Skin Fungus

Anti-Fungul Preparation

Fungal infections of the skin are not serious, so treatment is not urgent. In general, the fungus needs moist, undisturbed areas to grow and will often disappear with regular cleansing, drying, and application of a powder to keep the area dry. Cleansing should be performed twice daily.

If you need a medication, there are effective non-toxic agents available. For athlete’s foot use one of the zinc undecylenate creams or powders, such as Desenex. In difficult cases, tolnaftate (Tinactin) is very effective. This agent is useful for almost all sin fungus problems, but it is more expensive.

Dosage

For athlete’s foot, use as directed on the label. For other skin problems, selenium sulfide is available by prescription in a 2.5% solution. Over the counter, a 1% solution is available as Selsun Blue shampoo. Use the shampoo as a cream and let it dry on the lesions; repeat several times a day to compensate for the weaker strength.

Side Effects

There are very few. Selenium sulfide can burn the skin if used to excess, so decrease application if you notice any irritation. Selenium may discolor hair and will stain clothes. Be very careful when applying any of these products around the eyes. And don’t take them by mouth.

Learn to Observe Yourself

The careful physical examination requires skill and experience. Some important observations can be made at home. If you can report accurate information on these points, you can further help your doctor.

Temperature

Don’t say “fever” or “running a temperature” or “burning up.”  But a thermometer, read the instructions, practice shaking the thermometer down, and be able to report the exact temperature. If you have a small child, buy a rectal thermometer and learn how to use it.

Pulse

If the problem involves a rapid or forceful heartbeat, know exactly how fast it is beating. Feel a pulse in the arm or throat, or put an ear to the chest. Count the exact number of beats occurring in one minute, or have someone do this for you. If you think that there is a problem with the pulse, determine whether the beat is regular or irregular. Is the heart “skipping a beat,” “turning flip-flops,” “missing every other beat,” or is it completely irregular? A pulse irregularity often gone by the time you reach the doctor. If you describe it accurately, your doctor may be able to understand what happened.

Breast

The mammary tissue is normally a bit lumpy.  Adult women should carefully examine their breasts every month in order to detect changes. Press the breast tissue against the chest wall, not between the fingers. Try several positions-lying down, sitting, and with the arm on the side being examined raised over the head. Look particularly for differences between the two breasts. If you note a suspicious lump, see the doctor immediately. Many women delay out of fear. Please don’t. Very few lumps are cancerous, but if the lump is malignant, it is important that it be removed early. Often the patient can feel a lump that the doctor misses; help the doctor locate the problem area.

Weight

Changes in weight are frequently very important. Know what your normal weight is. If your weight changes, know by how much and over what period it changed.

Other Findings

Know your body. When something changes, report it accurately. A change in skin color, a lymph gland on the back of the neck, an increase in swelling in the legs, and many other new events are easily observed. Just as important, knowledge of your body will help you avoid reporting silly things. The “Adam’s apple” is not a tumor. “Knobs” on the lower ribs or pelvis are usually normal. The vertebra (bone) at the lower neck normally sticks out. There is normal bump at the back of the head-the “knowledge bump.” I’ve known patients to report each of these as emergencies.

Constipation

A natural diet is recommended with natural vegetable-fiber residue, to the use of any laxative. But if you must use a laxative, the most attractive alternatives are psyllium as a bulk laxative or milk of magnesia to hold water in the bowel and soften the stool.

Bulk (Psyllium Containing Laxative)

Metamucil and Effer-Syllium contain substances refined from the psyllium seed. They can help both diarrhea and constipation. Psyllium draws water into the stool, forms a gel or thick solution, and thus provides bulk. It is not absorbed by the digestive tract but only passes through; thus, it is a natural product and essentially has no contraindications or side effects. It has been recommended as a weight-reduction aid when taken before meals because it induces a feeling of fullness that may reduce appetite; however, it doesn’t seem very effective in this role.

Dosage

One teaspoonful, stirred in a glass of water, taken twice daily is a typical dose. A second glass of water or juice should also be taken. Psyllium is also available in more expensive, individual-dose packets, for times when you don’t have a teaspoon. The effervescent versions mix a bit more rapidly and taste better to some people.

Side Effects

If the bulk laxative is taken without sufficient water, the gel that is formed could conceivably lodge in the esophagus (the tube that leads from the mouth to the stomach). Sufficient liquid will prevent this problem.

Your Doctor Can Save You Money on Drugs

Your doctor plays a major role in the cost of drugs by choosing the drugs to be prescribed. For example, if you have an infection due to bacteria, you may be given tetracycline or erythromycin. Tetracycline costs about twenty cents a capsule, whereas erythromycin costs about $9. At the doctor’s option, a steroid prescription for asthma may be prednisone at 14 cents per tablet or methylprednisolone at $1 or more per tablet. Medically, such drug choices are between agents of similar effectiveness. If your doctor prescribes a drug by its trade name, in many states the pharmacist must fill the prescription with that particular brand-name product.  The brand-name product frequently costs many times more than its “generic” equivalent. Does your doctor know the relative cost of alternative drugs? Many doctors do not.

The drug-prescribing habits of different doctors can be divided into two groups: the “additive” and the “substitutive.” With each visit to an “additive” doctor, you receive a medication in addition to those you already have. With a “substitutive” doctor, the medication you were previously taking is discontinued and a new medicine is substituted. Usually the “substitutive” practice is advantageous to your health as well as your pocketbook.

Most of the time, medication can be taken by mouth. Sometimes medication is given by injection because of the physician’s uncertainty that you will take the medication as prescribed; by injecting it, there is no question that the medication has been taken. However, as a thoughtful and reliable patient, you can assure your doctor that you will comply with an oral regimen. Taking medication orally is less painful, less likely to result in an allergic reaction, and far less expensive.  There are exceptions, but whenever possible you should take medication by mouth rather than by injection.

If it is clear that you must take medication for a prolonged period, ask the doctor to allow refills on the prescription. With many drugs, it is not necessary to incur the expense of an additional doctor visit just to get a prescription written. However, under some circumstances, the doctor may prefer to examine you before deciding whether the drug can safely continued or is still required. Ask your doctor if refills on the prescription are permitted.

The careful doctor will ensure that you fully understand each drug that you are taking, the reasons you are taking it, the side effects that may arise, and the expected length of time that you will taking the medication. A daily medication schedule will be arranged so that it is convenient as well as medically effective. If the program is confusing, ask for written instructions. It is crucial that you understand the why and how of your drug therapy. Do not leave the doctor’s office for the pharmacy without understanding your medication.

The Marketing of Medical Services

Increased competition in medicine is here. With nostalgia, we note a certain loss of dignity.  Hospitals compete with other hospitals for patients. Health insurance plans compete with other plans. Doctors compete with doctors. There are advertisements and direct marketing to consumers (patients).

You need to be aware of these changes because once-conservative institutions are now trying to influence your choices. A new event, the hospital “chain” with facilities in many cities and national marketing practices, has developed. Payment for spectacular new technologies, such as the artificial heart, may be internally justified, at least in part, because it calls attention to the merits of particular companies. Marketing directors, or their equivalent, have been hired at many hospitals, even small ones. The hospital public relations director interacts with media, and regular press releases as well as attractive brochures are prepared.

To an extent, the marketing educates and aware of the features of the alternative choices you might make. But beware of hype and jargon. Guidelines from this blog might be more effective means of finding good-quality care than slick brochures and press releases.