Acne affects 85% of the adolescents in the United States!  Skin-care products, doctor visits, and prescription drugs cost Americans over 2.2 billion dollars annually.

 PREVENTION:

By far, most cases of acne are inherited!   Having a first-degree relative affected by acne is the greatest risk factor.  There are no high-quality studies showing that skin-care products or diet can prevent acne.  However if chocolate or greasy foods seem to make it worse, then it would be wise to avoid those foods.  Also, good personal hygiene is also advised.  For example, washing acne-prone areas twice a day and using only oil-free (non-poreclogging) skin-care products.

A friend of mine recently returned from India. She was concerned about some red itchy “pimples” on her waist. She asked me if she had gotten bitten by bed bugs. (ugh)The Harvard School of Public Health has a wealth of information on many things- including bed bugs.I ran across a blog devoted to bed bugs- bedbugger.com. This is an amazing resource if you are unfortunate enough to have this problem. The photos are great and the advice and tips are extremely informative.WedMD also has an article called “Don’t Lose Sleep Over Bed Bugs“. Check out the bed bug slide show.Not something you want to read about before bedtime!

Here’s some excellent practical advice for weight loss- keep a diary!

Check out Dr. Gwenn’s practical advice. The study was published in the August edition of American Journal of Preventive Medicine.

I am going to highlight the clues in this case.

I got a phone call from a good friend this weekend. She was miserable! It all started a few months ago. She was having brief, intermittent episodes of abdominal pain. The pain was in her upper abdomen and would last about an hour. Nothing, including antacids, relieved the pain. It usually occurred after eating and sometimes at night.

This weekend, the pain was unrelenting. It radiated around to her back on the right side. She was nauseous, vomited twice, and had a low grade fever.

She is a healthy 44 year old woman, happily married with three elementary aged children. She does not smoke and rarely drinks alcohol.

Breaking it down will help us focus on the important points in this case:

• a healthy mom with a few months of intermittent right-sided, upper abdominal pain after eating
• now has constant pain with nausea/vomiting and fever

These are the clues and we are the detective. This is what makes medicine fun! We are using the clues to solve a mystery- just like Sherlock Holmes!

The clues from the story help us narrow down our list of possible causes of abdominal pain.

• Upper/intermittent abdominal pain:
  • Peptic ulcer disease (PUD)
  • Biliary colic (gallbladder)
  • Irritable bowel syndrome
  • Renal colic (kidney stone)
  • Mesenteric ischemia (blocked blood flow to the bowel)

• Constant/severe upper abdominal pain with nausea/vomiting/fever:
  • Biliary colic (gallbladder) (right-sided)
  • Renal colic (obstructing kidney stone)
  • Bowel obstruction
  • Pancreatitis
  • Mesenteric infarction (dead bowel due to lack of blood flow)

In general, a young healthy person experiencing “episodes” of right-sided upper abdominal pain either has biliary colic or renal colic. Once the pain became severe and constant with nausea and vomiting- it usually suggests obstruction of an organ (in this case, a gallstone or a kidney stone).

The pain, vomiting and fever are 3 very good reasons for her to seek immediate medical attention.

She did go to the emergency room. She had blood tests, urinalysis and an abdominal ultrasound. The ultrasound revealed gallstones and a thickened gallbladder wall surrounded by fluid. During the ultrasound, the probe was pushed against her gallbladder wall. This caused her to experience the exact same pain.

She was diagnosed with acute calculous cholecystitis. In English, that means she had gallstones (cholelithiasis) in her gallbladder and one of the stones got stuck in a duct (tube) coming out of her gallbladder. This blockage caused her gallbladder to become inflamed and painful. She underwent a laparoscopic cholecystectomy without any complications.

In a nutshell:

1. My friend had gallstones in her gallbladder (cholelithiasis).
2. In the past few months, she was having episodes of biliary colic. Biliary pain is most frequently caused by transient obstruction of the common bile duct or the cystic duct by a gallstone.
3. This weekend, one of the stones was stuck blocking the normal drainage of the gallbladder causing it to become inflammed/enlarged/tense/reddened with a thickened wall and surrounding fluid (as seen on her ultrasound).
4. She went to surgery and had the gallbladder removed.

Acute Calculous Cholecystitis is a common complication of cholelithiasis that affects 20 million Americans annually!

I hope this was helpful! Feel free to let me know what you think.

I got a phone call from a good friend this weekend. She was miserable! It all started a few months ago. She was having brief, intermittent episodes of abdominal pain. The pain was in her upper abdomen and would last about an hour. Nothing, including antacids, relieved the pain. It usually occurred after eating and sometimes at night.

This weekend, the pain was unrelenting. It radiated around to her back on the right side. She was nauseous, vomited twice, and had a low grade fever.

She is a healthy 44 year old woman, happily married with three elementary aged children. She does not smoke and rarely drinks alcohol.

What should she do next?

The Genetic Information Nondescrimination Act (H.R. 493) was passed by Congress in May 2008.

This new federal law prohibits health insurers and employers from requesting or requiring people to take a genetic test. The health insurance provisions will go into effect in 12 months. The employment provisions will be effective in 18 months. The law includes all of the provisions that were recommended by the American College of Physicians. It does not address the possibility of discrimination for life insurance or long-term disability insurance.

There are about 1,200 genetic tests available. For more information about genetic and rare diseases, visit the National Human Genome Research Institute website. You can learn about genetic disorders, testing, counseling, research, prevention and treatment options. Check out all of the clinical trials that are currently in progress. You can even create a personalized family health history report. This tool can help you develop disease prevention strategies for you and your family.

“Push hard, pump fast and have good recoil.” That is a recent quote from Dr. Persoff on the new CPR guidelines from the American Heart Association.

The “Hands-Only CPR” is recommended when an adult suddenly collapses.

The bystander should:

1. Call 911
2. Push hard and fast in the center of the chest.

Don’t be afraid!

Check out the website and the humorous videos! Tell everyone you know. You could save a life!

Hello everyone!

I just finished a great book- Road Map to Holland. I recommend it to anyone involved with a child born with any sort of disability. As a physician, mother and aunt of a child with special needs, this book touched me in so many ways.

The author, Jennifer Graf Groneberg, had one healthy son and wanted another child. She soon became pregnant with twins boys. A few days after the premature birth of her twins, one of them was diagnosed with Down syndrome. She shares with us her journey of initial shock, fear and anxiety. We witness, through the eyes of this loving parent, how our medical community addresses these types of situations. Our hearts reach out to Jennifer and her boys (including Tom, her husband). We watch her transform into an accepting parent who clearly realizes the gift she has received in all of her sons, each one having his own individual personality and talents.

I also had twin boys born prematurely, with an older son at home. Her book brought me back to my days in the NICU. Her raw honesty was both refreshing and painful. I relived some of my worst memories through her stories. I am amazed at how a NICU in Montana can be so similar to a NICU in Illinois. Or is it that postpartum, hormonal women view the world in a similar way?

Her book is filled with hope and love. She now writes a wonderful blog (Pinwheels) that is an inspiration and resource for all mothers/caregivers who are also trying to cope with a similar situation.

I am proud to be affiliated with an institution that has an Adult Down syndrome Center. It’s been part of my “charities” blogroll since I started this blog.

Thank you Jennifer for your wonderful book!

Have you read a great book lately? Feel free to share it with everyone in my comments section.

Our poor elderly gentleman has contracted scabies from visiting his wife in the nursing home!  

Scabies is a contagious skin disease caused by the mite Sarcoptes scabiei.  Nursing homes and child-care centers are perfect breeding grounds for these tiny parasites.  They are spread by prolonged skin-to-skin contact with an infested person.

The prominent feature of scabies is itching.  It can be severe and is worse at night.  The lesions are pimple-like and occur on the webbing between the fingers, wrists, elbows, knees and in skin folds.   

 Treatment:

There are several options available by prescription.  The first-line therapy is 5% Permethrin  cream.  It should be applied to the entire body from the neck down to the soles of the feet.  The cream should be removed 8 to 14 hours later by a bath or shower.  All bedding and clothing need to be washed and dried in a hot dryer.  Diphenhydramine (Benadryl) will help with the itching.  And of course, the nursing home will have to be notified!

Now that summer has finally arrived in Chicago, I am itching to give you a new case. Good Luck!

A 78 year old gentleman complains of itching every night for the past week. He is under an unusual amount of stress because his wife was recently placed in a nursing home after she had a stroke. He visits her daily. During the day, the itching rarely bothers him. At night, it becomes severe and disturbs sleep.

He has a history of high blood pressure, and has been treated with the same medication for the past 7 years without any problems. He is a retired accountant. He’s been married to his wife for 52 years. He has been living alone since his wife had the stroke 6 weeks ago. He still drives and buys groceries on his own. He does not smoke and rarely drinks alcohol.

On examination, he has small red lesions that are shaped like a pimple on various parts of his body. There are some between his fingers, under his arm pits and around his belly button. There are a few very thin reddish/brown lines that are about a centimeter long.

He desperately wants help because he wants to get back to his wife as soon as possible.

What is the most likely diagnosis? How should he be treated?