EDmedblog

Athlete’s foot is an infection of the skin of the feet. It is caused by one of several funguses that grow best in moisture. The mildest cases cause itching, scaling, and cracking between the toes, particularly between the fourth and fifth toes. Athlete’s foot may spread to the sole of the feet as small blisters and scaling. In severe cases it may spread to the ankles and legs. It may invade and deform the toenails. Scratching may cause additional (secondary) infections. The condition is most common during adolescence, but it may occur at any age—even occasionally in infants.

Signs and symptoms

The scaling and cracking appearance of the feet and the itching that accompanies it are symptoms that may indicate athlete’s foot.

Home care

Apply fungicidal ointment once or twice a day (half strength for delicate skin). Or you may use ointments containing undercylenic acid or tolnaftate (available without a prescription). To decrease sweating of the feet, avoid rubber-soled or plastic-soled shoes. Use cotton socks to absorb moisture. White socks may be best since some dyes can irritate the skin.

Caution: Many “incurable” cases of athlete’s foot are not athlete’s foot itself but contact dermatitis caused by the treatment. Contact dermatitis is a skin rash or inflammation caused by some irritating substance. In some people, the ointments used to treat athlete’s foot may cause such irritation; the athlete’s foot fungus is actually cleared up, but the skin remains irritated. If treatment for athlete’s foot does not relieve the symptoms, check with your doctor to determine if the skin irritation is contact dermatitis.

Precautions

• Continue treatment until the skin is completely clear; funguses not completely treated flare up again.

• If improvement is not prompt and lasting, see your doctor; you may have a skin condition that is not athlete’s foot. Many athlete’s foot medications can cause contact dermatitis in some people.

Medical treatment

Diagnosis is confirmed by scraping the skin and then culturing the fungus or identifying the fungus under a microscope. Your doctor may prescribe other fungicidal ointments or lotions or a fungicide taken by mouth. If a secondary infection has developed, your doctor may prescribe oral antibiotics and soaking in a solution of potassium permanganate or aluminum sulphate and calcium acetate.

*17/84/5*

In the game of life, more than half of all men are benchwarmers, says the American Heart Association (AHA). That means that more than 50 percent of men don’t get moving for a minimum of a half-hour a day, three days a week.

That’s a sin, Dr. Goldberg says. “Studies show that exercise may be more effective at heading off an early death than quitting smoking, losing weight, or stopping drinking,” he says. Here are some tips for getting in gear.

Prevent the big “C.” After studying 47,723 male doctors for six years, Harvard researchers found that men who got the most exercise had only half the risk for colon cancer as those who got the least. So, do your colon a favor by exercising for 30 minutes at least three times a week, recommends Dr. Goldberg.

Aim for gains. It doesn’t matter what your fitness level is when you start. It matters that you improve, says Dr. Goldberg. Researchers at the Cooper Institute for Aerobics Research studied the effects of increasing fitness levels on 10,000 men over a five-year period. Men who improved their fitness level enough to run a minute longer than their original treadmill time also had a lower death rate than those who stayed unfit. In fact, every one-minute increase in maximum treadmill time equaled an impressive 8 percent drop in risk of death.

“You should constantly challenge yourself to improve your fitness level,” says Dr. Goldberg. If your exercise of choice is walking or running, try to increase your speed or your distance every few months, he suggests.

Decline the decline. As you age, it’s likely that your physical performance will decrease over time, and the more that performance decreases, the more susceptible you can be to disease. You can slow that decline simply by exercising more, says Dr. Bortz. After about age 30, people who exercise start to see only a 0.5 percent decline in performance each year, he says. “Unfit folks of the same age see a 2 percent decline. That means the man who exercises will have surrendered only about 15 percent of his vital capacity by the time he’s 65; the non-exerciser, 70 percent.”

The AHA estimates that more than 30 percent of men ages 45 to 54, more than 40 percent of men ages 55 to 64, and more than 55 percent of men ages 65 to 74 have high blood pressure. Making matters worse, about 50 percent of men in this country have cholesterol levels higher than 200 milligrams per deciliter. And that’s just the numbers that have been reported. Many men are never diagnosed.

“There’s just no excuse,” says Ichiro Kawachi, M.D., Ph.D., associate professor of health and social behavior at the Harvard School of Public Health. “These are conditions that are easily detected and treated.” Here are some things you can do yourself to minimize the damage.

Burn your arteries clean. Playing half-court hoops for 30 minutes a day can raise your levels of “good” high-density lipoprotein (HDL) cholesterol by as much as 6 milligrams per deciliter. A group of Spanish researchers has found that, on average, for every 100 calories you burn a day, your levels of artery-clearing HDL cholesterol rise by about 2 milligrams per deciliter.

Go low. Researchers from several U.S. cities put 459 folks on a low-fat diet chock-full of fruits, vegetables, grains, and low-fat dairy products. After eight weeks, those with high blood pressure saw their systolic pressure (the top number) drop an average of 11.4 points and their diastolic pressure (the bottom number) dip an average of 5.5 points. This may sound like a lot to swallow, but the famous Food Guide Pyramid recommends eating 2 to 3 servings of dairy products, 3 to 5 servings of vegetables, 2 to 4 servings of fruits, and 6 to 11 servings of grains every day.

*9/36/5*

Though family history is a strong indicator of the diseases that may be in your future, it is far from the last word, Dr. Pyeritz says. “Two people can, have the same high-risk gene mutation, and one will get the disease and the other will not. It’s hard to know one way or another when we’re talking about one gene among 99,999 other genes that also have some influence,” he says.

But the greatest influence is exerted by the lifestyle choices-some small, some large-that you make every day: whether you smoke, how much you drink, what you eat, whether you exercise.

The following are some tips that experts offer for taking your health into your own hands.

Know your tree. “You should retrieve all the information you can about your family history and what diseases run in your gene line,” Dr. Mulvihill says. “When it comes to fighting disease, knowledge is power. When we know what we’re up against, we can keep on the watch for it and do all we can to prevent it. A good example of how helpful this can be is the skin cancer called melanoma.

“If you’ve inherited a mole pattern on your skin that contributes to melanoma, you’re not going to change that,” Dr. Mulvihill continues. “But before we started identifying people with this risk pattern, the death rate was much higher. Now that we know what to look for, some of these folks may still get the disease. But we catch it in stage one, so people don’t die from it.”

Keep a running tab. Knowing you’re at risk does you little good if you don’t bother watching for signs of disease. That’s why Dr. Ken Goldberg of the Male Health Institute recommends keeping tabs on yourself, including performing a monthly testicular self-exam, a skin exam for changes in moles or unusual markings, a quick check of your glands for swelling, a heart-rate check, and a scan for lumps around your chest. If you have high blood pressure or have had a high blood pres sure reading, you should also have your blood pressure checked monthly. And if you have a family history of or are at risk for diabetes, you should have your blood glucose measured monthly as well, says Dr. Goldberg. If your blood pressure and blood glucose are normal, you need have them checked only once a year, he adds.

Recognize your inherited habits. Bad habits often can run as strongly down the family lines as bad genes, says Dr. James Enstrom of the University of California, Los Angeles.

Take an inventory of your habits, Dr. Enstrom says. Do you smoke? Do you exercise? Do you sleep enough? How much do you drink? Do you eat too much? While these things are important for all of us, they’re particularly important for folks who have a history in their family of poor health, he says.

Don’t pull that trigger. Once you’ve tracked down your disease profile, learning the common environmental factors that trigger that disease and avoiding them is your best line of defense, Dr. Mulvihill says.

People who are at high genetic risk for colon cancer may be able to lower their risk for polyps by following a low-fat, high-fiber diet because they’re staying away from known triggers, Dr. Mulvihill says.

Likewise, diabetes is often a case of genetic tendency meeting an environmental trigger, says Dr. Mulvihill. Genes that predispose many people to adult-onset diabetes were probably survival genes for our ancestors to help them store energy during prolonged periods of near-starvation. Today, when these genes are combined with the typical sedentary Western lifestyle and high caloric intake, we end up with obesity, insulin resistance, and adult-onset diabetes. The answer again is to control what you can, Dr. Mulvihill says. And that’s how you live. It’s well-known that avoiding high-fat, high-sugar fare is a good way not only to keep off excess pounds but also to avoid adult-onset diabetes.

Finally, when it comes to beating your odds for heart attack,

I there’s still nothing better than giving your lifestyle a good spring cleaning, says Dr. Ichiro Kawachi of the Harvard School of Public Health.

“Things like not smoking cigarettes, eating less fat and junk food, eating more fruits and vegetables, exercising, and relieving stress are a whole lot more important than worrying about your genes,” Dr. Kawachi says.

Genes or no genes, the incidences of heart disease and stroke have decreased markedly during the past 30 years because people have been taking their health into their own hands, says Dr. Pyeritz.

*22/36/5*

Social improvements

As we saw earlier, the sober truth is that the poor are much less healthy than the more advantaged socioeconomic groups and do not benefit nearly so much from medical advances. A book like this is no place to go into this in any great detail but suffice it to say that the resources that would be needed to make an impact on the health of poor families are so great that they could not come solely out of the ‘health’ kitty.

Modification of lifestyle

If no one smoked, death from all cancers would fall by a third; almost all long-term lung diseases would disappear; several diseases of the arteries would be eliminated; about one quarter of heart attacks would be prevented and there would be a small reduction in perinatal mortality. Some of these benefits can be obtained by switching to low-tar cigarettes. Preventive measures include better health education, further restrictions on tobacco advertising, the restriction of smoking in public places, and increased taxation of tobacco. All of these have been proved to work both alone and in combination.

Any diet that helps people slim, increases dietary-fibre intake and reduces calorie and fat intake will reduce the risk of cancer of the endometrium and gall bladder, may reduce the risk of breast and colon cancer, and may reduce the risk of cancer generally in a number of ways. There is little doubt from several studies that being overweight makes it more likely that you will get a cancer. The avoidance of obesity also reduces the risk of high blood pressure and diabetes, and can reduce the risk of having a heart attack. It reduces the likelihood of suffering from a hiatus hernia, other hernias, degenerative arthritis of the knees and many foot problems. Most people say that when they lose weight the quality of their lives improves dramatically because they feel better, look better and enjoy life more.

Alcohol produces effects not only on the drinker but on those whom he or she influences while drunk. Alcohol consumption is rising and although a little alcohol has been claimed to protect against heart disease most people who drink find it difficult to draw the line and end up having too much.

Too little physical activity results in obesity, high blood pressure, high cholesterol and too much insulin. The benefits of regular, controlled physical activity are now beyond doubt. Perhaps the most valuable is the effect it has on weight loss. People who take regular exercise find it easier to lose weight and to keep it off. This occurs because the body’s metabolic rate continues to remain high even after the person stops taking the exercise. There are also suggestions that the sense of well-being that exercise produces means that people who would otherwise have eaten because they felt ‘low’ now have no urge to do so.

3 Protection against injury

Death rates on the roads are now below the levels of the 1930s despite the vast increase in traffic, but car accidents are still far too common. Worldwide the traffic death toll is calculated to be 250,000. Given that there are about forty times as many injuries as actual deaths it is easy t see how big a problem road-traffic accidents are.

But injuries don’t just take place on the roads. Accidental injury, which includes homicide and suicide, is the fourth commonest cause of death in the US and is the commonest cause of death under the age of 35 in the UK. In the US more people are killed as a result of accidental injury under the age of 40 than by all other causes put together. About one in three of the population of the US each year has a non-fatal injury bad enough to cause them to lose a day or more of normal activities and a fifth of these injuries put the person in bed for at least a day. In the developing countries also, injury is a very common cause of death.

*17/72/5*

Many older people like to think back over their lives and this can give great pleasure. One of the assets that a dementia sufferer usually has are his or her early memories. This ability is sometimes used therapeutically in day hospital and elsewhere, for example encouraging people with dementia to draw pictures of their past, use photographs and other visual material to make a collage, or write notes if this is still possible. A folder of relevant material or a box of objects relating to the past can be used many times in an attempt to bring out happy memories. Old photographs of family, friends, holidays, weddings, and so on are also helpful. Records, or somebody playing music from the past on the piano, will often evoke memories that may stimulate conversation.

An alternative approach is to use stimuli, such as pictures or music, as part of a simple game. Often the questions can be made up as one goes along and a single object can be used repeatedly as the basis for different questions.

*100\138\2*

Coping with dementia can generate two different types of family problem. The first is the stress that can be caused by the demands that the disease process makes on the carers and often their children. The second, connected with the first, is the ill-feeling that can sometimes be fostered within families because one or two members feel that they are taking most, if not all, of the responsibility and providing the greater part of the care.

It is important that all members of the family are involved in making decisions about the pattern of care that is to be provided and the support that is required. If you are a lone carer among others who are helping only a little or not at all, it may help to arrange a family conference so that they are all aware of how you are feeling and what you are having to cope with. If you are beginning to feel that you have gone as far as you can on your own, make this plain in a sensitive way and ask the others not just whether they can help, but how they can help. If the time has come when lack of additional support means the sufferer will have to go into an institution, for example, they have to realize that this is a family decision and not just yours. You have done all that you can and they are saying that they have done all that they can. Even if you are the mainstay of the care that is being given to your relative with dementia, it is not just you that is responsible for any change in the pattern of care, but all your family together. In other words, the change is occurring not just because you can’t carry on but because they can’t help either. Above all, don’t carry on nurturing ill feelings beneath an apparently unworried outward appearance. Dementia is a family disease, and the whole family has a responsibility to anyone suffering from it.

When younger relatives take an aged parent with dementia into their household, this often has an impact on their own children. Children can suffer anything from the loss of their bedroom to less personal attention from their parents, though they tend to be remarkably good at coping with situations like this and adapt very well. It is often the parents’ worries on behalf of their children that are the problem, rather than the effect on the children themselves. Sometimes, however, children can be affected adversely and there is no way of predicting this in advance. Fear, particularly in younger children, can often be overcome by explaining what is going on and why their grandparent is now so different, and also letting them see how you handle situations and relate to their grandparent. Very often children form a delightful relationship with a demented elderly person, particularly in the earlier stages of dementia, and this is probably beneficial to all involved. Children’s love can be very different from that of adults — a natural expression of affection rather than a feeling of duty, which is so often a part of the emotional relationship between an adult and his or her ageing parent.

The biggest problems usually involve teenagers. They may be embarrassed to bring their friends home and feel isolated as a result; they can feel reluctant to let their friends know the situation, in case they become the object of ridicule. There may also be clashes, either because they are asked to help or because although they would like to, it would conflict with the demands made upon them by the usual teenage activities. It is very important that they understand what is going on; sometimes, as is the case with younger children, teenagers can make a major and very positive contribution to the care of a person with dementia.

It is essential, when accepting an older person with dementia into your home, not to expect that the whole family should arrange their lives around the sufferer. The other family members will still need time and attention from each other, possibly even more so than before, and everyone will have to be very sensitive about one another’s needs. Hostility or aggression in one member of the family should not be allowed to spread; rather, the underlying stresses and strains should, if possible, be addressed.

In some cases, despite the best of intentions, taking a relative with dementia into the family is disastrous. If this happens, you have to rest content with the knowledge that you have at least tried to do the best that you can. It is important not to feel guilty about exploring alternative approaches to care. It is the integrity of your own immediate family that is most important. If this breaks up, not only will the sufferer lose out, but so will everybody else. Take seriously any tendency to arguments and family unhappiness before it goes too far.

*78\138\2*

Much of what has been said about the relationship between patients, relatives, and general practitioners is also true in the context of the hospital clinic. There are, however, several practical points that should be borne in mind. Aim to arrive at least ten minutes before the appointment time or, if parking is likely to be difficult, even earlier. If transport has been arranged by the hospital make sure that you are ready a good quarter of an hour before the time that the ambulance or car is due. It is very likely that you will have to wait for some time both before seeing the doctor and while some of the assessment is taking place, although you will be involved in quite a lot of this yourself. It is important therefore to take something to occupy yourself and if possible something that will occupy your relative with dementia. It is also a good idea to make sure you know where the toilets are and if you have to make use of them, let the nurse in charge of the waiting area know where you are going, and that you won’t be long. If you have to leave your relative in the waiting area, make sure that the nurse knows that he or she will be unattended, particularly if wandering is a problem. If your appointment is near a mealtime, ask whether there is a cafeteria for patients in the hospital or take sandwiches. It is better to do this than risk going without a meal. Make sure that the clothes your relative is wearing are easy to take off as he or she will probably need to be examined fully.

Remember that the staff at the clinic are there to help you. It may well be more difficult to talk to them than it is to your own general practitioner whom you know better and whom you see in relatively familiar surroundings. Even if the doctors, nurses, and others seem busy and hurried, remember that you have come a long way to see them, probably at great inconvenience to yourself and possibly others, and that it is important that you leave the clinic with a clear idea of the present position and what is going to happen next. After all, if you return home and find that one of your most pressing questions hasn’t been answered, it won’t be as easy to find out the answer as if you had only to repeat a visit to the general practitioner’s surgery.

Despite being well-organized, many people nevertheless discover when they arrive home that they have forgotten something that was said or have forgotten to mention something. Don’t worry about this! There are two courses of action that you can take. One is to make an appointment to see the family doctor and ask him whether he could answer the question for you or find out the answer. The other approach, possibly the better of the two, is to write a letter to the specialist explaining the position and putting the question again.

I would like to stress again that although the staff in hospital clinics may well seem more difficult to approach, either because they are less familiar than the local general practitioner or because they seem exceptionally busy, it is important that you take this opportunity of finding out the answers to your questions. Don’t be intimidated by them. As long as you ask your questions in a courteous and friendly manner, you will most likely be treated with consideration.

*56\138\2*

Many people suffer from hardening of the arteries, including those of the brain, as they grow older. This means that the wall of the blood vessels thickens and narrows, causing a slowing down of the blood flow. It is, however, not this narrowing that causes the dementia, but a complete blockage causing the death of brain cells. Many people live with narrowed arteries for twenty or thirty years without any effect on their intellect; it is only a sudden, complete blockage that causes a stroke and an accumulation of these blockages that leads to MID. In many cases disease in the cardiovascular system elsewhere — outside the head — has resulted in small particles or clots travelling along the arterial system to a small artery in the brain that they then block, depriving that part of the brain of its blood supply with the resulting death of cells. This therefore is the sudden blocking off of small arteries referred to above whereas arteriosclerosis, when it occurs, blocks off arteries very slowly and may take years to cause significant narrowing of a blood vessel. It is not therefore always arteriosclerosis in the brain itself that causes the problems, but changes in the blood vessels elsewhere in the body, especially those between the heart and the top of the neck. Further causes of small strokes are discussed later.

Infarcts in the brain look similar, irrespective of the way in which they are caused. When they have been present for a long time there is often a small hole as the body’s natural processes remove the dead tissue. This hole usually fills up with fluid. Where this hasn’t happened there is usually a patch of softened material. Examining the brain with the naked eye can usually reveal all of these changes. Looking down the microscope will confirm that the microscopic changes that one expects to be associated with a stroke are also present.

If enough tissue is destroyed, there will be a reduction in brain size and weight with enlargement of the ventricles inside the brain and wasting of the ridges on the brain’s surface.

As one might expect, the severity of the dementia parallels the number of areas of the brain that have been destroyed. It has been suggested that dementia only occurs after a certain amount of brain tissue has died and this threshold has been estimated to be approximately 50 ml — the equivalent of ten teaspoonfuls. In many cases, however, we come across people who have multiple infarct dementia, but in whom there is less than 50 ml of dead brain tissue. Whether or not a person develops dementia seems to depend not only upon the total amount of brain tissue that has been lost, but also upon the site of the strokes. Some brain structures are more important than others in this respect.

Smoking

It is now well established that people who smoke cigarettes are more likely to have a stroke than non-smokers and it has even been suggested that about a third of strokes or similar episodes may be caused by cigarettes. There is, however, very little specific evidence to link smoking with dementia as opposed to paralysis of the limbs or face. Nevertheless because there is no doubt about the effects of smoking on the blood vessels, it makes sense to cut down or preferably to cease smoking altogether if there is any evidence of even a single stroke, whether this is affecting mental function or the limbs.

*34\138\2*

Like so many other conditions that mainly affect older people, there always seem to be more elderly women who are affected by these illnesses than men. This is probably a reflection of the fact that in general women live longer than men, the average woman of sixty-five having a reasonable chance of living into her early eighties whereas most men of this age have a life expectancy of approximately thirteen years — into their late seventies. The situation isn’t quite as simple as this, however, because there is a suggestion that women with Alzheimer’s disease, the most common cause of dementia, tend to live longer than men with Alzheimer’s disease. There is no obvious reason for this, but it may be that female demented patients are fitter than the men. Some of this difference in life expectancy may be a result of the earlier habits of the men who are now old, since men used to drink and smoke far more than women. It will be interesting to see whether contemporary changes in these habits will even out the difference in the length of life expected by normal old men and women, and those with a dementing illness.

There is no unequivocal evidence that dementia strikes any particular social class or professional group more than others. Certain types of illness that cause dementia occur more frequently in certain groups; people who drink too much alcohol are more likely to have dementia, caused either by the brain damage that results from the excess drinking or because of the associated vitamin deficiencies that many alcoholics suffer from. However, as the commonest cause of dementia is Alzheimer’s disease which does not show a particular affinity for any specific group of people, dementia in general would appear to affect men and women in roughly equal measure and not to be associated with any other particular sub-group. The socio-economic group to which a person with dementia belongs does, however, have one important effect upon the progression of the illness, since those from lower socio-economic groups are more likely to be admitted to hospital or an alternative institution for prolonged periods of care and for the management of intercurrent illness.

*12\138\2*