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  • 8/16/2018 I recently had to remove some toenails. Why on earth would someone want that done? Because they were infected with fungus. The medical term for a fungal infection of the toenails or fingernails is onychomycosis (OM).
    This condition is generally more of a nuisance than a real health threat. However, infected nails can become quite enlarged and painful. Diabetics and people who have poor immune function need to be concerned about OM. Infected nails in these folks can lead to inflammation of the skin around the nails and entry of skin bacteria that can lead to serious skin and even bone infections.
    Most people visit their doctors for OM because of the ugly nails. It is the most common nail disorder in adults and affects up to 13 percent of North Americans. It is 30 times more common in adults than children.
    OM is caused by three types of fungi. The vast majority of these infections are caused by fungi that invade and feed on hair, skin and nails. These organisms are called dermatophytes and account for 90 percent of OM. Trichophyton rubrum (70 percent) and Trichophyton mentagropytes (20 percent) are the most common dermatophytes.
    Yeasts and molds cause the remaining cases. It’s often difficult to tell what organism is causing the infection without doing a culture in the lab which is usually recommended prior to starting treatment.
  • HAMILTON HEALTH - Leaflets Three…Let It Be!
    8/4/2018 

    We’ve had pretty good weather so far this summer, allowing many of our readers to commune with nature.

    This has resulted in a lot more rashes showing up in my office. Most of this contact dermatitis was likely caused by poison ivy, one of three plants in Indiana in the genus Toxicodendron. This genus also includes poison sumac, and occasionally poison oak.

    The physical appearance of the poison ivy plant is highly variable, though it always has leaves in sets of three (see illustration). A memory aid from my days as a Boy Scout lets me recall what it looks like – “leaflets three let it be, berries white a poisonous sight.”

    The white berries can sometimes be seen in wintertime. The plant is small and low to the ground when young. As it grows, it can be found in various sizes all the way up to thick vines attached by small red roots to trees or other structures.

    The rash of poison ivy, like most contact rashes, results from the reaction of the immune system to a foreign compound on the skin. The compound binds to skin cells, is recognized by the immune system, and attacked. 

  • 7/29/2018 

    The joy of summer sports and yard work has resulted in a number of patients coming to see me complaining of sore shoulders, elbows, hips and knees.

    Many of these folks have been suffering from bursitis. Most of you have probably heard the term, but what is it? 

    Any time a medical term ends in the suffix “itis,” it indicates inflammation of the tissue or organ involved. In this case, bursitis is an inflammation of a bursa (pleural bursae or bursas). Bursa is Latin for purse, a very good descriptor of what it looks like – a small sac made of connective tissue.

    A bursa is lined by a synovial membrane that secretes fluid into the sac. This turns the bursa in to a little pillow filled with a slippery liquid that helps cushion structures around it. It also allows these structures to glide more easily over each other.

    Here’s a fun activity for the kids; make your own bursa by putting just a little water in a small balloon.

  • 7/22/2018 

    I continue to be amazed when I ask women what the No. 1 killer of women is.

    The majority respond, “breast cancer.”

    While breast cancer is the No. 1 cancer killer of women, and is estimated to have claimed about 40,000 women last year, it is not the biggest threat women face. It’s estimated that 10 times that many died of heart disease last year.

    Cardiovascular disease is arguably the most important women’s health issue, and is largely preventable. How can women be so unaware that they have a one in 31 chance of dying from breast cancer but a much higher one in three chance of dying from heart disease?

    Could it be that breast cancer gets so much more coverage in mainstream and social media? Is breast cancer generally more frightening and potentially disfiguring? Is heart disease just plain boring to talk about?

  • 7/15/2018 

    I saw a young athlete two weeks ago who complained of shin pain.

    He had been upping his running mileage; the pain was due to a stress fracture. It is estimated that between five and 30 percent of athletes and military recruits develop a stress fracture each year. Briefhaupt first described the condition in 1855 when examining military recruits.

    Everyone is familiar with bone fractures, especially those that result from acute trauma. These fractures are usually easy for an untrained person to see on an X-ray – the bone looks like a broken stick. Stress fractures, however, can be much more difficult to diagnose.

    Stress fractures result from repeated stress on the bone. This repetitive microtrauma causes disruption of the microscopic structure of the bone over time that eventually exceeds the bone’s ability to heal itself. A tiny crack subsequently develops in the bone that may or may not be obvious on an X-ray. Think of bending a piece of metal over and over; eventually it weakens and breaks.

  • 7/8/2018 

    Kidney stones are a topic near and dear to my heart as I’ve had the distinct pleasure of passing four of them.

    Stones are also known as calculi, from the Latin for pebble. They can form and stay in the kidneys (renal calculi or nephrolithiasis) or move down the ureters, the tubes connecting the kidneys to the bladder (ureteral calculi or urolithiasis). Stones may also be found in the bladder.

    The ureters are very small tubes that contain smooth muscle cells. These cells contract involuntarily to help move the urine from the kidneys to the bladder. When a stone is too large to pass down the ureter, it can partially or completely block the flow of urine, causing pressure to build up. This pressure, along with contractions of the muscles in the ureter, causes deep, severe, unrelenting pain known as ureteral colic. Stones may also cause blood in the urine.

    The peak onset of kidney stones is in the third and fourth decades.

  • 7/1/2018 

    This week I want to tackle the subject of generic vs. name brand medications.

    There are a number of reasons this topic is important. First of all, medications in general are becoming prohibitively expensive for many patients. Insurance companies are also pressuring patients and physicians to prescribe generics whenever possible to reduce health care costs (not necessarily a bad thing, but certainly a pain in the rump at times).

    I receive many questions about generics in the office. People want to know why every medication doesn’t have a generic substitute and if not, how long will it be until one is available. They also want to know if they are safe and effective.

    First, let me describe what generic and name brand drugs are. Generic drugs are chemical compounds that either never received patent protection or the patent on the name brand drug has expired. In contrast, name brand drugs are protected by a patent, meaning no other companies can produce or sell that particular drug.

     
  • 6/24/2018 

    Urinary tract infections (UTIs) account for about eight million visits to physicians each year in the United States. These infections are much more common in adults, particularly in women. Children account for one to two percent of all UTIs, but their infections are often more serious. About 40 percent of women and 12 percent of men have a UTI at some time in their lives.

    The urinary system or “tract” is composed of the kidneys, ureters, bladder and urethra. The kidneys filter waste products from the blood and produce urine that passes down the ureters to the bladder, where it is stored, before passing out the urethra. An infection can involve one or more parts of the urinary tract.

    Bacteria that normally inhabit the bowel and live around the anus are the cause of most UTIs. The gut bacterium Escherichia coli (E. coli) is far and away the most common offender. Bacteria cause UTIs by making their way to the opening of the urethra where they can enter and start to grow anywhere in the urinary tract.

  • 6/17/2018 

    Barbecue season is in full swing and it’s a good time to review food safety. Food-borne illness is something that almost all of us have experienced at some point in our lives.

    Food-borne illness is defined as more than two people having a similar illness with evidence of food as the source. The overall rate of these illnesses has gone down drastically in the last century with improvements in food handling and sanitation. However, we still hear about illness outbreaks.

    There are approximately 76 million cases of food-related illness in the United States each year. There are also about 325,000 hospitalizations and 5,000 deaths. Underdeveloped countries, as a group, experience about one billion cases annually and four to six million deaths.

  • 6/10/2018 

    The mother of one of my patients asked me to write about meningitis.

    Meningitis is a very rare condition. The incidence of all types of bacterial meningitis in the United States is about two to three cases per 100,000 people per year, while viruses cause about 11 cases per 100,000 per year.

    I frequently witnessed the devastation of meningitis during my training in the late 80’s. However, with the advent of vaccines to prevent the most common causes of bacterial meningitis, physicians rarely see a case today.

    Meningitis is a condition that causes inflammation of the meninges, the coverings surrounding and protecting the brain and spinal cord. Most of the symptoms of meningitis are caused by the inflammatory reaction of the body to infection by viruses and bacteria, and rarely fungi or parasites. These microorganisms reach the meninges either through the bloodstream or by direct contact of the mininges with the nasal cavity or skin, usually through some type of trauma.

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