Appendicitis

Acute appendicitis is the most common abdominal surgical emergency in the world. The appendix is a pouch that projects from the large intestine on the lower right side. The pain often starts near the navel and then moves to the right side. There is often nausea, vomiting, fever and chills. The standard treatment is immediate surgical removal; these days the surgery is most often done via a laparoscope (Band-Aid operation).  If not treated, an acutely inflamed appendix could burst and cause a life-threatening infection.

There are some trials that show that treating acute appendicitis with antibiotics alone is effective. The risk with this choice is a recurrent/relapsing infection or missing a hidden cancer. It is easy, even with sophisticated imaging, to underestimate the severity of disease.  Many medical centers have operating rooms ready to go twenty-four hours per day but it appears safe to wait twelve hours (the next morning) if the patient presents in the middle of the night. Antibiotics need to be started immediately in any case.

Thirteen to twenty percent of acute appendices will perforate (burst). The surgery may be delayed if the diagnosis of perforation is made initially. The patients are often sicker and delay of surgery allows stabilization and better antibiotic coverage.

Less than one percent of cases of acute appendicitis will show a cancer. The diagnosis may not be made until the pathologist reviews the specimen.

Severe abdominal pain, especially when accompanied by fever, chills, nausea and vomiting, requires prompt evaluation by a medical professional. Imaging and blood tests are almost always required. The emergency department might be the first and best place to seek care.

Cold Feet

The most obvious reason that you have cold feet is because your feet are cold. If it’s cold enough to wear a jacket and your feet are bare – maybe you just need to put on some socks. However, there could be medical reasons that your feet are cold.

It’s possible that not enough (warm) blood is getting to your feet. This could be due to poor circulation when the heart can’t pump well enough or from not moving around enough. With exercise, the leg muscles help the veins return blood to the heart allowing fresh blood to enter the feet. It’s counter-intuitive, but blood flow is better with leg elevation so too much sitting can be a problem. Smoking causes blood vessels to constrict, also reducing reducing blood flow. Raynaud’s phenomenon, which causes blood vessel spasm from cold, can be so severe as to temporarily cut off blood supply entirely.

An underactive thyroid can reduce the body’s temperature and heart rate. Both of these can cause cold feet. A partially clogged artery due to high cholesterol will reduce the blood flow to the lower extremities. Not only will there be cold feet, but also pain with exercise since the muscles will not have enough oxygen-rich blood.

Nerve damage can give the sensation that the feet are cold as well as reduce blood flow. An unfortunately common cause of this kind of damage is diabetes.

What to do? First, put on a pair of socks and get some exercise. The next step is to check with your physician to make sure that you don’t have any underlying disease that causes cold feet.

Dense Breasts

Breasts are not just two lumps on the chest wall: they are composed of metabolically active tissue that adapt in response to time, outside stresses and health changes. Since breasts are not static, it is important to have mammograms at regular intervals to look for worrisome changes.

In a great simplification, breasts are composed of fibrous and fatty tissue. Dense breast have a higher proportion of fibrous tissue. Breast density is influenced by age (decreases after menopause), number of completed pregnancies, breastfeeding and certain medications. Fatty tissue appears black on mammograms and fibrous tissue shows as white. The big question: what is hidden in the tangle of white?

Forty percent of women older than age 40 have dense breasts. These women may benefit from additional breast imaging. Digital mammography (tomosynthesis) is more effective in detecting suspicious masses but may still miss cancer in very dense breasts. Ultrasound is often used as an adjunct and select patients may need MRI.

Physicians may recommend a program of breast studies for high risk patients. High risk for breast cancer include a first degree relative (mother, father, brother, sister or child) with breast cancer or certain gene mutations such as BRCA1 and BRCA2, hormone use and alcohol intake.

One out of eight American women will develop breast cancer in her lifetime. Early detection may improve outcomes.

To learn about breast cancer risk.

A discussion about breast density.

Healthy Nails

Your fingernails — composed of laminated layers of a protein called keratin — grow from the area at the base of the nail under your cuticle. Healthy fingernails are smooth, without pits or grooves. They're uniform in color and consistency and free of spots or discoloration.

Sometimes fingernails develop harmless vertical ridges that run from the cuticle to the tip of the nail. Vertical ridges tend to become more prominent with age. Fingernails can also develop white lines or spots due to injury, but these eventually grow out with the nail.

It’s time for medical attention if you notice changes in nail color, such as discoloration of the entire nail or a dark streak under the nail. Other possible concerns include thinning or thickening of the nails or pain or swelling.

Don’t use harsh nail care products. Limit your use of nail polish remover. When using nail polish remover, opt for an acetone-free formula.

Some research suggests that the nutritional supplement biotin might help strengthen weak or brittle fingernails. There is anecdotal evidence that prenatal vitamins are helpful in growing healthy hair and nails.

If you rely on manicures or pedicures for healthy looking nails, keep a few things in mind. Stick to salons that display a current state license, and work only with technicians also licensed by the state board. Don't have your cuticles removed — it can lead to nail infection. Also, make sure your nail technician properly sterilizes all tools used during your procedure to prevent the spread of infection.

You might also ask how the foot baths are cleaned. Ideally, a bleach solution is used between clients and the filters are cleaned regularly.

Tips from the American Academy of Dermatology.

Carbon Monoxide Poisoning

Carbon monoxide is a colorless, odorless, tasteless gas produced by burning gas, wood, propane, charcoal or other fuel. Improperly ventilated appliances and engines, particularly in a tightly sealed or enclosed space, may allow carbon monoxide to accumulate to dangerous levels.

Hemoglobin in the red blood cells carries oxygen to cells. Carbon monoxide is a very aggressive molecule: it knocks oxygen off hemoglobin and binds very tightly. As a result, less oxygen is transported to cells and they ‘suffocate.’

Depending on the degree and length of exposure, carbon monoxide poisoning can cause:

•   Permanent brain damage

•   Damage to your heart, possibly leading to life-threatening cardiac complications

•   Death

There are common conditions that can cause CO levels to rise quickly:

•   Appliance malfunction, i.e. the heat exchanger on your furnace cracks

•   Vent, flue, or chimney is blocked by debris or even snow

•   Fireplace, wood burning stove, charcoal grill or other source of burning material that is not properly vented

•   Vehicle is left running in an attached garage and carbon monoxide seeps into the house

•   Several appliances running at the same time and competing for limited fresh air can be a cause of carbon monoxide buildup. This condition can result in incomplete combustion and produce CO, even if all appliances are in good working condition

Leave the area immediately if you suspect carbon monoxide poisoning. Call 911 for help. Do a headcount but do NOT re-enter – emergency responders with respirators will assess and rescue others if needed. 

MEDLINE from the US National Library of Medicine. 

Update from the Centers for Disease Control and Prevention

With a good carbon monoxide detector there will be plenty of time to evacuate. Install and save lives.