Looking Your Age

Getting older is not for sissies. I have had grey or white hair for nearly 15 years (I had to check some older photographs to be sure), so I look a bit older than my 57 years. I have been offered senior citizen discounts for over ten years now. At first, I was ready to beat the crap out of the teenager at Taco Bell that offered me my first discount; then I thought...why not? A buck is a buck. My wife, on the other hand, looks younger. She is 62; five years my senior - eligible for early Social Security, and a legal recipient of the coveted senior discount.

Since we both work together in the same clinic and commute in the same vehicle, we walk out together through the waiting room. Several boys about age 5 or 6 were sitting there watching television. One of them - one of my wife's patients - noticed us walking by.

"Is that your Dad?" he said, while pointing in my direction.

Of course, I did what any normal, reactionary medical provider would do under the same or similar circumstances. I picked him up and tried to kick his little butt, as he laughed and screamed. My wife thought it was great comment.

My next door neighbor married later in life to a younger woman. He was about 63; his wife was about 40. They had a ten year old son. One evening, they called me when he started to have chest pain. Although it did not seem cardiac in nature, I called an ambulance just in case. I decided to accompany him and his young son to the hospital in a separate car, mostly so I could bring him home when he was (hopefully) released. As he registered at the ER, a kindly receptionist put a sympathetic arm around the ten year old.

"Your grandfather will be just fine," she said.

"That's NOT my grandfather. That's my dad!" Of course, I pointed out that I was just a neighbor; not the father.

Working in a pediatric office, I see many examples of people "not looking their ages" - from the parents (grandparents?) to even the kids.

Children are maturing earlier now; especially the girls. Some blame it on our calorie-rich diet; others blame it on hidden hormones in our food and water or genetic aberrations. You expect a nine-year old to be just a little child, playing with dolls and such. You do not expect them to have breasts and other maturation signs like a 12 year old. By the time they do reach twelve, they are wearing some very suggestive clothing and look like they are 16 or 17. Parents are letting them wear low-riding pants that show most of their belly down to the pubis; and showing about an inch of their butt cracks. Some have (real) belly-button rings and sport fake tattoos.

Some of the mothers in my practice dress like the kids (or vice versa). Some appear too young to even have kids (they like to hear that), and of course, not all of them are the biological mothers. Some of the mothers are the younger, second wives - the step-mothers. And, a few of the young-looking mothers are actually the grandmothers! I routinely ask ANY woman accompanying a child if they are the parent or not. I don't assume anything...anymore.

When I was a kid, all we had to make us look bigger were candy cigarettes. Now, 40 years later, some of us are getting candy cancer from them. When I was a teenager, I desperately wanted to look older. I would color in my blonde mustache with my mother's eyebrow pencil so people could see it. As soon as my armpit and chest hair started growing in, I wanted to keep my shirt off at the pool. Now, 40 years later, I have hair growing out of my ears and covering my back like some kind of Sasquatch. Of course, my hair is just about white, so I guess it would be closer to the Abominable Snowman, or even Santa. Santa, of course, is ageless. I don't even think that Santa was ever a child. You never see any baby pictures of Santa, so that troubles me a bit.

With age comes wisdom, so I guess it is okay to look older...but, not too old. I never remember my grandmother as anything but old. I figured out that when I was six or seven years old, she was about 57 - my age!

Related Topics:

• WebMD Video: Getting a Kick Out of Aging
• WebMD Healthy Aging Center

Airplane Ears

As the holiday travel season approaches, people will be heading to the airport for destinations unknown, especially since it is too expensive to drive anywhere now. Most air travelers will not have problems with their ears when the cabin is automatically pressurized on take-off or depressurized on landings, but some will (especially children). It even happened to me.

I suspected that I had a cold. No big deal, since I get my share of upper respiratory infections dealing with sick people every day. Although I have become more of a white-knuckle traveler since 9/11, the flight from Washington, DC, to Detroit was surprisingly smooth. I was sitting in the worst seat in the plane - last row; no window, over the noisy engine, and by the bathroom. Henry Kissinger once said that there are only two reasons to sit in the back of the plane by the bathroom: either you have diarrhea, or you enjoy talking to others that do. I was sitting with an elderly woman who remained seated the entire flight, so I am guessing the Kissinger theory did not apply.

For some unknown reason, the plane suddenly descended on the approach to Detroit. Of course, I am thinking this is an evasive maneuver to avoid a mid-air collision, or the pilot couldn't find the airport until the last minute. The plane rapidly dove a few thousand feet and I thought my ears would explode. The little old lady sitting next to me must have noticed my extreme discomfort, profuse sweating, and grimace on my face. At that point, I was glad I didn't have diarrhea! She reached over and held my hand, lovingly stroked my arm and said, "Don't worry, honey... everything will be just fine." She then proceeded to share a few of her near-death experiences during air travel. I must say it took my mind off of the excruciating ear pain. My ear remained painful and stuffy for the next four days.

I am sure that everyone has noticed that some babies cry as the plane is landing. Although they have no verbal ability to tell us, they are most likely crying because of ear pressure-related pain. Not only is crying an indication of pain, crying is also therapeutic. Crying, like swallowing, will help open the eustachian tubes and relieve middle ear pressure. I do not recommend that adults cry and scream during plane flights. It worries the other travelers.

The eustachian tubes are tiny ventilation and drainage tubes that run from the middle ear space (the area on the other side of your eardrum) to the back of your throat. The primary function of the e-tubes is to make sure the pressure in the middle ear is the same as the outside atmosphere. Rapid changes in barometric pressure that can be experienced during take-off and landings can cause ear pain (otalgia) if the eustachian tubes are not functioning well. In children, the e-tubes are very tiny. In adults, the eustachian tubes are often compromised if you have a cold, allergies, or other types of inflammation in the nose, ears, or throat. People who smoke can have throat inflammation that can cause the eustachian tubes to malfunction. Of course, when your ears are painful it is a bit too late to worry about the cause.

There are a few things you can do BEFORE you fly:

Adults

• If you have a cold or allergy problem, talk to your doctor about prescribing or recommending some medications that may help prevent "airplane ears". These include oral or short-acting nasal decongestants, combination decongestant/antihistamines, or prescription nasal steroids sprays. Since many of these medications have side effects or problems for people with high blood pressure, heart disease, pregnancy, thyroid disease, etc., you should NOT self-prescribe (or treat others for that matter) without first consulting your medical provider.


• Yawning and swallowing will open the eustachian tubes. Many seasoned travelers chew gum, suck on mints or candy, or slowly drink water during take-off or landings.


• "Popping your ears": If nothing has worked to prevent the ear pain, you may need to unblock your ears by this pressure equalization maneuver -- Pinch your nose and close your mouth. Try to direct the air to the back of your throat and then gently blow (not too hard!) to increase the pressure, directing the air up the eustachian tube. If you hear or feel a "pop" your ears should "open". This maneuver may need to be repeated throughout your descent. Do not blow TOO HARD or you can make the problem worse.


• A special type of ear pressure-regulating earplug (EarPlanes) available at pharmacies or the airport convenience stores may be worth trying during ascent and descent. Personally, I have never used them, but some of my patients swear by them.

Infants and Children

• Like adults, infants with ear infections really should not fly. If possible, the trip should be postponed for a few days to give the antibiotic a chance to work, although I realize that this is not always possible for many reasons.


• With the permission of your medical provider, infant decongestant nasal sprays* can be safely used for children over the age of two. It is used about one hour before flying (or one hour before landing). For children younger than age two, decongestant cold medicines are no longer recommended, according to the guidelines of the American Academy of Pediatrics. Unfortunately, these are not miracle preventatives.

*Since cabin humidity is notoriously dry, the frequent use of saline (salt water) nasal sprays may also be helpful in the dry air of an airplane for people of any age. You should also fly "well-hydrated". This means water, and not alcohol, carbonated, or caffeinated drinks.

• During landing (and even take-off), babies should be encouraged to either breast or bottle-feed to encourage swallowing. Since babies are safer strapped in their car seats, using a bottle would be best. Pacifiers are not a substitute, since they do not encourage beneficial swallowing. Older children can sip from a cup or juice box. If you squeeze the straw a bit as they drink, this extra effort in sucking will be more beneficial in clearing their ears.


• If the ear pain does not go away relatively soon after landing, your medical provider should be consulted. While not all ear pain is an ear infection, it is not unusual for infants and young children to develop middle ear infections after a recent plane flight, mostly due to the stagnation of fluid in the middle ear and the exposure from new pathogens.
  

Take your hygiene measures to the highest level. Whip off those tray tables and the arms of the seats with a disinfectant wipe, wash your hands often, and be especially careful when using the bathroom or changing diapers. Avoid touching your own eyes or nose - key entry points for germs. If the person sitting next to you is clearly ill, consider changing seats if possible.

Related Topics:

• Ear Problems and Injuries,Age 12 and Older
• Ear Problems and Injuries,Age 11 and Younger

Tonsil Stones - Dealing with Tonsilliths

Unlike generations past when troublesome tonsils were removed at the discretion of a doctor, nowadays we tend to keep our tonsils for life. Tonsils are good and serve many important immunological functions by protecting us from certain diseases. There is really no reason to take 'em out, unless they become seriously problematic.

Tonsils can become so large that they look like bookends when you peer into the throat. If they are so large as to cause difficulty with eating, swallowing, or breathing, they may need to live elsewhere - in a jar. Tonsils that collect strep several times a year, or worse, constantly harbor strep (strep carriers) may need to come out. Tonsils that become so infected that they form abscesses (peritonsillar abscess) usually need to be surgically removed.

Tonsils that become temporarily enlarged due to viral infections, mononucleosis (mono), or random bouts of strep are quite treatable without surgery. Viral infections and mononucleosis will self-resolve in time with a little gargling and chicken soup. Laboratory diagnosed strep tonsillitis responds well to a short course of antibiotics; usually plain 'ol, cheap penicillin or erythromycin. Believe it or not, antibiotics are not used primarily to treat the tonsillitis, but to used to prevent possible strep complications (albeit, rare) of rheumatic fever, or heart/kidney involvement.

I constantly get miffed when people with enlarged tonsils, tonsils with "white stuff" on them, or sore throats are simply treated with antibiotics without a confirming lab test. Since most cases of tonsillitis and sore throats are viruses, it does not make sense to throw antibiotics at them. Antibiotics have absolutely NO EFFECT on viruses. When medical providers pronounce "Strep" based solely on a brief visual examination, they are wrong up to 50% of the time. They might as well flip a coin.

When people only look at their own throats, or the throats of their children, when they have a sore throat, you may no what this area normally looks like. Kids can have very big (normal) tonsils, and tonsils may have that ominous "white stuff" when there is nothing really wrong. While it is possible to get white material on the tonsils when there is an infection (called exudate), it is not necessarily a sign of strep, or an indication that you need antibiotics.

Some tonsils normally have holes, or crypts on the surface. Over time, these crypts can collect an impressive amount of food particles and other debris. This debris will decompose and rot due to the moist, warm environment of the throat. It can also calcify; becoming as hard as a stone. These tonsillar stones are called "tonsilliths". Tonsilliths run in families; yet another thing we can blame on our parents. From time to time, the tonsilliths will dislodge, releasing the trapped, decomposed material underneath; resulting in a disgusting taste and smell. As nasty as these things are, this is not considered an infection.

There is very little that can be done medically to deal with tonsilliths. Once you overcome your own gag reflex, you can reach back and flick 'em out of your tonsils when you see them; or you can use a moistened Q-tip to dislodge them (one of the few approved uses of these cotton-tipped applicators). If you get into a habit of gargling with warm water (or weak salt water) after every meal, you can effectively prevent most of the accumulation of food debris.

The only definitive cure for recurrent tonsilliths would be the surgical removal of your cryptic tonsils. Since money-pinching insurance companies rarely approve surgery for this reason alone, you will need your ENT to be a strong advocate, or you can pay out of pocket to have your tonsils removed (not cheap!). Since they may be genetically-linked, maybe you can convince your parents to chip in (not likely).

Like ugly toes, premature baldness, big noses, weird belly-buttons, tonsilliths are just one of life's misfortunes.

Related Topics:

• WebMD Video: Child Behavior Issues Could Be Linked to Their Tonsils.
• WebMD Video: Tonsil Surgery Just Got Easier

Itching to Make a Comment

A woman is suing Victoria Secret because she developed a contact dermatitis on her breasts due to a chemical contained in the fabric, namely formaldehyde, a chemical used for embalming. Now, I don't know squat about why formaldehyde is used to make bras, but I am highly in favor of preserving breasts. Working in pediatrics, breasts are essential to feeding our babies - their primary/original purpose. Victoria's Secret's mission is to make them look better by scrunching them together, and pushing them back up to where men can see them better. Babies are just interested in eating.

This is an interesting issue since I just asked my wife about trying on clothes the other day.

"Do you try on bras before you buy them?" I asked.

"Of course, how else are you going to know if they fit?"

As a man who would never think of trying on a pair of underwear in a store dressing room, I was puzzled. Of course, trying on underwear is a bit different, knowing what is contained in those pouches. Breasts are probably a lot cleaner; infinitely cleaner than our hands, so trying on bras would be like trying on a hat (I guess...I have never done it). As a non-woman, I assume you've got to get a good fit and this is going to require some bra-to-skin contact, not over some t-shirt or something. Non-lactating breasts do not usually leak, and of course, a lactating woman is not going to be shopping for a nursing bra at Victoria's Secret. I sure hope women do not try on underwear skin-to-skin.

Men rarely try on anything at the store, except maybe a coat. We are too lazy and in a hurry, and no one wants to remove a few hundred straight pins from shirt. We just go into the dressing room, hoping we can see the size of the shirt, pants, or underwear we are wearing now, as a guideline. Of course, men also rip off those annoying tags, so size is always a question. If our pants are too tight, we go up a notch. If shirt sleeves are too short; we buy some with longer sleeves. This is not rocket science. Some men continue to wear the same size underwear they did in Junior High. Sometimes, it IS the same underwear we wore in Junior High!

When my wife brings home clothes, and I must admit that she brings home LOTS of clothes, she washes them first. This is a good policy, unless of course, it shrinks up, fades, and looks like old, used clothes again. I like to have new clothes washed, since I have this fear of getting scabies or crabs (also called the California Crotch Cricket). I have sat outside a lot of dressing rooms in my life (waiting for my wife), and I have seen some pretty scuzzy people walking in there with an arm-load of clothes to try on.

After over three decades in primary care medicine, I have seen my share of contact dermatitis - an itchy rash - from chemicals in unwashed, new clothes. This is especially common after Christmas. There are LOTS of chemicals in clothing. I wasn't aware of formaldehyde, but I can't imagine this is the only chemical trapped in the fibers of that bra in question. Even when you wash clothes, you will leave chemical residuals.

One of the more interesting things I see in pediatrics is "Bounce dermatitis" - a chemical reaction to a perfume-laden dryer softener sheet. The residual chemical sort of reactivates in response to moisture - usually the moisture associated with a quick bathroom trip. There are other products, not just Bounce, that have sensitizing chemicals. The goal is to make our clothing, especially our underwear, smell nice...at least for a while before we insert a stinky butt. Incidentally, Bounce-Free (no perfume) does not usually cause Bounce dermatitis.

"No matter how you shake and dance, there are always a few drops that get on your pants."

Of course, I am talking about urine. A few residual drops of urine will stir up those perfumed chemicals and start the itching reaction. My own nemesis is Tide. There is something in Tide that drives me crazy with hives (urticaria).

I don't know how this lawsuit is going to turn out for Victoria's Secret, but I hope they win. My wife doesn't shop there and I have only stood near the doorway (or the display window), not wanting to be labeled as a pervert.

I am sorry for the women that got itchy boobs from the formaldehyde, but a little hydrocortisone cream would fix this mild, temporary, unintentional allergic reaction. If you happen to work in a morgue or prepare anatomical specimens, high doses of formaldehyde can be liver toxic, but I doubt the residual amount in this bra would cause any long-lasting health issues.

It is my on-going mission to keep you abreast about the latest news; mostly to help distract you from what's happening with the economy.

Related Topics:

• WebMD Slideshow: Adult Skin Problems
• Skin Reactions to Beauty Products

One Lump or Two?

Some of the more common postings that I encounter on the WebMD ENT message board are concerning lumps and bumps that are usually self-discovered in the neck, around the ear, or even viewed in the mouth or throat. Since lumps could indicate an ominous diagnosis (like cancer - yes, I said it), people are frightened and post for reassurance that it is "...not a tumor".

As you might imagine, the Internet poses some insurmountable barriers when it comes to making a definitive diagnosis, primarily due to my inability to perform a hands-on examination. A description on a posting - no matter how detailed or graphic - is not sufficient to make this important call. Lumps cannot be identified by appearance, so even if people could post a picture, this would not be helpful. Lump identification starts with palpation - the medical act of feeling it for size, consistency, and mobility - but it doesn't end with this careful examination. A definitive diagnosis - determining the true nature of a lump - often requires a pathological diagnosis. A specimen may need to be obtained by biopsy (surgically removing a little piece), needle aspiration of cells, or even the complete removal of the lump. Since the vast majority of these worrisome lumps are innocent (not cancers, but merely moles, cysts, warts, skin tags, etc.), based on the medical provider's examination, watchful waiting may precede any surgical intervention.

Lumps that are deeper in the neck - those that are suddenly tender and movable - are often "reactive lymph nodes". Lymph nodes are an important part of our immunological defense system, and lymph nodes (we have hundreds of them located all over our bodies) will enlarge in response to infection and/or inflammation in their drainage area. For instance, a lump in the front of the neck, under the jaw, could indicate infection/inflammation somewhere in the throat, tonsils, mouth, teeth, salivary glands, neck, or skin. It is up to your medical provider to search for and locate a source for this reactive event.

Some scary lumps are just normal anatomy. People are often frightened when they feel one of their salivary glands, the thyroid gland, or the tip of the hyoid bone in the neck. Muscles in the neck can also have lumps of spasm or tenderness. In other words, some lumps are supposed to be there.

When women get a breast examination, the medical provider spends a great deal of time digging around in the armpits. Why? The axillary lymph nodes are the drainage area for problems in the breast. A breast cancer will often be detected early by the discovery of a hard lymph node in the armpit.

Infants often have tiny breast buds that frighten new parents. These are due to maternal or breast-feeding hormones and are innocent. Even a tiny amount of breast milk can be expressed from these baby boobies. As children approach puberty, lumps will appear under the breasts of girls that may start on just one side. These little buds are the hallmark of normal breast development.

Even more concerning is when breast lumps called gynecomastia occur in teenage boys. Regardless of our gender, we all produce both male and female hormones. Gynecomastia in young males, though alarming, are very common and tend to resolve spontaneously in a few years. You can always tell the teenage boys that have them. They are often the ones always wearing t-shirts at the swimming pool. Don't get me wrong, teenage boys like breasts - but not growing on them.

Because of nerve pathways, reactive lymph nodes in the neck or under the jaw can cause pain to be referred to the ear. It is not uncommon for people to present with ear pain and not have an ear problem at all, but rather an infection somewhere else.

Because of their immature (and constantly challenged by colds and other infections) immune systems, children have an abundance of lymph nodes that can be felt. Parents will often feel their own necks for comparison, and be shocked when they do not find any. Children can have so many palpable lymph nodes that their necks feel like a bag of marbles sometimes. Innocent, normal lymph nodes tend to feel soft to firm, moveable, smooth, and round/oval. Once enlarged, they may stay that way for a few weeks, or in some cases, months or even years.

When to be concerned?

Hard, fixed (stays in the same place as if attached to the underlying tissue), irregularly shaped, and growing lumps should ALWAYS be medically evaluated since they may be a hallmark of something more serious, such as a cancer or lymphoma. A very dear friend recently found several hard lumps in her neck that met these criteria. Her doctor sent her for a CT scan of the neck which showed some suspicious changes. A biopsy made the definitive diagnosis. Our friend had lymphoma.

After meeting with the oncologist, a course of chemotherapy was prescribed. A few months later, she is in complete remission. Unlike past generations, lymphomas are now highly treatable.
Sadly, some lumps are cancers. The sooner you consult a medical provider, the sooner you can be properly examined, diagnosed, and treated. Even if your self-discovered lump turns out to be "nothing", the price of reassurance is worth the cost of an office visit or insurance co-payment. Reassurance cannot be given via the Internet, based on a posting alone. Always err on the side of caution if you find a suspicious lump...anywhere.

I sincerely hope that you hear those Arnold Schwarzenegger words from Kindergarten Cop: "It's not a toom-a!"

Related Topics:

• Swollen Glands and Other Lumps Under the Skin
• WebMD Video: Cryoablation for Breast Lumps