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Nail Care for Men

If you’re a woman you probably can skip this whole article.

But for us men, read on for the essential nail care!

My promise is I’m not going to bog you down with products and laborious routines.

So basically I had a wife come ask about her husband’s problem nail…

It had broken off almost in half and the nail plate was almost detached….

Ouch!

So what to do?

Here’s the 5 step Guide:

  1. Soak the nail in cold salty water to disinfect
  2. Carefully trim any snags which may catch on clothing
  3. Put on Vaseline or Pawpaw
  4. Cover with a non-stick dressing (avoid sticky bandaids)
  5. Take Nurofen for the pain

Repeat for at least 10 days to allow your skin to regain its strength.

How long till my new nail grows out?

Finger Nails: 6 months

Toe Nails: 18 months

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GERD: Gastro Eosophageal Reflux Disease

Today we had a customer with chest pains complaining that it wouldn’t go away..

Handing me two scripts: one for Gaviscon and another for Somac…I put on my detective hat and asked her about any history of stomach issues starting with the questions:

  • Do you think this is related to any foods you eat? (No I eat very healthy)
  • Do you drink much coffee? (I used to but now just 1 cup a day)
  • Are you bowel motions regular? (Yes, every day)

She appeared lean and told me she is super fit as in: plays soccer twice a week and gyms every other day.

Hmmmm

At this stage it hasn’t quite clicked in my mind yet so I’m digging and digging…I really like solving puzzles like this…someone so young and fit shouldn’t be having symptoms that more often are seen in someone overweight and eats crap.

Now lets not get ahead of ourselves..the doctor has prescribed an antacid and a proton pump inhibitor (PPI). So there must be a diagnosis here…

So now I’m suggesting to her that perhaps it’s worth investigating for bacteria if her symptoms persist. In my mind I’m thinking perhaps it’s Helicobacter Pylori….but part of me is resisting the diagnosis. First because it’s too early..she’s only had persistent chest pain over the last three days…and secondly because she is so young and fit.

To reaffirm this thought…The customer interjects that she’s been on the diet and routine for ages and never has this occurred before.

I suddenly recall a condition called GERD ….not goat…but GERD: gastroeosophageal-reflux-disease. A mouthful I know! It’s basically when people suffer heart burn and chest pains for no apparent reason. Well actually the medical definition is the reflux of stomach contents up the food pipe thereby causing irritation and the physical symptoms of pain. Anyway I never really liked this diagnosis as the treatment always revolved around fluffy ideals like: stress less, lose weight, cut cigarettes, cut alcohol, cut spicy and fatty food. Heck this patient doesn’t have a problem with any of these!

But hang on, she does stress….stress in the physiological sense. She has been exerting herself in soccer matches and at the gym non stop basically….and GERD does have stress as one of the triggers. Still very fluffy but its in the definition……I hold that thought in mind…..

I loop around to the fact that she drinks coffee and ask her:

What time do you have it? (Timing is important see..) What do you know? She has it at 7.30AM-first thing in the morning BEFORE her Weet-bix; which by the way is my favourite breakfast cereal (with honey).

Suddenly I have a light bulb moment! Hang on….if she has coffee, it’s most likely to have gradually irritated her stomach lining to the point of inflaming it.

To test this hypothesis of mine, I ask her questions to see if there are OTHER signs of inflammation:

Do you suffer from break outs (aka acne) or cold sores ever?

Legit as soon as I said that I noticed what looked like a cold sore on the corner of her top lip. She says…YES! I have two cold sores, one right here as you can see (points) and three ulcers at any one time over the last few weeks!

BINGO!

I excitedly explain to her that despite her diet being on-point, the fact that she is under so much physical strain means perhaps her body is running a deficit of nutrients during those exact times….and as such is manifesting these symptoms in her mouth: ulcers and cold sores AND the stomach pain.

It makes sense when you think about the body’s fastest growing cells being those lining your stomach, and the skin in your mouth and hair on your head. Those undergoing chemo often lose their hair first and suffer terrible nausea as these cells are the most demanding in terms of nutrients and so if supply cannot keep with demand…you have problems.

if supply cannot keep up with demand…you have problems.

Before I get to what I finally recommended her lets touch on GERD….

GERD is represented by symptoms of

  • acidic taste in the mouth
  • heart burn
  • bad breath
  • chest pain
  • vomiting

Alarm symptoms that demand immediate GP attention include:

  1. difficulty swallowing
  2. bloody stools
  3. weight loss
  4. anaemia

So to my final recommendation:

I told her to start a multi-vitamin.

Guess what: she just started one that day!

Good on her! I told her to continue that as the extra nutrients will act like a buffer especially during times of physical stress (soccer/gym).

Think of it this way: if the recommended dietary intake of Vitamin C is 75mg daily and she obtains this through her diet..fantastic. But what happens when you are training 7 days a week? You’re probably going to need more in reserve. Hence why I suggested she start that multi-vitamin, to increase her reserves.

Go for goal!

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Constipation: How to fix chronic constipation

The following is the script to the podcast :

https://anchor.fm/e/d38bdc?at=1358881

Young lady suffering a slow tract for 5
yrs…holddd up! what’s a slow tract i hear
you say!

it’s when you cant shit! A simple test: what
you eat generally exits within 2 days..if it
takes 3 or more days to pass..you’ve got a
slow gut. Caveat…must be ongoing for
6months+ your norm will be different to my
norm….some go three times a day…others
go every THREE days..

who cares i hear you shout! You’re right!
you’re more concerned about the blating, the
nausea, the stomach pain!

but plz, let me drop some knowledge:

technical term for it is when your colonic
transit time (CTT) is >48hrs, as measured by
swallowing a radioactive dye and seeing how
long it passes through.

For px with STC, laxatives dont work well
and neither does more fibre in the diet.

About 1 in 10 poeple with constpiatoin will
suffer the type known as a slow tract. The
other kind of constipatoin is where there
are obstructions. i shouldnt laugh here but
that sounds kinda funky…rectal
obstructions

 

Why does this even happen? is it cos you eat
a shit diet? I went in hunt of the answers

Reasons..
1) obstructions….maybe the theres a
prolapse of the rectum,
2) slow colon (colonic inertia)
3) IBS
4) psychological stress
5) nerves being numb

 

STC confirmed by nuclear transit
study..basically u swallow some radioactive
barium and monitor its progress from mouth
to anus…fun days

Another method is the popular Wexman
Questinnaires which asks: how often u go,
pain level when you shit,
did you go fully or half way,
pain in stomach,
time to shit, how much help did u need to
shit-im talking laxatives,
how long uve been constipated, how many
unsuccesful attempts at pooping.

 

//////////////////// clinical trials///////

 

lets move onto the clinical trials. Now be
forewarned that some of these experiments
will sound very wacky….like real wacked.
eating poop kind of wacked. But im getting a
head of myself…lets start with the more
acceptable studies done.

three entrepreneurials scientists stuck
electrodes to childrens belly buttons and
found that after six months, with one hr of
stimulation daily…that the kids started
pooping more…gosh hardly exciting to be
hooked up to some electrodes when u just
wanna go play in the sandpit.

http://onlinelibrary.wiley.com/doi/10.1111/n
er.12734/full

Another group in Britain did a similar thing
but found no benefit…mind you they were
sticking the electrode to the soles of the
feet….kind of sounds farfetched, we’re
trying to fix something at the buttocks not
the feet…but if you look at the nerve path
it does seem to converge at the spinal cord
level.

http://onlinelibrary.wiley.com/doi/10.1111/c
odi.13388/full

An australian bunch did a similar thing but
placed the electrode pads on the tail bone
area and found this to be somewhat
effective. The real issue is the effect
didnt last too long after stopping therapty.

http://www.nobleresearch.org/Content/PDF/16/
2399-8199.2017-1/2399-8199.2017-1.pdf

By now you’re probably thinking, gosh
scientists sure like to zap things…first
Pavlov’s dogs and now kids…rest assured,
things get real wacked now…

///////wacked up research/////

FMT? Fecal microbiota transplantation. The
process of donating someone elses poop and
putting it into your stomach. WTF?! Yep
there woudl be a donor who would rock up on
the day of the experiment, dump a shit, then
scientists would whizz it up in a blender
and pump it via a nose tube into actual
patients.Bat shit crazy!
And if u were wondering, the amount of shit
used was 100g blended in 500mL of saline.
that’s half a litre of brown stuff.
Not surpringly, side effects included:
venting, nausea, abdominal pain and
diarrhoea. what’s venting? i had to look it
up. it says here: a vent is an opening such
as one that discharges pus like the anus.
hmmmm

an opening permitting the escape of fumes,
liquid, gas or steam

So the verdicT? about a 30% improvement…an
increase in number 2s, softer shit, faster
transit times (this is the bus timetable but
the time it takes to pass out some feces

http://journals.plos.org/plosone/article?
id=10.1371/journal.pone.0171308

//////////////////////average Joe and
probiotics//////

 

OKAY so whats the average Joe do when he
listens to all this…well basically if you
wanna avoid constipation…ensure you
actually drink water each day, have fibre in
ur diet from food sources like fruits and
vegetables and add a yoghurt to your routine
as this has been shown to help gut motility.

Now on the topic of yogurt, we all know that
yoghurt contains beneficial bacteria called
probiotics…well

China scientists are pumping real
interesting research on this area. In
fact…at the time of writing my notes…I
had a Eureka moment! Lots of laxatives are
exported to china each day…if you work in
pharmacy you’ll notice this too…things
like Nulax sell like hot cakes! Could it be
something in the water?…a topic of another
podcast no doubt!

 

///////////////HOW do these critters affect
us?///////////

One example are:

methanogens..these methanogens are elevated
in harder stools and correlated with
farting…true enough we all learned in
science lab that methane gas is that partly
the gas found in fart.

another example are the byproducts of
probiotics….

SCFAs and Bile acids….these were shown to
stimulate serotonin receptors in the gut
producin muscle contractions! so how do we
get more of these two acids? more fibre! and
for the case of Bile acids….healthy fats!
hohoho sounds like a healthy balanced diet
to me!

 

A fun point of this research was that the
poop belonging to a group of chemicially-
induced constipated rats were pumped into
stomachs of healthy rats….in turn causing
the healthy rats to be constpiated!

https://www.ncbi.nlm.nih.gov/pmc/articles/PM
C5428802/

now……Taking a slight tangent in our
thought processes

Perhaps its the degeneration of nerves in
the gut that is responsible for slow tract
constipation! kinda like neurodegenerative
disease like Alzheimers and Parkinsons?!
Again a third group of Chinese researchers
took biopsies of peoples lower guts and
examined it under powerful electron
miscroscopes.
They found that in one 69yo woman..that her
nerves had shrivelled up into whats known as
a vacuole and is possibly why she has taken
laxatives for the last 6 yrs!! They rkn that
the same nerves that can be damaged during
child birth are the ones damanged in this
69yo.

https://www.ncbi.nlm.nih.gov/pmc/articles/PM
C5369939/

 

///////// in closing////////
To close of this podcast…i’d like to
return to our original customer’s anxieties
and would just like to say that her
condition is a rare one, and isn’t something
to laugh about….its quite
debilitating….it affects one’s social
life, causings much psychological and
physical distress…..To this friend, I
would say that getting a good doctor on your
side who is willing to try different
approaches to this riddle is key. Very key.
as there are alot of doctors who will just
shrug this into the “too hard basket”.

for the average person, the key take aways
are to eat a diet filled with fibre and
healthy fats along with fermented foods that
are high in probiotics like yoghurt kimchi,
pickles, kombucha etc…

As I mentioned earlier, the probiotics eat
the fibre to product beneficial SCFAs and
bile acids which promote a regular bowel
movement.

Now how many times have you heard this said?
HEAPPPS….well now you have the science to
back it up. Enjoy..

Now before you all head off…if you enjoyed
this podcast, please leave a commment, pass
it onto a friend who may benefit, show us
some love!

 

 

 

Wexman scale:
https://pdfs.semanticscholar.org/9c30/96521a
00e759a1cd345b6aec3ee88a9fc9e2.pdf

 

phyla Bacteroidetes, Firmicutes, and
Actinobacteria. Bacteroidetes:Firmicutes
ratio, and negatively related to Akkermansia
and Methanobrevibacter abundance.
unclassified_Ruminococcaceae, Alistipes,
and Oscillibacter were negatively correlated
with the mean stool frequency3

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Question of the Day: Should I stop my Acne medication?

Question Of The Day! 

 
Latif asks: should I stop my isotretinoin?
 
Disclaimer: if you are on any prescribed medications, speak to your doctor before you start/stop anything.
 
Isotretinoin better known under the guise of Roaccutane, Oratane, Accutane etc… it’s a wonder for severe cystic acne and many other skin conditions.
 
What concerns us in today’s question is that Latif was getting stomach aches about 6 days into using it and needed to know whether to be concerned or not.
 
Vien’s Answer: I said look probably a good idea to stop it and speak to your doctor the following Monday. In the meantime I did some digging around and basically found the following:
 
1) there is a long history of associations of isotretinoin and stomach issues like irritable bowel disease (IBD); a form in inflammation in the gut
 
2) whether there are links to Crohn’s disease (a much more severe form of inflammation that continually relapse) we cannot say for certain
 
3) some people have even gotten IBD AFTER stopping isotretinoin which may suggest a dormant form of IBD which may have been triggered by the drug.
 
4) It isn’t practical to check every single person for signs of inflammation so common sense should say: be more cautious if you have a family history of gut issues; if you take non-steroidal anti-inflammatories e.g. Nurofen, aspirin; and if you smoke.
 
Summary: before starting isotretinoin, review your medical history thoroughly with your doctor. If you notice anything out of the ordinary, err on the side of caution and tell your doctor!
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Apple Cider Vinegar (ACV)-Does it actually do anything?

“One might think that fresh lemons and limes and raw organic apple cider vinegar are acidic, but they actually become alkaline when consumed.”

What a non-sensical claim! Before I get into the details of this, I’d like to say that after spending almost 12hours looking at material online regarding apple cider vinegar (ACV), I haven’t found any shred of evidence to show of it’s 20+ health benefits.

origins

ACV is basically apple pulped up, placed into wooden barrels and allowed to ferment. Much like the process of making wine, alochol is formed by this process. ACV however requires one further fermentation cycle to then produce the acetic acid aka “vinegar.” In fact, vinegar is French for “wine gone sour.”

 

Cider-making process in France.png
Microorganisms in Fermented Apple Beverages: Current Knowledge and Future Directions by Fabien J. Cousin and others.

Now before anyone gets upset, I’ll state clearly that a lack of evidence does not equate a lack of effect. A lot of drugs lack evidence for their effects/side effects until years down the track. In the case of the humble ACV, it’s been around since ancient Egypt times-analysis of urns have revealed traces of acetic acid. Ironically, anything left for that long would go “off” (ferment).

Now the purported benefits of ACV range from the mundane to the fantastical: antibacterial, reduces blood pressure, antioxidant, reduce sugar levels in diabetics, reduce cholesterol, improve brain function, relieve acid reflux, treat warts, treat cancer, treat bad breath, treat gout, treat urinary tract infections, and of course treat head lice.

 

Basically summarised, it can detox, help digest, and improve your energy levels. But does it really?

Rather than repeat what other reputable sources already mentioned on this topic, I will simply provide a summary of it below and provide links to a few reputable sources of information (see below).

 

Stated Health Claim Believable or Not?
Antibacterial Believable: acetic acid at concentration of 3% have been tested. Household vinegar is typically 5% (1)
Reduce blood pressure No studies found
Antioxidant Perhaps: like most plants, there exists phytochemicals (aka bioactive substances) that may defend against free radicals. There are thousands of these in nature and we can’t be sure which is what
Reduce diabetes Unlikely: there was a study on 30 people (FYI a good study requires thousands of people to have enough power). Ten were diabetes, ten were non-diabetics, and ten were pre-diabetic. After about a month of ACV, there fasting sugar levels were slightly lower.  These sorts of studies are too small for drawing conclusions. They also don’t look at factors like participants changed diets whilst in the program. (2)
Brain function No studies found
Acid reflux No large studies done. One was a doctoral thesis project consisting of a handful of volunteers with no conclusive answer.
Warts No studies found. Warning: chemical burns can occur with even standard 5% ACV despite being a weak acid. See images below.
Arthritis No human studies found. One study on arthritis-induced rats showed no effect. Link below
Antifungal One study on denture-associated candida showed it had some effect
Antidandruff Folk remedy but otherwise no studies found
Probiotic Whilst there does exist plenty of probiotics in ACV, there were no human studies on the benefits.

Studies in carp fish show that using ACV in combination with other probiotics may boost the immune system. Whether this relates to humans is unknown.

Helicobacter pylori Studies show that taking ACV with triple-therapy did not show benefit towards H. pylori eradication

What’s my take on it? Drink it for it’s likely beneficial probiotic effects. Always dilute it with a glass of water-add honey to taste. Ignore all the other “benefits.”

 

References

  1. Antibacterial effects of ACV
  2. Vinegar improves insulin
  3. Mother Earth-make your own ACV
  4. superFoodly’s analysis of ACV
  5. Dr Mercola’s analysis of ACV
  6. Science behind why pH won’t budge
  7. Fish fed ACV+probiotics
  8. Helicobacter pylori eradication with ACV
  9. Probiotics in ACV
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Spinning out-You too have Vertigo?

Dim asks: “I have vertigo, what medications are available apart from Serc (betahistine)?”

*Couple of scrap notes from my research on Vertigo..

Almost 25% of the elderly have dizziness lasting more than one month.

Targets for therapy:

  1. hallucination alleviated through vestibular suppressants eg anticholingerics, benzodiazepines, or antihistamines
  2. Nausea and vomiting plus anxiety alleviated through antidepressants
  3. Enhance vestibular compensation through physical head exercises

Armamentarium:

  • benzodiazepines
  • histamingerics
  • Sympathomimetics
  • Calcium channel blockers
  • Steroids methylprednisolone
  • repositioning maneuvers

Differential diagnoses:

  • psychiatric
  • motion sickness
  • otitis media
  • cerumen impaction
  • herpes zoster (shingles)
  • seizures

Risk factors (elderly syndrome? like falling, delirium, incontin)

  • anxiety
  • depression
  • hearing impairment
  • taking more than 5 medications
  • postural hypotension
  • balance impairment
  • past heart attack

Dizziness shouldn’t be taken lightly (even though the majority of cases resolve on its own) as there is greater morbidity associated such as: increased chance of falls, having a stroke, ending up in nursing home care.

Types of dizziness:

  • paroxymsal positional
  • acute vestibular neuronitis/labyrinthitis
  • Menieres+tinitus
  • migraine
  • anxiety disorders
  • vertigo
  • presyncope
  • disequilibrium
  • peripheral vs central vertigo
  • and the list goes on!….

A simple screening test to separate dizziness requiring medicines and those that require further checkup is if the dizzy spell lasts less than one minute or if it lasts for hours to days. The latter you would consider trial of certain medications and following this further medical treatment should it not improve.

Causes:

  • Ototoxic: some medications can be toxic the little hairs in our ear leading to permanent hearing loss and dizziness.
  • Multi-system impairment: data shows that elderly people suffer more dizzy spells than young people. We’re not sure why but perhaps a combined deterioration in visual acuity, muscle strength, hearing ability, etc is the reason; much like in dementia and falls.
  • Viral infections: of the inner ear leading to inflammation of the vestibular nerve causing mixed signals at the brain.

Tests

American guidelines do not recommend any lab tests except for:

  • Audiometric tests: when suspecting hearing loss
  • Brain imaging: when suspecting tumor or stroke
  • MRI: when suspecting acute vertigo with hear loss

Treatments

Type of dizziness Treatments
Labyrinthitis (inflammation of inner ear) Triggered by cold or flu virus, therefore goes away on it’s own. In resistant cases: vestibular suppressant + vestibular rehabilitation
Ménière’s disease No cure. Just relieve symptoms with: a low-salt diet, and/or diuretics
Vertiginous migraine Dietary changes, a tricyclic antidepressant, and a beta blocker or calcium channel blocker.
Vertigo with anxiety Slow introduction of selective serotonin-reuptake inhibitor (SSRI)

 

 

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Weight Loss with Saxenda

Today’s blog post is brought to you by one of our female customers who is struggling to lose extra flab around the belly. Sound familiar?

Well to make matters worse for this lady she has PCOS aka Poly Cystic Ovarian Syndrome. It’s a terrible cluster of issues leading to:

  • irregular periods or none at all
  • pimples
  • hair loss on head/hair overgrowth on arms and body
  • infertility
  • high cholesterol
  • diabetes
  • weight gain

It’s thought to be a genetic problem in the ovaries and its tough as hell to fix.

One of the indirect ways of dealing with PCOS is losing weight which is the focus of today’s blog.

(Other treatment modalities include: metformin, contraceptive pills to rebalance hormones, hormone blockers like clomiphene)

Saxenda is the new kid on the block and is one of three main players. It’s a surprisingly empty field because like anything complex, there is no silver bullet. Diet and exercise help but if you want something more, read on…

Saxenda is a GLP-1 analogue (if you’re a nerd, search it up on Wikipedia) which basically slows down your stomach contents causing you to feel fuller for longer; it also acts at the brain level to alert you to feel that enough is enough; finally, it tells your pancreas to pump more insulin for each meal you have.

It’s an injection done to the thigh, abs or upper-arm ONCE per day (there’s actually another one on the market called Byetta but that’s twice daily with similar results). A pack will set you back $400-500/month (not on the

To be eligible for a script from your GP you have to have a BMI of 30+ (or 27 with diabetes, heart problems, and/or PCOS)

So how long does it take to work? Best results happen at the beginning thankfully…with most of the weight loss during the initial 20 weeks or 5 months. People tend to lose 5-10% of their starting weight.

If you haven’t lost at least 5% by week 12, then chances are it won’t work much further-stop and save your money.

Side effects include nausea and vomiting-50% of people experience this as mild to moderate in severity. In studies people actually have vomited-which ironically for the drug company…is probably a factor in helping with weight loss. Thankfully for us mere mortals it does improve with time. Other side effects can include: irritation, pain, bruising at the injection site. Other things like gall stones and allergies are quite rare.

Risk of pancreatitis (inflammation of pancreas) is very, very rare but hey we don’t know the complete picture because it’s a relatively new drug. There is concern that it may be associated with cancer of the pancreas. Watch this space.

Apart from the weight loss benefits, it also helps to reduce your chances of diabetes by reducing things like your HbA1c  and your sugar spikes after a meal.

I hope this has been informative for our customer and for others like her who are going through PCOS which is a dreadful disease.

As always speak to doc about your personal situation.

Best

xoxo Vien

 

 

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You’ve taken a fall and now you’ve got scars to show Q: What’s the best scar treatment?

This question comes from Iman who asks what scar creams are available apart from Vitamin E and Silicone?

This is an age old question and surprisingly it’s still a new field of dermatology that is yet to be revolutionized.

We’re still using old technology from the 70s aka the humble silicone gel sheets. But that’s because it works.

Scars are bothersome to us humans because they affect our self-esteem in public. Scars can be large, look red, itch like hell, and  feel hard to the touch which can affect our dexterity.

Scarring is the end process of skin healing following trauma be it a cut, burn, graze etc. Skin goes through three stages:

1) inflammation (things get swollen through extra blow flow to the area, pus forms as a by-product)

2) granulation (new blood vessels form, the structural components are laid down) and

3) matrix remodeling (a fancy word for collagen being packed down)

It’s this third stage that causes often gets out of hand and produces excess collagen and hence the raised look of a scar. The story gets worst in the case of keloid scars as they not only regrow but grow beyond the border of the original damage. See images :

 

(Left) Keloid Scars often overgrow the border of the damage site whereas (Right) Hypertrophic scars stay within the border and are less aggressive in growth.

Why do scars even occur? From a cave-man survival perspective…should we ever get a laceration or trauma, the best thing to ward of infection and ensure quick receovery is to have an inflammatory response that tells the body to lay down plenty of collagen to fill up the exposured areas. It’s a biological response. I read somewhere that only certain reptiles can actually rebuild skin to the exact specifications as the original!

So back to humans. Silicone gel sheets are the go-to. They work by occluding (form a protective barrier) the scar and adding hydration. Left on for at least 12hours a day for 6-12months. Downside is the impracticable nature of strapping on a silcone sheet to your body. Especially if it’s on flexure points like elbows or chin.

Compression Garments/Pressure therapy has been proven to reduce the size of scarring especially those across large areas of the body.  They are thought to work by mechanical pressue on the underlying blood vessels thereby restricting blood flow and hence collagen formation at the damage site. Another theory is they provide the shear forces to help re-organize new collagen. The downsides include the tedious nature of putting them on and off-they’re tight!; must be worn for 23 hours each day for up to one year; needs replacing every 2-3 months to maintain their pressure ~25-30mmHg. Here are some photos:

The combination of compression with silicone is superior to either alone and so there are brands they incorporate silicone into pressure garments.

Now for the white elephant in the room: Vitamin E oil. Known as an antioxidant, the main one in the skin in fact, people including doctors have always used it on anecdotable eveidence that it helps scars-but does it? I read lots of articles on it and nowhere is there solid proof that it works.

If anything it may cause some irriation. If used too early on fresh scars it can actually weaken the scar and cause the scar to widen. Its possible the type and strength of Vitamin E count for something…one study was using 320 IU per gram of cream. Typical Invite E cream in pharmcies is only 100IU per gram (Invite E oil is 25IU per drop).

Not surprisingly scientists decided to use Vitamin E with silicone gel sheets to see what wopuld happen and results blew them away-the combo dramatically improved scar colour, size and appearance.

invite e
Source: http://www.pinsdaddy.com/pure-vitamin-e-oil_6yJEc3SKpc4Ur*0Wu55Ru*QT3cKaAHw5FtCj1eyhdtU/

Now I could go on about the various other remedies out there but not much evidence exists so I’ll just briefly list them here:

  • Onion extract (only slightly better than using Vaseline!)
  • Imiquimod 5% (needs more research, some promise)
  • Vitamin A (aka retinoic acid; reduces scar sizes, can be a teratogen if absorbed into the body, needs more research)

 

More invasive options do exist however…

  • surgical excision (cutting it out) but for keloids, they recur in 45-100% of cases (reserve for resistant scars)
  • Steroid injections (corticosteroids): first line therapy for keloids. Response rate 50-100%, Recurrence of 9-50%. Painful. Side effects: discoloration, dimples, spider veins.
  • Radiotherapy: most effective treatment for keloids but high exposure to radiation. Response rate: 10-94%, Recurrence rate: 50-100%.
  • Laser (carbon dioxide, argon, flashlamp-pumped pulsed-dye): conflicting results. more research needed.
  • Cryotherapy: flattens keloids after two sessions. Side effects: permanent skin discoloration, pain, skin shrinkage. reserved for small scars.

An unusual observation is the use of paper tape to hold together fresh incisions made by a surgeon, used for several weeks, seemed to be “useful”. albeit not as effective as silicone, it could serve the purpose of prepping the skin prior to silicone gel sheets.

So for our friend Iman, I think sticking to silicone gel sheets like Scar FX or Cica-Care is her best bet with the addition of some Vitamin E oil (optional) and a pressure garment.

Sources:

Keloids

Pressure Garments

https://www.regionshospital.com/rh2/specialties-and-doctors/specialties/burn-center/garments/index.html

Burns Scars

http://www.smith-nephew.com/key-products/advanced-wound-management/cicacare/

Scar FX 1" x 22" Self-Adhesive Silicone Sheeting

 

 

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Recognizing Signs of Asthma Attacks

 

The reason some children suffer asthma and not others isn’t 100% clear but its partly genetics. Of course this shouldn’t cramp your child’s playtime! Speak to your doctor about safe and effective medications tailored just to your child’s needs and remember to write up an asthma action plan-a simple step by step guide to walk you through times of emergency-just as you has an evacuation plan, this is a plan for your child.

This video is made upon request by one of our Instagram followers who asked me what signs she should look out for during as asthma attack beside the skin tugging (which I’ll explain later). For everyone else watching, it could be a life-saver because recognizing the signs of an asthma attack and acting quickly is the goal of the day.
Asthma attacks occur when the body recognizes foreign particles entering the body and as a natural defense mechanism, limits the air flow to minimize further exposure. This air flow limitation causes the difficulty breathing, the wheezing sound you hear and the coughing fits.

Triggers include viruses or bacteria (the same ones as during a cold),passive cigarette smoke, weather changes (even when the air is coldest such as early morning or late at night), the reflux of acid and food from the stomach, and environmental irritants such as saw dust from daddy’s man cave.

Minor Signs

Where do you look to recognize the signs of an asthma attack? Immediate ones that may come to your mind include: 1) rapid breathing 2) wheezing and 3) coughing. And you would be correct. These are the early signs of MINOR attack. SIT THEM UP STRAIGHT, Pull out the Ventolin and Spacer.

Severe signs

A SEVERE attack would look a little different. Your child may or may NOT be coughing and wheezing because by now they’re exhausted from all that coughing! Think of the last time you coughed so hard it hurt! Another reason they’d be tired is because the air flow is so limited, your child will be using every muscle they have in their chest to expand those lungs. So look for signs of 4) tiredness on the face-your child may even tell you their 5) tummy is sore because of their abdominal muscles being utilized. 6) Now our friend on Instagram mentioned skin tugging, what is that? It’s when those same abdominal muscles are working over-time expanding and contracting so much so that the surround soft skin gets stretched taut giving rise to the term tugging. The medical term for this is retractions. It’s most obvious around the neck area and ribs (I’ll stick a picture here for you to see). In a SEVERE attack, call ambulance 000 SIT THEM UP STRAIGHT and give Ventolin whilst you wait.

Life Threatening Signs

Now this third and last stage during an asthma attack is rare but is a MEDICAL EMERGENCY! It is life-threatening and you must call ambulance 000 SIT THEM UP STRAIGHT and also give Ventolin whilst you wait. Signs to look out for: exhaustion, gasping for air, NO cough or wheeze-remember you’re too tired to even cough or breathe so if there’s no air flow, there’s no wheezing sound, confusion and blue lips.

If there’s ONE thing you took from this video, it’s to call 000 even when you’re unsure of the degree of asthma. Delays can be deadly.

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Your baby lacks Vitamin D from the Breast

Did you know that babies cannot rely on breast milk to get sufficient vitamin D for their growing bones?

Instead they get Vitamin D through the maternal blood supply-which if low, means your baby is born low.

It’s the reason why doctors frequently check Vitamin D levels and why IVF mums get put on high dose vitamin D.

How much vitamin D do you need?

If you’re living in Sydney during spring, summer, or autumn: 6-8mins at 10am or 2pm; and during winter: 15 minutes at midday. No need for sunscreen for this purpose.

If you’re planning on extended outdoor activities, check the UV index. UV Index 3 or above, use sunscreen. Below 3 not to worry generally speaking.

UV Index 3
Source: Council Council Victoria

Where do you check the UV index? On iPhone it’s built into the weather app. Load it the swipe up.

For Android it’s probably the same. There’s also an app called SunSmart that gives you alerts for when the UV index rises above 3. Download it here: http://www.sunsmart.com.au/tools/interactive-tools/free-sunsmart-app

Finally,  for the like-minded geeks out there here are statistics on UV Index across major Australian cities over the four seasons.

UV Index calender
Source: Council Council Victoria

Soak up that sun fellow sunseekers!

xoxo

Vien

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