health

Readers Offer Advice on Doctors' Visits and Treating Rashes

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | December 26th, 2017

Hello again, dear readers! Your letters continue to pour in, and we are impressed by and grateful for your curiosity, kindness and your thirst for knowledge. We, too, are lifelong students and love learning from you.

-- Lawrence, a nurse anesthetist from Suffolk, Virginia, expands on the column about bringing a written list of questions to your medical appointments. He suggests maintaining a comprehensive health profile on your computer, which can easily be printed out as needed.

"I include not only medications, but a list of diagnoses, surgical history, contact info and insurance info," Lawrence writes. "The profile is about 2 inches wide by 6 inches long and fits in the front of my wallet, where it would be easily found if I were incapacitated."

-- In response to the column about Grover's disease, a condition that manifests as a rash that can often be maddeningly itchy, readers shared novel ways to deal with the itch.

A reader diagnosed with Grover's disease five years ago recommends using a thin layer of a mentholated topical ointment, like Vicks VapoRub.

"This does two things for me," he writes. "First and fabulous, the itching pain ceases immediately." He reports that the ointment also helps the rash to "dry up" and also prevents spreading, which happens when he scratches.

Another reader living with the condition, who is allergic to steroids, has found relief with a hair dryer. By using a low setting that doesn't burn or damage his skin, he reports that the warm air not only relieves the itch for several hours, but also seems to cause the rash to retreat.

-- The column about the ick factor of the traditional colonoscopy prep solution brought a ton of mail. We have reached out to some colleagues here at UCLA who use an alternative approach and will be addressing the topic again in a future column.

-- And finally, a bit more about service dogs -- or more specifically, fake service dogs. We heard from many of you about the frustration of seeing people abuse the privileges extended to genuine service animals because they want to bring their pet into a store, restaurant or theater. Brad from Naples, Florida, wrote of a plane trip during which an unruly collie brought aboard as a service dog spent the entire flight barking and lunging at passengers.

It's true that some people are taking advantage of the honor system that gives service animals carte blanche to access public places. However, just because you can't "see" a person's challenge or disability doesn't mean the dog is a mere pet. For example, some people with diabetes or epilepsy, which are mostly invisible conditions, depend on their service dogs for warning of a medical emergency.

That said, we share your dismay when poorly trained, ill-mannered or aggressive animals are passed off as service dogs. Not only is it selfish and dishonest, it's also detrimental to the reputation of true service dogs, and makes things even more difficult for their owners.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

health

Reduce Kids' Risk for Asthma and Allergies by Going Outside

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | December 25th, 2017

Dear Doctor: Some researchers say the main reason for many health issues today, including allergies and asthma, is that our children are kept too clean and have no resistance to anything. What are your thoughts?

Dear Reader: First, let's discuss the benefits of hygiene. The greatest boon to human longevity, at least in developed parts of the world, has been our ability to deal with wastewater. Separating humans from the waste they produce, and treating that waste, has decreased our susceptibility to a host of diseases. In Yemen, for example, the number of cases of cholera currently exceeds 800,000 due to the inability to manage wastewater. In fact, inadequate sanitation, combined with a limited ability to properly disinfect hands, is estimated to cause 4 percent of deaths worldwide.

But yes, there may be a risk to too much good hygiene. Humans live in symbiosis with the bacteria within and upon their bodies, and an inherent balance is necessary for a healthy life. This balance may extend to the bacteria in our environment, meaning that restricting our bodies from normal outdoor organisms may have a downside. The Amish in the United States, for example, live on farms and spend much of their time outside. Coincidentally, their children have much lower rates of allergies, eczema and asthma compared to non-Amish children who don't live on farms.

The evidence extends beyond that correlation. A 2017 study of adult farmers and their spouses compared their childhood exposure to a farm environment against their rates of allergies and asthma. Those who were exposed to farming as children were less likely to have allergies as adults. Further, those whose mothers worked on a farm while pregnant also had a lower rate of asthma and allergies.

Then there was a Swedish study on pacifier cleaning. Researchers found that the parental practice of cleaning a pacifier by putting it in one's own mouth before giving it back to the infant was linked to a lower rate of eczema and asthma in children at age 18 months. That same study also showed that vaginal birth, with its increased infant exposure to bacteria, was linked to a lower rate of allergies at 18 months compared to Caesarean delivery.

Other studies have shown that having an older sibling decreases a child's risk of allergies and eczema, supposedly because older siblings bring more bacteria into the house. Similarly, having a pet in early life (especially if it's a dog) has been linked to a lower rate of allergies and asthma in children.

But bacteria may just be one factor in the allergy equation. Exposure to allergens themselves may desensitize a child to them later in life. That brings us to the fact that children and their parents overall are spending less time outside. At the same time, children in densely populated urban areas are exposed to pollutants at younger ages. Both factors may increase the risk of allergies and asthma.

In summary, it's clear that the rates of asthma and allergies have incrementally increased in the United States over the last 50 years. Although the research is largely correlative, it seems equally clear to me that we can reduce that risk in our children by getting them -- and ourselves -- outside the house as much as possible, exposing them to their surrounding biome (within reason), and pushing for a reduction in pollution.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

health

You're Extremely Unlikely to Catch the Same Cold Twice

Ask the Doctors by by Eve Glazier, M.D. and Elizabeth Ko, M.D
by Eve Glazier, M.D. and Elizabeth Ko, M.D
Ask the Doctors | December 23rd, 2017

Dear Doctor: My wife had a bad cold, and then I unfortunately caught it. Then, just as I was recovering, she got it again. What's going on? I didn't think it was possible to get the same cold twice.

Dear Reader: It's tempting, and even logical, to think that your wife's cold has ricocheted between the two of you. However, viruses are abundant and opportunistic, so who was infected with which bug, and at what point in time, is up for grabs.

It's entirely possible that you became infected with the same virus that caused your wife's cold. But it's equally likely that you brought home another virus of your own. If so, then on her next go-round, she may have actually caught your cold.

If she did indeed pass along her virus to you, then the second cold she caught was most likely a new and different virus. That's because, thanks to the marvels of our immune systems, it's extremely unlikely to catch the same cold twice. Even if you do manage to become re-infected, thanks to the antibodies provided by your immune system, the new cold takes a significantly milder form.

However, cold and flu viruses mutate readily. When that occurs, despite having developed antibodies to fight off the original cold, the altered virus can indeed make you sick again. Whether your family's illnesses were the result of one, two or even three different viruses, there are simple and effective steps you can take to limit their spread. These precautions are worth implementing at home, at work and while out in public.

Viruses can survive for up to three days on surfaces and inanimate objects. When caring for someone who is ill, don't share food, drink, dishes, glasses or cutlery. Wash everything used by the cold sufferer in hot, soapy water as soon as possible.

Be aware that the books, pens, remote controls, telephones, electronic gadgets and doorknobs that the sick person touches can harbor the virus. A spritz with a bleach solution or a disinfectant cleaner is a good idea. Making sure the sick person frequently washes or disinfects their hands is important. Ditto for the caregivers and all others in the house.

Do what you can to build up your own immune system. Eat well, drink plenty of fluids, take part in regular exercise and get enough sleep. Avoid rubbing your eyes, touching your nose or putting your hands to your mouth after touching public spaces where viruses may linger. And don't forget your annual flu shot.

If you do get sick, please don't try to power through. If your employer offers sick leave, take it. Your co-workers will be grateful. If you have no choice but to go to work, don't try to be a hero. Take advantage of the many over-the-counter remedies that can lower fever and reduce the symptoms that make colds so miserable. And follow good cold hygiene by taking every precaution possible: Sneeze and cough into a tissue, wash your hands often, and don't share food, phones or any objects that may harbor germs, so as not to spread the virus.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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