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