Zicam and also as a wound healing element in the clinical side of the medical field but there are so many more important functions of Zinc.  I bet you are shocked to know that Zinc can treat symptoms of night blindness and cataracts, Diabetes, Asthma and many skin conditions such as psoriasis and eczema. 

There is also lots of compelling research that proves zinc can be used as treatment for ADHD, bland taste buds, promoting weight gain in Anorexia Nervosa patients, Alzheimers, and Irritable Bowel Disease.   I am not one to recommend supplements when not needed as it just creates expensive urine, so let's talk about deficiency symptoms.     
                                                                                                                                                                
If you routinely suffer from low Insulin levels, loss of appetite, irritability, generalized hair loss, dry skin, dermatitis, poor sense of taste and smell, diarrhea, and nausea you could not be consuming or absorbing the amount of Zinc your body needs to function.  Although the symptoms above can also be caused by other circumstances, I have recently decided to recommend Zn checks on all of my picky eaters (super tasters/smellers), Anorexia Nervosa patients, and IBD clients. The research is that impressive, and it takes a lot to impress me with what's printed these days.                                                        

I will always promote getting your vitamins and minerals from whole foods so consume these:

meats
seafood
dairy products
nuts
legumes
whole grains                                                                                            

If you feel like you are at risk of a zinc deficiency because you don't eat much of above, don't worry. Zinc is a trace element so we need very little of it, BUT if you consistently have some of the symptoms I discussed above, talk to your provider or work with a dietitian. I'm not a fan of supplementing on your own.     
                                                                                                               
My thoughts on Zinc: If you are a picky eater or have a picky eater who may be a super taster or smeller, if you are suffering from Anorexia Nervosa or ADHD, and if you suffer from chronic diarrhea, look at your diet, pay attention to your symptoms, and treat in conjunction with your provider.

Pair that symptom relief with Cancer prevention and you've got a home run!

              
In Good Health,

Amy and Kris

The Big "C"

DISCLAIMER: This post contains graphic images and is not for the faint of heart or stomach!

If you read our last post on Vitamin D, but still feel the need to get your "D" from the sun, let me talk to you about the Big "C".......CANCER!

1 in 5 Americans will develop skin cancer in their lifetime. I am always surprised at how many patients just don't think it will ever happen to them.  Some patients just chuckle when I ask if they use sunscreen like I am asking them if they ever met the Pope.

Not all skin cancer is terminal, so when patients get basal cell carcinomas from the sun (UVB exposure), they don't think it's such a big deal!  Well, unless it's on your face....

photo source: James WD, Berger TG, Elston, DM. "Mohs Surgery" In:Andrews' Diseases of the Skin, 11th ed. USA. Saunders Elsevier:2011.

The above image is a young female patient with a basal cell on the left side of the nose. This picture was taken in surgery right after the cancer was removed before the stitches were done.  

The left side of the face gets UVB exposure primarily from being on the driver's side window of the car. For those of you with long commutes, you are accumulating UVB exposure every time you get behind the wheel. 

Also, think about the sun exposure during simple tasks like:

*walking between buildings at work

*sitting at your kids' baseball games

*walking the dog

*getting the mail

The radiation from the sun builds on itself year after year.  Even if you had burns years ago as a kid or used a tanning bed as a teenager for the prom, you are still at higher risk for skin cancer.

Pictured below is a male patient during a surgical procedure for removal of a skin cancer on the top of his head.  This image depicts how a quarter size skin cancer can turn into a much bigger scar due to the area on the body that is affected.  

photo source: James WD, Berger TG, Elston, DM. "Mohs Surgery" In:Andrews' Diseases of the Skin, 11th ed. USA. Saunders Elsevier :2011.

CLICK ON THE LINK BELOW FOR INSTRUCTIONS ON REGULAR SELF SKIN EXAMS:

How to Detect Skin Cancer

The biggest thing I tell patients to look for is change.  Patients know when a mole has been there since they were a kid or if something is new.  

Here are a few questions I get asked all the time:

1.  Will a base tan keep me from burning? 
Answer:  NO-A base tan is already an absorption of the UVB radiation. Tanned skin is the result of the UVB radiation pulling the colored cells of your skin to the surface to protect itself; it's your bodies' defense mechanism. Short, intense periods of radiation (like a tanning bed) increase the risk of skin cancer significantly.

2.  Are self tannner or spray tans safe?
Answer: YES-self tanner is the way to go if you want to give some color to your skin.

3.  Do I only need a skin exam if I notice something?
Answer: NO-Annual skin exams with your dermatologist are an important way to track your moles and help you to know when something has changed or doesn't look right. Dermatologists compare exams to the previous year. At my office we have 3-D image capabilities in our electronic record so we can place and record exact size, shape, and location of moles.

SO NOW THAT YOU ARE FREAKED OUT......

STAY TUNED FOR NEXT WEEK ON PROPER USE OF SUNSCREEN AND BE PREPARED TO "GO HEAVY ON THE METALS!!"

In good health,

Kris & Amy



statistics and skin exam link are from spotskincancer.org and the American Academy of Dermatology