Mens Health Blog. Medical Blog

• The first thing to remember is the less fragrance the better. Perfumes and perfumed cosmetics are the major allergens. Besides the usual redness and irritation, they can do strange things in sunlight. A brownish or smoky streak may appear where perfume was applied to the skin, usually behind the ears or on the neck – a reaction unique to fragrances. Certain lipsticks and deodorant soaps, too, have been known to cause burning and irritation only under exposure to sunlight. If you still want to splash on a pleasant scent, make your own scented water by packing rose petals or lavender in a jar of cold water. Add a tablespoon of lemon juice. After ten days, strain and use as a subtle, refreshing perfume.

• Lipsticks are usually made of oil, waxes, dyes and perfumes. If you like the ‘wet look’ on your lips but react to the lanolin in lip gloss, smooth petroleum jelly over applied lipstick. If the perfume causes trouble, look for unscented lipstick.

• Use a sponge applicator, not your fingers, to apply foundation, lipstick and eye shadow. (Rubber-sensitive people should use latex or natural sponges.)

• Nickel-sensitive people should use only stainless steel eyelash curlers and tweezers. They may also have to avoid nail polish with a metal mixing ball – solvents in the polish may leach out nickel.

• Eye irritation is less likely if mascara is applied just short of the inner and outer corners of the eyes. Also, brush mascara only on the outer two-thirds of your lashes.

• When applying eye shadow or liner, leave a thin makeup-free zone along the edges. Never use liner on the inner rim of the eyelids.

• Wand-style applicators should be used for no longer than four months, to avoid the build-up of bacteria and the risk of eye infection. Also, do not spit on liner, mascara or eye shadow to moisten it – that, too, fosters growth of bacteria.

• If your makeup starts to wear off during the day, it’s safer to patch it up than to remove it and start all over again. This minimizes exposure.

• Use plain mineral oil to remove eye makeup. Commercial eye makeup removers are generally composed of mineral oil and fragrance. Non-oily removers, on the other hand, are harsh and drying.

• Never go to sleep at night without removing your makeup.

• Above all, don’t use any eye product that irritates your eyes in the hope that you will get used to it. The irritation will only get worse.

• If you find a product that agrees with you, stick with it. Jumping from one brand to another only increases the likelihood of exposing you to a new allergen.

• For a non-drying, alcohol-free astringent, combine four parts water to one part apple cider vinegar. Swab on with cotton balls.

• People allergic to corn should not use powders containing cornstarch.

• Apply nail polish carefully, to avoid bumping it against cuticle or skin. Also, nail polish is not allergenic once it has thoroughly dried, so allow ten to fifteen minutes before touching anything – especially your eyelids, face or neck.

• Be wary of cream and lotion collecting under your rings.

• Mouthwashes can create all kinds of problems on the soft, delicate tissues inside the mouth, including redness, ulcers and even ‘bald spots’ on the tongue. The reactions disappear as soon as the mouthwash is discontinued. If you feel you need a breath freshener, chew on a sprig of fresh parsley or suck on a whole clove.

• The hair dyes most likely to produce a reaction are the oxidation type and those containing the chemical paraphenyl-enediamine. The allergic reaction may occur a few hours after application and usually becomes full blown after one or two days – so a patch test done just before your hairdresser is about to dye your hair is really no predictor of reaction.

Other coloring methods – progressive dye, semi-permanent organic dyes (like henna) and hair rinses – seldom cause trouble. Ask your hairstylist to help you choose a less allergenic product.

• Sunscreen lotions are a must for sunbathing. But have you ever used a sunblock and got a reddened, blistery rash anyway?

You could be allergic to the fragrances or benzocaine in the product – or even to PABA, a highly effective and otherwise safe sunscreen ingredient. An effective alternative is sunscreens containing benzophenone.

• Fragrance-free deodorants and antiperspirants with aluminium chlorohydrate are less likely to cause allergic reactions.

*75/65/5*

The questions most people ask about insect allergy are: How do I know if I’m allergic to insect stings? How can I tell if my child is allergic to them?

No one experiences a life-threatening reaction the first time they’re stung. A severe local reaction, however – exaggerated swelling, nausea, weakness and so forth – is almost a certain harbinger of potential and more severe systemic reactions. And, as is the case with other types of allergy, whether or not you ever experience that ominous first reaction depends on a number of factors:

What Bit You. Anyone who is allergic to bees is apt to be allergic to wasps, hornets and ants. However, the potency of insect venom varies from species to species, so some can cause more of a problem for you than others.

The Amount of Venom. Naturally, the more venom injected the more chance for a reaction. And more stings mean more venom. But venom levels can also vary for other reasons. In the early spring and late autumn, for instance, honey-bees carry around far less venom than they do at the peak of summer.

Other Allergy. Nearly one-third of people who are allergic to insects are allergic to drugs, especially drugs that are injected, like penicillin. Other than that, coexisting allergy doesn’t seem to have much bearing on susceptibility to insect stings.

Your General State of Health. Although it has no bearing on whether or not you’re allergic to insects in the first place, your general state of health may influence how well you tolerate a sting or bite. If you’ve ever had a run-in with any insect that resulted in anything more than a slight swelling, you should be on your guard against future encounters. And you should tell your doctor all the details. Don’t be macho – mild reactions are the best clues for predicting life-threatening reactions and shouldn’t be played down. The information can save your life.

Your doctor will also need to know what bit you. The problem is, most of us don’t know one insect from another and assume anything that stings is simply a bee. So if you possibly can, take the insect’s body to the doctor with you, even if it’s squashed. Lacking a body as evidence, some doctors stock photos of common stinging and biting insects – rather like mug shots used to help identify criminals.

*64/65/5*

Allergic reactions to drugs are usually mild or moderately severe – no more than some itching or a few hives. But occasionally a drug reaction can be fatal. That’s why allergic people should learn all they can before they take any drugs, whether prescribed by a doctor or purchased over-the-counter.

Each drug has a number of known side effects – health problems caused by the drug, which doctors have learned to expect. An allergic reaction, on the other hand, is an unexpected reaction which people who respond to a drug with known side effects rarely have. One out of every four adverse reactions to drugs is allergic.

The chemistry behind drug allergies hasn’t been pegged down as an antigen-antibody reaction, or any other identifiable immune reaction. Just the same, the possible symptoms are identical to those of other allergies: skin rashes, asthma, hives, and shock. And reactions occur only after a prior, uneventful exposure to the drug or a chemically related substance. So doctors regard drug sensitivities as allergy in the true sense despite a lack of measurable immunological changes.

But how does your doctor know whether you are experiencing a side effect or an allergic reaction? For one thing, side effects, no matter how numerous and varied, are spelled out either on drug package inserts or in one of several reference books containing drug information, such as The British Formulary of Drugs: A Handbook of Psychoactive Medicines. More important, however, an allergic reaction follows a latent period – usually seven to ten days – after you first take the drug. In other words, your doctor starts you on penicillin today, but you may not react until next week. Then the next time you take penicillin, you may react immediately – and explosively. And if you’re allergic, you’ll react no matter how small the dose.

The skin is the organ most likely to suffer when you swallow a drug or get an injection that doesn’t agree with you. Here is a list of possible symptoms.

Itching. Alone or with other symptoms, itching is so characteristic of drug allergy that if you don’t itch, you probably aren’t really allergic.

Hives. Huge hives all over the body are almost a sure sign of allergy to certain drugs – notably penicillin, aspirin and related compounds (salicylates) or even allergy treatment extracts. Rashes. Drug-induced rashes come in a variety of shapes and hues, from bright red, itchy patches to bumps or scattered spots that resemble measles. Occasionally, the rash takes on a bluish tint. Whatever the form or colour, it usually centers on the trunk.

A mixed bag of eruptions known as erythema multiforme is the ultimate in drug-induced rashes. The blotches vary in size, shape and appearance, are usually distributed on the backs of the legs or forearms, and are frequently accompanied by fever, general discomfort, stomach and abdominal upset and joint pains. It’s reassuring to know that all clears up when the drug is discontinued.

Generalized Swelling (angioedema). This often affects the eyelids, lips, hands and feet. Broken Capillaries (purpura). These red or purple threadlike squiggles beneath the skin surface are less common but occasional signs of drug allergy.

Photosensitivity. Sunlight presumably alters certain drugs so that they readily form allergy-triggering substances in the skin. The resulting flare-up resembles contact dermatitis or eczema, and may not appear until days or months after the sun/drug encounter.

Scaling and Shedding of the Skin (exfoliative dermatitis). Needless to say, this is one of the more drastic symptoms of drug allergy. Sometimes the hair and nails fall out, too. Fever, chills and overall discomfort go along with it. Don’t worry about being taken by surprise, though; this problem doesn’t develop overnight. The trick is to alert your doctor to any patches of scaly skin early on, before things get out of control.

While the skin takes the brunt of our allergic encounters with drugs, the rest of the body is not off limits. Bronchial asthma can be caused by aspirin. (Most people who get this already have regular asthma.) Fever – rarely a consequence of other types of allergy – can develop as part of a drug reaction, and can easily be mistaken for a symptom of the illness that’s being treated. By far, though, anaphylaxis is the most severe and dangerous non-skin drug reaction, and one that’s most commonly caused by penicillin. With little or no warning, blood pressure drops, the pulse weakens, the throat swells closed and the individual collapses – all within minutes or even seconds after getting the drug. Anaphylaxis, by the way, is far more likely to occur after an injection than after oral medication.

*53/65/5*

Beyond keeping our homes dust-free and mould-free, many of us are probably too clean for our own good – especially when it comes to allergies. Furniture polishes, window cleaners, aerosol sprays of all types, disinfectants, floor waxes, moth balls – all contribute to an invisible mist of chemical vapors in our homes. Most of these products are a combination of petroleum-based or coal-based ingredients, fragrances and complex chemicals.

‘One of the major factors in chronic illness today is the products we clean with,’ says Dan R. O’Banion, author of the books An Ecological and Nutritional Approach to Behavioral Medicine and The Ecological and Nutritional Treatment of Health Disorders (Charles Ñ Thomas, 1981).

Dr O’Banion is talking about chronic illness from chronic exposure. We all have heard the horror stories of people who mixed chlorine bleach with ammonia and keeled over dead. But repeated single, smaller exposures to these and several other products pose hazards of their own. ‘Even mild exposure to certain chemicals may lead to chronic bronchospastic responses [such as wheezing] or allergic reactions in susceptible persons,’ write Drs Rose H. Goldman and John M. Peters in the Journal of the American Medical Association.

The two worst household offenders are probably oven cleaners and air fresheners. Oven cleaners because they’re the strongest; anything that replaces good old elbow grease in battling six months of burned-on fat and pie drippings has to be pretty potent. And air fresheners – either scented aerosols or the perfumed ornaments slapped on the lid of a rubbish bin – because they add more chemicals to the home environment.

But you don’t need either of these products. Keep your oven clean by always wiping it out soon after you use it (and it’s still warm) or by scraping off dried grit with steel wool. And a far better – and cheaper – air freshener, suggests Dr Boxer, is an opened box of plain old baking soda. ‘That will absorb odours, not add them,’ he says.

Baking soda, in fact, is one of many simple, old-fashioned items that do the job of several expensive and odorous housekeeping supplies.

If you must keep strong commercial cleaners on hand, store them in a tightly sealed container, preferably outside the home in a detached storage shed. That includes: paints, solvents, lacquers, turpentine, lighter fluid, charcoal fire-lighters, glues, odorous soaps and detergents, polishes, mops and cleaning cloths, chlorine bleaches and ammonia. When you use them, be sure the windows are wide open and a fan is on. Afterwards, leave the area for several hours while the fumes dissipate.

When it comes to painting, refinishing and re-modeling, you may not have much choice of products. All may be highly odorous. In general, however, alkyd-base paints are better tolerated than latex or epoxy paints, whose odour seems to linger for months. If you’d like to test your personal tolerance to a particular product before making it a permanent part of your home, there are some ways to get an idea of what you can and cannot tolerate.

*42/65/5*

What people miss most on a Rotary Diet is not so much their favourite foods but the spontaneity of eating what they want, whenever they want. A therapeutic diet of any kind takes at least some organization and planning. If you are in the habit of not deciding what to serve for dinner until you’re driving home from work at 5.15, a Rotary Diet will require some self-discipline. But the minor inconveniences are better than feeling miserable all the time. Feeling better, in fact, will reinforce your determination to stick with it and enjoy what you can eat all the more.

Doctors who treat food allergies with the Rotary Diet say people will have better luck if they follow a few basic rules.

1. For the first few weeks, try your best to avoid all foods to which you know you are even moderately allergic – giving yourself an allergic ‘rest period’. If you wish, you can start a Rotary Diet without that initial rest period. However, you’ll probably experience some symptoms for the first few cycles.

2. Learn about food families. Nature is full of surprises, and learning about relationships between foods can be fun. White potatoes and sweet potatoes are not related, for instance. Neither are tuna and prawns. Or raisins and prunes. Peanuts are not really nuts, but legumes. Ginger, clove and cinnamon are three totally different plants. So there is no such thing as an allergy to all spices. Or all nuts, for that matter. Or all fish. Chances are you can find suitable and appetizing alternatives to your favourite foods by choosing members of unrelated families.

Surprises work the other way, too. Asparagus is related to onions and garlic. Cucumbers are related to melons. Carrots are related to celery. Working out a Rotary Diet teaches you to think about foods in a new way.

3. Diversify your foods. By working in members of food families that are new and different for you, you make your menus more interesting and find it easier to stick to the diet. Within familiar food families, eat a variety of foods. Diversification also helps to prevent future allergies.

4. Stick to primary foods – fish, meat, poultry, fruits and vegetables – as close to their natural state as possible. Avoid secondary or combination foods – mixes, sauces, blends or packaged foods.

5. Similarly, rotate only wholesome, nutrition-packed food, not cupcakes, soda and the like. ‘I tell my patients to rotate and stay off junk food,’ said Dr Boxer. And stay away from alcohol, coffee and tobacco.

6. Select a minimum number of foods for each meal and fill up on them, rather than choose a potpourri of multiple foods. For instance, an eight-ounce portion of broiled fish, half a plateful of steamed broccoli and a large potato would comprise a typical Rotary Diet meal.

7. Whenever possible, avoid eating the same food more than once a day.

8. Grow as much organic, additive-free food as you can. Or buy organic food when you’re absolutely sure it’s the real thing and not a fake-labelled, high-cost rip-off.

9. Don’t forget to rotate spices, cooking oils and beverages. Soybean, safflower and sunflower oils, for instance, are derived from different families. Among herb teas, lemongrass, mint, sassafras, verbena, hibiscus and rosehips are unrelated to each other.

10. Write down everything you eat. Otherwise, it’s practically impossible to keep foods straight.

*30/65/5*

Sometimes when there is something wrong with people with dementia all that they can indicate to us is that they are in discomfort. This may be apparent from an increased level of agitation or a deterioration in their behavioural pattern. It can be extremely difficult to discover whether pain really is at the root of the increased confusion and, if so, what it is caused by. The source of pain can be a full bladder that won’t empty, as happens in some men with an enlarged prostate gland, or perhaps an undetected broken bone; indigestion from ulcers can also be the culprit, and so on. A person with dementia is just as likely to develop all the physical problems that the rest of us can have. All that the doctor can normally do is exclude obvious and easily diagnosed causes of pain, and if a specific diagnosis is not apparent, treat the pain in a general way in the hope either that it will settle down or that other indicators of the underlying problem will eventually become apparent.

*93\138\2*

Hallucinations – seeing or hearing people, voices, or things that aren’t really there – often happens as a result of dementia. It can be very frightening, both for the sufferer and the carer. Some people with dementia form quite a close attachment to their ‘invisible friend’ but more often than not the experience is a distressing one. This situation is best handled by reassurance. Explain that you know they can see someone who you can’t and try to be supportive.

Sometimes visual hallucinations result either from a false impression given by an inadequately lit and dimly perceived object or from poor sight. If the illumination in the room appears poor, improve it and see whether this helps.

If hallucinations become a major problem it is important to seek medical advice, as this is one situation where medication may actually be helpful. There is, however, no point in treating them unless they are causing distress or upset or are disrupting the daily routine.

A similar problem, although not really a hallucination, can occur when people with dementia see their own reflection in a mirror. They may fail to realize that it is their own image they are seeing and interpret their reflection as indicating the presence of a stranger. This can sometimes provoke an aggressive or fearful response. If this is a particular problem, a small curtain or cloth can be draped across the mirror, enabling others to use it when necessary, while at the same time removing the cause of the distress.

*71\138\2*

There is no doubt that the brain of a sufferer from Alzheimer’s disease contains an unusual quantity of aluminium. It now also seems fairly clear that the aluminium is especially concentrated in those structures that are most affected in Alzheimer’s disease and that it is found in association with the senile plaques and the neurofibrillary tangles. This of course has led to considerable speculation that aluminium could be the cause of, or a contributory factor to, the development of this type of dementia in at least some sufferers, if not most.

This theory is further strengthened by the results of experiments on animals that have shown neurofibrillary-tangle-like structures developing in brain cells exposed to large quantities of aluminium. Further, people with kidney failure who have to undergo renal dialysis run the risk of developing a confusional state if the dialysis procedure allows too much aluminium to enter their body. Although this is now rigorously controlled, in earlier days before the relationship between aluminium and brain damage in kidney patients was established, some people with kidney failure died of a condition known as dialysis encephalopathy. Excess levels of aluminium were implicated in this process.

Although this all makes for a good prima facie case for aluminium as a potential cause of Alzheimer’s disease, one has to remember that aluminium might be accumulating in the brain as a result of the condition rather than as an agent which is causing it. It is possible that damaged tissue may accumulate aluminium in greater quantities than undamaged tissue. Most people working in this field believe that aluminium accumulates passively as a consequence of ageing or damage to brain cells. Moreover, accumulation of aluminium is known to occur in other brain disorders, in which the characteristic changes of Alzheimer’s disease do not occur. The people dying of dialysis encephalopathy did not develop the same changes in the brain as are found in Alzheimer’s disease or if they did, to only a very minor and possibly insignificant extent. In addition, aluminium does not accumulate in all places where plaques and tangles occur and in at least one study it was found not to have accumulated in that part of the brain that is usually most severely affected by the abnormal changes. If aluminium really were important, one would have expected the highest levels in this area – the hippocampus.

A lot of prominence has recently been given to the level of aluminium in drinking water. Aluminium is added to the water supply as part of the purification process and in many parts of the country water has a naturally high level of aluminium dissolved in it. Although a recent study claims that Alzheimer’s disease appeared to be more common in parts of the country with higher than average levels of aluminium in the water, even this evidence is not strong enough to implicate aluminium as the cause of Alzheimer’s disease.

The study is a difficult one to interpret for a number of reasons; although in general it was reported that there were more cases of Alzheimer’s disease in areas where the water was high in aluminium, some areas with the highest levels were not associated with the greatest number of cases. Besides, we take in a lot more aluminium with our food than in our drinking water. The latter is responsible for only a small proportion of the 5-6 mg of aluminium that most adults ingest each day.

If aluminium is one day shown to be an important contributory factor and the scepticism of many of us shown to be inappropriate, it will prove very difficult to minimize our intake of the substance. Aluminium is one of the most common elements in the earth’s crust and is present all around us. Not only does it occur in our water and naturally in our food, it is a common component of some food additives. It is present in cosmetics and talcum powder and in the dust that we breathe.

In any case the link, if one exists, between aluminium and Alzheimer’s disease is unlikely to be a simple matter of cause and effect. Two people can live side by side for sixty years, having got married in their late teens or early twenties, consuming a very similar amount of aluminium throughout their life. Only one of them develops Alzheimer’s disease and their neighbours who probably have a not dissimilar lifestyle, are also spared. Why this selectivity? It is possible that some subjects with Alzheimer’s disease inherit a tendency to be particularly sensitive to aluminium or process it within their nervous systems in an abnormal manner. Although this possibility does exist, there is as yet no firm evidence in its favour.

Finally, an alternative and totally speculative hypothesis involves the suggestion that the aluminium that we consume during our adult lives is irrelevant and that if this element plays any part at all in causing Alzheimer’s disease, it is aluminium intake in early life, perhaps even before birth, that is important, causing damage to nerve cells in the brain which does not become apparent until much later in life. There is, however, no evidence at all at the moment to support this possibility and I only mention it for the sake of interest.

*49\138\2*

The frontal lobe is the part of the brain that controls certain aspects of our personality, particularly keeping our behaviour in check. Some forms of frontal lobe damage will lead to uninhibited behaviour, for example when a person has drunk too much alcohol. It seems as if alcohol is a stimulant, but in fact it depresses those parts of the frontal lobe that control behaviour, releasing inhibitions.

One of the features of Alzheimer’s disease that is said to differentiate it from the dementia that is characteristic of small strokes, is the change in personality often noticed in the Alzheimer’s sufferer. This can take the form of being unusually irritable or apathetic, or showing a lack of concern about matters that would formerly have been of importance to the sufferer, such as the management of the family finances. In the early stages the subject may realize that forgetfulness is a problem, but it may cause no undue anxiety; in some cases, however, the realization may be accompanied by considerable anxiety. It is usually relatives or friends who are responsible for alerting the doctor to the fact that something is wrong. Sometimes mood is very unstable, with anger or tears suddenly appearing for no obvious reason. This, however, is also a feature of the dementia that is caused by small strokes. As the disease progresses, restless wandering may occur and later becomes particularly troublesome at night. Eventually there is an almost complete disintegration of personality, with a lack of interest in personal hygiene, standards of dress, and occasionally the development of unpleasant behavioural habits -including going to the toilet in inappropriate and embarrassing places.

Many sufferers from Alzheimer’s disease lose things and accuse others of having stolen them. This paranoid behaviour sometimes progresses to the stage where it is imagined that others are plotting or planning against them, especially if there has been any talk of alternative accommodation. Hallucinations may also occur and these may take the form of the sufferer seeing people or objects that are not really there or, less occasionally, being told to do things by voices from uncertain sources.

As mentioned earlier, another feature of Alzheimer’s disease is the development of difficulty with speech. Speech and language functions are controlled by special centres in different parts of the brain, not just the frontal lobe, but will be considered here for convenience.

The most important language disorder is difficulty with names. This can take two forms. The names of common objects may be forgotten so that when a pen is required, it will be referred to as ‘that thing you write with’ and as the disease progresses even this way round the problem may not be possible, with the sufferer just pointing at an object and demanding that he or she be given it. Sometimes, however, a second type of difficulty with language occurs and this is not so much the naming of an object, but difficulty recognizing the name as used by somebody else.

There is a particular area of the left frontal lobe in most people that is responsible for the control of language and this is affected early on in the course of Alzheimer’s disease. Sometimes it isn’t noticed in the very early stages unless careful tests are undertaken. However, once the language disorder has become marked, it usually indicates that the disease is going to progress more rapidly than hitherto. Generally, difficulty in using the name of an object occurs earlier in the disease whereas difficulty in understanding the name of an object when somebody else uses the word occurs later.

One further aspect of frontal lobe function that is often abnormal in the later stages of Alzheimer’s disease is the reappearance of reflexes that are more typically found in young babies. If the palm of an infant is stroked with a finger, the finger will be seized. Because these reflexes occur early in life and disappear as the nervous system matures, they are referred to as primitive reflexes. When there is significant degeneration in the frontal lobes, the grasp reflexes and others reappear. Although they are occasionally present in apparently normal people throughout life, their presence in an Alzheimer’s sufferer usually indicates quite an advanced stage in the disease.

*27\138\2*

When a diagnosis of ‘dementia’ is made, it is essential not to accept this on its own but to insist that a proper diagnosis of the underlying cause is made, as early in the course of the illness as possible, in case the underlying cause is treatable. The family, or others who are in a caring role, can then make sure that they are aware of what is available locally by way of support from both the statutory bodies – the health service and social services — and also from the voluntary sector, such as the Alzheimer’s Disease Society. Where the provision of support is inadequate, if a group of carers gets together they may be able to press for better resources more effectively than individuals on their own.

If someone you care about has an illness causing dementia the path ahead will probably be a long and difficult one. The purpose of this book is to try to help lighten your load while at the same time assisting you to improve the quality of life of the person who is afflicted.

*4\138\2*