The Rash of Hives

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What are hives?  In medical terms, hives is known as urticaria just to confuse everyone. This is a very common disorder affecting up to 20% of people sometime in their lifetime. A typical rash is very itchy, along with red plaques (patches of skin). Individual lesions (the bumpy stuff) appear within minutes, come together to coalesce and then disappear within minutes. Other lesions may stay around longer and then disappear after a few hours.

Can hives be dangerous?  There is a particularly severe form of urticaria called angioedema that is defined by swelling deeper in the skin. This can involve the tongue, lips and throat. Needless to say, this can be a medical emergency. The triggers of such can be a drug, foods, insect bites or stings, or infection. These triggers would be possible for new onset urticaria but usually no cause is found in many cases, especially when the condition persists for weeks or months.

Urticaria is classified as acute( less than six weeks) or chronic ( more than six weeks). The rash is present on most days of the week, not necessarily daily. For both, the rash looks the same.

Some of the rashes look quite large:

There may be different presentations. Some are called cholinergic urticaria which is triggered by rapid changes in body temperature( such as taking a shower) that feels like a burning. There is something called dermatographism where the skin is hardened appearing where the skin has been firmly stroked or scratched:

What causes hives?  There are so many possible causes of hives although no specific cause can be identified in many people. All of them, however appear to have some sort of allergic trigger causing the release of mast cells. Of the possible food triggers, reactions typically occur within 30 minutes. Milk, egg, peanuts, tree nuts, soy, and wheat are the most common foods to cause rash in children. For adults, fish, shellfish, tree nuts, and peanuts are most common. Other foods, such as tomatoes, and  strawberries can cause generalized rash through an non-allergic mechanism, especially in younger kids.

These are round bumps on the skin called papules that appeared within 30 minutes of exercise.

There are some factors or warning signs to look out for in addition to angioedema: the rash that is recurrent, persistent, and difficult to treat. Definitely see your doctor about this. 

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Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
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Whiplash...Injuries of the Neck

The crunch, the crash, the whiplash. Whiplash is usually due to trauma such as a car accident. So what is whiplash ? A whiplash injury of the neck is one that involves an abrupt movement of flexion and extension( bending forward and backward). Symptoms include severe pain, spasms, loss of motion of the neck as well as headache. In my opinion, every case of trauma should be evaluated by a doctor or other qualified health professional to rule out cervical neck injury (spine). Pain can be persistent despite only little identifiable abnormalities found on xrays or even MRI scans. Often with the case of whiplash, it is the soft tissues, spinal nerves, discs, ligaments, or small joints in the spine, called facet joints, that are injured.

These injuries are very common after trauma, even more than fractures. They are; however, poorly understood. In a study involving nearly nineteen-hundred people involved in a car accident, 26% had neck pain for greater than a day. There were eight risk factors identified for whiplash injury: females, younger age, prior history of neck pain, rear injury collision, stationary vehicle at the time of the impact, the severity of the collision, not being at fault, and monotonous work( isn’t that one interesting?). In a review of some 47 studies, approximately 50% of adults with whiplash injury reported neck pain symptoms at the end of one year. If you are involved in a car wreck or have an injury to the neck either directly or indirectly, seek help sooner as opposed to later.

The cause or pathology of whiplash is unclear. Theories include micro-vascular bleeding into the ligaments as well as the release of inflammatory cells. This would explain the short term symptoms but hard to explain why many people remain with symptoms months or years later. A study using high resolution MRI of the Cervical spine in patients with a history of whiplash injury average of 6 years previously, demonstrated soft tissue damage was not detected in the MRI images of patients without symptoms( the controls).

There was a study published in the United Kingdom a number of years ago. It stated that the most important factors to predict if someone would have pain at the end of one year were pain severity (or how painful it was) at the time of the rear-end collision and the presence of a compensation claim. This is also likely to be true here in America where we have whiplash “experts” and personal injury attorneys. This is why I call this the “wild wacky world of car accidents!” In fact, Australia had a change of law where financial compensation for pain and suffering were removed from whiplash claims. This was associated with improvement in functional status as well as pain. Interesting.

So, if you have had a car accident or some injury to your neck, see your doctor for an evaluation. He is the one who will most likely look out for your best interest! =)


Dr. Frank Marinkovich and his wife Rita own and operate Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Be sure to find out more about their NEW specialized Laser Treatment. Visit them online at http://www.eastsidefamilyhealth.com or call them at (425) 899-2525.

UGLY NAILS

How would you describe your toenails? Do you disguise them with polish? Or avoid wearing sandals or being seen bare foot?  Chances are that the nails you may describe as ugly are actually infected toe nails that can be treated and can even be treated without medication.

Ever since the FDA approved laser therapy for the treatment of nail fungus, there has been a heightened response from people for this therapy. It is due to the fact that the only real treatment available since this has been a potentially toxic treatment with oral therapy with success rates maxing out in the 70 percent range.

The technical term for nail fungus is onychomycosis which refers to nail infections caused by fungus, yeasts or molds. Most people with the toenail variety also have tinea pedis( athletes feet).

By most studies, the prevalence of onychomycosis is  up to 18% of the population with toenails involved and the most common being fungus. It is not only the nail but the root of the nail that is involved meaning that the nail is bad to the core. As a result, only medications or laser (no soaks or tree oil or oregano!) will kill it.

There are some situations that increase risks to getting this infection, but anyone can get it since it lives on our skin. Those risks include: diabetes, older age, swimming, athletes feet, and living with someone with fungus. Note that psoriasis of the nail is not infectious and will not respond to medication or laser.

The big toe is usually the one infected first but easily spreads to all toes. The involved nail often looks heaped up, discolored, irregular with flaky contents under the nail itself. The nail may also look white or chalky.

It is possible to biopsy the nail to figure out what the cause of the ugly nail is, however, only about half the time does the culture show the organism even though it is present. Insurance companies are increasingly requiring a positive diagnosis before paying for the medications.

So, why treat the ugly nail?

•    They look bad
•    The nail can cause discomfort/pain  since it is infected
•    You can infect others in the house
•    Adds to risks of infection especially in those who are diabetic or have swollen ankles/legs, or prior cellulitis( skin infections).

As stated, treatment can include medications, such as Lamisil. This drug is to be taken for 84 days consecutively with a success rate of about 73%. Multiple blood tests for liver function should be done during the course of treatment to guard against liver toxicity. Recurrence is common especially when dealing with toenails.

Some have tried nail removal. This however often proves fruitless as infected nail grows out since the root is infected in addition to the nail itself.
Finally, there is the laser. There are studies reporting the success of this treatment. It is called photodynamic therapy involving the application of a topical gel( photosensitizer) followed by treatment of the nail with a light energy source. Recently, the FDA has approved the use of laser for the treatment of nail fungus.

So, do you or someone you know have ugly nails? It may be a fungus! And it is an infection that should be considered to be treated.

Dr. Frank Marinkovich and his wife Rita own and operate Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle,  Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Be sure to find out more about their NEW specialized Laser Treatment. Visit them online at www.eastsidefamilyhealth.com or call them at (425) 899-2525

Sleep Apnea...Does it Concern Me?

Obstructive Sleep Apnea or OSA, is a challenge to many people and as sleep medicine is a field that has come to the forefront in the past few years, sleep apnea has been put in the spotlight. Sleep apnea is a condition where people have moments where they miss breathes while they sleep. OSA is more common than you might think. As well, it is amazing how many other diseases and conditions are affected by and linked with sleep apnea.
Does this really affect that many people? Chances are you know someone that this is affecting. It may even be you or someone in your family. An estimated 26% of Americans live with OSA, that’s an average of 1 in 4 people. To test for OSA, a sleep study should be done. During the study, the individual is monitored while they sleep. Their sleep activity is then scored using a standard called the Apnea-Hypopnea index. A score of 5 or more per hour would give you this diagnosis of OSA.
So who is at risk for OSA? Generally, men are twice as likely to have OSA as compared to women, however up to 4% of women also have OSA. As you age, your chances to suffer from OSA also increase. Increasing steadily from 18 to 45 where they plateau, and then finally increasing sharply at age 65.

Another significant risk factor is also the most documented. Obesity. As the body mass increases, the prevalence of OSA goes up progressively. Also contributing to risk are certain internal facial abnormalities such as a wide based tongue, large tonsils, adenoids and a narrow jaw. Chronic nasal congestion is also another factor for OSA risk. Finally, smokers are three times more likely to get OSA compared to non-smokers.

The exact cause of apnea is unknown. OSA can be broken down into 2 types, central and obstructive apnea. Central Apnea is defined where the brain fails to stimulate the body to breathe. This is called diminished neural input. Obstructive sleep apnea is caused by other factors such as obesity, craniofacial abnormalities, and soft tissue upper airway abnormalities.

So what do you need to look for? Some features of OSA that could tell you if you have it include: snoring and daytime sleepiness. These are the most common complaints. Additional symptoms include restless sleep, fragmented sleep, poor concentration, periods of not breathing, loud snorts, gasping sensation or smothering. Daytime sleepiness or fatigue is a very common presenting feature as well. This usually is noticed during boring or monotonous situations, such as meetings. One way to find out if you suffer from any of the sleep related symptoms is to ask your partner or family member as they may have greater insight than the patient.

Here is a list of some common symptoms:

• Awakening with a sensation of choking or smothering
• Awakening with a dry mouth
• Restless of fitful sleep
• Moodiness
• Lack of concentration
• Morning headache
• Nighttime urination
• History of hypertension( high blood pressure), heart disease, stroke, kidney disease, diabetes,reflux( GERD), obesity and can’t lose the weight.
• Restless legs syndrome

I recommend testing should be done on anyone who snores and who has daytime sleepiness or who snores and has any of the features shown in the above list. Also, if you are a pilot, bus and truck driver or other critical profession you should have a sleep study if you snore.

There are many diseases related to OSA! More and more studies are linking the condition to heart disease, stroke, kidney disease, high blood pressure, inability to lose weight, or even psychiatric illness.

So, if you think you qualify for the diagnosis, talk to your doctor. The best test in my opinion is the overnight sleep study. Treatment will be based upon the results!

For more information contact us at 425-899-2525 or visit us at http://www.eastsidefamilyhealth.com/

Tuberculosis Skin Testing

Tuberculosis, TB, skin testing is common test given to people for screening. For most people, interpreting a skin test for TB is confusing, especially when one is faced with the possibility of having to take medication for a number of months after the results are read. This is to help shed some light on the whole matter.

Although the first priority for tuberculosis control is to treat active TB, the second is certainly to identify and treat those people who are at risk of active disease by discovering what is called latent infection. Latent means that the person is infected but their infection is controlled by their body’s own defense mechanisms. However, latent infections have the potential to develop into active disease at any time, usually under conditions of stress. Finding and treating latent infection can reduce the development of active disease by as much as 90%.
The most common test for the identification of latent TB is the PPD skin test, or the tuberculin skin test( TST). Only those specifically trained should administer the test as there is a specific technique to performing it.

So, who should be tested? High risk people who should be tested include those at high risk who have immunocompromising conditions (conditions that reduce an individual’s body defenses) such as lymphoma, leukemia, chemotherapy, HIV, or on chemotherapy, etc. Other patients, who are considered at moderate risk include those who have diabetes or those on steroid therapy. Patients considered at slightly increased risk are those who are underweight, smoke cigarettes, or have an abnormality on chest x-ray.

Testing implies treatment, so thought needs to be given to who is actually tested. If you are over 65 years old, testing and treatment are indicated only if risk is high( see above). Between the ages of 50-65, the risk of hepatitis from the treatment is about 5%, which is high enough so that testing and treatment are indicated only if the risk of reactivation of latent TB is high or moderate. For those less than 50, the risk of hepatitis is less than 3%( for those less than 35 y/o the risk is less than 1%), testing and treatment is indicated if the risk of reactivation is slightly increased, moderate or high.

So, testing and treatment are not warranted for individuals older than fifty with only a slight increased risk of reactivation and individuals older than sixty-five with moderate or slightly increased risk for reactivation.

As always there is more to be said but this should shine some light on who should be treated and when!

To find out more about us visit www.eastsidefamilyhealth.com or call us at 425-899-2525.

What Dr's Wish Their Patients Knew...

Recently I came upon an article in the March 2011 issue of Consumer Reports “What Doctors wish their patients knew.” Interestingly, the results were a compilation of some 660 primary- care medical providers that responded to an online survey in September 2010 regarding personal professional challenges and how a patient could get the most out of their relationship.


A highlight of survey results and primary- care medical provider recommendations for patients to ensure they receive better healthcare included:

1. Forming a long-term relationship with a primary care medical provider is the most important thing a patient can do to obtain better medical care. Steve Grumbach, M.D. , professor and chair of the department of family and community medicine at UC-San Francisco, confirmed stating “A primary care doctor should be your partner in overall health, not just someone you go to for minor problems or a referral to specialty care.”

2. Being respectful and courteous toward your medical provider and recognizing that respect is a two way street.

3. Complying with advice or treatment recommendations once they have been discussed and agreed upon by both provider and patient.

4. Recognizing that primary care medical providers are harder on themselves than patients were when it came to judging their ability to minimize pain, discomfort or disability caused by a condition.

5. Keeping track of your medical history by compiling an informal log of treatments, drugs, changes in condition, notes from previous doctor visits tests and procedures and bringing this information to your appointment.

6. Taking a friend or relative to your office visit to be a second pair of eyes and ears.

7. Researching your medical condition online was discouraged by primary care medical providers due to a variety of websites that are advertiser funded and designed to guide you to a specific treatment. If you must research, it is better to look at government sites such as those for the CDC, FDA, and National Cancer Institute.

8. Recognizing that the volume of insurance paperwork, financial pressures, and health plan rules and restrictions can interfere with a primary care provider’s ability to provide optimal care. Therefore, it is recommended a patient plan ahead for an appointment by jotting down questions or concerns you might have and prioritizing them.

Increased awareness and implementing these valuable recommendations can make for a better, more productive and healthy outcome for both the provider and patient alike. This will begin to set the patient on a path of achieving and maintaining a lifestyle of holistic health.

Something for the LADIES...

Ladies, have you ever thought you had a yeast infection? Experienced an itching that wouldn’t go away or a smelly vaginal odor? Vaginal yeast infection, known as vaginal candidiasis, is an infection involving fungus or yeast. The most common fungus seen is a form known as Candida Albicans. Normally this yeast is found in normal proportions in warm and moist areas of the body. However, when Candida multiplies to the point of an infection, symptoms such as vaginal inflammation, irritation, odor, vaginal discharge, and itching can result.

Causes of yeast infection can include antibiotic use, steroid use, diabetes where elevated blood sugars can affect the ph of the vagina , a weakened immune system, use of douches, tight underwear or jeans, and hormonal changes.
Although over the counter creams such as Monistat can treat a yeast infection, many women who think they have a yeast infection and treat as such, find no relief. This is due primarily to the fact they may have another type of vaginal infection such as bacterial vaginosis, trichimoniasis, or streptococcus B. In this case seeing a medical provider is necessary to accurately diagnose via special testing and treat the infection with prescriptive oral medications.

Furthermore, any woman experiencing symptoms such as foul smelling or yellow vaginal discharge, bloody discharge, increased urination, stomach or back pain, vomiting and fever should contact a medical provider for a thorough evaluation.

What to do after an Auto Accident

As a physician who is involved with patients in all aspects of a car wreck, I want to share some basics of what to do in case you are involved in an automobile accident and how to prepare yourself to get the treatment you need after you have had an accident.
Firstly, motor vehicle accidents (MVA) account for approximately 1.3 million deaths annually and are the leading cause of death in youth (those less than 35 years old). With these statistics, it is not only legally necessary, but also wise to possess insurance coverage. If you drive, it is likely that you will be involved in some form of MVA sooner or later. My advice is that if you drive a vehicle, insure the vehicle fully including the most personal injury protection or PIP that you can get. PIP is the part of your car insurance that covers your immediate medical bills. Most policies have basic coverage for $10k. Consider, however, that a single MRI (a common diagnostic test) may cost up to $1500.00 and physical therapy typically costs about $90.00 per session. PIP is especially crucial if you do not possess adequate medical insurance. The key to healing from your injuries is to get the proper care, including diagnostic tests over the right amount of time. More and more, it is difficult to find quality providers including physical therapists and specialists who are willing to see and treat individuals who only have coverage through the other party’s insurance, also called third party.
So, what to do if you get involved in a car accident? Here are some thoughts, not necessarily in order:
1. Call 911—if you think you need to. If hurt, call 911 to be properly assessed in the field. Stay in the car to help gather yourself and wait for the aide car. In some circumstances, get out of the car if the placement of the car is in a risky place on the road.
2. Do not admit fault—this is not the time! Let the insurance company sort all of that later. This is to protect you in case your memory of the events or your understanding of who is at fault is wrong.
3. Call the police—I am amazed of how facts get redefined after the motor vehicle accident! If it’s more than a small bump or superficial injuries, call the police (use 911). Get a copy of the report at the scene. The ticket is the police’s opinion of fault.
4. Get the other driver’s license and insurance information---copy down everything from the other driver’s license. All of it, the state, the ID number, the address. Do not forget to get phone numbers. Also do not forget to get the make, model, and license number.
5. Call your insurance company—let them know what happened. This is especially true if you are not the one at fault. They will want to work especially hard at proving the other driver is at fault.
6. Be assessed by emergency department—if you have any symptoms either immediately or later that day, it is prudent to be assessed in the E.R. to clear internal injuries, neck injuries, etc.
7. Get in to see your doctor soon—preferably the next day. Early assessment, ordering of diagnostics studies, and treating inflammation early is important to getting healthy again. The key to attaining the goal of pre-accident status is early assessment and treatment. If you are no better after two weeks of the accident, get a referral by your doctor to a physical therapist, chiropractor, massage therapist, or acupuncturist. Which one you see is dependent upon your injuries as they all have their areas of expertise.
8. Consider a lawyer—this should not be the first step and not all lawyers are of the same quality. Many are out for the dollar and not your best interest. I think it best to see who your physician recommends and trusts. Consider legal representation if your injuries are serious, if there is a pre-existing history of injuries or if your insurance company does not seem to have your best interest in mind.
If you would like more information on our services, contact us at http://www.eastsidefamilyhealth.com or by phone: 425-899-2525
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Dr. Frank Marinkovich and his wife Rita own and operate Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Be sure to find out more about their NEW specialized Laser Treatment. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
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