The Skinny on the Sun

You would never think so looking at it, but the skin is an organ just like the heart or the liver. In fact, it happens to be the largest organ in the body.

The skin, as the border between the self and the outside world, is also the organ that defines us. It protects our internal organs from environmental threats. And for many people, the skin’s appearance, the presence or lack of wrinkles, for instance, is what defines aging, more so than the condition of their vital internal organs. Our skin is very important to us, but skin health is not something to which we give much (or any) thought.

The Skinny on Skin

Number of days it takes for the skin to renew itself: 28

Thickness of human skin in inches: 0.06 to 0.16

Average weight of adult male skin in pounds: 7

Surface area of adult male skin in square feet: 22

Millions of skin cells in average adult: 300

Number of hairs on a square half inch of skin: 10

Number of sweat glands in a square half inch of skin: 100

Number of feet of blood vessels in a square half inch of skin: 3.2

Number of days it takes for the skin to replace itself: 52 to 75

As that part of our body that is the most exposed to the environment, the skin’s greatest threat is the sun’s rays, and overexposure to these rays appears to be the most important factor in the development of skin cancer, which is on the rise worldwide. One out of every five Americans will develop skin cancer, and nearly 10,000 will die from it each year. Skin cancer was long considered a problem only for people over 50, but in the last couple of decades, the rate of skin cancer for people in their forties and younger has multiplied explosively. You need to think about your skin before it’s too late.

Sunny Myths

Sunscreen protects you against all ultraviolet rays from the sun.

FALSE. It protects you from the sun’s UVB rays, but no sunscreen product screens out all UVA rays, which are the cause of melanomas. So just because you put on sunscreen, you are not 100 percent protected.

You don’t need to reapply sunscreen when you come out of the water if you use waterproof sunscreen lotions.

FALSE. There’s no such a thing as a waterproof sunscreen. If you go into the water, you have to reapply these creams immediately because they get washed off.

Suntans are a sign of healthy skin.

FALSE. A tan is a sign of skin damage. The tanning occurs when the skin produces additional pigment (coloring) to protect itself against burns from the sun’s ultraviolet rays.

The sun produces two types of ultraviolet radiation. The ultraviolet A (UVA) rays, which penetrate deeper into the skin, are more responsible for melanoma, the most deadly type of skin cancer. The ultraviolet B (UVB) rays are responsible for sunburns and cause nonmelanomas, the squamous and basal cell skin cancers. Though melanomas account for only 4 percent of skin cancers, they are responsible for nearly 75 percent of all skin cancer deaths. Melanomas usually begin as flat, quarter-inch-sized, mottled, light brown to black blemishes with irregular borders. These blemishes can then turn red, blue, or white; crust on the surface; or bleed. Most frequently seen on the upper back, torso, lower legs, head, and neck, they can occur anywhere on the body.

Anyone can get skin cancer, but you are at increased risk if you

–have a family history of skin cancer

–have many moles or large moles

–have naturally blond or red hair

–have blue or green eyes

–have had five or more sunburns

–have been overexposed to the sun early in life

–are Caucasian with fair skin

While skin cancer is the most common type of cancer, and kills more young women than any other type of cancer, it is also the most preventable.

The best defense against skin cancer is sun protection. Because the sun’s ultraviolet rays can damage the cellular structure of the skin, the use of sun protection is important beginning at a young age and continuing throughout life. Whenever you are out in the sun, it’s a good idea to use a sunscreen with a sun protection factor (SPF) of 15 or higher. Apply it 15 to 30 minutes before going outdoors, and reapply it every two hours. If you can’t avoid being out and about in the hours of peak sunlight—ten a.m. until four p.m.—seek the shade whenever possible and wear a hat, visor, sunglasses, and other protective clothing during prolonged periods of sun exposure.

Since skin cancer has a 95 percent cure rate when detected early, by your late thirties you should have a skin physical every two years. This is particularly important if you are at greater risk for skin cancer. At a skin physical, a dermatologist will go over your entire body looking for atypical birthmarks, blemishes, and moles. This exam could save your life.

Skin cancers aside, chronic sun exposure also creates skin stains and premature wrinkling. Smoking, too, is bad for the skin. On the other hand, the aging of the skin can be slowed by a good diet. Certain foods, like salmon and the omega oils found in salmon, have been found to be extremely beneficial for skin health. On the other hand, while skin creams may reduce dryness, or improve excessive oiliness, they will not alter the overall health of the skin. Creams merely affect the superficial layer of the skin. Good skin health comes from within.

Ah-Choo! Kids & Allergies

Forty percent of American children have seasonal allergies. When a parent has allergies, his or her child will probably have them too.

Most allergies tend to appear in childhood. So, if you have seasonal allergies as an adult, you probably started getting them as a kid.

As children, boys get more allergies than girls, but as they get older, women usually catch up to men.

Even though we say allergies are seasonal, they can occur year-round. In the spring, you can get allergies to grass and pollen, and in the fall you can get allergies to ragweed, molds and spores of different kinds.

Allergies occur when pollen, mold or dust kick your immune system into high gear, triggering a release of histamines, those chemicals that are mostly responsible for the sneezing, the runny nose, the itchy throat, and the watery eyes.

If teenagers weren’t properly exposed to their environment as children, their immune system won’t be able to recognize as harmless the pollen, dust and mold spores around them every day.

Loading the Virus Protection Program

Your immune system is essentially a system of specialized cells and organs that protects you from outside threats such as viruses, bacteria and other biological outsiders.

It is during the first decade of life that it learns which biological intrusions it needs to protect you against. What this means is, if you don’t get exposed to many of the harmless biological threats in your environment during your first decade of life, if you do not challenge the immune system early, you may pay the price with seasonal allergies and asthma throughout the rest of your life.

I’m talking about the dangers of over protecting our children. Some of this overprotection has been institutionalized in the form of widespread use of antibiotics, vaccinations against various diseases, cleaner food and water, and better living conditions.

But some parents may make this “problem” worse by keeping their kids at home in a “sterilized” environment – never taking them to the park, never letting them play in a sandbox, never letting them roll around in the grass, never letting them have a pet at home, and keeping them away from other kids who may be sick.

By underexposing our children to bacteria, certain viruses, and other minor threats in the environment, their immune systems will not develop the appropriate responses, and they may end up with seasonal allergies and other problems of an inexperienced immune system.

Studies show that if you have a pet when you’re a kid, you are less likely to get asthma. The same applies to running and rolling around in the grass at the park when you are three years old; those who do tend to have fewer seasonal allergies later on. A little exposure is a good thing.

Allergy Prevention

Prevention is the best treatment for seasonal allergies. Have you heard of spring cleaning? They don’t call it that for nothing.

If people in your household have allergies, it is important to do a thorough cleaning of the house, especially in the spring, by removing all the dust that has collected in your house over the winter.

It’s a good time to shampoo your rugs, vacuum all the nooks and crannies, and remove the mold from all kitchen, bathroom and garage surfaces.

If you have allergies in the spring and summer, take a few precautionary steps to avoid bringing allergens back into the house.

When you come in from the outdoors, don’t bring the clothes you’ve worn outdoors into the bedroom; change in another part of the house and take a shower, if you can.

Avoid being outdoors from the late morning to early afternoon, as those are the peak hours for pollen production. Keep your windows closed if you’re really allergic.

Fun Summer Activities

When faced with any sort of unstructured time, children are likely to get bored. They are also likely to let you know about it often! Summer is meant to be a time for rest and relaxation but also for exploring and education outside of the classroom. Here are some ideas for keeping your kids happily engaged this summer.

*Have a scavenger hunt in the house on a rainy day. Vary the clues depending on your children’s age. For younger children, use clues such as “Go to the room where you take a bath,” or “Go to the room with the blue walls.” For older children, use clues such as “This is the room where Dad watched the baseball game last night,” or “Find the room where Mom likes to read quietly.” The prize can be a gift certificate to a local bookstore or a new game the family can play together. Make sure everyone gets a prize or that it’s a team effort and everyone works together to find the prize. If not, you’ll be hearing “Not fair!” instead of “I’m bored!”

*Have a backyard camp out! Bring sleeping bags, tents, and build a fire. If you don’t have camping equipment, lay out an old sheet or blanket to sit on. Instead of telling ghost stories, have each family member tell a story about their favorite thing about your family. Don’t pressure your children to sleep outside, as they may be nervous or uncomfortable. Staying up late and having some special snacks is plenty fun! Just remember to use bug repellent so you don’t wake up with itchy campers in the morning!

*Use an old shoebox and create a special art box. Store all sorts of “extras” inside: buttons, scraps of paper, ribbon, washable markers and glue. Allow your children to create their own masterpiece on a piece of construction paper using all the materials inside the box. Make sure the items in the box are things your child can use independently. This way, your children can sit at the table and work while you make dinner or throw in a load of laundry. You can also use old magazines and cut out pictures to tell a story or re-create a family event.

These are just a few fun things you can do with your family this summer. Don’t be afraid to think outside the box and try something new. You can always have a family meeting afterward to discuss the pros and cons of your new, adventurous outing. The important thing to remember is relax and enjoy time together as a family, regardless of what you are doing.

E.D. Education

It used to be called impotence. But thanks to the proliferation of drug industry advertisements that now threaten to overwhelm our television programs, today we know it as erectile dysfunction, or, more discreetly, simply as E.D. Whatever you want to call it, though, it’s the man’s inability to achieve or maintain an erection sufficient to satisfy him or his partner during intercourse.

When it occurs in young men, it’s usually just a matter of momentary anxiety. In middle-aged men, it’s often caused by stress, guilt, or overwork. In fact, most men experience it at some point in their lives by age forty, though usually only briefly, and they are not psychologically affected by it.

But it gets more common with age, and for some men – as many as 30 million of them according to the drug companies – it occurs frequently and causes serious emotional and relationship problems.

In many cases, E.D. is due to the deterioration of the blood vessels that carry blood into the penis. A host of things can cause this deterioration, including nicotine, which narrows the blood vessels, excessive alcohol, and certain prescription drugs, notably antidepressants. Some physical problems can contribute to the deterioration, too, such as diabetes, high blood pressure, and obesity.

If you have difficulty getting an erection, get help. Discuss it with your partner, and consult your doctor, who will help you find the cause of your E.D. Treatment will, of course, depend on the cause. Though there are a number of mechanical devices that can help men get a better erection, including splints, rings, and pumps, it’s the E.D. drugs that have revolutionized the treatment of this problem. They work well for most men, and if one drug doesn’t work for you, try one of the others – but always work with a doctor’s guidance since the drugs can have significant side effects.

Type 2 Diabetes: The Choice is Yours

The statistics for type 2 diabetes are staggering. There are about 20 million Americans with type 2 diabetes, a high sugar condition caused by poor nutrition, being obese, and a lack of exercise—factors that can all mostly be prevented.

About two-thirds of the people with type 2 diabetes have been diagnosed, which leaves about 6 million people walking around with undiagnosed diabetes. That’s a huge number of people who have a very serious disease and don’t know it. And that makes type 2 diabetes, like hypertension, another silent killer.

Unlike type 1 diabetes, type 2 diabetes is not a failure of the pancreas, but an inability to produce adequate amounts of insulin for a body that is out of control. On top of that, the insulin that is being produced is not acting the way it should, a situation called insulin resistance that occurs when the insulin can no longer stimulate the cells to process the sugar in the blood. This causes the sugar to build up in the blood, ultimately doing damage to the heart, eyes, and kidneys, and creating small-vessel disease.

Type 2 diabetes is now an epidemic, and if not corrected in this generation, it will probably be responsible for most of the strokes, hypertension, and cardiovascular disease that we will encounter in our sixties and seventies. Type 2 diabetes is especially common among African Americans, Latinos, Native Americans, and certain Asian populations.

Most people develop type 2 diabetes because they are overweight. Basically the human body does two things: it takes in calories, and it burns calories. When you consistently bring in more calories than you burn off, all those extra calories turn into fat. That fat first gets stored in the abdomen and the intestines, and then it begins to infiltrate the muscle mass of our body. And what you end up with looks very much like a marbleized piece of sirloin that you see at the butcher shop. That marbleization is one of the hallmarks of people with type 2 diabetes.

If you keep piling on the extra calories, the pancreas, whose function begins to slow down anyway with age, is no longer able to meet the demand for large quantities of insulin needed to metabolize all that sugar in the blood.

If you were to lose weight, a significant amount of weight, I mean, your type 2 diabetes could disappear almost overnight. Yes, it’s that simple. I, myself, was a diabetic. I had very elevated sugars. I was overweight, excessively stressed, and exercise-phobic. I had a very clear, black-and-white case of type 2 diabetes. So I lost 50 pounds; I now exercise three times a week, and I’ve maintained that weight loss.

Today, I am no longer diabetic. If, like me, you have not had type 2 diabetes for very long, and if you can overcome it by simple weight loss, you will end up with no permanent damage to your organs.

If you have any choice in the matter, diabetes is a road you don’t want to go down. Just to give you an idea, here are a few numbers:

–Heart disease from diabetes accounts for 65 percent of deaths in diabetics.

–The risk of stroke is two to four times higher in diabetic patients than in nondiabetics.

–Seventy-three percent of adults with diabetes have hypertension.

–Diabetic retinopathy, which is damage to the vessels of the retina, creates about 24,000 cases of blindness in America every year.

–Diabetes is the leading cause of kidney failure.

–One-third of people with diabetes have gum disease.

–About 10 percent of pregnant women who are diabetic may experience a spontaneous abortion or have children with major birth defects, including spina bifida.

–About 82,000 people lost a foot or a leg last year because of diabetes.

The list of damage diabetes does to the body is virtually endless. If you are a diabetic, you must learn to prevent complications and stay ahead of the game. Being a diabetic is a full-time job, and there are several measures you will have to take to ensure you keep your health on track.

You will constantly have to monitor your cardiovascular risks by monitoring your blood pressure and keeping it under control.

You will have to watch your cholesterol levels.

You will have to visit your ophthalmologist regularly to ensure you don’t development retinopathy.

You will need very comprehensive dental and foot care.

But, most important, you will have to monitor and control your sugar levels. Several times a day you must take a glucose reading either by using Accu-Chek or doing a finger prick. You will look at your morning sugar and at your sugar two hours after you eat. For the most part you want your morning sugar to be less than 100 milligrams per deciliter, and you want your postdinner values, usually two hours after you eat, to be 120 and 130 milligrams per deciliter.

If your sugar is high, you will need either to inject yourself with insulin or to take an oral hypoglycemic. This kind of supply-and-demand treatment model may soon give way to more convenient methods, made possible by new research into diabetes. Devices are now being developed in which a sensor that continuously monitors your sugar levels triggers a tiny pump when your blood sugar is elevated to release small doses of insulin.

Other new research is focusing on the possibility of transplanting the pancreatic cells, called isolet cells, into those who need them, in the hope of restimulating insulin production inside their body and minimizing the amount of insulin that needs to be injected. The hope is that this research will one day lead to a cure, whereby insulin will once again be naturally produced in the body. But as of right now, diabetes is not cured; it is treated.

Diabetes can be managed. Ultimately, if you’re talking about juvenile diabetes and you start very early in the game by getting diagnosed and getting effective treatment, you can probably expect a normal life expectancy, but it’s a very dedicated type of life.

If you are now in your forties and you develop type 2 diabetes, and you continue for a decade or more without any checks and balances, it’s very unlikely that you’ll make it into your late seventies or eighties. There’s just not enough time in the pot. In other words, if you are 40 years old, 50 or more pounds overweight, with high blood sugar levels and high cholesterol, and you don’t exercise and you don’t watch what you eat, you will without doubt see the effects 10 to 15 years from now.

By the time you’re in your sixties, you will most likely have hypertension, stroke, and cardiovascular disease. Don’t go there.

Sweet Questions

“I’m a fifty-five-year-old woman with two married daughters. We all have a sweet tooth in our family, and I’m worried that we might all become diabetic. Can people who eat a lot of sweets become diabetic?”

No. If you exercise and for the most part follow a balanced diet, you can like sweets and not become diabetic.

“Can people with diabetes eat sweets?”

If it’s part of a healthy lifestyle involving a good diet and exercise, a diabetic can eat sweets.

“Can you catch diabetes from someone else?”

No, though some people think they can. Diabetes is probably largely a matter of genetics for Type 1 and lifestyle factors for Type 2.

“Are people with diabetes more likely to get colds or other illnesses?”

No. Your immune system is not compromised when you have diabetes. However, people with diabetes should get regular flu shots because any infection can interfere with blood-sugar management.

Stroke: Know the Signs, Save Lives

Your heart is not the only potential victim of cardiovascular disease. Your brain can be, too. Stroke is a type of cardiovascular disease that affects the arteries leading to and within the brain. A stroke occurs when the blood vessels that carry the oxygenated blood and nutrients to the brain are either blocked by a clot or break.

This prevents the brain from getting the oxygen and nutrients it needs, and within minutes to a few hours brain cells begin to die. Every 45 seconds someone in the United States has a stroke, and every three minutes someone dies of stroke. That’s about seven hundred thousand strokes a year, of which about 160,000 result in fatalities.

I can’t stress enough how important it is to learn how to recognize the symptoms of stroke because it can save your life or the life of someone you know. The most characteristic symptom is a sudden numbness, weakness, or paralysis of the face, arm, or leg, usually on one side of the body. Other symptoms include loss of speech or trouble talking, blurry vision, double vision, decreased vision, dizziness, loss of balance and coordination, an out-of-the-blue bolt of pain, headache, vomiting, or altered consciousness and disorientation or memory loss. Usually these symptoms strike suddenly and without warning.

It is important to recognize the signs and symptoms of stroke because every minute counts when it comes to treating one. The longer a stroke goes untreated, the greater the damage and potential disability. So if you have any of the signs and symptoms of stroke, it is important to get help immediately.

Eighty percent of strokes are ischemic, which means they are caused by an obstruction from a blood clot or particle of cholesterol plaque that reduces the blood flow to the brain. The brain cells die within minutes of this happening. There are two types of ischemic stroke. Thrombotic strokes are caused by clots that originate in the arteries that supply the brain, like the neck arteries, or the arteries within the head itself. Embolic strokes originate from blood clots that form away from the heart but are swept up through the bloodstream and into the narrow arteries of the brain.

The other 20 percent of strokes are hemorrhagic; they occur when a blood vessel in the brain leaks or breaks. The most common risk factor for hemorrhagic stroke is uncontrolled hypertension, though it can also be caused by an anatomical weakness of the blood vessel itself, that is, an aneurysm, or by an abnormal connection of the arteries and veins in the brain.

There are several risk factors for stroke.

People who have transitory ischemic attacks—a temporary halt to the flow of blood to the brain—have a ninefold increase of developing a full-blown stroke. At higher risk are those who have a family history of stroke, are older (the older we get, the greater the chance of stroke), and are African American, partly due to the high prevalence of high blood pressure and diabetes among the black community.

Other factors include hypertension, high cholesterol, cigarette smoking, diabetes, obesity, cardiovascular disease, and high homocysteine levels. Homocysteine is an amino acid in the blood, and people with elevated homocysteine levels have a higher risk of stroke. Women taking birth control pills or hormone replacement therapy may also be at higher risk for stroke.

The good news is that there actually are some things you can do to avoid being a victim of stroke. Even though you cannot do anything about your race, your sex, your family history, or your age, since cardiovascular disease and stroke go hand in hand, you certainly can look at your risk factors for heart disease and hypertension and focus on early screening.

Get your blood pressure checked; learn what your body mass index is; and check your cholesterol and glucose levels every two to five years.

Exercise, manage your stress, limit your alcohol consumption, don’t smoke, and stay away from foods with saturated fats.

Take a vitamin B complex, like B6, B12, and folic acid, which are essential in helping to reduce the levels of homocysteines in the body.

Don’t take illicit drugs, like cocaine, which may trigger a stroke.

People with risk factors for stroke should consider a brain-healthy diet that includes several servings daily of fruit and vegetables with nutrients rich in potassium, folate, and antioxidants. Eat foods high in soluble fiber, like oatmeal, to help reduce cholesterol, as well as foods rich in calcium and soy that help reduce your bad cholesterol and raise your good cholesterol. Foods rich in omega-3 fatty acids, which include, of course, plant oils, salmon and other cold-water fish like tuna, are also good weapons in the battle against stroke.

When it comes to the treatment of strokes, some hospitals have actually established special stroke emergency rooms that are manned by a multidisciplinary team well versed in their diagnosis and treatment. Whoever the doctor is, however, he or she must first determine the type of stroke and its location before treating it.

A wide variety of diagnostic tests are available to the doctor, and they all fall into one of three categories: imaging tests, which provide a better-than–X-ray picture of the brain; electrical tests, which record the impulses in the brain; and blood flow tests, which show any problem that may be causing changes in blood flow to the brain.

Essentially, all emergency room doctors will attempt to improve and restore blood flow to the brain of a stroke victim. One way to do that is by injecting a clot-bursting drug, or thrombolytic, that helps dissolve the clot. Other techniques include performing a surgical procedure such as a carotid endarterectomy, in which the surgeon opens the carotid arteries and removes the plaque from them, or angioplasty, in which a balloon-tipped catheter dilates the arteries to improve the blood flow.

Once a stroke has been diagnosed and treated, most individuals end up taking preventive medicines to minimize the chances of recurrence. Some may receive antiplatelet drugs to make platelet cells in the blood less sticky and less likely to form a clot, or anticoagulants, which again prevent the blood from clotting. In cases of hemorrhagic stroke, where a blood vessel has ruptured, surgical intervention is needed to minimize further bleeding by clipping, cauterizing, or removing the clot and any vessel that is actively bleeding.

Stroke survivors must cope with a life-changing experience. They are often significantly disabled and, as a result, need a strong support system. Usually the support system is a team of rehabilitation doctors, which might include a psychiatrist, a dietitian, an occupational therapist, a physical therapist, a speech therapist, and social workers.

A stroke victim has to deal with impaired movement, which has implications for walking, balancing, speaking, swallowing, and breathing; bladder and bowel dysfunction; and diminished sex drive—as well as all the emotional issues that result from those problems. A stroke victim’s family is also profoundly affected because they now have to take part in caring for the individual.

Stroke can change your life completely, so learn to recognize it and treat it urgently to minimize the terrible disabilities it can inflict on its victims.

The Other Victims of Stroke

The obvious result from a major stroke is devastating disability—such as speech impairment, weak hand and leg movement, and depression. But a stroke can also have an indirect effect on the health of the victim’s family and friends.

Imagine a very strong and vibrant man who has never been sick, who has been a good husband and provider, who has been a great father. His family, and especially his wife of 45 years, marveled at his strength. He was healthy and looking forward to a peaceful and blessed retirement. Then one day he suffered a major stroke, which left him unable to speak and walk. For the family, the confusion and shock were intense. How could this have happened?

This is not a fictional story. It happened in my family. When I first met my future father-in-law, I never imagined that one day his life would end up in such a way. However, this same scenario is played out over and over again in many families across the United States and around the world.

All of a sudden, responsibilities that were the stroke victim’s are now delegated to other members of the family, and in some cases the majority of the responsibilities falls on the spouse. From everyday things like shopping or paying bills to new responsibilities like making daily trips to the rehabilitation center; feeding, bathing, and keeping up with all the medications; and becoming a motivational guru.

All of this can have a tremendous impact on the caregiver’s health. Suddenly, what was once an ordinary life becomes an extraordinary one burdened by the pressure and eased by the love for the ailing family member. We doctors sometimes forget about the families, and that’s a big mistake. When dealing with stroke survivors, focusing on the family as a whole is always important. We must listen, support the changes that are needed, and monitor stress and the effect that it has on the people taking care of stroke survivors.

Family members take care of one another; they become the pillars of health care in the home and improve the outcome that any therapy in the hospital could bring. I remember the look of my mother-in-law as she dealt with her husband’s disabilities, a look of love, duty, and compassion. But we must always make sure that, as we take care of others, we take care of ourselves.

If you don’t take care of your own health, you may very well end up being unable to take care of the person you love. So stay healthy. They don’t say “in sickness and in health” for nothing.

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