If tingling, numbness, or pain in your hand, as a result of carpal tunnel syndrome, is affecting your ability to sew, garden, or do other hands-on activities, there are several treatment options to consider. The primary goal is to relieve pressure on the median nerve, which runs through the carpal tunnel in your wrist.

Conservative treatments are usually recommended first. Splinting with a wrist brace, especially at night, prevents further irritation of the median nerve. The brace looks like a fingerless glove that has a rigid support that keeps the wrist in a neutral position. You can buy one at your local drug store, which makes it an excellent first step. However, it may take weeks to see improvement, and the relief might be minimal. Corticosteroid injections offer a more direct approach by reducing inflammation and swelling in the carpal tunnel. These injections can provide significant relief; however, the effects can be temporary, and repeated injections are generally not recommended due to potential side effects like weakening of the surrounding tissues. Acupuncture can also be an effective alternative for managing carpal tunnel syndrome; however, it is generally considered less predictable compared with traditional methods.

For persistent or severe cases, surgical intervention might be warranted. Carpal tunnel release surgery involves cutting the ligament pressing on the median nerve, thereby relieving pressure. This procedure has a high success rate and can provide long-term relief, but it may take several months for full strength and sensation to return.

Ultimately, the best treatment depends on the severity of your symptoms and how they affect your daily life. Discuss your options with an orthopedic specialist, who can tailor a treatment plan that’s best for you, ensuring that you can continue to enjoy your activities pain-free.

I generally take care of my feet, but no matter what I do I cannot escape an ingrown toenail on the third toe of my left foot that keeps coming back. What can I do?

A recurring ingrown toenail despite a diligent foot-care routine can be frustrating and painful. The primary reason for this persistent issue often lies in the way the nail grows or how pressure is applied to the toe. Factors like tight-fitting shoes, improper nail trimming, or even genetic predispositions can contribute to the problem. In some cases, repeated activities that put stress on the nails—such as an exercise routine that includes running—can exacerbate the condition.

First, ensure proper nail care. Trim your nails straight across, avoiding rounded corners, which can encourage the nail to grow into the skin. Opt for comfortable, well-fitting shoes that provide ample toe space. If these measures do not resolve the problem, soak your foot in warm water several times a day to help reduce swelling and alleviate pain.

If you have tried all of these measures and none are effective, it’s probably time to consult a foot specialist. A podiatrist can assess the situation and may recommend procedures like lifting the nail to allow it to grow out properly or, in more severe cases, removing part or all of the nail in a minor surgical procedure called a partial nail avulsion. This involves removing the problematic section of the nail and sometimes the underlying nail bed to prevent regrowth in that area. The procedure is quick and done under local anesthesia, providing long-term relief with minimal risk. Consistent follow-up care and adhering to your podiatrist’s advice can help prevent future occurrences.

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What are Mushrooms?

Mushrooms are the fruiting body of a fungus. One of the most sustainably produced foods in the U.S., mushrooms require only a small amount of water and land compared to other foods.

There are thousands of mushroom species around the world (some edible and some poisonous). White button mushrooms are most common in the U.S., but there are many more, each with its own size, shape, texture, and flavor. See “Types of Mushrooms” for more information.

Nutrition.

Mushrooms may not be plant or animal, but they provide many of the nutritional benefits of both. Much like human skin, if mushrooms are exposed to ultraviolet (UV) light vitamin D is produced, making them the only natural non-animal food source of this under-consumed vitamin. (Mushrooms grown in the dark will not have vitamin D. Look for information on package labels or ask the grower at farmers’ markets.)

Although mushrooms do not supply much protein—100 grams (g) of white button mushrooms has 3g protein, while 100g of chicken breast has 22g—the protein they do provide is “complete.” This means mushrooms, like animal proteins, have all the amino acids the human body needs, which is rare in non-animal foods. They also provide some dietary fiber and potassium, and are a good source of selenium, riboflavin, and niacin (although most U.S. adults already get enough of these nutrients).

How to Handle.

Select mushrooms that look fresh and have a firm, smooth surface. For richer flavor, choose varieties with exposed gills, such as portobello and shiitake. Before using, wipe mushrooms clean with a damp paper towel, or rinse gently with water and pat dry. The stems are edible and come with lots of flavor, but cut them off if they are tough (consider chopping and adding to a mixed dish). Keep mushrooms in their original packaging or a paper bag in the refrigerator for up to one week.

Get Cooking!

Mushrooms can be eaten raw or cooked. They work well in soups, salads, wraps, pasta dishes, stir-fries, whole-grain sides, sheet-pan recipes, as pizza toppings, or chopped as a replacement for some or all of the ground beef in recipes like Bolognese sauce and sloppy Joe’s. One simple way to enjoy mushrooms and reap the most flavor is in a quick sauté. Heat a small amount of plant oil in a skillet over medium-high heat. Add one or several mushroom varieties, whole or sliced, along with minced garlic and sliced green onion, and cook until just softened and fragrant, they will begin to give off their liquid. Serve sauteed mushrooms as a side dish or mix into whole grain dishes, pastas, and egg dishes (scrambles, omelets, and frittatas). Stuff large white or cremini mushroom caps with a mixture of minced stems, whole grain breadcrumbs, parsley, and just enough plant oil to hold the mixture together, top with Parmesan cheese, and bake. Or simply add raw mushrooms to salads and wraps, or serve them as an appetizer with dip. Enjoy!

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Hyper vs. Hypo

The thyroid is a small butterfly-shaped gland situated in the neck, just below the larynx. Its function is to absorb iodine, an element that occurs mainly in salt, bread, and fish, and convert it into triiodothyronine (T3) and thyroxine (T4). These hormones control your metabolism, influencing everything from the speed at which you digest fats and carbohydrates, to the rate at which your heart beats.

Another hormone—thyroid stimulating hormone (TSH)— also plays an important role in thyroid function. TSH stimulates the thyroid to produce T3 and T4. As such, measuring the level of TSH in the blood can flag underlying thyroid issues. High TSH levels may indicate that the thyroid is not producing enough thyroid hormone (hypothyroidism, which also is known as underactive thyroid), while low TSH levels may mean that your thyroid is producing too much thyroid hormone (hyperthyroidism, or overactive thyroid).

Hypothyroidism

This is the most common thyroid disorder and occurs when T4 levels are too low. Low T4 levels cause body processes to slow down— as such, symptoms typically include fatigue, weight gain, sluggish bowel movements, and increased sensitivity to cold. However, in older adults, these symptoms are less common—instead, an underactive thyroid may cause depression, loss of appetite, weight loss, and joint pain. Since these symptoms are associated with other diseases that are common in older age, recognizing hypothyroidism is challenging. Dr. Arakawa adds that it also is possible to develop subclinical hypothyroidism, in which TSH levels are only slightly elevated while levels of T3 and T4 are normal. “People who have subclinical hypothyroidism may report nonspecific symptoms, such as an altered mood and cognitive impairment, while many don’t have any symptoms,” she says.

HYPOTHYROIDISM RISK FACTORS

You are at increased risk for underactive thyroid if you have a family history of thyroid disease, have been treated for an overactive thyroid, and/or have had extensive surgery or radiotherapy to your neck. Some medications also raise the risk— for example, the cancer drugs sunitinib (Sutent®) and imatinib (Gleevec®) can cause or worsen an underactive thyroid, as can amiodarone (Corderone®, Pacerone®), which is used to treat heart arrhythmias.

It also is possible for underactive thyroid disease to arise from an autoimmune condition called Hashimoto’s thyroiditis, which impedes the thyroid gland from secreting hormones. Hashimoto’s usually causes a goiter, which is a swelling in the neck arising from enlargement of the thyroid gland.

TREATING HYPOTHYROIDISM

Dr. Arakawa emphasizes that treatment has not been shown to have a significant impact on symptoms in older adults with subclinical hypothyroidism. Although subclinical hypothyroidism is associated with an increased risk for progression to overt hypothyroidism and adverse cardiovascular events, the policy is to monitor people with subclinical disease and initiate treatment only if overt hypothyroidism occurs.

Treatment for overt hypothyroidism is a synthetic version of thyroid hormone called levothyroxine (Synthroid®, Levoxyl®). The drug is one of the most prescribed medications in the United States, but overusing it is known to increase the risk of osteoporosis. Recent research suggests that levothyroxine overuse also may increase the risk of cognitive issues in older adults. The 2023 study (JAMA Internal Medicine, Oct. 23) included 65,931 older adults and focused on thyrotoxicosis (excess T3 and /or T4 levels in the body). The new study suggests that thyrotoxicosis caused by medication raises the risk of cognitive decline. Dr. Arakawa says the data are a useful reminder for doctors to be cautious when prescribing thyroid hormone to older adults. “It’s important to regularly monitor people who are taking levothyroxine and decrease the dose if needed,” she notes.

Hyperthyroidism

This occurs when the thyroid releases too much T3 and T4, and it causes the body to “speed up.” Younger people may experience symptoms like an increased appetite, palpitations (the sense your heart is “skipping” beats), a tremor in the hands and arms, more frequent bowel movements, excessive perspiration, anxiety, and insomnia. But—as with hypothyroidism—overactive thyroid symptoms may be different in older adults, who “tend to present more nonspecifically, with fatigue, weight loss, and mood changes,” according to Dr. Arakawa. “Cardiovascular manifestations of hyperthyroidism also tend to predominate, particularly the abnormal heart rhythm atrial fibrillation,” she adds.

HYPERTHYROIDISM RISK FACTORS

In older adults, hyperthyroidism usually is related to abnormal growths that form in the thyroid gland. Called thyroid nodules, these can produce more T3 and T4, which is what makes the thyroid overactive. An overactive thyroid also can be caused by an autoimmune condition (Grave’s disease). Studies have linked Grave’s disease to an increased risk of cognitive decline. In other cases, drugs may trigger thyroid overactivity— for example, amiodarone, which can trigger both overactive and underactive thyroid disease.

TREATING HYPERTHYROIDISM

Untreated hyperthyroidism is known to increase the risk of developing osteoporosis, a condition that raises the risk of fractures. “Hyperthyroidism also can impact the pumping and rhythm functions of the heart, which may lead to conditions such as heart failure and atrial fibrillation,” Dr. Arakawa says. “These risks are augmented in people ages 65 and older, so treatment is recommended to correct hyperthyroidism.”

Treatment options include anti-thyroid medications, such as methimazole (Tapazole ®), which blocks the production of thyroid hormones. Alternatively, radioactive iodine can destroy the overactive thyroid cells, rapidly shrinking an enlarged thyroid gland. This can leave the thyroid unable to produce any hormone, and it’s likely you’ll eventually become hypothyroid and require treatment for that.

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What are Phytonutrients? Phytonutrients are bioactive compounds produced by plants as part of their defense mechanisms against environmental challenges such as pests, UV radiation, and diseases. Unlike essential nutrients required for basic bodily functions, phytonutrients are not necessary for survival but can significantly enhance health and reduce the risk of chronic diseases.

There are thousands of different phytonutrients, each with unique properties and health benefits. These compounds can be categorized into several classes, including carotenoids, flavonoids, phenolic acids, and glucosinolates, among others.

Major Classes of Phytonutrients.

Carotenoids: Carotenoids are pigments found in brightly colored fruits and vegetables, such as carrots, sweet potatoes, spinach, and tomatoes. They are responsible for the red, orange, and yellow hues of these foods. Some well-known carotenoids include beta-carotene, lycopene, and lutein.

Beta-Carotene is a precursor to vitamin A, essential for vision, immune function, and skin health.

Lycopene is linked to a reduced risk of prostate cancer and cardiovascular disease.

Lutein and Zeaxanthin are important for eye health, reducing the risk of age-related macular degeneration and cataracts.Flavonoids: Flavonoids are a diverse group of phytonutrients found in a wide variety of plant-based foods, including berries, apples, onions, tea, and red wine. There are several subtypes of flavonoids, such as flavonols, flavones, flavanones, and anthocyanins.

Quercetin, a flavonol, has anti-inflammatory and antioxidant properties, helping to reduce the risk of chronic diseases like heart disease and cancer.

Catechins, found in green tea, are associated with improved heart health and weight management.

Phenolic Acids: Phenolic acids, such as caffeic acid and ferulic acid, are found in coffee, whole grains, fruits, and vegetables. These compounds have strong antioxidant properties, helping to neutralize harmful free radicals and reduce inflammation.

Caffeic Acid is linked to anti-inflammatory and antidiabetic effects.

Ferulic Acid has been shown to protect against UV radiation and reduce the risk of chronic diseases.

Glucosinolates: Glucosinolates are sulfur-containing compounds found in cruciferous vegetables like broccoli, Brussels sprouts, and cabbage. When these vegetables are chopped or chewed, glucosinolates are broken down into biologically active compounds such as isothiocyanates and indoles.

Sulforaphane, an isothiocyanate, has anticancer properties and may enhance detoxification processes in the body.

How They Work. Phytonutrients exert their health benefits through several mechanisms:

1. Antioxidant Activity: Many phytonutrients have strong antioxidant properties, which help neutralize free radicals—unstable molecules that can damage cells and lead to chronic diseases. By reducing oxidative stress, phytonutrients protect against conditions such as cancer, cardiovascular disease, and neurodegenerative disorders.

2. Anti-Inflammatory Effects: Chronic inflammation is a common underlying factor in many diseases. Phytonutrients like flavonoids and phenolic acids can modulate inflammatory pathways, reducing inflammation and the risk of associated diseases.

3. Modulation of Detoxification Enzymes: Some phytonutrients enhance the activity of detoxification enzymes in the liver, helping to eliminate carcinogens and other harmful substances from the body. For example, sulforaphane in cruciferous vegetables boosts the production of phase II detoxification enzymes.

4. Hormonal Balance: Certain phytonutrients can influence hormone metabolism and activity. Indole-3-carbinol from cruciferous vegetables, for example, helps balance estrogen levels and reduce the risk of hormone-related cancers.

How to Get Phytonutrients. Given their significant health benefits, it is important to include a variety of phytonutrient-rich foods. Here are some practical tips:

Eat a Rainbow: Consume a wide range of colorful fruits and vegetables to ensure you get a variety of phytonutrients.

Choose Whole Foods: Whole grains, nuts, seeds, and legumes are excellent sources of phytonutrients.

Keep it Fresh (as Possible): Fresh, raw, or lightly cooked foods tend to retain more phytonutrients compared to heavily processed ones.

Experiment with Spices and Herbs: Many spices and herbs, such as turmeric, ginger, and garlic, are rich in phytonutrients and can enhance the flavor and nutritional value of meals.

The Bottom Line. Phytonutrients are vital, bioactive compounds found in plants that offer a multitude of health benefits. By incorporating a diverse array of phytonutrient-rich foods into your diet, you can support overall health, reduce the risk of chronic diseases, and promote longevity.

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Signs, Symptoms, and Risk Factors

Pay attention to subtle signs that may signal osteoporosis, such as loss of height and back pain. Compression fractures in the spine can cause a gradual loss of height, which may result in a stooped posture. These compression fractures can also lead to back pain, which may be sudden or develop gradually over time. If you experience any of these symptoms, bring them to the attention of your primary care provider or a rheumatologist. “Certain women are at a higher risk of osteoporosis due to genetics,” says Alana Serota, MD, an osteoporosis expert at the Weill Cornell-affiliated Hospital for Special Surgery. “But aging, illness, medications, poor nutrition, and other lifestyle factors can significantly increase the risk of osteoporosis, as well, particularly in the first five years after menopause.”

Reducing Your Risk

There are steps you can take to reduce your risk of osteoporosis. Weight-bearing exercises such as walking, jogging, dancing, and strength training help stimulate bone formation and increase bone density. “Women over 50 should focus on maintaining a healthy diet and weight, engaging in regular exercise, getting sufficient sleep, and ensuring adequate intake of calcium, vitamin D, and protein. The goal is to consume 1,200 milligrams of calcium per day. Any not obtained through diet should be made up with supplements,” says Dr. Serota. Generally, the daily recommended amount of vitamin D is 600 international units (IU) for women ages 51 to 70 and 800 international units (IU) for women over 70.

Diagnosis and Treatment

If you are diagnosed with osteoporosis there are several treatment options available. “When osteoporosis is treated, women can expect to maintain or even improve their bone density, depending on the medication used. This significantly reduces the risk of fractures. However, if osteoporosis is left untreated, bone density will continue to decrease, leading to a higher risk of fractures,” says Dr. Serota.

Available osteoporosis medications include:

Bisphosphonates: These medications are typically taken orally, usually as a once-weekly or once-monthly tablet.

Hormone therapy: This typically involves the use of estrogen or a combination of estrogen and progestin. Estrogen therapy can be administered orally in the form of tablets, or it can be delivered transdermally through patches or gels applied to the skin.

Selective estrogen receptor modulators (SERMs): Medications such as raloxifene are taken orally as a daily tablet. SERMs act like estrogen in some parts of the body, such as bone, but have anti-estrogen effects in others, such as the breast and uterus.

Monoclonal antibody medications: These medications, such as denosumab, are administered as an injection, and are typically given once every six months by a health-care provider in a clinical setting.

Anabolic Agents: These drugs, which stimulate bone growth, include PTH-analogues—teriparatide (Forteo) and abaloparatide (Tymlos), as well as the sclerostin antagonist romosozumab-aqqg (Evenity). “All of these approved treatments prevent fractures, and their benefits far outweigh their risks. Ultimately, the choice of treatment is a shared decision between the patient and doctor,” says Dr. Serota.

What to Expect

Medicare generally covers bone density testing DXA (dual energy X-ray absorptiometry) scans every other year for women over the age of 65. The Bone Health and Osteoporosis Foundation recommends that scans can begin as early as age 50 for women who have risk factors for fractures. For women who are diagnosed with osteoporosis, regular monitoring and follow-up appointments with health-care providers are crucial to ensure the effectiveness and safety of prescribed treatments.

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1. Prunes. Prunes are uniquely beneficial for bone health due to their composition of vitamin K, potassium, boron, and polyphenols, which support bone density and may reduce the risk of fractures. They also contain dietary fiber, calcium, and magnesium, which may improve nutrient absorption and reduce inflammation. Research shows that regular consumption of prunes can improve bone mineral density and prevent bone loss, particularly in postmenopausal women.
2. Dairy. Dairy products are excellent for bone health as they are rich sources of calcium, vitamin D, and protein. Calcium is essential for building and maintaining strong bones, while vitamin D enhances calcium absorption and bone growth. Protein supports bone structure and repair. Consuming dairy products like milk, cheese, and yogurt can provide these vital nutrients, helping to prevent osteoporosis and maintain bone density throughout life.
3. Leafy Greens. Leafy greens are rich in vitamin K content. Vitamin K plays a crucial role in bone metabolism by helping to regulate calcium and promoting the binding of calcium to the bone matrix, which strengthens bones. Consuming leafy greens like kale, spinach, and broccoli can significantly contribute to maintaining bone density and reducing the risk of fractures and osteoporosis.
4. Collagen. Collagen is essential for bone health as it provides the structural framework for bones, contributing to their strength and flexibility. As a major protein found in the body, collagen supports our bones, as well as surrounding tissues like joints, skin, and connective tissue. It helps maintain bone density and integrity, reducing the risk of fractures and osteoporosis particularly in postmenopausal women. Collagen-boosting foods include bone broth, sources of protein, zinc, and copper (e.g., beans, beef, and chicken), and vitamin C-rich foods (e.g., citrus fruits and peppers).
5. Nuts. Nuts are beneficial for bone health due to their high magnesium content, which is crucial for bone formation and maintenance. Magnesium helps in the conversion of vitamin D into its active form, enhancing calcium absorption and supporting bone density.
6. Salmon. Salmon is an excellent food for healthy bones as it provides vitamin D and omega-3 fatty acids. Vitamin D works together with calcium for proper absorption, while consuming omega-3s may reduce bone breakdown and improve inflammation.

—Caroline Thomason, RD

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Joint Invasion

Septic arthritis is most likely to develop in synovial joints. Synovial joints are the most common joint in the body—examples include the hips, knees, and ankles. They are characterized by the presence of a fluid-filled space (known as the joint cavity) between the bones. The joint cavity is a sealed, sterile space, but it is possible for bacteria to gain access to it via the bloodstream if an infection develops elsewhere in the body. Having inflammatory arthritis, such as rheumatoid arthritis, may predispose you to this type of spread. “Rheumatoid arthritis in particular increases susceptibility to septic arthritis because it severely damages joints,” Dr. Kerr confirms. “Also, the drugs used to treat rheumatoid arthritis and other forms of inflammatory arthritis, like lupus and gout, often suppress the immune system, making it harder for the body to fight off bacteria.”

Septic arthritis also is more common in people with diabetes, kidney and liver problems, HIV, and those receiving immunosuppressive therapy for cancer.

Another way for infectious agents to invade a joint is through the skin. In these cases, a bacterium called Staphylococcus aureus (S. aureus)—known as staph—usually is responsible (in fact, most cases of septic arthritis are caused by staph). Staph is present on the skin of most people, and it usually doesn’t cause problems. But a crack or wound in the skin near or over a joint can provide it with a route inside, as can joint injections and joint surgery.

Septic Arthritis in a Natural Joint

In a natural joint, septic arthritis usually presents with a single swollen, intensely painful joint. The knee is most likely to be affected and usually will be hot to the touch and stiff, with a reduced range of motion.

Septic arthritis treatment usually requires a hospital stay of several days. The infected synovial fluid is drained through needle aspiration or arthroscopic drainage. During an arthroscopic procedure, an instrument called an arthroscope is introduced into the problem joint via a small incision. The arthroscope incorporates a camera so your doctor can view the joint. “As well as draining fluid, your doctor also may debride the joint, which means scraping away contaminated and dead tissue,” Dr. Kerr says.

Prompt antibiotic treatment of the underlying infection is essential. Laboratory testing will guide your treatment, but antibiotics may be prescribed on a best-guess basis until your lab results are confirmed. Antibiotics usually are given for two to six weeks, though a longer duration may be needed for infections in larger joints, such as the knee, and hip.

Joint immobilization with splints is required for at least five days. If there is a good response to treatment, gentle mobilization under the watchful eye of a physical therapist may begin, followed by intensive physical therapy for several weeks.

Artificial Joints Also Vulnerable

Septic arthritis also can develop in an artificial joint. If it occurs soon after joint replacement, symptoms typically include fever, swelling, and redness. There also will be fluid drainage from the wound. It also is possible for the infection to develop months or even years after joint replacement, due to bacterial spread from elsewhere in the body. In these cases, a period of apparent recovery will give way to the gradual onset of pain in the joint, but there may be no other obvious signs of infection.

The treatment approach for septic arthritis in an artificial joint is the same as that used for managing the condition in a natural joint, although longer antibiotic regimens may be needed. “This is because bacteria can adhere to the prosthetic and form a “biofilm” that resists antibiotics,” Dr. Kerr explains. The artificial joint components may be left in place during treatment, but if the infection is persistent the implant may need to be removed. In some cases, a new prosthetic joint may be implanted immediately, with antibiotics given concomitantly. Other people may need a recovery period of six to eight weeks before a second artificial joint can be implanted.

See What You Can Do for advice on how to prevent septic arthritis in natural and replacement joints.

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It’s understandable that your son doesn’t want to lose his father and it is important that you both listen to him express his feelings and grief about this. But it also is important for your son to listen to his father explain why he does not wish to continue treatment and accept that this is his father’s choice to make. Also be sure your son understands that his father isn’t entirely forgoing treatment. He will instead be receiving a different type of care—an approach that prioritizes alleviating his symptoms and preserving his quality of life and dignity, instead of exposing him to potentially unpleasant drug side effects for what may be very little gain. (A recent study focusing on this very topic suggested that systemic treatment of people who are near the end of life due to cancer does not improve survival rates.) It also is important to emphasize to your son that this still can be a fulfilling and happy time you spend together, sharing old memories and making new ones that will help sustain you after your husband has died.

Rosanne M. Leipzig, MD, PhD

Geriatric Medicine

I keep reading that exercise benefits knee arthritis, but I find it hard to believe. I have osteoarthritis in one of my knees—I’ve seen this type of arthritis described as “wear-and-tear” arthritis, so how can forcing my knee to keep flexing back and forth possibly be beneficial?

Numerous studies have shown that exercise eases arthritis symptoms and may help people delay knee replacement surgery if they don’t feel ready to take that step. Regular exercise helps maintain range of motion in an arthritic joint, supply lubrication to the remaining cartilage, and strengthen the muscles and bones that support the joint. There also is a less direct benefit—physical activity may help you avoid the weight gain that subjects arthritic knees to even greater stress. Exercise also boosts your mood, which may help you better cope with your symptoms. If you find exercise difficult and/or uncomfortable, you may be exercising at a duration and intensity that is too much for your knee. Ask your doctor to refer you to a physical therapist who can work with you to establish a regimen that strenghtens the muscles around your knee while ensuring that you avoid overtaxing the joint.

David C. Thomas, MD, MS, MHPE

Medicine, Rehabilitation and Physical Medicine

My elderly father-in-law refuses to wear sunscreen outdoors. He says that since he is African American he doesn’t need to wear sun protection because darker-skinned people don’t get skin cancer. Is this true?

Compared with white people, Black people and other dark-skinned individuals do have a slightly lower risk of skin cancer. This is because their skin contains higher amounts of melanin, a pigment that gives skin its color and provides some protection against the sun’s harmful ultraviolet rays. However, low risk doesn’t mean no risk; moreover, skin cancer in people of color often is diagnosed at a more advanced stage that makes it harder to successfully treat. It is possible that this late diagnosis may be due to the fact that when melanoma occurs in people of color it often develops in less obvious areas of the body that may not have seen much sun exposure (such as the fingernails, soles of the feet, groin, between the fingers/toes, mouth, and genitals). If your father-in-law has been lax in using sun protection for many years, I recommend he regularly examine these areas for possible cancers (signs include darker spots and patches on the skin, a rough patch of skin, a sore that won’t heal, or a dark line underneath a fingernail or toenail). I also recommend he take appropriate steps to protect himself from the sun in the future, by applying sunscreen with a sun protection factor of at least 30 and staying in the shade when the sun is at its strongest (10 a.m. to 4 p.m.).

Michael Cameron, MD

Dermatology

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A calcium scoring test is a diagnostic imaging procedure used to assess the amount of calcium deposits in the walls of the coronary arteries. These deposits, known as calcifications, are a marker of atherosclerosis, a condition that can lead to coronary artery disease, carotid artery disease, peripheral artery disease, and aneurysm. During the test, a computed tomography (CT) scanner takes detailed images of the heart, and this provides your doctor with measurements that describe the extent of calcium buildup—or its absence.

There are several reasons why a doctor might recommend a calcium scoring test, and the primary one is it can help assess an individual’s risk of developing coronary artery disease, which is a leading cause of heart attacks. In your case, the test was probably recommended to get a clearer picture of the extent of your heart disease because of your risk factors and family history. Depending on the results, your doctor will either confirm that your current blood pressure and cholesterol treatment regimen is sufficient or modify your medications and implement a plan for lifestyle modifications, such as weight loss and regular exercise.

If you are still on the fence about scheduling the test, discuss this with your cardiologist. If you are concerned about the cost, discuss that with someone in the business office at the imaging center. They may offer to set up a payment plan that breaks down the fee into affordable monthly payments.

I am going camping, and I’m concerned about Lyme disease. I’ll be sleeping in a cabin, but will spend most of my time outdoors. What can I do to minimize my risk?

Lyme disease is caused by bacteria transmitted by ticks, which are most often found in wooded or brushy areas with high grass or leaf litter, so it’s natural to have concerns about Lyme disease when planning a camping trip. To minimize your risk, take preventive measures such as wearing long sleeves and pants, using insect repellents that contain 20 to 30 percent DEET on exposed skin and clothing, and using products that contain permethrin on gear such as your backpack and hat. DEET repels ticks, and permethrin can immobilize them on contact. They are both safe, but permethrin should not be used on skin. Perform regular tick checks during and after outdoor activities using a handheld and/or full-length mirror, and shower as soon as you return from a hike. If you find a tick attached to your body, you can remove it with tweezers; or you can use rubbing alcohol on a cotton ball to smother the tick.

Symptoms of Lyme diseaseinclude a bull’s-eye-pattern rash, along with flu-like symptoms such as fever, headache, fatigue, and muscle aches. If left untreated, Lyme disease can progress to more serious complications affecting the joints, heart, and nervous system.

Most cases of Lyme disease respond well to antibiotics, especially when diagnosed and treated promptly. However, if the infection is not detected early or if treatment is delayed, it can sometimes lead to persistent symptoms known as post-treatment Lyme disease syndrome. Prognosis is generally good with early diagnosis and treatment, but it’s essential to seek medical attention if you develop symptoms suggestive of Lyme disease.

The post Ask Dr. Etingin: Calcium scoring test; Lyme Disease appeared first on University Health News.

Early Antibiotics Effective

Lyme disease is transmitted via the bite of the black-legged tick (also known as the deer tick). The infection usually is easy to detect because a non-itchy bullseye-shaped rash typically develops around the tick bite within three to 30 days (the average is seven days). You’ll also experience flu-like symptoms (fatigue, muscle and joint pain, headaches, fever, and chills).

If Lyme disease is diagnosed early, it can be effectively treated with antibiotics, although the symptoms remain chronic for about one in 10 people. However, it is possible for the condition to go undetected if you’re among the 20 percent of infected people who don’t get the rash. “People who don’t develop the rash may not realize they were bitten by a tick,” Dr. Bloom says. “The ticks that are most likely to bite are immature ‘nymph’ ticks that may go unnoticed because they are no bigger than a poppy seed—moreover, their saliva contains a natural anesthetic that means you may not feel them bite you.” If you develop flu-like symptoms after hiking in areas where ticks are endemic (the Northeast, Upper Midwest, and South), ask your doctor about getting tested for Lyme disease.

Complications Can Be Serious

If no rash develops there is a risk that Lyme disease may be misdiagnosed, since other symptoms mimic other diseases and conditions. People with Lyme disease often are misdiagnosed with chronic fatigue syndrome, fibromyalgia, multiple sclerosis, and depression. Meanwhile, the underlying Lyme infection progresses unchecked, and can affect any body system—potential complications include arthritis, facial paralysis, meningitis, nerve pain, and impaired memory, and these may occur months or even years after you were bitten. Less common complications include Lyme carditis (inflammation of the heart muscle that may interfere with your heart rate), and inflammation of the eyes and/or liver.

Black-legged ticks also can spread other infections, including anaplasmosis and babesiosis. Anaplasmosis typically causes fever, headache, chills, and muscle aches. Babesiosis may be signaled by flu-like symptoms, and can cause serious complications, including anemia, heart failure, kidney failure, and sepsis (an extreme bodywide reaction to an infection).

Preventing Lyme Disease

There is no vaccine against Lyme disease, although trials currently are underway to test a vac-cine that has shown some promise (results are expected in 2025). This means that prevention is your best defense, especially if you live in an area where black-legged ticks are common. See What You Can Do for prevention tips from the CDC.

Removing a Tick

If you discover a tick attached to your skin, don’t panic. “You’re unlikely to develop Lyme disease if the tick is attached for less than 36 hours, and you may be able to guesstimate how long the critter has been hitching a ride through its size,” Dr. Bloom advises. “It may have been attached for long enough to feed if it is larger than a poppy seed—if this is the case, alert your doctor.”

Remove the tick by using tweezers to grip it as close as possible to the surface of your skin and pulling upward with steady, even pressure. “Don’t twist the tick, since its mouthparts may detach and remain embedded in your skin,” Dr. Bloom warns. “After removing the tick, wash the bite area with soap and water.”

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