Hidradenitis suppurativa: hard to pronounce, hard to live with, and hard to treat

Dr. Crutchfield, my cousin had a skin problem where she developed pimples in sensitive areas that would get bigger, become painful, turn into boils and break. The areas would smell bad. She saw a dermatologist and was diagnosed with a condition called “hidradenitis suppurativa.” What is hidradenitis suppurativa?

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that may be caused by an inappropriate response of the body’s immune system.

No one knows for sure what exactly causes HS. One theory is that HS is the result of an abnormality in hair follicles. HS tends to occur when hair follicles become blocked, leading to a clogged hair follicle. When the follicle is blocked, pressure builds up in the follicle, causing a rupture and leakage to the sides of the follicle, deep into the skin. The leakage produces a response by the immune system to the material in the skin. The immune response is in the form of inflammation.

This cycle can repeat itself over and over and in many areas, producing a chronic medical condition. The lesions of HS appear as boils in the skin. The medical term for a boil is an abscess. The abscesses of HS can be mild, moderate, or severe.

  • Mild: This means a single abscess or a few abscesses that don’t connect or drain. They can be very painful.
  • Moderate: Commonly, several abscesses are widely separated. These are painful. They may connect and drain with pus and blood.
  • Severe: Multiple abscesses that are close together and cover large areas. These are painful and drain profusely. The common areas are the scalp, on the neck, around the ears, under the arms, under the breasts, in the groin, and on the backside. These areas coincide closely with hair-bearing areas.

HS starts as pimples in sensitive hair-bearing areas that enlarge and turn into large abscesses that can be extremely painful, connect and rupture, and smell foul. The connection between abscesses is called a sinus tract.

HS is an inflammatory skin disease. It is a chronic medical condition, meaning it lasts for a long time, maybe even a lifetime. Some people mistakenly think that HS is an infection. It is not an infection, but is actually a malfunction of one’s immune system.

There are a lot of misconceptions about HS. Here are some other things you should know:

  • HS is not the fault of the person who has it.
  • HS is not transmitted sexually.
  • HS is not caused by poor personal hygiene.
  • HS is not contagious.

What are the symptoms of HS?

The lesions of HS are boils or abscesses. They form under the skin in areas where hair grows and the skin may rub together. They are painful and fill with pus and blood. When they get big, the lesions can rupture and release a very foul-smelling fluid. The amount of fluid produced can be quite significant, and in severe cases they can drain all day long, causing the person to have to wear absorbent pads in the areas that need to be changed often.

Larger regions can connect by tunnels in the skin known as fistulas or sinus tracts. Over time some areas can form scars, and new areas can form. The constant drainage of bad-smelling drainage can lead to a foul odor that travels with the affected person.

As one could imagine, the condition is terribly embarrassing and can interfere or prevent normal personal social interactions, leading to an inferior quality of life. As a result, many dermatologists believe that HS is one of the very worst skin diseases to have.

In some cases, HS may temporarily subside, but it often comes back. It may start out as mild but rapidly progress to severe. Being overweight and smoking are two factors that can be managed and have an impact on the severity and progression of the disease.

Treatment

Physicians will recommend smoking cessation and weight reduction. In addition, these treatments are available:

  • Antibiotics (as anti-inflammatories, not to treat infection)
  • Steroids
  • Surgery
  • Hormone therapy
  • Immunosuppressant medications
  • Biologic medications

HS can be devastating for self-esteem and lead to profound depression. If HS is impacting social relationships, self-esteem, and/or depression, it is important to talk to experts in the fields of mental and sexual health. It also may be helpful to join a support group so you can share feelings and information with other people who have HS. 

For stubborn or severe cases, you should visit a dermatologist who specializes in HS. These dermatologists are medical doctors who have experience in diagnosing and treating inflammatory conditions of the skin. They understand what you’re going through and can recommend treatment options that are appropriate for you.

There are good treatments for HS, and no one should have to suffer from this terrible condition. Fortunately, there is an FDA-approved biologic treatment (named ‘adalimumab’) for HS.

To find a dermatologist who specializes in the treatment of HS and for a list of national support groups to join, visit www.noBSaboutHS.com.

That dry, itchy scalp might not be dry at all

Dr. Crutchfield, I seem to be having a problem with dandruff and a dry, itchy scalp, especially this winter. Can you help me?

Your concern over a dry, itchy scalp is a very common one. In fact, I see several patients every day with the same complaint.

I tell patients that when it comes to treating dry, itchy scalps, I have good news and I have bad news. The bad news is that there is no cure for the condition, but the good news is that it can be managed and controlled to the point where it seems like it does not exist.

The surprising fact is that the condition that everyone seems to think of as dry, itchy scalp is not dry at all. It is a unique type of eczema (also known as dermatitis) that makes the scalp seem like it is dry because it produces lots of flakes.

 The flakes are not a result of the skin being dry; rather, the skin grows too fast as a response to inflammation in the scalp. Sheets of skin pile up because they can’t be shed quickly enough. The inflammation is driven in part by the oil production or sebum in the scalp.

This massive amount of skin flakes tricks us into thinking it is dry skin when it really is not. It is a very common skin condition called “seborrheic dermatitis.” The condition is so common that it probably affects 25 percent of all people to some degree. It can occur on the scalp, face (especially sides of the nose), eyebrows, ears, chest, belly button, groin, armpits, and even the backside’s “gluteal cleft.” 

For now, I will only talk about seborrheic dermatitis when it occurs on the scalp. The familiar, non-medical name of seborrheic dermatitis when it happens on the scalp is dandruff. It is a common skin disease that causes the skin to be red, itchy and flakey.

Seborrheic dermatitis can wax and wane and appear and disappear at any time. Sometimes the condition will resolve without treatment, but more often than not it may require medical treatment.

Seborrheic dermatitis can occur in all people. In babies, it is commonly called “cradle cap.” It can also occur in a baby’s diaper area. It tends to occur most often in infancy and adulthood and in men more than women. It is more common among family members, in people with oily skin, and for some odd reason in people with Parkinson’s disease and HIV.

The condition is harmless and not contagious, although it certainly is a nuisance. The constant itching and abundant skin flakes can be extremely problematic and embarrassing. 

Interestingly, the exact cause of seborrheic dermatitis is still not completely understood. Perhaps the excess oil in our skin serves as a food source for yeast that commonly live on everyone’s skin. The yeast grow, and for some unknown reason some people have a brisk reaction to the larger population of yeast on the surface of the skin. This response comes in the form of inflammation (redness, flaking and itching).

The yeast component is only a part of the problem. The other part is purely genetic, and the common areas are prone to inflammation with or without yeast. The diagnosis can be made easily by an examination by a doctor, especially a dermatologist.

As mentioned earlier, there is no cure for seborrheic dermatitis. The goal is management and control of the condition until it is unnoticeable and no longer a nuisance.

For scalp seborrheic dermatitis, I have a two-part treatment plan. First, let me say that I am not a big fan of using a hair shampoo to treat a skin condition. I recommend a medicated oil applied once per week to reduce and maintain scalp inflammation. This part is the maintenance program.

Washing one’s hair weekly is also very important. I recognize that weekly hair washing may be a challenge for some, but it is essential to clean the scalp skin and wash away the dead skin and flakes that are continually building up.

Secondly, I have a very potent topical treatment to use for five days if the condition should flare up and break through the maintenance program. Three two-treatment steps work exceptionally well.

If you or a loved one has dry, itchy scalp, talk to your doctor to see if it really is the medical condition called seborrheic dermatitis. If it is, rest assured there are excellent treatment programs to make the embarrassing and troubling situation much better to the point of seeming not to be there at all.

Six tips for staying healthy in a world of germs

Dr. Crutchfield, it seems like everyone at work is sick. What can I do to protect myself from getting sick at work?

Here are some tips on protecting your health in the workplace in spite of all the germs that may be lurking there.
 


Tip 1: Wash your hands.
As you entered your office, you probably touched one of many common surfaces just teeming with germs. These common surfaces include elevator buttons, escalator railings, and door handles. Whenever possible after such contact, wash your hands for 15 seconds with warm, very soapy water.
I was at a professional sporting event this weekend and the men’s bathroom was extremely full. I counted 30+ people. I paid very close attention, and half the people did not wash their hands.

The ones who did attempt to wash their hands did so in such a poor manner that they really only wasted their time. Many just splashed or rapidly rinsed their hands under the water for less than five seconds. No soap. It was almost like a theatrical performance or a gesture of washing hands so as not to look bad in front of the other bathroom patrons. They did not engage in a significant, worthwhile, useful hand-washing event. 

Remember, you should engage in at least 13-30 seconds of hand washing with warm, soapy water. True story: When I did wash my hands, I did it properly, and the man behind me commented, “Dude, you’re washing your hands like you’re a doctor!” Wow, did that bring a smile to my face.
Also, be sure to keep a bottle of hand sanitizer handy. Make sure it contains at least 60 percent alcohol. It can be almost as effective as washing your hands with warm, soapy water.

When it comes to your desk, the area is mainly contaminated with your own germs, so they are unlikely to make you sick unless you brought germs in with you (as from doorknobs, elevator buttons) and did not clean your hands.

Also if you have other people who may work in your personal work area, like an IT person working on your computer, then you should clean your area. This is best done with commercially available disinfectant wipes. Keep these handy and use daily or whenever someone else works in your space or uses your computer.
 
Tip 2: Try not to touch your face.
This is much easier said than done, but with practice and concentration, you can minimize or decrease how much you touch your face. Studies have shown that most people touch their face 60-100 times per day, and some people even much more.
Your hands carry germs, and they can enter your body through your mouth, eyes and nose. Minimizing the number of times you touch your face will minimize how often you get sick.
 
Tip 3: Keep your distance.
Maintain a safe distance from your co-workers. You can’t control if your co-workers arrive sick, but you can control the distance between you. Most germs, including the flu virus, are unlikely to spread beyond three feet.
For good health, be sure to stay three feet away from co-workers, especially anyone who is sick. Wearing a mask may seem safe, but in most work environments it is not practical.
 
Tip 4: Sneeze into your elbow. 
In the old days, we were taught that when sneezing we should do so into our hands to prevent propelling germs into an aerosolized cloud that could contaminate those around us. Unfortunately, our hands subsequently touch many surfaces like telephones, coffee pot handles, refrigerator door handles, doorknobs, vending machine buttons, etc.
Sneezing or coughing into our hands just allowed germs to spread differently, not to mention transmission by shaking hands. Coughs and sneezes should be done into one’s elbow or a tissue.
 
Tip 5: Get vaccinated.
Vaccination is one of the best things that you can do for your good health. It protects you and also those around you, including people who can’t get vaccinated, like infants or those with weakened immune systems.
Sure, there are all kinds of cold medicines that can make you feel better if you are sick, but the best strategy is to prevent getting sick in the first place. Eat a healthy diet rich in fruits and vegetables that will help boost your immune system — and get vaccinated.
 
Tip 6: If you are sick, stay home.
You will recover faster at home and not spread your illness to your co-workers. The rule of thumb is that if you have a fever, do not go to work. If you are ill but not feverish and can work, this is the one time to wear a mask and keep your distance from coworkers.
 
Remember, you can’t completely eliminate getting sick at work, but you can do many things to minimize your risk of getting sick that will protect both you and your coworkers.

Carbon monoxide is a silent winter killer

Carbon monoxide is a very sneaky killer. The poisonous gas has no odor, no color, no smell, and no taste.

Carbon monoxide is a gas given off by everyday fuel-burning items that we regularly use. Usually, using appliances is not a problem, but if there is improper ventilation in an area where an engine or other devices are burning carbon monoxide-producing fuels, carbon monoxide can build up to dangerous levels. Humans in the area can breathe it in and become poisoned.

Breathing in smoke from a house fire can also cause carbon monoxide poisoning. Because carbon monoxide is odorless, colorless and tasteless, a person can be exposed to it and not even know it.

This situation is especially dangerous for people who are sleeping or intoxicated. Carbon monoxide poisoning can more easily affect unborn babies, children, elderly adults, and persons with heart conditions.

The way carbon monoxide poisons a person is that the carbon monoxide molecule binds to hemoglobin in our blood, preventing the usual binding of oxygen to hemoglobin. Our blood typically carries oxygen to all the cells in our body. Without oxygen, our tissues and organs can become damaged and even die. A fresh and constant supply of oxygen is essential for life.

Every year, 16,000 people are rushed to the emergency room with carbon monoxide poisoning. Over 500 people die from it every year in the U.S. Most deaths from carbon monoxide occur in the winter, especially December and January.

The experts suspect that the numbers of deaths from carbon monoxide poisoning are much higher due to under-reporting. Less than 15 states require the reporting of carbon monoxide deaths, there are no good autopsy tests for carbon monoxide poisoning, and coroners rarely suspect it as a cause of death.

When certain fuels are burned, they will produce carbon monoxide. Common fuels that can produce carbon monoxide when burned include:

  • Gasoline
  • Wood
  • Propane
  • Charcoal

Common producers of carbon monoxide include:

  • Gas furnaces
  • Charcoal grills
  • Automobiles
  • Propane stoves
  • Portable generators

The symptoms of carbon monoxide poisoning are common and non-specific. They include:

  • Headaches
  • Nausea and vomiting
  • Weakness
  • Lightheadedness
  • Fatigue
  • Dizziness
  • Blurry vision
  • Shortness of breath
  • Confusion
  • Loss of consciousness

Depending on how much carbon monoxide one is exposed to, the results of carbon monoxide poisoning can cause:

  • Severe illness
  • Irreversible brain damage
  • Heart damage that can be life-threatening
  • Death of an unborn baby in pregnant mothers
  • Death

To prevent carbon monoxide poisoning, the Centers for Disease Control and Prevention suggests:

  • Annually, have a certified technician check your furnace/heating systems, water heaters, and other gas-burning appliances. Your utility company can help you with this.
  • Install carbon monoxide detectors on all levels of your home and outside of sleeping areas. Change the batteries with daylight saving time changes, twice per year. If the alarm goes off, leave the area immediately and call 9-1-1.
  • Seek immediate medical attention if you suspect your ill-feeling, dizziness or nausea is the result of being near a fuel-burning engine or appliance.
  • Never use a generator, a camp stove, charcoal grill, or any other fuel-burning device inside a home.
  • Never use fuel-burning devices near a window even if they are running outside.
  • Never run an automobile inside a garage, even if the garage door is open.
  • Never use solvents inside. Many can produce fumes that can break down into carbon monoxide, especially solvents used to thin and clean varnish and paint. Use only in a well-ventilated area.
  • Never burn anything in a fireplace if it is not properly open or vented to the outside.
  • Never use a gas oven to heat your home.

The treatment of anyone with carbon monoxide poisoning includes getting into fresh air and getting medical help immediately. At the hospital, treatment may require breathing pure oxygen or even placement into a special pressurized oxygen treatment chamber.

Carbon monoxide poisoning is a life-threatening medical emergency. It is a silent, poisonous killer that is common in the winter or anytime one is around burning fuels. If you think you or someone you’re with may have carbon monoxide poisoning, get into fresh air and seek emergency medical care immediately by calling 9-1-1.

Experts agree: More activity, exercise mean better health

Last week, the federal government came out with new recommendations for exercise and health. It is the first update issued by the government on exercise in 10 years.

A unique new position of the proposal by the U.S. Department of Health and Human Services (HHS) is that exercise, even in small amounts, can make a big difference. “Sit less and move more. Whatever you do, it all matters,” said Brett P. Giroir, assistant secretary for the HHS, in a recent interview.

The new guidelines are much more flexible. Previously, they said exercise should take place in blocks of at least 10 minutes. Not anymore. Even brief periods of activity, including housework, can count toward the overall daily total.

The report, published in the Journal of the American Medical Association, also states ongoing concern that the minimum goals of exercise are not being met by 80 percent of Americans, and almost 40 percent of Americans are obese.

The new exercise guidelines (for adults) cite 150 to 300 minutes of moderate-to-intense activity per week or 75 to 150 minutes of vigorous-to-intense activity per week. Additionally, two days per week should include muscle and bone strengthening activities. For older adults, balance-improving work should occur weekly, too. These are goals consistent with the 2008 recommendations.

Moderate-to-intense activities include:

  • Brisk walking
  • Raking leaves
  • Vacuuming
  • Playing volleyball
  • Casual swimming
  • Casual biking
  • Dancing
  • Softball

Vigorous activities include:

  • Jogging
  • Running
  • Intense fitness class
  • Intense biking
  • Intense swimming
  • Basketball
  • Intense dancing
  • Carrying heavy groceries
  • Active soccer

Recommendations for kids and teens (ages 6-17) call for at least 60 minutes of intense or vigorous activity daily, combined with three days per week of muscle-strengthening exercises. New to the guidelines are exercise recommendations for preschoolers, ages three to five. The report calls for three hours of daily activity for this group too. Activity means active play.

One parent reports a successful way to pull children away from screen time is to structure active play with other children and in groups settings. Have their friends over and let them play without devices/screens.

Experts state that overweight preschoolers often continue to be overweight children, and the continued obesity becomes harder and harder to correct over a lifetime. The health status and activity level of small children, unchecked, can chart a course for decades.

The report also has exercise guidelines for pregnancy, for the post-partum period, and with disabilities as detailed in the reference provided below.

Doctors say that since the 2008 report, we have come to confirm and understand more than ever how vitally important movement and exercise are for our overall health benefits. Increased movement and exercise show improvements in:

  • Sleep
  • Cancer prevention (especially bladder, colon, esophagus, stomach, breast, endometrium, kidney and lung)
  • Anxiety
  • Depression and post-partum depression
  • Emotional health
  • Bone health
  • Cognitive function and academic success
  • Balance and fall prevention in older adults
  • Diabetes
  • Weight control and healthy weight maintenance

Researchers report that every year in the United States alone, we spend over one billion dollars in healthcare costs related to the problems of inactive lifestyles. Experts say that even exercising one day a week can have profound health effects.

“Being physically active,” the guidelines reports, “is one of the most important things people of all ages can do to improve their overall health.”

Remember, a journey of 100 miles begins with a single step. Talk to your doctor or a physical fitness expert to get started on an exercise program today. Think about including the whole family. Starting at just a few minutes a day and building on that foundation can have fantastic quality-of-life and health benefits for you and your family.

 

Reference: The Physical Activity Guidelines for Americans, bit.ly/2P2HlRz

Everything you need to know about acute flaccid myelitis

This rare but very serious condition can cause paralysis in children

Dr. Crutchfield, I saw on the news that many Minnesota children are developing polio-like symptoms. What is this about? The condition is called acute flaccid myelitis (AFM). It is a rare, but very serious condition that affects a person’s nervous system via the spinal cord. The results are a weakening of one or more of the arms or legs or other muscles of the body. The weakening of the legs can cause extreme difficulty walking and even paralysis. As a result, the condition is very similar, clinically, to polio. Some patients make a rapid recovery and others may have a lengthy, perhaps even permanent paralysis. The prognosis can vary depending on the patient. If a person does have AFM, it is essential to use all treatment and rehabilitation options available. We currently are uncertain of what causes AFM. There may be one singular cause, or the condition may be a result of many causes that can produce the same effects. Scientists postulate that it could be a yet-to-be-identified virus or even environmental toxin. I would also submit for consideration infectious proteins called “prions” that can cause disease. Additionally, doctors are not sure of any factors that would increase one’s risk of developing AFM. What we do know
  • The condition is very rare, affecting less than one in a million persons in the United States.
  • There have been six documented cases of AFM in Minnesota, with over 20 suspected cases.
  • From August 2014 through September 2018, there have been about 390 reported cases of AFM in the United States. (Reporting is voluntary, so this number is probably lower than the actual number of cases that have actually occurred.)
  • Most cases are of children. The average age is four, and 90 percent of cases occur in those younger than 18.
  • In no cases have doctors discovered a causative agent, including the polio virus.
Symptoms
  • Sudden weakness in the arms or legs
  • Facial droop
  • Facial weakness
  • Slurred speech
  • Drooping eyelids
  • Difficulty moving the eyes
  • Difficulty swallowing
  • Difficulty breathing. This is the most severe complication of AFM because a weakening of the muscle that controls breathing is a medical emergency that, without immediate support, can lead to death.
What the Centers for Disease Control (CDC) is doing The CDC is actively investigating all reported cases of AFM and working closely with doctors and other healthcare providers and health departments to increase awareness of AFM. CDC activities include:
  • Encouraging healthcare providers to be watchful and report suspected cases of AFM
  • Actively looking for risk factors for developing AFM
  • Testing specimens, including stool, blood, and cerebrospinal fluid, from alleged AFM cases
  • Working with researchers across the country and world to determine the cause of AFM
  • Disseminating all new information on AFM to doctors, healthcare providers, and health departments as it becomes available
What you can do Because the condition mimics the result of a viral infection, it is essential to:
  • Practice good hand-washing techniques
  • Use appropriate mosquito repellants and protection
  • Ensure all vaccinations are up to date
If your child develops weakness of any limb, especially if they have cold-like symptoms or other viral symptoms, take them to the doctor immediately. The prognosis now depends on getting prompt medical care as soon as possible. Eventually, we will understand the cause of AFM. Until then, these action steps are our best hope for prevention and a good recovery.

Cutting one’s skin is a cry for attention and help

Many things happen behind closed doors and in private, sometimes going completely unnoticed or unimaginable. One of those things is self-harm, such as cutting, which occurs much more often than people would expect. Every year, one in five females and one in seven males engage in self-injurious behavior. About 90 percent of those who participate in self-harm began during their pre-teen or teenage years. Approximately two million cases are reported annually in the U.S. Imagine how many cases there actually are, since a majority of the cases go unreported. When cutting occurs, it usually manifests as horizontal scars across the lower arms (as in the picture) and upper thighs. These are both areas that can easily be covered with clothing. Cutting isn’t the only form of self-harm that can be done. Other types of harm that can be self-inflicted and warning signs to look out for include:
  • Burning
  • Picking at or reopening wounds
  • Punching or hitting oneself
  • Inserting objects into the skin
  • Purposely bruising or breaking one’s bones
  • Pulling out one’s hair
There are several myths about cutting and other forms of self-harm, which are important to recognize, understand, and even debunk. First, cutting isn’t considered an attempt at suicide. According to the Diagnostic Manual of Mental Disorders (DSM-5), the authoritative guide for doctors, cutting is considered a non-suicidal self-injury disorder. Second, it is not a mental illness. Cutting is a behavior indicating a lack of coping skills for emotional pain, intense anger and frustration. Even though self-injury brings a brief feeling of calm, it is usually followed by guilt, shame, and the return of painful emotions. This destructive cycle can become addictive to the point that it becomes a compulsive behavior and difficult to stop. There are a great many reasons why people engage in cutting. It can be triggered by someone’s social environment. An overwhelming amount of stress can lead someone to feel like there’s no way out or to feel so empty that the only emotional release is through inflicting pain. What you can do: In order to help prevent someone from harming themselves, it helps to understand the risk factors and to be aware of red flags of secretive behavior. Risk factors include, but are not limited to:
  • Age (teenagers and young adults most common, although it can happen at any age)
  • Having friends who self-injure
  • Abuse (sexual, physical or emotional)
  • Social isolation/ loneliness
  • Mental health issues (i.e., borderline personality disorder, eating disorders, depression, anxiety disorders, substance abuse, conduct, and oppositional defiant disorders)
Common signs and symptoms might include:
  • Parallel linear scars on the arms
  • Fresh cuts, scratches, bruises or other wounds
  • Possession of sharp objects, like a razor
  • Difficulties with relationships
  • Persistent questions about personal identity, such as “Who am I?” and “What am I doing here?”
  • Emotional and behavioral instability, impulsivity and unpredictability
  • Statements of helplessness, hopelessness or worthlessness
Each of us has a responsibility to look out for friends, family and acquaintances for any signs or suspicions of self-harm and to offer help and support during whatever is compelling someone to hurt themselves. If you have a friend, loved one or acquaintance who is self-injuring or has revealed thoughts about self- harm, you must take it seriously. You may feel shocked, scared, or even feel you’re betraying their privacy. However, this is too big of a problem to ignore, and their safety and well-being are the most important considerations. If you know anyone injuring themselves, suggest they reach out to someone they trust, such as their parents, friends, teachers, a counselor, a physician or spiritual leader. Furthermore, always keep the suicide hotline number close by: 1-800-273-TALK (1-800-273-8255). If you find yourself in an emergency situation, this requires a quicker but, most importantly, calm response by calling 911 or other local emergency numbers. Do not condemn or criticize anyone who has cut themselves for their behavior. What they need most is support and healthy coping skills rather than added negativity. Preventing self-harm should be the utmost goal. There’s no fool-proof way to do so, but there are various avenues that can be taken to curtail it, including many seemingly small things anybody can do to look out for others and make a real difference. Help is available If you have ever harmed or currently harm yourself in any way, or if you’ve had suicidal thoughts, remember one thing: You can overcome almost any challenge. If you have injured yourself and believe your injury is life-threatening in any way, immediately call 911 or the suicide hotline. Most importantly, reach out to somebody, anybody. If you can’t talk to your family members, talk to your doctor. If the doctor is not available, there is always help available at the hospital’s emergency room. Be it family, friend, minister or doctor, there is always someone there to help you. Please reach out.

Five principles for closing the learning gap in babies

When it comes to improving learning and increasing brain development in children, the earlier we involve infants, the better. Sociologists are talking a lot about something called “the learning gap.” This is a gap in knowledge and ability seen between different groups of children. These groups can vary based on race or socioeconomic status. The key is identifying ways to close, or even eliminate, this learning gap in children. Closing the learning gap is a passion for Harvard professor Dr. Ron Ferguson. He was stunned to be able to identify a learning gap in children as early as age two. As he has stated, “Kids aren’t halfway to kindergarten, and they’re already well behind their peers.” Brain development techniques can be implemented by caregivers well before any formal learning programs, like preschool, begin. Even more encouraging is that these techniques are mainly low cost or free. In a recent interview with NPR, Dr. Ferguson said, “Things that we need to do with infants and toddlers are not things that cost a lot of money. It’s really about interacting with them, being responsive to them.” So he developed a plan to help eliminate the learning gap in kids. It is a series of five principles that all caregivers can implement to increase early childhood development significantly. He calls these principles “The Boston Five.” His goal is to introduce “the Five” to the Boston area and then across the country. According to a recent report on NPR.com, the “Boston Five” principles are:
  1. Maximize love, manage stress. Babies pick up on stress, which means moms and dads have to take care of themselves, too. It’s also not possible to over-love or be too affectionate with young children. Research shows feeling safe can have a lasting influence on development.
  2. Talk, sing and point. “When you point at something, that helps the baby start to associate words with objects,” Ferguson explains. Some babies will point before they can even talk.
  3. Count, group and compare. This one is about numeracy. Babies love numbers and counting, and there’s research to show they’re actually born with math ability. Ferguson says caregivers can introduce their children to math vocabulary by using sentences that compare things: “Oh, look! Grandpa is tall, but grandma is short,” or “There are two oranges, but only three apples.”
  4. Explore through movement and play. “The idea is to have parents be aware that their children are learning when they play,” Ferguson said.
  5. Read and discuss stories. It’s never too early to start reading aloud—even with babies. Hearing words increases vocabulary, and relating objects to sounds starts to create connections in the brain. The Basics also put a big emphasis on discussing stories: If there’s a cat in the story and a cat in your home, point that out. That’s a piece lots of parents miss when just reading aloud.
Maximize love and manage stress, principle number one, is related to a previous article I wrote on minimizing insecurities and maximizing success (“A good childhood can prepare us for a good life,” March 21, 2018 MN Spokesman-Recorder). Evident and crucial situations involving food, housing, and family insecurities can have devastatingly adverse predictive effects on children. For many people, this new understanding can open doorways to addressing and overcoming obstacles that can be life-changing. In a recent CBS news segment related to the issue of adverse traumatic childhood events and the way they affect subsequent human behavior, the correspondent, Oprah Winfrey, commented that this new way of looking at and understanding human behavior was “absolutely life-changing and will influence all of her future relationships.” Principle number four must include music and art. These are essential for the developing brains of infants, too. Studies have evaluated the social, intellectual and emotional outcomes of young children who participated in art forms such as music, art, dance, theatre/acting, drawing and painting. Emerging research supports the intimate involvement in these activities and a positive influence on brain and intellectual development in children. Dr. Ferguson has decided that the best way to spread the word on these early learning techniques is to teach them where the babies and parents are. This teaching includes hospitals, community centers, social service organizations, pediatric clinics, barbershops and hair salons, and churches. When it comes to closing the learning gap in babies, they need love and attention. The more interactions we have with little ones, the better. Their brains are like super-sponges. They soak up everything that comes their way. Learn and use Dr. Ferguson’s Boston Five principles. Use them as soon as your baby is born. By doing so, you will put your child in the best position to enjoy a happy, successful life.

Breast reduction surgery: For some, it’s a good option with exceptional results

Question: Dear Dr. Crutchfield, my sister recently had breast reduction surgery. She said she is delighted with the results. What is breast reduction surgery and why would anyone have it done? Breast reduction surgery is the process of having skin, tissue and fat surgically removed from the breasts to reduce their size physically. The medical name of the procedure is “reduction mammaplasty.” Breast reduction surgery is often considered to reduce the stress and pain on the shoulders, neck and back caused by having abnormally large breasts. It can be done to decrease one’s breast size so they look more proportional to their body. Reduction mammaplasty can also improve a person’s self-esteem and self-image and allow them to comfortably engage in many physical activities, including various sports. Breast reduction surgery is a serious surgery and should be considered with a skilled physician and board-certified plastic surgeon. The surgery has benefits, as well as possible complications and risks. It is essential to come to a sound understanding with your surgeon about realistic expectations and outcomes of the procedure. Breast reduction surgery can be done at any age, including teen years. It is preferable to do so when the breasts are fully developed, but if there is enough reason to have the procedure done as a teen, a second surgery can be done later in life when the breasts are fully developed. Men can also have breast reduction surgery, but for different reasons. The rest of this discussion will focus on breast reduction surgery for women. Reasons to consider surgery Reduction mammaplasty may be considered if a woman has large breasts and they are causing:
  • Back pain
  • Neck pain
  • Shoulder pain
  • Inability to participate in certain physical activities and sports
  • Chronic skin problems under the breasts
  • Difficulty in getting bras that fit
  • Poor self-esteem
In certain circumstances, reduction mammaplasty may not be appropriate. These include:
  • Persons with significant health problems such as heart disease or diabetes
  • If one is extremely overweight
  • If one wishes to avoid scars or has a history of keloid formation
  • If one smokes heavily (this is a relative contraindication)
Reduction mammaplasty may be postponed if one is considering childbirth with subsequent nursing. Nursing after mammaplasty can be difficult and challenging. There are special surgical techniques to increase the possibility of nursing, but they are not 100 percent successful. Many who consider mammaplasty will wait until after they are done having children. Also, reduction mammaplasty may be postponed if you are considering a significant weight-loss program. Sometimes the weight-loss program may cause enough of a reduction that surgery is easier; or, more commonly, the operation will be most effective when breasts are at a stable, smaller size. Risks include:
  • Bruising
  • Bleeding
  • Swelling
  • Infection
  • Discoloration
  • Scarring
  • Inability to breastfeed or difficulty doing so
  • Loss of sensation in the area around the nipples
The procedure Before the surgery, your doctor will perform a complete physical examination with bloodwork. Additionally, they may take photos of the breasts and order an imaging study (mammogram). You should stop medications that will cause increased bleeding (such as aspirin or similar NSAIDs). Your doctor will review with you the risks, goals and expectations of the surgery, including scarring and numbness. The procedure is done under general anesthesia. The exact location of the tissue removal will vary depending on how much tissue needs to be removed and the preference of the surgeon. The surgeon will use a particular pattern that allows the breasts to maintain a natural shape and keep an optimal positioning of the nipples. The surgeon will also recommend how long you will be in the hospital. Sometimes one can go home the day of surgery, and sometimes it is better to stay in the hospital for a short while (one or two days) after the procedure. You will also be started on pain medications and antibiotics to reduce the chance of infection. After reduction mammaplasty, your breasts will be swollen and tender. Your doctor may recommend special dressings and compression garments. Plan on plenty of ice and loose, comfortable shirts. You should plan on taking at least a week off of work or school. You should also plan on no strenuous activities for at last one month after reduction mammaplasty. You can see results of reduction surgery right away, but keep in mind that full healing, including swelling and maximum scar resolution, can take many months, even up to one and a half years. Breast reduction surgery can successfully relieve pain, stress and discomfort; allow one to engage in previously prohibited activities and sports; and offer one a higher degree of self-esteem. If a physician deems it medically necessary, the cost of the procedure is usually covered by health insurance. If you think you are a candidate for breast reduction surgery, talk to your doctor. Many of my patients have told me it was one of their best decisions.

Diverticulitis: challenging but manageable

Dear Doctor: A friend recently told me he was feeling under the weather due to a flare of his diverticulitis. What is diverticulitis? Diverticulitis is the process of inflammation of small areas in the intestines. Occasionally, our intestines can develop small out-pouches along the length. If one or more of the pouches become inflamed, the condition is called diverticulitis. Diverticulosis can occur anywhere along the length of the intestines, but it is most commonly observed in the intestines that reside in the left side of the abdomen. There are several reasons for diverticulosis and, without any additional complications, the condition is considered benign. The inflammation can be relatively mild, involving only one or two areas, to the involvement of extensive areas that can lead to abscesses and breakdown and rupture of the intestines, a life-threatening emergency. Most people with diverticulosis are unaware of it. Diverticulitis, on the other hand, can have very pronounced symptoms. In some cases, diverticulosis may cause left-sided abdominal pain and cramping that is relieved with passing gas or moving one’s bowels. The abdominal cramping pain can be extreme and severe. Also, one may experience flu-like symptoms and can even run a fever. Diverticulosis can also produce red blood in the stool. Diverticulitis can present as a few isolated attacks, or be longstanding and chronic, without ever becoming entirely free of inflammation. With chronic diverticulitis, a blockage of the intestines can occur. When this happens, stools can become thin, one can experience constipation or diarrhea, and stomach cramping and bloating. With extreme cases of intestinal blockage, one may also experience excruciating abdominal pain and nausea and vomiting. Without treatment, diverticulitis can cause pockets of infection that can rupture into the abdomen and require immediate surgery, scarring that can lead to intestinal blockage, severe bleeding (that may require a blood transfusion), and a strange condition called a fistula. A fistula occurs when an inflamed portion of the intestine (diverticulitis) touches a neighboring organ and actually forms a connection to that area. Most commonly, the connection can occur with the bladder, and when that happens, the kidneys can get infected. Other less common areas of fistula formation include connections to the vagina and the skin. Risk factors
  • Age over 40
  • Overweight
  • Consuming a diet high in red meat
  • Taking NSAIDS or steroids on a regular basis
  • Eating a diet high in saturated fats
  • Low water intake
  • Family history
  • Personal history of polycystic kidney disease
Diagnosis It is essential to make sure the diagnosis is correct before embarking on a treatment plan. Many conditions can cause abdominal pain. Acute appendicitis, fibroids, other intestinal infections, and cancers of the abdomen (colon and ovarian) are good examples of conditions that need to be ruled out. If a patient has a well-documented history of diverticulosis, the diagnosis of diverticulitis may be more straightforward. Imaging studies can be quite helpful. The imaging study of choice is a CT scan. If the patient is pregnant, a CT scan is not appropriate due to the radiation exposure, so an MRI is an acceptable alternative. Colonoscopy can also aid in the diagnosis of diverticulosis, but in an acute flare of diverticulitis, colonoscopy should not be used because the inflamed tissue can easily damage the scope as it travels along the intestines. Colonoscopy should be done six weeks or longer after the flare of diverticulitis has subsided. Rarely, exploratory surgery may be needed to make the correct diagnosis of diverticulitis. Treatment The treatment of diverticulitis will depend on the severity of the flare-up. For mild flare-ups, the treatment may be as simple as staying at home for a while with bed rest, antibiotics by mouth to address any infection, a liquid diet while inflammation and healing occur, and a mild over-the-counter pain reliever, if needed. If the flare-up of diverticulitis is severe, the affected person may have to be hospitalized. At that time, IV antibiotics may be administered with stronger, prescription pain control medications. If there is an infected pocket, such as an abscess, it may have to be surgically drained. If there is a consideration of a perforation of the bowel contents into the abdomen (peritonitis) or fistula formation, or even a blockage of the bowels, surgery will be required. In some cases, the diseased portion of the intestines can be removed and the intestines can be re-joined without the bad segment. This rejoining of the sections will allow patients to have regular bowel movements. In another case, if there are large areas of involvement, the intestines may be re-routed to empty outside of the body through a colostomy, and intestinal waste drains into a bag next to the stomach. In some of these cases, if the inflammation subsides, the colostomy can be reversed, and the normal intestinal function can be restored. If one does have diverticulitis, several lifestyle modifications can be made to minimize episodes. These include:
  • Exercise regularly
  • Maintain a healthy weight
  • Minimize red meat consumption
  • Eat plenty of high-fiber fruits and vegetables
  • Drink plenty of water
  • Minimize saturated fat intake
  • Minimize steroid and NSAID use
Diverticulitis can be a challenging disease. Fortunately, it can be managed. If you have diverticulitis, talk to your doctor about a regular visit schedule, what to do with episodes of exacerbation, and ask for advice on minimizing flare-ups.