Tag Archives: primary care associates

Fashion Fads, and 13 unintended health consequences

‘Light Reading for Sick Rooms and Parties’

Unhealthy Fashion Fads:

1. Hair pullback:   Severe and under tension hair pullback will yield an enlarging forehead. It permanently  damages hair, causing hair loss.  So does wearing hair extensions for long periods. Tight ponytails, headbands, and braids can cause headaches.

2. Hair on forehead:  Bangs in adolescence are associated  with aggravation of acne via the oiliness of hair in contact with the skin.  Hair should be held off the forehead during sleep.

Remember ‘Hands, Hair, and Hydration”.   The dirtiest part of our bodies are our hands:  keep them off your face.  Get hair off the face too, at least during sleep.   2/3 of your body is water; skin is your largest organ.  Help your skin by staying well hydrated (70-90 ounces/day)

3. Tight belts, tight pantyhose:  can cause numbness in the leg by pressure on the lateral femoral cutaneous nerve that runs from the abdomen to the outer thigh. A similar problem occurs with policemen and journeymen who carry guns or equipment on their hips.

Symptoms includes numbness on the side of the leg, back pain sometimes radiating into the buttocks or hip. A fat wallet carried in the hip pocket is a common culprit for symptoms as well.

Victorian style corsets  could crush ribs and interfere with digestion;  today we have  too tight jeans. “Tight Pants Syndrome” coined in 1993 can cause abdominal discomfort, distention, heartburn, and belching especially after eating. Also possible:  low back pain, yeast infections in women and a condition known as lipoatrophia simicircularis (horizontal skin changes around the thighs, much more unwelcome appearing than cellulite).

4. Spanx and other “body tamers”:   can cause nerve compression, digestive issues, and painful welts.

Compression wear for the abdomen can prevent full expansion of the lungs and cause lightheadedness.

5. Tight collars, or ties: can reduce circulation to the brain, increase pressure in the eyes, decrease range of motion of the neck.

- 67% of men buy shirts that are smaller than their necks. Ties are seldom cleaned, can carry infection.

- Lingerie experts say 75% of women wear the wrong size bra.  If too big it give no support which causes pain and back strain.

6. Tight bike shorts: can raise temperature of the testes, reducing sperm production.

Also, allergies occur more often with synthetics and blends than cloths that are all wool, silk or cotton. People who develop rashes  from clothes are reacting to dyes and fabric softeners that can include formaldehyde. Washing new clothes a couple of times before wearing can reduce that.

7. Socks with tight elastic:  can cause raised reddish welts around ankles.  The marks are harmless but can last for years.

They can also occur around wrists from tight mittens.

8. Shoes with heels hight than two inches:  are linked to bunions, hammer toes, stress fractures and ankle sprains.

Bony protrusions on the back of heels (“pump bumps”) can also develop, along with nerve damage between the toes (neuromas), and circulation blockage causing foot bones to die.

Do your shoe-buying after 3 or 4 in the afternoon when your feet are most swollen.  Remember that one foot is larger than the other and size your shoes to that foot.

9. Years of wearing high heels: shortens the Achilles tendons making flat shoes uncomfortable.

Flats can lack support and lead to plantar fasciitis (pain that feels like you are stepping on a nail when you get up in the morning) .

10. Flip flops are worse: Wearers have to clench their toes to keep them on, leading to foot fatigue, sore calf muscles and an altered gait which could cause long term ankle and hip problems.

11. Heavy handbags and book bags:  throw the back out of line, causing back and neck problems.  Don’t carry more than 10% of your weight on a shoulder, and don’t do it long term without sharing the burden equally on both shoulders.

12. Body piercings: Over 20% of body piercings  get infected. In my experience 80% of naval and nose piercings get inflamed or infected.

Also nickel allergy is common, and nickel even in very small amounts is included in rings, earrings, and watchbands.  People who have no allergies to their jewelry can develop an allergy when exposed to citrus (e.g. lime or lemon).  It is the combination of the acid in contact with  nickel in the jewelry,  and the allergy becomes a permanent one even without future exposure to the citrus. Sometimes the jewelry can still be worn if a layer of protection (e.g. fingernail polish) is applied to that part of the jewelry that contacts the skin (e.g. the back of a watch or ring).

13. Fingernail extensions and appliques:  very, very frequently develop bacterial, and more often  fungal infections.

Have a Care;  Buyer Beware.

Bruce Kiessling, M.D.





‘Just a G.P.’

What does Health Literacy have to do with your next visit to the doctor’s office or emergency room?

First things first: Health literacy is a person’s ability to understand health information and to use that information to make good decisions about their health and medical care. Health information can overwhelm even people with advanced literacy skills. According to the U.S. Department of Health and Human Services, about one third of the adult population in the United States has limited health literacy.

I started my radio program in 1988 in part because of the medical disinformation on the airwaves and in the media generally:

  • Shameless marketing and unrepentant opportunism masquerading as medical science.
  • The enduring nonsense: “Yang wallows in the bloody heart and lungs; Yin resounds in the hollow bowels and bladder.”
  • Alternative Medicine demands to be seen in perspective.  Whereat it disappears beneath the horizon.

‘Alternative’ [medicine] is the fashionable word to make the meaningless sound meaningful.  It embellishes a mixture of medieval mysticism, herbalist nonsense, dietetic garbage, electrical toys, superstition, suggestion, and plain fraud.  It is the substitution of ignorance by fallacy.

“You can try aromatherapy which smells nice, dance therapy which is fun, yoga and meditation which makes for a relaxed evening, iridology if there are convenient eyes worth gazing into, palmistry which submits your fate to the fibrous skin bands of your hand,  exorcism if you can persuade the bishop, and Christian Science if you want to live dangerously.” - GordonThe Alarming History of Medicine

But trust me, when you are ill your situation demands scientific treatment, NOT alternative medicine.

Limited health literacy can affect your ability to:

▪  Fill out complex forms. Several studies have made clear that most consumers need help understanding health care information; regardless of reading level, patients prefer medical information that is easy to read and understand.

▪  Locate providers and services. Limited health literacy increases the disparity in health care access among exceptionally vulnerable populations (e.g. racial/ethnic minorities and the elderly).

▪  Share personal information such as health history

▪  Understand how to take medicines

▪  Manage a chronic disease. Literacy skills are a stronger predictor of an individual’s health status than age, income, employment status, education level, or racial/ethnic group.

What does low literacy foster?

▪  More medication and treatment errors.  Only about 50% of all patients take medications as directed

▪  Patients are less able to comply with treatments.

▪  Patients lack the skills needed to successfully negotiate the health care system.

▪  Health illiterate patients are at a higher risk for hospitalization than people with adequate literacy skills.

Much of this blog has been lifted from the National Patient Safety Foundation (npsf.org) whose website you should visit for more information. Their efforts include promoting the health of patients, starting with good communication.

Their registered and trademarked ASK ME 3 is a patient education program that encourages patients to understand the answers to three questions:

1) What is my main problem?

2) What do I need to do?

3) Why is it important for me to do this?

I could not agree more with the NPSF: You must ask these three simple but essential questions in every health care interaction.

“Just a G.P”

B. Kiessling, M.D.

Want to hear more about this topic? Download MD Talk radio show Just a G.P. Podcasts and listed to Dr. Kiessling reference this blog.

Sinus Q & A – Last resort: Sinus surgery

After suffering frequently, season after season, with facial pain and symptoms commonly attributed to “sinus” problems, patients are asked to consider surgery.

Following are some frequently asked questions and answers from Dr. Mamikunian, an Ear, Nose and Throat specialist in Anchorage who has helped Primary Care Associates patients for over 15 years:

Q:  What percentage of patients who suffer from sinus symptoms eventually end up requiring surgery?

Dr. M:  It’s a small percentage overall, maybe 10%.

Q:  Why such a small figure?

Dr. M.: Because there are a large percentage of patients who have symptoms of recurrent sinus pressure and pain that are actually not due to sinus infections.

Q: What other things might mimic sinusitis?

Dr. M.:  Many people suffer headaches in the front of their face or around/behind their eyes and misinterpret these symptoms as “sinusitis’ when it’s really a headache problem.

1) If they have colored nasal drainage and fever, not just facial pressure, it’s more likely an infection.

2) If the patient has a personal or family history of migraine headaches, or if they say that their pain is frequently “behind their eyes”, I suspect that their symptoms are more related to headaches or “atypical migraines”.

Q: Please explain “atypical migraines”.

Dr. M.:  Classical symptoms of migraine usually begin with a warning, called an aura, before the onset of the pain.  Then patients typically experience a strong aversion to bright lights and loud noises.  Atypical migraines often don’t have these symptoms and the pain might be in the sinuses, eyes, or ears.

Q: What studies do you consider most helpful when trying to clarify whether repeated symptoms are from the sinuses or headaches?

Dr. M.: The most reliable study is a “Limited CT scan of the sinuses”.  These are rather expensive but they really help direct proper care.

Q: Don’t you find undetected or undertreated allergic conditions a common predisposing cause of recurrent sinus infections?

Dr. M.:  Absolutely.  Swelling inside the nose caused by allergies can block up the drainage sites from the sinuses into the nasal cavity and this can lead to recurrent infections.  These patients need aggressive medical management of their allergies.  If this can be successfully accomplished, most of these patients don’t require sinus surgery.

Q: O.K. so now we’ve separated those patients with symptoms which mimic sinusitis and which are instead atypical migraines, and we’ve treated the allergy symptoms adequately, and we’re left with those patients who really are having recurrent infections.  What is the proper management of these patients?

Dr. M.: In these patients I pursue an aggressive course of antibiotic therapy.  Because it is difficult to obtain a good culture to see which bacteria are causing the infection, or because the infection may involve several bacterial types, I employ a treatment regimen of three

different, two-week courses of antibiotic therapy.  All are strong antibiotics which attack bacteria from different directions.  I will have obtained a pre-treatment CT scan to confirm the presence of chronic infection and will then repeat their CT scan after they have completed the 6 week course of antibiotics.

Q:  And if the post treatment CT scan shows no sign of infection?

Dr. M.:  Then we have been successful at avoiding surgery.  It is only after aggressive medical therapy has failed that surgery is appropriate.  Surgery is a last resort.

Q: Are their exceptions?

Dr. M.: Very rarely, in my 25 years as a sinus surgeon, have I seen extenuating circumstances where there are significant anatomical variations in an individual which may be the cause of sinus pressure or recurrent infections.

Q:  For elective surgeries, including sinus surgery, I encourage patients to get a second opinion.

Dr. M.:  I strongly agree; patients should do so before agreeing to any surgery.  If the matter is very straightforward, it should be simple to bring records and scans to be sure all avenues of treatment have been exhausted.  A surgical recommendation is an admission of failure:  the failure to cure their disease by any means other than surgery.  If the patient has been treated appropriately and aggressively by their family physician or specialist, then they can feel confident that surgery is the appropriate next step.

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