Truths and Myths About Warts

 Once last summer I went with my family to the beach. We had a great time. This was a Tuesday. By Wednesday evening there was a tender spot on my foot. By Friday, it was becoming painful. It was kind of a slow day at work so my co-worker and I used our available resources to rule out a lot of things that it wasn't. My foot looked perfectly fine. I was beginning to think I had a acquired some exotic foot disease at the beach.  By Sunday evening, it hurt so much that I couldn't walk.
 First thing Monday morning I made an appointment to see a podiatrist. He looked at my foot with a magnifying glass and said "Hmm". Then he cut off a few layers of skin. "Hmm". Then he cut off a few more layers. After this he came to the conclusion that deep inside my  foot there was a cluster (or mosaic) of more than a dozen warts, which had nothing to do with our trip to the beach. I just thought it was a more pleasant picture than the warts on my foot.  Fantastic. Personally, I'd rather have an exotic foot disease.
  So while I was sitting there with my foot in the air and him cutting a hole in it, followed by him freezing those annoying little things, I tried to focus on something other than the pain by picking his brain. Here are a few things that I learned from the experience and one other run-in with warts years ago.

• Warts are caused by a human papillomavirus. They are contagious. There are many varieties of this virus and they are specific to certain areas of your body. (The HPV that causes plantar warts is not the same HPV that can give you genital warts or cause cervical cancer.)
• They can disappear on their own after a few months, last for years or reoccur.
• Common treatment of warts include cutting, freezing, salicylic acid (that over-the-counter Dr. Scholl's stuff) and lasers.
• When I had a stubborn wart removed in high school, a dermatologist injected it with Bleomycin. He described it to me as an acid that they inject into cancerous tumors. It's pretty expensive and it feels like hell. But it worked.
• There is some validity to the urban myth that duct tape can get rid of warts. It's not as effective as previously listed methods, but my podiatrist told me that studies have shown evidence that it is sometimes effective.
• Same story for painting a wart with fingernail polish. Although he said that the studies couldn't explain exactly why for either method.
• For unknown reasons Cimetidine (yes, as in the OTC heartburn medicine) is very effective in helping your body to fight off and get rid of warts. I tried it and it did seem to help. Of course I did this at the same time I was having him treat with it with liquid nitrogen and the knife.
• Sometimes the skin around the wart will turn purple a couple of days after freezing. I was concerned when a fairly large portion of my foot turned purple. I called his office. His receptionist was an idiot and told me she was sure that it was because I had my band-aid on too tight. I'm pretty sure that a bachelor's degree in nursing qualifies me to correctly place a few spot band-aids, and that wasn't the problem. When I talked to him, he let me know that sometimes that happens and not to be concerned.

Strep Throat vs. Spinal Meningitis

 Once when I was in the fourth grade I had a fever, headache, nausea and I felt lousy. My mom tried to get me to touch my chin to my chest. I couldn't/wouldn't. My mom rushed me to the emergency room because she was sure that I had spinal meningitis. As it turns I wouldn't touch my chin to my chest because I had a nasty case of strep throat. It hurt too much. Now it was great that she took me to the doctor, but it didn't really didn't merit an ER visit. (Of course I don't remember what day or time it was, that may have been the only option.) Complications of untreated Strep can include scarlet fever, rheumatic fever, and glomerulonephritis, but those are less likely to happen if antibiotics are started in a timely manner (and don't forget to take the whole course of antibiotics, not just until the symptoms go away.)
  It was years later when I was in nursing school that I realized what my mom was looking for. She was looking for a positive Brudzinski's sign, however it isn't based on whether a child can voluntarily touch their chin to their chest. To test for Brudzinski's sign, have a child lay flat on their back on a firm surface. (A floor or table will work.) Then firmly push their chin to chest. A positive sign will result in their legs and hips flexing involuntarily. If you see this, I would recommend taking your child to the emergency room, pronto. (Of course, you may be ok, going to a clinic first, if you can get in quickly and are admitted from there. Sometimes that's faster than going through the ER (and generally significantly less expensive). Where you should go to depends on where you live, how far the hospital is from you and your average ER wait times. But don't deliberate about the matter for too long.) The point is that this is serious business. Not to say that a negative Brudzinski's sign rules out a diagnosis of spinal meningitis, because it doesn't. But a positive Brudzinski's will not be seen in any other disease.

Symptoms of spinal meningitis include headache, fever, nausea, vomiting, irritability and lethargy. (See how the two can be confused?) Although the symptoms in meningitis are often more extreme than what will be seen in strep throat and also sometimes include muscle rigidity, bulging soft spots in infants, cold extremities and abnormal skin color. Of course you don't need all of these symptoms to have spinal meningitis. Small children sometimes only have fever and irritability, which can make a "phone or internet diagnosis" difficult. The surest way to diagnose spinal meningitis is with a lumbar puncture or spinal tap. I know that sounds really scary to a parent, to think about multiple people holding your child down while a doctor puts large needles into your child's spine, but if there is a chance that your child has this disease, you need to know. Not only that, you need to know what is causing it, whether it be bacteria or virus and what kind, so the doctor can pick the most effective medication.
 Meningitis is an inflammation of the meninges, which are the protective coverings of the brain and spinal cord. If those tissues become infected, because of their location, it can lead to serious problems. Complications can include permanent brain damage, deafness, epilepsy (a seizure disorder), sepsis (wide spread systemic infection), gangrene of limbs, shock and death. Does this mean that if your child has meningitis that they are going to die or have these complications? No. I have cared for many, many kids with this diagnosis, and I have never seen one die and I can list on one hand the kids I have seen who have had serious complications. But if your child does not get immediate treatment, their risk greatly increases. Bottom line, if you remotely suspect that your child has spinal meningitis, get it checked out as soon as possible.

Folic Acid A Key To Healthy Babies

When I saw this headline on the cover of yesterday's paper (sorry I was going to link to the article, but for some reason the Sunday cover story isn't listed on the Salt Lake Trib's website, weird I know), I was a little surprised, I mean research proved this in the 1980's. The problem is that health care officials and educators assume that people know this and they stop harping on the matter, but every year a new group of women enter their child bearing years and need to hear this information. And even though I have gotten on this soapbox before, I am going to share a few important facts about folic acid and urge moms everywhere to share this with their friends and with their daughters.

• Folic acid occurs naturally in foods like fruits and vegetables, but our bodies absorb it best in it's synthetic form. To get your daily RDA of folic acid from your diet you would have to eat 200 red apples.
• Insufficient folic acid can lead to birth defects (or defects that result in miscarriage) including defects of the brain, skull, spine, heart, arms, legs, face, hard palate (cleft lip and/or palate) and urinary tract. A mother can reduce the risk of her child having these defects by 50-70% by taking 400 micrograms of folic acid a day.
• The most crucial time for you to be getting folic acid is in the first 28 days of pregnancy. Most women don't even know that they're pregnant in the first 28 days. 
• Hince why, EVERY woman in her child bearing years should take a folic acid supplement.
• Folic acid is used to create and repair DNA (necessary for cell production), which is why it is so vital during early pregnancy. The first 28 days are when your little bundle of joy goes from 2 microscopic cells to a something with a heart beat. Isn't that just phenomenal to think about?
• Folic acid is crucial not just for the growing baby, but mom too. During pregnancy folic acid demands increase because it is needed to produce the new cells that are making up the increased blood volume, and general increased everything that come with pregnancy.
• According to a March of Dimes survey in 2009, only 11% of women took folic acid before pregnancy.
• Apparently there is a myth going around that multi-vitamins will make you fat. This is false. However, if your multi-vitamin has iron in it and you're not drinking enough water, it can make you constipated which can lead to bloating and discomfort. Stay well hydrated and you should be fine. 
• Since 1998 the U.S. Food and Drug Administration mandated that folic acid be added to white flour, bread and pasta, which has resulted in about 1000 fewer children born with neural tube defects each year. 
• Many Hispanic women have genetic deficiency that interferes with the metabolism of folic acid. Which means that they should be taking even more folic acid.
• The average life-time cost of spina bifida per person in the United States is $532,000. 
• Currently the Center for Disease Control and Prevention, the March of Dimes, and the Spina Bifida Association along with corn and flour tortilla manufacturers are working with the FDA to supplement corn tortillas, a staple for many Hispanic diets. It is estimated to cost $3 million per year, but will save $145 million in direct medical costs for defects.
• If you are a woman living in Utah you can sign up for free vitamins at poweryourlife.org 

Myths About Asthma

Yesterday was a kind of a slow day at work so I decided to brush up on my asthma education. I found several debunked myths about asthma that I thought were interesting.

Myth: Children usually outgrow asthma

Reality: How asthma effects a patient varies throughout their lifespan. Even if the symptoms go away, the tendency towards asthma is still there and can flare-up with stress and triggers.

Myth:Asthma treatments don't work.

Reality: Newer treatments are actually very effective. But in order to be so you have to have proper inhaler technique, take your medications as prescribed and be aware of environmental changes.

Myth: Mild asthma doesn't require treatment.

Reality: Asthma is a chronic disease without a cure that should be taken seriously. Even if you usually don't have symptoms right now, it is important to take care of yourself to prevent flare-ups.

Myth: The best time to give a child an inhaler is when they are crying, because they get more medicine in the lungs that way.

Reality: If you give a child an treatment while they are crying most of it stays in the upper airways, not deeper in the lungs where it is needed most. It is best to wait until they are done crying.

Myth: Steroids aren't safe.

Reality: Inhaled corticosteroids are actually very safe, even for very young children. They are great for helping to control asthma.

Myth: If you can tough it out and not use your inhaler you're better off.

Reality: Going without your inhaler when you really need it does microdamage to your lungs which decreases your lung strength and capacity over time.

If you have asthma or your child has asthma, it is important to stay on top of it. Don't wait until it gets out of hand to act. Be persistent when giving medications to your child.  If they know that it is important to you, eventually they will stop resisting. Don't make your child feel like their condition makes them weird, it's just a problem that they have that can be overcome.

 If your child's medication isn't helping, they're having a hard time breathing, they can not walk, talk or play, they're lips are blue and or their peak flow is less than half their personal best, take them to the emergency room. Do not pass go, do not collect $200, go directly to the ER. The only other direction is downhill.

For more information about asthma go to intermountainhealthcare.org/asthma. This site has lots of information and it can refer you to more resources.

What to do and what not to do for a bloody nose

Last night my daughter got a random bloody nose.  It reminded me that until I went to nursing school everyone I had ever encountered had been doing the wrong thing for a bloody nose, myself included. If you get a bloody nose take a kleenex and pinch your nostrils shut while leaning forward and breathing through your mouth. This seems counter-intuitive, no? If you lean forward you may drip blood onto yourself, clothes or something else. If you don't you can possibly have bigger problems.

 One morning before the crack of dawn I had a relative call me in a panic. "Jane woke up vomiting large amounts of blood. What should I do?"
Me: "Take her to the emergency room."
"I don't want to do that. What else can I do?"
Me: "I am not a doctor. Even if I was, I am not close enough to do anything for you. Even if I was, I would still tell you to go to the emergency room."

 A few hours later I called to check back. They decided not to go to the emergency room. Said relative decided that Jane had gotten a bloody nose in her sleep (which she was prone to do) and since she was laying on her back, it dripped down her throat and into her stomach, and the quantity was large enough that it made her vomit. The same thing can happen if you tilt your head back when you get a bloody nose. Which is what I was taught to do and what I always saw everyone else do when someone got a bloody nose. It is better to get a few drops of blood on your clothing, than to vomit blood all over who knows what. When you lean forward into a tissue the blood is will more quickly dry and clot, whereas when you tilt your head back the blood is flowing through a warm humid area (the throat) and won't clot off as fast. Most nose bleeds originate near the front of the nose, so pinching the nose and holding pressure usually will stop the bleeding. And once the blood does clot, don't try blowing the clots out, you can start a fresh bleed. If you have been holding pressure for twenty minutes or more and your nose is still bleeding, seek medical intervention. A continuing nose bleed can be a sign of a skull fracture or a symptom of other illnesses.

Nose bleeds can be caused by many things. Any medication that thins the blood (ibuprofen, aspirin, coumadin, etc.) make you more susceptible to getting a bloody nose. As do hot, dry climates (hello, St George, UT) cold climates (the your heater dries out the air), illness and infection. When your nose is dry, cracked or irritated it is more likely to bleed. When I was in nursing school one of my instructers taught us a simple secret to help prevent us from getting sick, as we would be exposed to so many illnesses in our clinicals. (And we were generally stressed out and sleep deprived which doesn't help your immune system.) The secret is nasal saline. You can buy it over the counter or you can make your own. Whichever method you choose, squirt a small amount in each nostril as often as it takes to keep your nose slightly moist. In order for your nasal mucous to most effectively trap bacteria and viruses, it must be moist. Moist mucous membranes in your nose means fewer illness and fewer nose bleeds.

Alcohol Substitutions in Cooking

It seems that many recipes call for alcohol and as a strictly non-drinker, it's not something that I keep in my pantry. However, I have found that there are a few simple ingredients from my pantry that substitute well for alcohol in many recipes. For a more extensive chart with substitutions for less generic alcohols see About.com.

Light beer- chicken broth or Sprite (Use your judgement based on the recipe.)
Heavier beer- beef broth or root beer
Red wine- chicken broth or red grape juice
Sake- rice vinegar
Sherry- orange juice
White wine- chicken broth or white grape juice

 I have read that when it comes to putting beer in bread or marinating meat in it, there is no substitution. I will beg to differ. One year for Christmas a friend gave me a beer bread mix and a can of Sprite. The carbonic acid that gives Sprite it's fizzyness will make the bread rise in the place of the yeast in the beer. Perhaps it didn't taste exactly like beer bread, but what it did taste like was AMAZING.
 Part of the reason beer marinated meat is so good is that the alcohol breaks down the muscle fibers making the meat more tender. The carbonic acid in soft drinks will do the same thing. The best steak I have ever had was a filet mignon in Argentina. A close second was an ordinary New York cut steak marinated several hours in Sprite and cooked over a camp fire and seasoned with salt and pepper.

I have also heard many times that cooking with alcohol gets rid of the alcohol content. That's only partially true. Below is a chart created by the USDA that I found on a kitchen myth website. So some of it cooks out, but not all of it. But before you get to paranoid, remember that ordinary bread with yeast contains alcohol. The rising takes place because those little micro-organisms produce alcohol. A major part of that fresh baked bread smell is the burning of the alcohol. A tiny bit of alcohol in your food is not going to hurt you.

Alcohol Burn-off Chart
Preparation Method	Percent Retained
alcohol added to boiling liquid & removed from heat	85%
alcohol flamed	75%
no heat, stored overnight	70%
baked, 25 minutes, alcohol not stirred into mixture	45%
Baked/simmered dishes with alcohol stirred into mixture:
15 minutes cooking time	40%
30 minutes cooking time	35%
1 hour cooking time	25%
1.5 hours cooking time	20%
2 hours cooking time	10%
2.5 hours cooking time	5%