Beauty and Health

How much water do you need a day ?

Link between Water and the Human Body

Water is an important structural component of skin cartilage, tissues and organs. For human beings, every part of the body is dependent on water. Our body comprises about 75% water: the brain has 85%, blood is 90%, muscles are 75%, kidney is 82% and bones are 22% water. The functions of our glands and organs will eventually deteriorate if they are not nourished with good, clean water.

The average adult loses about 2.5 litres water daily through perspiration, breathing and elimination. Symptoms of the body’s deterioration begins to appear when the body loses 5% of its total water volume. In a healthy adult, this is seen as fatigue and general discomfort, whereas for an infant, it can be dehydrating. In an elderly person, a 5% water loss causes the body chemistry to become abnormal, especially if the percentage of electrolytes is overbalanced with sodium. One can usually see symptoms of aging, such as wrinkles, lethargy and even disorientation. Continuous water loss over time will speed up aging as well as increase risks of diseases.

If your body is not sufficiently hydrated, the cells will draw water from your bloodstream, which will make your heart work harder. At the same time, the kidneys cannot purify blood effectively. When this happens, some of the kidney’s workload is passed on to the liver and other organs, which may cause them to be severely stressed. Additionally, you may develop a number of minor health conditions such as constipation, dry and itchy skin, acne, nosebleeds, urinary tract infection, coughs, sneezing, sinus pressure, and headaches.

So, how much water is enough for you? The minimum amount of water you need depends on your body weight. A more accurate calculation is to drink an ounce of water for every two pounds of body weight.

Vitamins

Diabetes occurs when the body has lost the ability to keep its blood sugar level within the range needed for good health. It is a growing risk for middle-aged people in developed countries due to lack of activity and serious obesity. Even with treatment, diabetics must take diet and exercise seriously to avoid poor blood sugar control damaging their circulation and risking sight damage, heart disease, foot gangrene, and kidney failure. The lifestyle that is beneficial for diabetics can also prevent many people from developing diabetes in middle age and can improve general health.

Topics

Vitamin A (Retinol) Vitamin B1 (Thiamine) Vitamin B2 (Riboflavin) Vitamin B3 (Niacin) Vitamin B5 (Pantothenic acid) Vitamin B6 (Pyridoxine) Vitamin E (Tocopherol) Vitamin D (Cholecalciferol) Vitamin K Vitamin H (Biotin) Vitamin M (Folic acid)

Sources of Vitamins Vitamin A (Retinol)

Liver and fish-liver oils Egg yolk Milk and dairy products. Beta carotene is found in dark-green and deep-yellow fruits and vegetables, such as carrots, apricots, and spinach.

Vitamin B1 (Thiamine)

Whole grains and cereals White flour and White rice are often enriched with the B complex vitamins and iron to replace some of the nutrients lost by processing. Legumes (dried beans, peas, and nuts), meat and eggs.

Vitamin B2 (Riboflavin)

Organ meat Breads and cereals Legumes (especially almonds), cheese, and eggs Meat, fish, and Dark green vegetables

Vitamin B3 (Niacin)

Meat Whole grains and cereals Legumes Eggs Milk Green leafy vegetables Fish

Vitamin B5 (Pantothenic acid)

Meat Yeast Raw vegetables Eggs Dairy products

Vitamin B6 (Pyridoxine)

Whole grain products Poultry Fish Nuts Meat Fruit Vegetables Eggs Dairy products

Vitamin B12 (Cyanocobalamin)

Poultry Cheese Eggs Yeast Meat Fish

Fruits Vegetables Citrus fruits, tomatoes, peppers, strawberries

Vitamin E (Tocopherol)

Vegetable oils Nuts Wheat germ and whole-wheat products Green leafy vegetables Egg yolks Green leafy vegetables

Vitamin D (Cholecalciferol)

Sun exposure is the primary source of vitamin D Food sources include vitamin D-fortified milk, eggs, fish liver oils, and fish

Vitamin K

Dark green leafy vegetables Eggs Cheese Liver

Vitamin H (Biotin)

Oats Organ meat Yeast Eggs Egg yolks Dairy products

Vitamin M (Folic acid)

Vegetables Organ meat Whole-wheat products Legumes Mushrooms

Minerals

Diabetes occurs when the body has lost the ability to keep its blood sugar level within the range needed for good health. It is a growing risk for middle-aged people in developed countries due to lack of activity and serious obesity. Even with treatment, diabetics must take diet and exercise seriously to avoid poor blood sugar control damaging their circulation and risking sight damage, heart disease, foot gangrene, and kidney failure. The lifestyle that is beneficial for diabetics can also prevent many people from developing diabetes in middle age and can improve general health.

Topics

Calcium Copper Iodine Magnesium Manganese Phosphorous Potassium Selenium Sodium Zinc

Calcium

Milk and dairy products Green vegetables Legumes Fish Calcium-fortified orange juice is also now widely available.

Copper

Organ meat Whole grain products Legumes Dried fruits Fluoride Seafood Tea Coffee Soybeans

Iodine

Salt water fish Shellfish Iodized salt Iron Red meat Organ meat Whole wheat products Nuts Dried fruit

Magnesium

Legumes Whole grain cereals Nuts Green vegetables

Smaller amounts are found in meat, seafood, and dairy products

Manganese

Tea Green vegetables Legumes Oats Rice

Phosphorous

If your diet is adequate in protein, you will get enough phosphorus.

Meat, fish, eggs, legumes, and dairy products. Whole wheat, corn, and rice are also good sources.

Potassium

Potatoes Dried fruits Bananas Legumes Raw vegetables Mushrooms

Lean meat, milk, and fish are also good sources

Selenium

Whole grain cereals Fish Meat Dairy products

Sodium(salt)

Sodium is found naturally in many foods and is added to many prepared foods.

Zinc

Shellfish (particularly oysters) Organ meat Lean red meat Yeast Whole grain cereals Legumes

Skin, Hair, Nails

Hair

Health Beauty HAIR CARE

Scalp Massage

A scalp massage will stimulate blood circulation that will feed the roots. It takes 2 or 3 minutes. Do this twice a week in addition to the good brushing (see A GOOD BRUSH section). People with oily hair especially need to massage as they age because they are more prone to a slowdown of circulation. Electric scalp vibrators with heat unit are the best tool for this.

Start at scalp line. Run the vibrator around the front and around the ears until your scalp tingles. Bend over and run vibrator over the back of your head and back of the ears. I like to use straight lines from my nape to my crown and back again. Then run vibrator along the top of your head in a concentric motion until it tingles. When your scalp is warm all over, you’re done. Finding a Good Brush

Treat your hair kindly by using a good brush. This is what to look for:

Must be made of animal bristles that have naturally rounded tips. Nylon or any manufactured bristles have straight ends that can snag the hairshaft and cause it to break. Don’t pull the brush through a tangle. Spray the tangle with a dilution of creme rinse to loosen it, then use your fingers to separate the tangle, then brush. Give your self a frequent brush massage about once a week. Don’t overdo this – once a week is sufficient. The bristles must be evenly spaced, embedded in rubber, and attached to a sturdy handle. Rubber will cut down on the static electricity that is built up when you brush. Wash the brush every other time you wash your hair. The best solution is to add a dollup of your shampoo with a few drops of ammonia in warm water. Brush with firm, regular stokes from scalp to the chin, until the scalp tingles – about 10 minutes. Then hold your hair in one hand and brush the ends below your chin. You don’ t want to run the brush all the way through long hair in one stroke because it puts too much pressure on the root and could pull the shaft from its root. Finally, bend over and brush the underside from your nape to the top of your head in short, regular stokes.

Finding a Good Comb

The teeth are widely spaced. You don’t want to use a comb that has thin, close teeth. Use this comb after shampooing instead of a brush. Wet hair is not as strong as dry hair, so you have to treat it gently. Wash the comb every other time you wash your hair. The best solution is to add a dollup of your shampoo with a few drops of ammonia in warm water. The comb should be sturdy and should not bend when you run it through your hair. Don’t pull the comb through a tangle. Spray the tangle with a dilution of creme rinse to loosen it, then use your fingers to separate the tangle, then comb.

Oily Hair

Lucky you! Oily hair tends to be very strong and healthy, and is easily styled. However, it loses its style quickly and becomes stringy and limp, and is prone to dandruff. Be sure to brush regularly and to massage your scalp to promote circulation. These actions do not increase oil production and they will maintain your hair’s health. Don’t use a daily or a baby shampoo. They will probably be too gentle to provide much cleansing. Avoid conditioning shampoos because they contain oils and waxes that will only add weight to your hair. If you use a conditioner, you don’t need one with aloe, balsam, protein, jojoba oil, or waxes. Look for ones with hydrolyzed proteins or silicones. If you have processed hair, apply the conditioner only at the ends of your hair where it’s drier. The best styling product is mousse because it does not contain oils and will add volume. Don’t use hair spray. It’ll only collect dust and moisture from the air. Use a cleansing-only shampoo. Ones with citric juice or malic acid will be especially effective in removing excess grease. Breck Shampoo is a good, plain shampoo. Others: Nexxus’s Aloe Rid, Redmond’s Australian Hair Citrifier. If you have dandruff, use a shampoo with sulfur. Over-the-counter products like Selsun and Sebulex are good. Your doctor can give you a prescription for a very strong sulfur shampoo. The best after-shampoo treatment is to add the juice of 1 lemon in a cup of warm water and pour it all over your hair. Rinse out with cool water. Lemon juice is an astringent that will close the pores in your hair, blocking the release of oil, and will make your hair shiny. Always blow-dry away from your scalp. Letting your hair dry naturally as it rests on your scalp allows it to pick up oils.

Dry Hair Dry hair occurs when your scalp produces a less than average amount of oils to naturally moisturize the shaft. Either you have few oil glands, or the glands produce a low amount of oil; dry hair is not influenced by hormones. Dry hair tends to occur in the darker shades, and it holds a style for along time. Dry hair does not respond well to perms or coloring and will become brittle due to water loss unless great care it taken.

Use a shampoo with a rich emollient that will clean and soften your hair. Look for products like Revlon’s Milk Plus 6 for Dry Hair or Nexxus’s Assure that have protein and balsam. Naturally dry hair, unlike dry hair caused by processing or coloring, is not weak or brittle, so you can use a conditioner that contains ingredients like ammonium salts to make your hair soft and manageable. Look for Tame or Ivory Conditioner. For styling products, look for alcohol-free ones. Clairol’s Condition Styling Gel, Revlon’s Flex Body Building Mousse are two options. If you have dandruff, use a shampoo with coal tar like Denorex. If the ends are extra dry, look for a conditioner with protein or balsam like Neutrogena Conditioner or Nexxus’s Ensure. After you’ve washed, conditioned, added styling product, and dried your hair, rub a little facial moisturizer onto your palms and run them through your hair. Then brush your hair to distribute the moisturizer.

Processed Hair Not only does processing – perms, coloring, straightening – take water out of your hair, it also changes the protein structure in your hair, making it brittle and weak. Merely layering oil on the hair will not remedy the dryness.

Use a shampoo rich in oil, protein, and moisturizer, low in pH; these ingredients will firm up the shaft and make it stronger. Hydrodyzed protein and balsam coat the hair and help retain water in the shafts. Try Fermo Caresse, Fermodyl’s Special shampoo, or KMS Labs’ Cleanse Phree. Creme rinses are too strong for processed hair. Instead, use a hair repair conditioner like L’Oreal’s Hair Repair to restore proteins to the shaft.

Coarse Hair / Curly Hair

Coarse hair – hair that feels rough, is dull, hard to style, and fly-away – is not dry hair and cannot be treated using dry-hair products. Most curly hair is in this category. While this type of hair is most common in African Americans, coarseness occurs in every gene pool. Actually, this kind of hair is very strong and is very healthy. Chemical straightening will relax the shaft so it can be styled, but it must be repeated frequently, which exposes your hair to stress.

Use alkaline-based products to soften the shaft. Use a shampoo without proteins, balsam, or body-building ingredients. Breck and Prell are good shampoos. Use a simple creme rinse – not a conditioner – with few ingredients. Rinse with warm water for a longer time than you’re probably used to. Take at least a minute – 60 seconds are longer than you think. Use a styling product. Your hair is ready to be tamed.

Wash your hair with very warm water. If you’ve read the other sections, I usually advise using warm or cool water. However, coarse hair, since it’s so strong, can handle a warmer temperature. Add your creme rinse to HOT water (you’re hair is strong – it can handle it!) and double or triple the concentration recommended on the product’s label. Keep it on your hair for at least 15 mins. Use a towel and pat your hair and gently absorb the water Don’t rub! You don’t want to create friction that will roughen up the shaft. After you’ve dried your hair, rub a little facial moisturizer onto your palms and run them through your hair. Then brush your hair to distribute the moisturizer.

Flat Hair

This usually occurs when too much conditioning remains on the shaft, making each shaft heavy so that it lies flat on the scalp.

Use a simple cleansing shampoo to remove the built-up residue. Regularly alternate a simple cleansing shampoo after every two or three uses of a conditioner or a conditioning shampoo. This will ensure that your hair does not have any residue. Don’t use conditioner every time you wash. Use a volumizing shampoo like Aveda Pure Abundance Volumizing Shampoo. A styling product like Jonathan’s Create Volume Thickening Foam will make your hair stand away from your scalp, which creates the illusion of thick hair.

Shampoos

Types of Shampoo

All shampoos fall into one of two categories: First Catagory:

Second Catagory:

cleansers (Prell, Herbal Essence, Breck) that need a follow-up conditioner

combo of cleanser and conditioner that don’t clean as well as a straight cleanser and don’t condition as well as a conditioner but will do a good job of both tasks. Most shampoos are in this category but differ as to which kind of conditioning ingredient they contain. Dry shampoos: powders brushed onto hair and are then brushed out. They don’t really clean, but it’s a good stopgap if you can’t shampoo. Shampoos for color-treated hair: these need to be rich in moisturizers and protein to return water to the shaft. They should be low in alkalinity, and should not have sulphated castor oils that will strip color. Daily use shampoos: these are very gentle and have low amounts of cleansers and usually contain conditioners. They’re not strong enough to remove the normal buildup of styling products. Baby shampoos: these are meant for babies, who have fine hair and not much of it. It’s not strong enough for an adult, even if you use it everyday. Shampoos for processed hair: these need to be rich in moisturizers and protein to return water to the shaft. They should be low in alkalinity.

Shampoo Tips

Use a simple cleansing shampoo. Thoroughly rinse your hair. The squeak test is a good measure Thoroughly dry your hair.

If you use a conditioning shampoo, don’t use a conditioner. Limit how many styling products you use to limit the amount of buildup. Give you hair an occasional rest from whatever routine you use. For example, when on vacation, let your hair go an extra day before you shampoo.

How to Give Yourself a Good Shampoo How to give yourself a good shampoo: Give yourself a massaging brush once a week (see HAIR section). Apply the shampoo a bit at a time, all over your scalp, using gentle rubs. Bring the shampoo out to the ends of your hair using your fingers, but don’t rub the ends. The ends don’t really need cleansing. Use whatever type of conditioner (See CONDITIONERS section) as directed. Wrap your hair in a soft towel and press it against your head to let the water absorb into the towel. Don’t rub the hair – this will only cause tangles or breakage. Apply your styling product. Shampooing in the shower is better than trying to shampoo in the bath because you can get a good rinse, which is very important. Use a gentle stream of warm water to wet your hair. Once the scalp has been covered, massage the scalp. Thoroughly rinse with a gentle stream of warm water until the shafts squeak. Thoroughly rinse with a gentle stream of warm water until the shafts squeak. Gently comb hair with a wide-toothed comb. Style and dry.

Finding a Good Shampoo

To help you decide which combo of ingredients you want in a conditioning shampoo, here’s a list: Proteins – amino acids, hydrolyzed proteins, keratin. (Eggs contain a protein that hair CANNOT absorb and adds no value to a product other than as a marketing tool.) This is good for the hair shaft. Nexxus Therappe, Revlon’s Flex Body Building Protein Shampoo, Revlon’s Milk Plus 6, Redmond’s Asuuie Mega Shampoo, Jhirmack’s Lite Frequent Use Shampoo. Balsam – excellent when combined with proteins. Adds volume by coating the shaft. Revlon’s Flex Body Building Protein Shampoo. Moisturizers – lactic acid, lecithin, urea. Especially helpful for dry or over-colored hair. Revlon’s Milk Plus 6, Jhirmack’s Gelave. Lemon – citric juice. Good way to strip accumulated oils and dirt for oily hair. Neitrogena Shampoo, Redmond’s Australian Hair Citrifier. You can also use a real lemon. Silk – coats the shaft and make it more reflective, and thus look shinier. Jhirmak’s Gelave, Alberto Natural Silk, Reinforcer’s Aqua Silk Shampoo. Polymers – almost all shampoos and conditioners have this and it’s a nice coating that adds volume, strength to hair. But it attracts moisture in the air and makes hair feel kind of sticky. It shouldn’t be a large component of the ingredients in the shampoo. Milk – for its protein, not for its fat. Good for split ends or damaged hair. Revlon’s Milk Plus Vitamins – Panthenol found in B5 is absorbed into the shaft and helps strengthen it. Oils and waxes – avocado oil, coconut oil, wheat-germ oil. Provide a coating to retard water evaporation and the coat makes the hair look shiny and smooth. Beeswax and spermaceti also protect against water evaporation but aren’t as oily as the other oils. Allantoin – from the comfrey root. Good conditioner, increases the shaft’s water retention, is antidandruff, dissolves excess kerotin on the scalp or shaft. Nexxus’s Therappe. Sunscreens – will add minor protection from the sun, but don’t assume it does for your hair what it does for your skin.

Things that do not help in a conditioning shampoo:

Eggs contain a protein that hair CANNOT absorb and adds no value to a product other than as a marketing tool Aloe – aids healing in burns but is only effective in living skin, not hair. Malt – appears mostly in men’s shampoos but isn’t the most effective protein option. Birch and all other herbs – birch is good when dabbed directly on an oily scalp for its astringent properties. All herbs effectiveness are totally lost when mixed in a shampoo. Jojoba – yes, it’s good while it’s on your hair, but it’s also water soluble, so it gets rinsed out. Carrot oil – used for aroma and color, not for hair health. Vitamin E – this is a nutrient. Your hair doesn’t eat. Vitamin – only B5 helps because it contains panthenol. Honey – does nothing to hair and is totally water soluble, so it gets rinsed out.

CONDITIONERS

Conditioner products relax tangles, remove static electricity, add body and volume, and moisturize.

TYPES OF CONDITIONERS

There are 6 types: Creme rinse: a combo of waxes, thickeners, and a chemical group called “quats.” It’s supposed to be absorbed into the shaft, with any residue rinsed out. Can make hair feel sticky if not completely rinsed out. Very little is needed; using a lot of creme rinse won’t hasten the absorption rate. Gillette’s Tame, Breck’s Cream Rinse, and Sasson’s Conditioning Finishing Rinse. Deep conditioners are products that are meant to be left on the hair for 30 mins, then rinsed out. They have thick emulsifiers, waxes, and oils and are effective for dry and damaged hair but have no benefit for normal or oily hair. They’re best when used a few days prior to a new coloring. Although a deep conditioner will repair the shaft, it’s not permanent and must be repeated. Jhirmack’s Nutri-Pak, Clairol Condition Beauty Pack Treatment, Sasson’s Protein Pak. Hair repair are products meant to remain in the hair. They’re applied after the shampoo and usually require several applications to fully repair the hair. L’Oreal’s The Hair Fixer, Estee Lauder’s 7-day Hair Repair.

Instant conditioners act very much like creme rinses but have different ingredients: waxes, oils, emulsifiers, hydrolyzed proteins, balsams with or without polymers. These conditioners coat the shaft – they are not absorbed. People with oily hair should use conditioners sparingly because their natural oils will be sufficient protection on the shaft. The grocery shelves groan with instant conditioners. Body builders are thin solutions of water and some kind of polymer, best suited for thin, limp hair. They will make dry hair drier and oily hair oilier, and can make normal hair dull and sticky. Styling gels and mousse are in these categories. Herbal rinses must be used alone. All herbs effectiveness are totally lost when mixed in a shampoo. For oily hair, chamomile, clover blossom, cornflower, and orange pekoe tea will make hair bright and shiny. Fennel and nettle are good antidandruff herbs. Use them this way: 1. Add one tablespoon of the herb in 8 oz. of boiling water for 30 mins. 2. Strain and cool. 3. Pour the water on the hair and massage it into the scalp. 4. Let it sit for 15 – 20 mins. 5. Thoroughly rinse our. 6. Dry gently. 7. Comb with a wide-toothed comb.

Finding a Good Conditioner

The conditioning ingredients in a conditioner are the same ones you’ll find in a conditioning shampoo. See SHAMPOO section for a list of those ingredients with some suggested shampoos that contain those ingredients. If you use a conditioning shampoo, you don’t need a conditioner. This list is the same list as in the SHAMPOO section but without the product recommendations.

Proteins – amino acids, hydrolyzed proteins, keratin. (Eggs contain a protein that hair CANNOT absorb and adds no value to a product other than as a marketing tool.) This is good for the hair shaft. Balsam – excellent when combined with proteins. Adds volume by coating the shaft. The quantity of balsam in the shampoo should be based by the kind of hair it will be used on – straight, wavy, curly.. Moisturizers – lactic acid, lecithin, urea. Especially helpful for dry or over-colored hair. Lemon – citric juice. Good was to strip accumulated oils and dirt for oily hair. Silk – coats the shaft and make it more reflective, and thus look shinier. Polymers – almost all shampoos and conditioners have this and it’s a nice coating that adds volume, strength to hair. But it attracts moisture in the air and makes hair feel kind of sticky. It shouldn’t be a large measure of the ingredients in the shampoo. Milk – for its protein, nit its fat. Good for split ends or damaged hair. Vitamins – Panthenol found in B5 is absorbed into the shaft and helps strengthen it. Oils and waxes – avocado oil, coconut oil, wheat-germ oil. Provide a coating to retard water evaporation and the coat makes the hair look shiny and smooth. Beeswax and spermaceti also protect against water evaporation but aren’t as oily as the other oils. Allantoin – from the comfrey root. Good conditioner, increases the shaft’s water retention, is antidandruff, dissolves excess kerotin on the scalp or shaft. Sunscreens – will add minor protection from the sun, but don’t assume it does for your hair what it does for your skin.

Things that do not help in a conditioner:

Eggs contain a protein that hair CANNOT absorb and adds no value to a product other than as a marketing tool Aloe – aids healing in burn but are only effective in living skin, not hair. Malt – appears mostly in men’s shampoos but aren’t the most effective protein option.

Feet Care

Your feet are living parts of your body. To stay happy and healthy, they need a constant supply of food and energy and a way to get rid of waste materials. Take care of Your feet.

Love Your Feet

Get to know your feet Seven steps to healthy, happy feet Open Sores

Get to know your feet

Arteries are the blood vessels that bring food and energy to your feet.

Veins are the blood vessels that carry off waste materials.

Your blood circulation (arteries and veins) is the “transportation system” that brings fresh blood to your feet, and carries blood back to your heart and lungs.

“Poor circulation” (or peripheral vascular disease) is what happens when your blood transportation is not functioning properly.

What causes “poor circulation”? Blood is prevented from either reaching or leaving your feet because:

Arteries become rigid or hard (arteriosclerosis). Arteries become clogged or blocked by fatty deposits (atherosclerosis). Veins become blocked or narrowed so fluid and waste materials spill out into the surrounding foot and ankle tissue (edema). Diabetes causes blood vessels to age and harden faster than normal. Diabetes can also damage nerves in your feet so you don’t feel the effects of “poor circulation”. Raise the level of sugar in your skin, increasing the risk of foot infection.

How can I tell if I have “poor circulation”? Pay attention to your feet!

If they hurt while walking or resting. If they lack sensation (feeling) in them. If they are cold, pale, blue or swollen. If they have sores that don’t heal. If the skin is thick, dry, scaly, calloused or cracked. They are telling you they need help.

Seven steps to healthy, happy feet

Daily Wash & Dry Daily Inspection & Lubrication Care of Toenails Proper Shoes & Socks Being Extra Careful Activity and Diet Regular Doctor & Nurse Visits

1. Daily Wash & Dry Poorly cleaned feet can lead to infection, especially if you have diabetes! Therefore:

Use mild soap. Don’t soak your feet for long periods. Wash with warm water (not hot). Test temperature first with your hand. Dry well, but no hard rubbing. Be sure to dry well between toes. But get help if you cannot reach. Your toes.

2. Daily Inspection & Lubrication Catch problems early with daily inspection.

Inspect your feet under good lighting. Put on your glasses. Get help if you cannot see your feet clearly or use a mirror. Check your feet for dry skin, cracks between toes, corns, calluses, blisters, any change in Color and sores (from shoes that don’t fit well). Dryness and cracks in your skin allow bacteria to grow, increasing the risk of infection. Therefore

After washing, drying and inspecting, use an approved lotion or cream to soften your skin. Do not put lotion in open sores or between toes! Do not use perfumed lotions.

3. Care of toenails When it’s time to clip your toenails, make sure you can see well and have adequate feeling in your feet.

Use clean nail clippers, not scissors. Cut straight across. Don’t use sharp instruments to poke or dig around corners. Do not use razor blades to trim calluses. No bathroom surgery! If you have thick, hard or curled toenails – or have trouble seeing- you could cut yourself and get an infection. Check with your doctor or nurse first.

4. Proper Shoes and Socks Improperly fitting shoes may lead to sores, toe deformities, blisters and calluses. Therefore:

Always wear shoes that offer good foot protection; hard soles and soft tops. Never go barefoot, even at the beach, wear sandals or sneakers. Avoid high heels and pointed toes- your toes don’t come to a point! Shake out shoes before you put them on- to make sure there is nothing inside. Avoid tight socks, garters or panty hose that could cut off your circulation. Wear clean cotton socks. White is best. Cotton allows your feet to “breathe” and helps prevent weating

5. Being extra careful If you have “poor circulation” or diabetes, your feet may not be able to detect temperature changes. As a result they may become:

Burned by water, sun or heating pads. Frostbitten in cold climates. Therefore:

Avoid too much sun; stay in a shaded area. Always check water temperature before entering. Do not use heating pads on your feet. Wear warm cotton socks and insulated boots in winter. Remember that most serious foot problems start with excessive pressure on blood vessels, or injury. Therefore:

Avoid tight clothing that could cut off your circulation. Don’t sit with legs crossed.

6. Activity and Diet

Activity Activity stimulates blood flow in your feet and fights “poor circulation.”

Walking is the best exercise (but ask your doctor or nurse before you start on walking program). Walk on flat ground. Do not walk when you have pain or open sores that rub on shoes or clothing. Walk in good, sturdy comfortable shoes. If your feet and ankles swell, elevate them. If your feet and legs hurt after walking, stop and rest for a while.

Diet Eat for your feet A proper diet provides necessary food and energy for your feet. A healthy diet includes:

Whole grain products (cereals, breads) Plenty of vegetables Fresh fruit and fruit juices Foods high in protein, low in fat Sufficient fluids. Limit the amount of cholesterol and caffeine in your diet by eliminating or cutting down on…

Butter Red meats Fatty meats and foods Eggs Whole milk Cheeses Coffee Chocolate Colas (soft drinks) Replace these foods with…

Poultry Fish Lean meats Skim milk Egg substitutes Margarine At least 4 glasses of water every day Being overweight makes more work for your feet.

7. Regular doctor & nurse visits To keep your body and your feet healthy, keep regular doctor appointments. Find a doctor and nurse who will get to know you and your feet and will have the time to talk with you when you need help.

Open Sores of the Legs and feet We certainly cannot count the number of small cuts and scrapes that have come and gone since our childhood. We keep them clean, and however we choose to treat them, sooner or later they all heal. In fact, in most cases, it is virtually impossible to stop a wound from healing; however this is not always the case.

When wounds stop healing To actually see a wound healing would reveal a world of intense activity. Like ants scurrying to repair a damaged anthill, blood cells rush to the injured area building defenses against infection and carrying oxygen or other supplies to assist the repair process. But if the blood supply to the injured area is reduced or cut off, this activity slows down or ev en stops. The result is a sore that will not heal and may even grow larger.

Leg ulcers

Leg ulcer is a term used to describe a variety of open sores below the knee that are slow to heal. Many of these ulcers are due to problems in the venous blood circulation, which in the lower leg, is under particular strain. Blood has to be pushed from our feet back up to the heart and small valves in the veins must keep the blood flowing in one direction.

Signs of stress in the venous circulation include swelling of the feet and ankles, called “edema”, or a brown discoloration of the skin around the ankles and the lower calf, called “staining”.

When these signs are present even minor damage to the skin can lead to the development of a leg ulcer.

For reasons not entirely understood, women are more likely than men to develop such ulcers.

Leg ulcers can also develop as a result of problems in the arterial circulation and not associated with “edema” or “staining”. Another factor which can contribute to the development of an ulcer is diabetes, as well as a variety of less common conditions.

General treatment Accurate diagnosis of the underlying cause is important and will help your doctor determine the most appropriate course of action. Commonly, treatment will include steps to improve the blood circulation and special ways to dress the actual ulcer to speed the healing process. It is possible, for example, to counteract problems in the venous circulation by prescribing periods of rest with the leg elevated above the level of the heart or by the application of special elastic compression bandaging.

Dressing the wound Researchers have discovered and established that we really can help nature heal faster by keeping wounds covered and preventing the formation of a scab! The all important blood supply to the wound can even be improved by sealing out the air. These discoveries have resulted in modern wound dressings that may be particularly important for difficult wounds lik e leg ulcers and pressure sores- where nature needs a helping hand. S o, if you have an open sore that is slow to heal, why not call your p hysician now and make an appointment? It could be the best step toward healing… and it’s up to you.

Wound Care & Dressings If you have been diagnosed with a “pressure ulcer” or “bed sore” or a leg ulcer, your physician or nurse will recommend a bandage for your wound. These bandages are referred to as “specialty dressing or sound care dressings”. The decision on which dressing to use on your wound will be based on (3) three important factors that can be observed when looking at the wound.

Size: What is the length and width? Is it deep – Is it shallow? Exudates: Does the wound produce a lot of fluid? I.e. is it wet or dry? Pain, if frequency of dressing change needed? Dressings are divided in three (3) broad categories :

Cover dressings: they protect, retain moisture and absorb wound exudates when wounds are dry or wet. Wound fillers: they can fill a wound that is deep and dry or a wound that needs fluid to be absorbed. Compression bandages: used to treat and manage venous leg ulcers and edema due to venous hypertension. Section Contributor Feet Clinic is run by Dr. Shazia Malik (D.P.M) Consultant Podiatrist. She works in Drummond Podiatry Center, Montreal Quebec, Canada and wil l glad to answer your queries. She deals in Primary foot care for corns, calluses, warts, fungal nails, and heel /arch pain; diabetic foot care inc luding open wounds; minor surgery including ingrown toenails; prescription or thotics (CRYOS technology) and sports medicine.

Pimples

Acne Vulgaris (Pimples)

Acne is a common skin condition which consists of blackheads, whiteheads, red spots, and sometimes deeper boil-like lesions called nodules or cysts.

It afflicts most people during the teenage years. However, the disease may affect women in their thirties.

Causes of Acne The exact cause is unknown. One theory is that when hormone levels increase during puberty, the skin of the acne- prone person reacts by producing excess sebum (oils). The bacteria on the skin alter these oils to produce substances that cause acne. The hair follicle, the site of acne may get plugged with dead skin cells. Sebum and bacteria may accumulate and cause pimples.

Types of Acne These include blackheads, whiteheads (comedones), the larger papules (pimples) and later, pustules and large cysts. Scars occur after papules, pustules and cysts. They are permanent.

Treatment of Acne Medical treatment can improve the appearance and prevent the development of scars. Doctor will prescribe treatment depending on the type and severity of the acne.

Some antibiotics (tetracycline or erythromycin), which are effective for acne need to be taken on an ’empty stomach, to improve absorption. Some otions or creams may make the skin red or flaky but usually this effect is temporary . Go back to see your doctor if the lotions or creams cause excessive redness and itchiness. Do not squeeze or scratch pimples. Do not attempt to cover pimples on the forehead with a fringe.

Topical Acne Medication They consist of peeling agents (sulphur), topical antibiotics (erythromycin, clindamycin, benzoyl peroxides) and topical vitamin A, (Airol, Eudyna, Retin A or Stieva A).

Diet and Acne There is no concrete evidence that food causes acne. Following the strictest diet will not by itself clear your acne. On the other hand, a few people find that their acne seem to worsen when they eat certain foods, particularly chocolates, fried food and chillies. These people should avoid the foods that clearly aggravate their acne.

Cleaning of Face Remove surface oil from the face by washing with soap and water or with medicated cleansers. There is no need to use special soaps. Ordinary toilet soaps will do. Wash frequently when the face is oily, about three times a day. Continue washing even when you acne is cured. Do not wash with harsh soaps or brushes.

Use of Cosmetics Avoid oily and greasy cosmetics. Use water-based, oil-free cosmetics sparingly. You can use eyeliners, eyeshadows and lipsticks.

Cystic Acne Do not despair. A new oral drug, isotretinoin, is available for the treatment of severe cystic acne. This medication can cause side effects and should be taken under the supervision of a dermatologist. In addition to this intralesional steroid injections cure the acne cysts.

Diabetic Feet Care

Ten Important Foot Steps for Diabetics If you have diabetes, you probably already known that you face special health challenges as the result of your disease. People with diabetes often suffer from poor blood circulation, which slows healing and may increase the risk of infections. Also, because of damaged nerves, many people with diabetes lose some of the sensations that make it possible to feet hot and cold, or the pain that might accompany an injury.

As you can imagine, complications like infection and injury can be particularly serious when they affect the feet. The good news is that by following these steps and taking care of your feet, you can greatly reduce your risk of having problems.

1. Check your feet Perhaps most important of all these suggestion is this one; examine your feet closely every day to look for any changes and/or breaks in the skin.

More precisely, what you are looking for in your feet is any redness, swelling, broken skin, sores, bleeding, pus-like discharge pale or blue skin, noticeable changes in temperature, or any unusual feelings like tingling or numbness. You may need to use a hand mirror to examine the bottoms of your feet. If that’s too difficult, either place a mirror on the floor to examine your feet, or have some-one else check them for you.

Any of these changes could indicate the early stages of a potentially serious complication, so you can imagine how important it is to identify problem early and make an appointment to see your diabetes healthcare provider as soon as possible!

2. Keep your feet clean Wash your feet with soap and warm water every day. And make sure the water is only warm – not hot – by checking it with your elbow. Don’t check it with your hands or feet, because they may not feel the temperature differences accurately enough. And be certain to dry your feet completely, including between the toes.

3.Go soft on your skin As much as one third of the diabetic population suffers from dry skin on their legs and especially their feet. You may need to apply a moisturizer to your feet every day to keep them from becoming dry and cracked- because damaged skin can lead to very serious problems. And if your skin is extremely dry, you may require more specialized treatment.

4. Where your feet are concerned, avoid the heat Do not use a heating pad or hot water bottle on your legs or feet for any reason.

5. Listen to your healthcare experts Be sure to stay in contact with the health professionals who make up your diabetes care team. Never use any medication on your feet unless you talk to your healthcare team first. And always follow their instructions exactly.

6. Let your clothes stay loose If you have problems with your blood circulation (ask your doctor if you’re not sure), avoid crossing your legs and stay away from garters, girdles, or other clothing that might restrict blood flow to your feet.

7. Be careful with sharp instruments Do not cut corns or calluses off your feet! This invites infection- and people with diabetes need to avoid infections even more than the rest of the population. And while we’re discussing sharp instruments, cut your toenails straight across to avoid ingrown toenails.

8. Maintain a proper weight Lose weight if you need to, because not only will it help you control your diabetes, it will mean less pressure on your feet.

9. Be kind of your feet Before you put on your shoes, examine them to make sure that there are no pebbles or rough surfaces inside. And check your socks to avoid rough seams or mended areas. Everything should fit smoothly and comfortably.

10. Kick the smoking habit People with diabetes already face blood circulation problems due to their disease- and smoking makes things even worse. Quitting might just be one of the best health choices you’ll ever make. Of course, following these guidelines is no substitute for seeing your doctor on a regular basis, but diligently following these steps will be a big help to you and your doctor.

Diabetic Foot Infection

Why are Diabetics at Risk? Increased incident of atherosclerotic occlusive dz Decreased tissue regeneration capacity due to difficulty in delivering of anabolic factors. Decreased protective threshold Decreased immune response due to defective PMNs (glucose >250mg/dl have negative effect on wound healing) Most Common Organisms S. aureus Coagulase (-) staph Streptococcus sp. Enterococci G(-) pathogens; Proteus, E. coli. Enterobacteriaceae Pseudomonas Anaerobes-Bacteroides sp. Exam: 1.Ulcer

Depth (probe with Q-tip for tracking sinus) Diameter (measure) Base (necrotic, granular, beefy red) Margins (keratolytic) Drainage (purulent, clear0 Odor (fecal smell-anaerobes, fruity smell-Pseudomonas) Erythema; note distribution and rate of progression 2. Vascular Pulses, if not present check with a Doppler Skin quality, nails, hair SPVPFT Ankle/Arm Index (aka Ankle/Brachial Index, Ischemic Index) 5 Minute Reactive Hyperemic Test Consider vascular consult if circulation is poor 3. Neuro Evaluate sensory/motor and reflexes Fibration and proprioception are the first sensations to be lost. Semmes-Weinstein monofilament wire-If pt. can’t feel size 5.07 then protective threshold is lost. Wound Classification : Knighton ; Wagner ; Description

Grade 1 ; Grade 0 ; No open lesion, may have deformity or Cellulitis Grade 2 ; Grade 1 ; Superficial ulcer Grade 3 ; Grade 2 ; Deep ulcer to tendon., capsule or bone Grade 4 ; Grade 3 ; Deep ulcer with abscess, OM, and jt sepsis Grade 5 ; Grade 4 ; Necrotic tissue in wound Grade 6 ; Grade 5 ; Gangrene Labs: 1. X-ray

Osteomyelitis Gas in tissue (Clostridium, Peptostreptococci, Bacteroides) 2. Cultures

Gram stain, guides initial antibiotic treatment Aerobic and anaerobic cultures Culture and sensitivity Take culture from deep in wound Most diabetic foot ulcers are polymicrobial 3. Blood

CBC (increased WBCs) Sed rate (to monitor progression or remission of infection) Fasting blood sugar Treatment: 1.Wound Care

Sharp debridement of all callous, necrotic, and devitalized tissue to healthy bleeding tissue Dry wound heals slower than wet so use (Wet to dry dressing) Other dressing may include:

Silvadene Topical Abx Duoderm Pads, post-op shoe, spenco 2.Antibiotics If ulcer is mildly infected and prophylaxis is desired consider”

Dicloxacillin 1st gen cep (Keflex) Augmentin Ciprofloxacin If pen allergic use

Clindamycin Erythromycin If patient is febrile or has associated cellulitis admit pt to hospital and start them on

Unisycin Timentin If patient become septic put pt on

Ampicillin/Gentamycin/Flagyl 4.Patient Education Wear soft moldable uppers (always with socks) Break new shoes in slowly by wearing only 2 hrs. at a time Buy shoes at end of day Avoid socks with mends and seams Feel inside shoes for seams and folds Avoid pads or devices not custom made Avoid constrictive bandages Never place bandaged foot in closed shoe Proper nail care Nightly inspection of feet including between toes Inspect inside of shoe for sharps Never go barefoot, open toed or open backed shoes Never trim calluses Beware of tapes, adhesives on risk areas Check bath temperature with finger Protect feet from sunburn Beware hard floor and cold exposure Never use OTC corn remedies Dry feet completely especially between toes

Skin Disorders

Measles

It is a viral infection of the upper respiratory tract and skin. It may be followed by secondary bacterial and neurological complications.

ETIOLOGY

Measles is caused by RNA virus of the paramyxovirus group. It’s incidence has dropped since the introduction of vaccination programmes. It is most common in spring and tends to occur in densely populated and lower socioeconomic areas. It is spread via respiratory droplets.

CLINICAL FEATURES

The incubation period is 10-12 days. There is a prodrome of fever, malaise, coryza and conjunctivitis, which resolve within a few days and a cough, which may persist. The exanthem begins on the fourth day as conspicuous red macules and papules on the face, behind the ears and on the upper part of the neck. It spreads to the trunk and limbs within 3 days. The initial lesions coalesce. Clearing occurs from the third day down the body, leaving behind a brown stain. An exanthem, known as koplik’s spots appears on the buccal mucosae during the prodrome. These are punctate, bluish white spots on a reddened base, which disappear by the peak of the exanthem. Measles resolves within 14 days of the height of the eruption.

TREATMENT

Prevention is better than cure. Live attenuated vaccine is available in a monovalent form for measles only, or in combination with mumps and rubella and is given at 15 months.

Treatment of the disease is symptomatic except for complicated cases where antibiotics may be required.

Rubella

It is a common viral infection affecting the skin, lymph nodes and joints. It is a benign condition except in the foetus.

ETIOLOGY

It is caused by a single stranded RNA togavirus. It is spread by pharyngeal droplets and is very infectious in school children and is often asymptomatic. Adults are more likely to develop symptoms.

CLINICAL FEATURES

A prodrome is not always present but it consists of malaise and a tender lymphadenopathy, which affects the postauricular, posterior cervical and suboccipital nodes and may persist for some while. The exanthem coincides with fever, headache and myalgia. It begins on the face and scalp and spreads downwards over the next 3 days, although it does not last long in each area. The lesions are very small, pink macules, which may become papular and then desquamate. Red petechiae may sometimes be observed on the soft palate. An arthritis particularly involving the fingers and wrists is common, especially in females. Effusions may be present. It persists for a fortnight.

Rubella is dangerous in pregnancy. All trimesters are at risk, although the greatest damage occurs in the first trimester. Deafness, heart disease and cataracts are the most common complications of the congenital rubella syndrome. Stillbirths, abortions prematurity and growth retardation are frequent. Encephalopathy, mental deficiency diabetes mellitus and thyroid disorders are late sequelae.

MANAGEMENT

A four-fold increase in antibody titres between specimens taken during and after the rash is diagnostic. A rubella specific IgM titre is also helpful for up to a month after the rash has gone. There is not treatment so rubella vaccine should be given at15 months as part of the MMR.

ERYTHEMA INFECTIOSUM

A parvoviral illness which is mild in children but which is hazardous to the foetus and may cause arthritis in adults.

ETIOLOGY

Erythema infectiosum is caused by human parvovirus B19. It is more common in the winter and spring in youngsters. It is also known as fifth disease.

CLINICAL FEATURES

After incubation period of about 10 days there is a mild prodrome of slight pyrexia, malaise and headache. The rash begins a few days later with a striking red, raised erythema over the cheeks followed by a symmetrical reticular papular eruption on the buttocks and on the extensor surfaces of the limbs. It lasts a week or two with a tendency to flare before complete resolution. The disease is common in the winter and spring. It has greater morbidity in adults. It may precipitate aplastic crisis in patents with sickle cell anaemia.

MANAGEMENT

Viral particles are identifiable by electron microscopy in serum, urine and respiratory secretions early in the disease. The diagnosis can also be made serologically. IgM parvovirus antibodies are positive for a couple of months and IgG antibodies persist indefinitely.

There is no vaccine and treatment is symptomatic.

Chickenpox

It is a common disorder caused by varicella zoster virus.

ETIOLOGY

The same herpes virus causes chicken pox and herpes zoster. It is a droplet infection.

CLINICAL FEATURES

The incubation period is 9-23 days. There is a mild prodromal phase consisting of fever and malaise for couple of days, followed by fleeting erythema. After this crop of macules, which become vesicles surrounded by erythema appear. Their content becomes turbid and crusted and in the absence of infection heals without scarring. Individual lesions are at different stages of development. The trunk is primarily affected followed by lesions on face, scalp, upper arms and thighs.

MANAGEMENT

The diagnosis is rarely difficult clinically. Only symptomatic treatment is required. Appropriate antibiotics for Cutaneous or other bacterial complications are indicated.

HERPES_ZOSTER

A painful involvement of cutaneous nerves resulting from a reactivation of a dormant varicella zoster virus.

ETIOLOGY

Herpes zoster is a common infection caused by the same virus that transmits the chicken pox. It is a DNA virus belonging to herpes group. The virus remains dormant in dorsal root or cranial nerve ganglion after the patient recovers from chicken pox. There may be latent period of decades before the virus is reactivated and start spreading along cutaneous nerves. There is no convincing evidence that shingles can be contracted from another individual. Immunosuppressed individuals are at more risk. The disease is more common in the elderly. The trigeminal nerve is most commonly involved cranial nerve. Overall the thoracic is the most commonly affected.

CLINICAL FEATURES

The first symptom is the abrupt onset of pain or discomfort. Physical examination reveals an eruption, which is limited to one side of the body and corresponds to a dermatome. The eruption starts with red macule then becomes papule and then turns into vesicle surrounded by erythema. The individual vesicles may become confluent and evolve over the next 2-3 weeks to become pustular, haemorrhagic and finally scabbed.

MANAGEMENT

The diagnosis is easy. However the virus can be identified under the electron microscope and can also be grown on tissue culture. There are a number of treatments:

Acyclovir 800 mg five times daily for 1 week.

Analgesia and bed rest Analgesia is essential, although it is best to avoid opiates.

Post herpetic neuralgia Treatment is unsatisfactory however amitriptyline or carbamazepine can be tried.

WARTS

A wart is a very common papilloma virus infection of the skin or mucus membranes.

ETIOLOGY

Human papilloma virus causes the warts. There are many types of HPV. Common mosaic warts are mostly HPV-2, plane warts HPV-3, genital warts HPV-6 and deeply inwardly growing warts of the palms and soles HPV-1. The infectivity of the virus in an individual depends on the viral load and host immunity. Cell mediated immunity is most important and they are common in immunosuppressed individuals.

COMMON WARTS

These are discrete, flesh colored papules with a rough surface. They may be single or multiple and occasionally can be quite large. They are most common on hands and easy to treat.

PLANE WARTS These are flesh colored or pigmented, very slightly raised, well-defined, flat topped lesions. They have a smooth or very slightly roughened surface. They occur particularly on face but can occur on hands and limbs. They are frequently misdiagnosed especially on the face where they are liable to be treated with topical steroids, in which case they spread.

VERUCAE These are discrete lesions that are only just raised, with a roughened surface. They can occur on palm but are more usually found on the sole. Deep plantar wart can be painful and can interfere with walking. If they are cut with blade there are small bleeding points.

MOSAIC WARTS

These are the plaques of roughened skin within which there are delineated individual warts. They are usually present on the palms and soles and around nails. They are resistant to treatment.

TREATMENT

Different treatment modalities, which can be used, are as follows.

Physical Measures

Surgery Electrosurgery Cryosurgery Lasers

Chemical Measures

Salicylic acid preparations Formalin in 3-10% solution

Chemotherapy

Podophyllin 5-flourouracil

Skin Infection

Common Skin Infections in Children

This is a skin infection caused by a pox virus. It is a common infection in children. It is transmitted by skin contact with an infected person.

Signs of Molluscum Contagiosum

The infection presents as small discrete, round, pearly-white growths on the skin. There may be single or multiple growths on the skin. These growths are usually symptomless. Common sites of infection are the eyelids, neck, trunk and anogenital area.

Eradication Of Infection

They are best treated by:

Trichloroacetic acid applications Liquid nitrogen applications Light electrosurgery

FOLLICULITIS AND FURUNCLE

Folliculitis is a superficial inflammation of hair follicle (hair pore) caused by bacteria. When the infection affect several hair follicles and the adjacent tissue, it is called a furuncle (boil).

The Presenting Feature The folliculitis usually affect the scalp, face, trunk and legs. The hair follicles are surrounded by either small pockets of pus or small red lumps. Sometimes, many adjacent hair follicles are affected at the same time giving rise to what is commonly known as boil or furuncle. In such instances, surgical drainage of the pus may have to be carried out besides antibiotic tablets.

Treatment In mild cases, antiseptic wash and antibiotic creams can easily eradicate the problem. Antibiotics pills are needed for extensive or severe cases.

VIRAL WARTS

It is caused by the human wart virus. It is a common infection in school children. Common sites involved are areas which are exposed to injury e.g. the hands, fingers, knees and soles.

Signs of Viral Warts Viral warts present as skin-coloured growths with rough and irregular surface. There may be single or multiple warts appearing at the same time on different parts of the body.

Treatment For small & superficial warts, warts lotion containing salicylic acid and lactic acid may be used.

TINEA CAPITIS

This is a fungal infection of the scalp. It is more commonly seen in children than in the adults. It is usually spread from pets or other children.

Features of Tinea Capitis There is patchy loss of hair and pain. The affected area may be red and covered with scales, pus or adherent crusts. The diagnosis can be confirmed by examining the affected hair under the microscope.

Treatment The infection can be treated by taking antifungal tablets. Early treatment is important to prevent permanent scarring and hair loss.

IMPETIGO

This is an acute superficial infection of the skin caused by bacteria. This infection is common in pre-school children and young adults.

signs of Impetigo The infection appears as skin blisters which later break down to become superficial sores with golden-yellow “stuck on” crusts on the surface. Common sites affected are the face, arms, buttocks and legs.

Treatment Antibiotic cream or pills are necessary.