With winter comes the threat of frostbite

The best strategy is prevention

Frostbite is a term that is used when skin is severely damaged by the cold. The skin and underlying tissues freeze and secondary injury occurs. As the skin freezes it becomes red, then numb, then solid/firm and finally pale.

Frostbite can occur anywhere on the body including areas that are covered and protected, but typically it happens in the extremities and regions commonly exposed to the cold and wind such as fingers, toes, nose, ears, cheeks and ears.

Frostbite is an injury where the skin actually freezes. In severe cases, the underlying tissue can be affected, too. First, your skin becomes painful and tingles. Next, the skin becomes very cold and red, then numb, hard and pale.

Sometimes, in severe cases, hands are difficult to close, or joints underlying the frostbite will be difficult to move. Exposed skin in cold, windy weather is most vulnerable to frostbite. But frostbite can occur on skin that is covered. Because the area that gets frostbitten often becomes numb, a sufferer may not even realize it until someone else points it out to them.

Frostbite commonly occurs upon exposure to cold weather, but it can also be caused by exposure to cold metals, ice or cold liquids.

In cold weather, one must be cautious and protective by wearing the appropriate clothing and covering vulnerable areas such as hands, ears and face. Temperatures below zero degrees Fahrenheit are especially concerning. Exposed skin can become frostbitten with just 10 minutes of exposure under these conditions.

Very early, mild frostbite is called “frostnip” and only requires rewarming. Other stages of frostbite need medical attention because severe damage can occur such as damage to muscles nerves and bone, and severe blistering can result in infection.

Stages of frostbite

Frostnip: Frostnip is the early, first stage of frostbite. The skin becomes tingly, red and painful. At this point, getting out of the cold and rewarming the skin is all that is required. The skin may become tingly again upon rewarming.

Superficial frostbite: In the second stage of frostbite, the red skin becomes pale or white/light. If the skin begins to have a burning sensation, this is an indication of severe skin involvement. The skin should be rewarmed, but as it warms it may become mottled in color, painful and swollen. Blistering can occur within 12-36 hours after exposure.

Severe (deep) frostbite: If the frostbite continues, it can affect the full thickness of the skin and nerves and the area beneath the skin including fat, muscles, bones and joints. A signal that this is happening is that one loses all sensation of discomfort, coldness or pain in the area(s).

If you experience any signs of frostbite including discoloration, pain, swelling or blistering, consult your physician. In addition to frostbite, the person should also be aware of developing hypothermia. That is where the cold overwhelms the body’s ability to maintain its temperature.

Signs of hypothermia

  • Unstoppable shivering
  • Thick and slurred speech
  • Fatigue and sleepiness

Frostbite risk factors

  • Poor circulation
  • Infants and children
  • Elderly
  • Drug and/or alcohol abuse
  • Tobacco users
  • High altitudes (decreases oxygen to skin)
  • Medical conditions that affect ability to feel cold or interfere with normal blood circulation such as diabetes
  • Dehydration
  • Exhaustion

Frostbite prevention tips

  • Check the forecast and plan your outdoor activities appropriately.
  • Limit the time you spend outside by employing several warming periods.
  • Dress in layers with material designed to both wick wetness away and maximize protection against the cold.
  • Cover your head, ears included.
  • Limit alcohol consumption.
  • Don’t become overly exhausted or dehydrated.
  • If traveling extensively in cold areas, have an emergency kit with supplies and warming materials.
  • Consider self-warming packs for hands and feet (available at sporting goods stores and online).
  • Don’t forget excellent gloves or mittens and thick warm socks.

Frostbite diagnosis

Continuing skin discoloration, swelling, pain and blistering are all signs of frostbite. Consult your doctor. Depending on the severity, the physician may order other tests to determine if any hypothermia, muscle or bone involvement is present.

Treatment: first aid and medical treatment

For frostnip, gentle rewarming is all that is required. For moderate to severe frostbite, or if hypothermia is suspected, get medical attention right away.

With frostbite, the gentle rewarming should include ONLY lukewarm water warming or a gentle warm bath only. Using other measures can cause burns. If the feet have been severely affected, avoid walking on them because this can cause further damage.

If blisters are present, do not break them. The first step is to immediately get out of the cold; rewarm using water at a temperature of 99-105 F; use an over-the-counter anti-inflammatory such as ibuprofen, Aleve or Advil; and get medical attention immediately.

If the case of frostbite is severe, the doctor may prescribe medications to prevent infection, increase blood flow to the affected areas, reduce pain or increase oxygen flow to the involved areas. Surgical treatment may also be needed.

Remember, when it comes to frostbite, prevention is the best strategy. If you do find yourself in a position of getting frostbite, get out of the cold, gently rewarm, and get medical attention without delay.

 

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Croup: a common childhood illness with a strange cough

Croup, most commonly, is a viral infection of the upper airway in young children. The condition can partially obstruct the airway. This blockage can cause the child to have a strange cough that sounds like a barking dog. Croup often starts out like a common cold, but breathing difficulties may soon develop.

The most common virus that causes croup is parainfluenza. The viral infection causes swelling and inflammation of the airway including the vocal cords, windpipe, and passages into the lungs.

When these areas have air forced through them as the sick child breathes, the sound can be that of a barking dog, a barking seal, or even like that of a high-pitched whistle. This whistling sound is medically called “stridor.”

The patient may also have a fever and a raspy or hoarse voice, especially when crying. Other symptoms include enlarged lymph nodes, fast breathing, drooling (difficulty swallowing), appearing lethargic, being dehydrated (few wet diapers), and a general rash.

Parents may also see a retraction of the skin of the chest between the ribs as the child struggles to breathe. Breathing retraction or turning bluish is a medical emergency.

The condition is most common for children ages four months to five years. Croup is more common in boys than in girls and is seen more often in the fall and winter.

The child is contagious until the fever resolves. Of the infectious forms of croup, 80 percent of cases are viral, and about 20 percent of the cases are caused by a bacteria.

There is a second, rarer type of croup called spasmodic croup. This is not caused by a viral infection, and doctors believe it is caused by irritation and inflammation of the throat and voice box (vocal cords) from either an allergy or from the acid in the stomach coming up into the throat when the child is lying down.

In this case, the child will wake suddenly grasping for air, have a barky cough, and have difficulty breathing. In spasmodic croup, the child will not have a fever.

No matter what the cause, if your child is having difficulty breathing, get medical attention immediately.

Prognosis

The majority of croup cases present as a mild illness and will get better in just a few days; the normal course is three to five days. In a small percentage of cases, the swelling of the airway can become so severe that it interferes with normal breathing and immediate medical attention is required.

Treatment

For mild cases, supportive measures with rest at home are all that is needed. These supportive measures include:

  • Keep your child relaxed and calm. Crying or getting worked up can worsen airway irritation and obstruction. Rock or hold your baby, cuddle, sing songs, read or tell stories. Offer your child the things that give them the most comfort, like a special blanket or favorite toy.
  • Use a humidifier. This will soothe inflamed airways and enable your child to breathe easier.
  • Hold the child upright. Breathing is easier when the child is positioned upright.
  • Push fluids. This includes milk, formula, water, soup and popsicles.
  • Have the child get plenty of rest. Rest allows the immune system to work at its best to fight the infection.
  • Use an over-the-counter medication to reduce pain and fever. Acetaminophen (Tylenol, others) is good for reducing pain and fever.

In croup, children often do better in the day and worsen at night. This is a medical phenomenon known as “sundowning.” Consider sleeping in the child’s room to provide them an extra level of security and enable you to act appropriately and quickly if the condition takes a turn for the worse.

If the symptoms are mild but last more than four days, or if your child has trouble breathing, call your doctor immediately.

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Water safety precautions to keep your summer tragedy-free

Preventive Medicine is a board-certified specialty of medical practice that focuses on the health of individuals, communities and defined populations. Its goal is to protect, promote and maintain health and well-being and to prevent disease, disability and death. With that in mind, I’d like to discuss tips for staying safe in and around the water this summer and always.

It’s summertime, and many fun activities involve pools, lakes, rivers and other bodies of water. Hanging out at the pool can be one of the best ways to beat the summer heat. Unfortunately, without proper safety precautions these water activities can have bad outcomes. Continue reading Water safety precautions to keep your summer tragedy-free

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It’s that time of the year again: Watch out for Lyme disease

Charles Crutchfield
Dr. Charles Crutchfield

The good news is that Lyme disease can be effectively treated

The weather is finally nice again, and we are beginning to spend more time outdoors. Unfortunately, experts are saying that the presence of outdoor ticks is at record-high levels. With ticks can come tick-borne diseases, most notably Lyme disease. It is estimated that over a quarter of a million Americans will get infected with Lyme disease, annually.

Lyme disease is an illness that is transmitted by deer ticks. Lyme disease is caused by a bacterium by the name of Borrelia burgdorferi. The bacteria can live in the blood of animals and spread by tick bites. It is very common in the United States and Europe. Continue reading It’s that time of the year again: Watch out for Lyme disease

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10 reasons why you should love & care for your liver

Charles CrutchfieldYour liver is an amazing organ that performs dozens of different bodily functions essential for life. The liver is the fourth-largest organ of the body. On average, the skin weighs 20 pounds, the intestines weigh eight pounds, and the lungs weigh five pounds; the liver weighs about 3½ pounds and is the size of a medium football.

The liver would be rubbery to the touch (if one ever touched it!). The liver is easy not to think about because it is inside the body and we never see it.

Your liver is located on your right side, below your ribs and above your abdomen. It is a red-brown organ with two lobes. In reality, it is involved with almost every function essential to life.

It stores energy, makes critical proteins for our blood, has immune system functions, and works hand-in-hand with the intestines, gall bladder and pancreas as part of our digestive system. The primary role of the liver is to filter blood coming from the intestines after absorbing food, and to capture and break down toxins, including medications and alcohol that we ingest.

Considering all the jobs the liver has, it is easy to understand why we can become so profoundly ill if the liver stops functioning properly.

The liver is an amazing blood filter and storage organ

As a filter for blood coming from the intestines, the liver can hold up to 10 percent of the total blood in the body when it is full. In fact, the liver can filter up to 90 liters of blood per hour.

The liver can regrow itself

The liver is the only organ that can regenerate itself. In fact, you can lose up to 75 percent of your liver, and it will regenerate itself and do so in robust fashion. It can reproduce itself back to normal size in as little as 15 days.

This super-growth fact is wonderful if one needs to donate a portion of a liver for a transplant. Doctors and researchers believe the liver has this unique and amazing regenerative property because of its vital role in the overall health of a person.

The brain depends on the liver

The liver is essential for a healthy brain. The liver controls the levels of both sugar and ammonia in the blood. A poorly functioning liver causes profound changes in brain health termed hepatic (liver) encephalopathy. A sick liver produces a sick brain.

The liver needs to be checked on

Liver problems are difficult to detect, especially early on. That is why it is important to engage in regular medical check-ups to maximize your best health. Your doctor will recommend the best medical check-up schedule for you.

The liver plays a vital role in digestion

The liver produces bile. Bile is a green fluid that is secreted into the intestines to help break down and absorb fat in food. Bile also contains toxic chemicals removed by the liver that get deposited into the intestines and eventually get released as stool.

Bile gives stool its characteristic brown color. If stool is not brown, it means the liver is not functioning properly and signals serious liver problems. Most people become familiar with bitter green bile when they are sick or they have ingested too much alcohol and are forced to visit the toilet on their knees.

The ability to absorb fat from food is essential for life. The liver can produce up to a liter of bile per day.

The liver can be damaged

Damage to the liver is called cirrhosis. Cirrhosis is a serious condition that develops over many years, causing the liver to have extensive and irreversible scarring. With the liver fibrotic and scarred, it can’t function properly. The blood flow is restricted or even blocked, and without treatment the liver can completely fail.

There are many causes of liver cirrhosis, but the three most common causes are long-term alcohol consumption or abuse, viral infections (hepatitis), and fatty liver disease. In fatty liver disease, the liver becomes infiltrated and choked off by excessive fat deposits.

The causes of fatty liver disease are poorly understood, but most experts agree that being overweight, having chronic elevated lipids and cholesterol, diabetes and elevated blood sugar, sleep apnea, and poor thyroid function can all play a role in developing fatty liver disease.

Common signs of cirrhosis include yellowing of the skin, eyes and tongue (jaundice), breast development in men, enlarged abdomen, abdominal pain, red palms, severe intractable itching, and fatigue.

The liver protects the kidneys

We produce new blood all the time the old blood is broken down, and one of the products is something called bilirubin. Bilirubin is extremely toxic and can damage the kidneys. The liver processes the bilirubin to a form that is not damaging to the kidneys. This liver-processed bilirubin gives urine its characteristic yellow color.

The liver is a master storehouse

The liver stores energy (sugar or glucose as glycogen), iron, minerals and vitamins for body use.

The liver is a master factory

The liver also produces special proteins necessary for blood clotting. It also produces cholesterol, needed to make cell walls and essential hormones.

The liver makes medicines work

Most of the medicines we take need to be processed and activated by the liver in order to work properly.

Your liver is a miraculous organ. The importance of the liver is illustrated by the fact that all vertebrate animals (animals that have a spinal cord) have a liver, and every liver is similar in structure and function.

The liver is responsible for multiple essential functions, including the detoxification of harmful substances, purification of the blood, and the production of life-sustaining nutrients. In fact, the liver performs over 500 different functions and is a key for good health and life.

To keep your liver healthy, minimize alcohol intake and make sure to maintain a regular medical check-up schedule with your doctor.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He received his M.D. and Master’s Degree in Molecular Biology and Genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Dr. Crutchfield was recognized by Minnesota Medicine as one of the 100 Most Influential Healthcare Leaders in Minnesota. He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations.

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Maximize enjoyment of sports by preventing injuries

Charles CrutchfieldSports are great for people of all ages, but it is important that safety takes a front seat, especially in kids with growing and developing bodies. While we have come to recognize the importance of protecting the brain from injurious concussions, we can’t ignore the rest of the body. In fact, in baseball-playing youth, arm injuries are at epidemic levels.

Why are kids hurting their arms?

Most arm injuries occur from pitching. Kids are pitching more. Instead of rotating through different sports throughout the year, many kids are playing the same sport (baseball) year-round.

Many kids are playing year-round as well as playing on multiple teams. Not only does this mean additional repetition in the arms of developing teens, but many coaches and even professional scouts report that teen pitchers are throwing much harder than ever. Many routinely throw in the mid-90 miles-per-hour, some even flirting with 100 mph!

Non-stop training and throwing harder can take a serious toll on arm health, especially for kids who pitch.

What is the most common arm injury in teen pitchers?

Damage to the ulnar collateral ligament in the elbow of teen pitchers is at an epidemic level, much like the epidemic of concussions seen in football. Ligaments are fibrous tissue cords that connect bones and hold joints together. The ulnar collateral ligament is the fibrous band located on the inside of the elbow. With the non-stop, repetitive stress from pitching, this ligament becomes stressed, stretched, frayed and tears, leading to extreme pain and joint instability.

What are symptoms of ulnar collateral ligament damage?

pain in the inner elbow
swelling in the inner elbow
tingling in the inner elbow
numbness in the inner elbow
sudden, shock-like pain radiating from the inner elbow
extreme discomfort when throwing a baseball

How is this injury treated?

The best treatment for mild to moderate cases of ulnar collateral ligament damage is rest. The best treatment for moderate to severe cases of ulnar collateral ligament damage is a surgical repair of the elbow joint.

The name of the repair is “Tommy John surgery.” In fact, almost 60 percent of all Tommy John surgeries are now conducted on teens ages 15-19.

What is Tommy John surgery?

Tommy John surgery, also known as ulnar collateral ligament reconstruction, is to repair the damaged elbow joint. It was first performed by orthopedic surgeon Frank Jobe, M.D. in 1974 in an attempt to repair the damaged elbow of professional baseball pitcher Tommy John.

The procedure was extraordinarily successful and allowed Tommy John to complete a distinguished career. Specifically, the damaged ligament is replaced by a non-damaged ligament from the person’s own body (forearm, knee, hamstring, lower leg or foot), or from a donated ligament from a human cadaver.

The surgery is done as an outpatient, and most patients go home the same day. It is performed on athletes from all sports, but most commonly baseball. The recovery for most athletes is one year, but patients can start using the treated arm carefully and gently at about 16 weeks.

Many but not all athletes return to the same or even superior levels of play. Reportedly, many professional athletes undergo the procedure as a way to extend their career.

What is the best way to prevent ulnar collateral ligament damage in teens?

USA Baseball, Major League Baseball, and Little League Baseball have initiated the Pitch Smart program designed to decrease the risk of elbow injuries in adolescent pitchers. Controlling the amount of pitching is important. This can be done by limiting (pitch count) the number of pitches kids throw in a game and in a season.

It also means not pitching year-round or participating in multiple leagues and teams, and playing different positions. Also, kids should rotate sports. Strength training and having experienced coaches and trainers evaluate and instruct pitchers on proper mechanics to reduce elbow stress is essential.

The goal is for kids to enjoy sports in a protected and long-lasting manner. As a parent, it is extremely important to talk to coaches to make sure that your child’s participation and training, in any sport, is being managed according to safety guidelines to maximize both safety and enjoyment.

To review the pitching safety guidelines in detail, visit http://m.mlb.com/pitchsmart.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He received his M.D. and Master’s Degree in Molecular Biology and Genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Dr. Crutchfield was recognized by Minnesota Medicine as one of the 100 Most Influential Healthcare Leaders in Minnesota. He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations.

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A cool solution to hair loss from cancer chemotherapy

Charles CrutchfieldWith respect to cancer treatment, chemotherapy has been extremely beneficial and effective. Unfortunately, it brings with it a common and undesirable side effect: hair loss. In fact, a small percentage of women will actually decline chemotherapy out of a desire not to lose their hair.

Fortunately, research and practice in Europe have brought new promise in minimizing the side effect of hair loss. Researchers have discovered that by reducing the temperature of the scalp during chemotherapeutic sessions, the cooling measure has a significant protective effect in preventing or greatly reducing the hair loss experienced by many patients undergoing the cancer treatments.

chemo

The concept is rational and straightforward: The cooling of the skin of the scalp causes the blood vessels to shrink, and it reduces the total blood flow in the skin of the scalp that surrounds the hair follicles. With less blood flowing to the area, there is much less of the chemotherapeutic drug available to affect the hair follicles. Less drug exposure results in less hair loss.

Both studies used a scalp cooling system where a chilled liquid coolant is continuously circulated inside a cooling cap that covers the head. The cooling is started before the initiation of chemotherapy, and the scalp cooling is continued for 90 minutes after the chemotherapy is discontinued. This machine-regulated, circulating system offers better temperature regulation over the older versions where caps filled with liquid coolant were kept frozen and changed out every 30 minutes or so.

WomenThe treatment itself is very well tolerated. No patient discontinued their participation in either study due to treatment discomfort. Most patients reported that the treatments were a bit chilly and mildly uncomfortable for just the first few minutes, after which the treatment became almost undetectable.

The results are both impressive and promising. It should be noted that there are several different chemotherapeutic agents used, so results are both dependent on the participant’s individual genetic response and the chemotherapeutic medicine used. Overall, among patients undergoing chemotherapy and using the scalp cooling system, 55 percent kept at least half or more of their hair, and approximately seven percent of the treated patients kept all their hair.

In contrast, women undergoing chemotherapy who did not use the cooling system experienced a significant or total scalp hair loss a frustrating 95 percent of the time.

The scalp cooling systems used in the two studies were 1) the Digni Cap and 2) the Paxman Scalp Cooling System. Both systems have received FDA cleared.

Experts comment that this type of treatment is best for the chemotherapy required for solid cancers, such as breast cancer, but not for liquid/blood cancers.

Currently, the scalp cooling systems are not widely available but are becoming more so. It is rarely covered by insurance, so the cost is paid out-of-pocket by the majority of patients using it, and the cost averages about $2,000 for a set of treatments. Patients and physicians alike are hopeful that insurance providers will provide better coverage as the procedure gains popularity and demonstrates continued effectiveness.

Patients and physicians both acknowledge that not every patient will want scalp cooling treatments. This choice is analogous to the case where not every woman has breast reconstructive surgery or elects to wear a hairpiece. For some patients, hair retention helps to preserve self-esteem; for others, it offers a measure of control over an involuntary and very difficult situation.

Nevertheless, most believe that every person should have the option of using a scalp cooling system to preserve hair during chemotherapy treatments. Fortunately, the scalp cooling systems are here now and becoming more readily available.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He received his M.D. and Master’s Degree in Molecular Biology and Genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Dr. Crutchfield was recognized by Minnesota Medicine as one of the 100 Most Influential Healthcare Leaders in Minnesota. He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations.

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How to respond to — and prevent — a measles outbreak

Dear Dr. Crutchfield: According to reports by the Minnesota Department of Health, there has recently been a limited outbreak of the measles in Minnesota. What are the measles?

The measles is an illness transmitted by a virus. It is extremely contagious. In fact, if you have not been vaccinated or have not had it before, the chances of anyone contracting it after being exposed to someone with it is extremely high.

Outbreaks in the United States are rare, but when they occur, they need to be addressed promptly. There are over 200 million cases of measles still reported annually worldwide.

not feeling well

What are the symptoms of the measles?

The symptoms start with a fever and flu-like symptoms. Then, shortly afterward, the patient develops a cough, very runny nose, little white bumps inside the mouth on the inner cheeks, and red, irritated eyes. Shortly after these symptoms appear, the classic red, bumpy rash starts on the face and neck and moves down, covering the entire body.

coughing

How is measles spread?

It is spread in water droplets that become airborne when an infected person coughs or sneezes. It is extremely contagious, so if one is exposed (by being in a room where an infected person has coughed or sneezed) there is a very high chance that, if not immunized, the exposed person will get measles.

There currently are no active areas (natural reservoirs) in the United States with large cases of the measles, so the way measles is spread is from someone who has traveled from a country with areas of large numbers of measles cases (natural reservoirs), who then brings it back to the United States. In all the reported cases in Minnesota, the people who contracted measles had not been vaccinated.

doctors office

How serious is the measles?

In one-half to three-quarters of cases, patients recover well without long-term effects. Unfortunately, in about one-quarter of the cases, there are additional complications beyond fever, flu-like symptoms, runny nose, irritated eyes and skin rash. These additional complications include diarrhea, pneumonia, and ear infections. In rare but serious cases, the virus can infect the brain, causing swelling, pain, seizures and even death.

How can measles be prevented?

The best way to prevent measles is to vaccinate children on schedule. The vaccination is a combination vaccine that protects against three viral diseases: measles, mumps, and rubella. The first vaccine is given at around age one, and a second booster vaccine is given about the time children start kindergarten, at about age five.

The pediatrician will recommend the best schedule for your child. For children under age one and adults who may need a vaccination for the first time, consult your doctor for the best recommendations in these special circumstances.

babies

What about parents who do not wish to have their children vaccinated?

This is still a problem, but it is not as common as it once was. Unfortunately, false reports linking vaccinations and autism have put a terrible scare into parents. There has also been a concern with trace amounts of mercury (a preservative) contained in vaccines. The research that suggested the autism-vaccination connection has been completely debunked and discredited.

There are now vaccines that are free of preservatives. There are no scientifically valid reasons why children should not be vaccinated. The reason we vaccinate is to protect our children, so people who are worried about vaccines should look at the goal, which is protecting children.

These diseases can kill children. That is why we vaccinate.

What should a person do if they think a family member has the measles?

Rather than bringing them to a clinic and exposing others at the clinic, first call the clinic for directions. Often, the clinic will refer them to a children’s hospital with an emergency room that is much better equipped and prepared to treat such an infectious viral disease.

How are measles treated?

Because the disease is viral, the treatment is mostly supportive care. That means hydration, reducing fever, assisting breathing, and soothing the rash. In three-quarters of cases, the disease will resolve without additional complications, like recovering from a bad cold or flu. In the cases with significant further complications, additional medical support will be required.

The best thing to do to treat the measles is to prevent it from occurring in the first place. That means following the vaccination schedule recommended by the pediatrician. Remember, the measles, mumps and rubella vaccine is extremely safe and effective.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He received his M.D. and Master’s Degree in Molecular Biology and Genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Dr. Crutchfield was recognized by Minnesota Medicine as one of the 100 Most Influential Healthcare Leaders in Minnesota. He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations.

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When it comes to medications, one size does not fit all

New advances will help patients respond better to medicines

Next time you find yourself in a crowd, take a look around. Notice that people come in all sizes, shapes and colors. These differences can be determined by genetic differences in all of us, and are cemented in our DNA and genes.

dna sequence

Genes can determine everything from eye and skin color to height. These same genes can also affect how we react to many medications. Doctors have long known that some medicines work great for some people and not so great for others.

In some circumstances, patients develop a serious side effect or complication from a medication, whereas many people who take the same medicine do not have the same bad experience and do very well. In fact, almost one million people per year in the U.S. experience adverse medication reactions, and it is estimated that close to 100,000 people die from adverse medication reactions. This is alarming.

pretty pills

To be fair, a person’s response to a particular medicine is also based on multiple factors including age, weight, gender, sex, health status, other current medications being taken, tobacco use, alcohol consumption, and environmental exposures. However, the major influence on how anyone responds to medications lives deep in their genes.

For example, if you have enzymes that break a medicine down quickly, there may not be enough of the medicine available to provide adequate help. In these cases, the medicine may be downright useless, or the patient may require larger doses for good effect.

Alternatively, if your genes produce enzymes that break medicines down slowly, too much may accumulate and cause unwanted or even toxic results. Also, these variations can have devastating results on babies who are being nursed by their mothers taking certain medications.

In fact, 10 percent of people receiving traditional pain medications don’t get any appreciable relief. This 10 percent figure holds true for most all medicines. Of the approximate 1,200 FDA-approved medications, approximately 125 (about 10 percent) will have widely varying effects based, in part, on a person’s individual genetics.

pills brain

These medications are broad-spectrum and are used, in part, to treat the following conditions:

Pain
Depression
Heart disease
Cancer
HIV
Bleeding disorders
Addiction disorders
Asthma
Migraine
Arthritis
Osteoporosis
Alzheimer’s
Psychiatric

The good news is that doctors and researchers have gained a great deal of information and insight on how a person’s genetic makeup can affect the way they respond to specific medications. This field of research (examining how drugs are affected by a person’s genes) is called pharmacogenetics.

Now, with a simple test (either a swab of the inside of the cheek or a blood sample), doctors can look at key genes that code the enzymes that process and affect different medications in the body. This will allow physicians to determine how patients will respond to over 240 different medicines, and the number is growing monthly.

By selecting the correct medicines based on the test, your doctor will then have the ability to limit many adverse drug reactions, avoid medicines that don’t work for you, and avoid any unintentional interactions between the many drugs you may be taking or drugs you may take in the future.

The bad news is that the tests are new and not generally covered by insurance, but that should change over time. Paying out of pocket, the test will cost around $250-$300. That price, too, may come down over time. Two leading companies that perform the tests are OneOme and MilleniumHealth.

Clearly, doctors recognize that when it comes to medicines for their patients, one size does not fit all. The field of recommending the best medication for a patient based on their personal genetics is part of what doctors are calling “precision medicine” and will have a significant impact on the future practice of medicine.

If you are taking multiple medications, have a history of adverse medication reactions, have taken medicines that have not worked, have a complex health history, are being treated with medications from the list of medical conditions listed above, or just want good health information and peace of mind, be sure to have a discussion with your physician about taking a precision pharmacogenetic test.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He received his M.D. and Master’s Degree in Molecular Biology and Genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Dr. Crutchfield was recognized by Minnesota Medicine as one of the 100 Most Influential Healthcare Leaders in Minnesota. He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations.

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