Mike Goodkind, (415) 725-5376 or 723-6911
Email: [email protected]
Health Tips from Stanford University Medical Center July 1997
PICKING A SUNSCREEN IS EASY IF YOU FOLLOW SOME SIMPLE RULES, SAYS STANFORD DERMATOLOGIST
Using a sunscreen during the hot summer months is a simple way to protect against skin cancer, and selecting the proper product doesn't have to be confusing -- despite all the different SPF numbers on the labels and an almost dizzying array of ingredients, says a Stanford Medical Center dermatologist.
"Each of the products is a little bit different, so it might take a bit of experimentation to find the product that is best for you. But if you follow instructions, using sunscreen correctly is easy," says Dr. Susan Swetter, assistant professor of dermatology and director of Stanford's Pigmented Lesion and Cutaneous Melanoma Clinic. Here are some points Swetter suggests you keep in mind:
* Apply sunscreen thoroughly and evenly. The average adult needs about two tablespoons -- no less -- spread evenly over the entire body. Remember that light summer clothing, such as a T-shirt, generally provides only limited protection.
* Don't agonize over the SPF (sun protection factor) number. Keep it simple: While light-skinned people are more susceptible to skin cancer, all races will benefit from following the same sun protection guidelines. Most people should use an SPF of 15 if their skin is normal, or an SPF of 30 if they are taking photosensitizing medications (such as certain blood pressure pills) or suffering from a disease (such as lupus) that would make their skin unusually susceptible to burns. SPF numbers lower than 15 probably won't offer enough protection, while those higher than 30 may not offer any additional benefits.
(The SPF, incidentally, tells you how long the product is expected to protect your skin from burning. For example, an SPF 5 sunscreen should protect your skin from developing redness five- times longer than no sunscreen at all, while an SPF 15 product should protect you 15 times longer than no sunscreen. However, the reality is that the thorough and frequent application of the sunscreen is as important as the SPF rating.)
* Buy a waterproof sunscreen. It won't be washed off quickly by your own sweat, and so is useful even if you're not going swimming.
* Check the label to make sure your sunscreen protects against both UVA and UVB light (i.e., "broad-spectrum"), since sunlight contains both types of ultraviolet rays.
* Be alert for sunscreen allergies, which may show up as rashes. If you have a skin reaction, switch to a brand with different ingredients. Generally, sunblocks with titanium dioxide are less likely to cause allergic skin reactions. Most sunblocks work by absorbing light, but the "physical" sunblocks, such as titanium dioxide, work by reflecting and scattering the sun's rays. Also, the fragrance or preservatives in a sunscreen can cause irritation, so simply changing brands (regardless of active ingredients) can sometimes be effective.
* If you are extremely sensitive to sunlight, use zinc oxide or an equivalent "sunblock" that keeps out all light. "You'll have to live with the product's white pasty look -- unless you try one of the new zinc sunblocks that come in fluorescent colors," Swetter notes.
"More than a million people in the United States each year are diagnosed with skin cancer, including more than 40,000 who contract potentially deadly melanomas," says Swetter. While many of the affected individuals are middle-aged or older, people of all ages should protect against excessive sun exposure, because cancer often strikes many years after a sunburn," she says. "These statistics are reason enough to avoid the discomfort of a sunburn and to invest in a good sunscreen."
DON'T BE SHY ABOUT TELLING YOUR EYE CARE PROFESSIONAL WHAT TO LOOK FOR WHEN YOU GET GLASSES
Regular eye exams aren't just to fit glasses, so alert your eye care professional to any current eye conditions or family history of problems before or after you read that giant "E" on the vision chart, says a Stanford University eye doctor.
Regular screenings for eye disease are crucial for anyone with diabetes, and older patients may be at increasing risk of macular degeneration or glaucoma, especially if they have a family history of these two problems, says Dr. Mark Blumenkranz, clinical professor of ophthalmology and chief of ophthalmology at Stanford Health Services.
"With managed care and increasingly busy physician schedules, patients may think they are helping their doctors by refraining from asking questions," says Blumenkranz. "But in the long run, it's better for the patient -- and more efficient for the eye doctor who may not know you too well -- if you say, 'I have diabetes,' or 'I have a family history of glaucoma or macular degeneration.' This will alert the eye doctor to give special attention to the tests he or she should be running as part of your exam."
Persons with diabetes should be especially proactive in asking for an annual screening for retinopathy, which affects about half of the nation's 13 million diabetics after a decade or more of the disease, Blumenkranz notes.
Early screening resulting in treatment -- often involving lasers to seal the leaking blood vessels characteristic of this disease -- can prevent or reduce complications including vision loss," Blumenkranz says.
"The eye is a virtual window to health, and doctors treating persons with diabetes can use the early signs of retinopathy to evaluate whether the overall treatment for the patient is optimal," he says.
Macular degeneration, an age-related deterioration of the insulating layer between the retina and the blood vessels behind it, affects some 25 percent of people over age 65, he notes. Glaucoma, characterized by damage from high fluid pressure in the eye, is most common in persons over age 40.
"So it's particularly important, as we get older, to make sure we have an eye exam to spot either of these conditions," Blumenkranz says. Treatments for macular degeneration include promising new laser procedures and medications. Glaucoma can be treated with eye drops, laser therapy or, occasionally, surgery, he says. With managed care, many patients have changed eye doctors or otherwise changed their screening patterns for disease, so it's also important to know that an appropriate professional is providing treatment.
"Only an MD ophthalmologist can treat diabetic retinopathy, glaucoma or macular degeneration. However, either an optometrist or an ophthalmologist can usually provide the initial screening," Blumenkranz notes.
WEIGHT TRAINING IN KIDS REQUIRES SPECIAL PRECAUTIONS
Strength training offers benefits for many people, but consider a few facts before you encourage your child or young teen-ager to head for the weight room, says the head of Stanford University's sports medicine program.
Before puberty, weight training is not likely to provide significant increases in strength. And up to two years after puberty, kids are at increased risk for injury if they lift weights improperly, says Dr. Gordon Matheson, associate professor and chief of the Division of Sports Medicine.
"I would not prescribe a weight program for a preadolescent, aside from a general strength and conditioning program not specifically designed to increase bulk. Without the increased hormone levels (e.g. testosterone) that occur at puberty, the strength benefits are marginal at best in both boys and girls. Kids who want to improve their athletic ability are better off developing skills by practicing and playing their sports," Matheson says.
"However, if your preteen is enthusiastic and wants to become active in weight training for its own sake, it can be safe as a sport if the child is trained and appropriately supervised. In this age group, machine weights are safer than the freeweights, or barbells, because they are enclosed and designed not to fall or drop on the user," he adds.
After puberty, boys gain strength and increased bulk from hormonal changes, and lifting weights can enhance these natural changes, Matheson says. But until 18 months to two years after the onset of adolescence, "kids are at increased risk of injuring tendons at the point where the still-developing growth plate attaches to the tendons," he says.
"The skeleton matures about 18 months before the muscles and tendons do, so during that period, the tendons and muscles are vulnerable to injury at the points where they attach to the skeleton," Matheson explains. Sports activities of all kinds, not just weight training, can cause injuries in young adolescents, so caution and a prudent, supervised stretching and training regimen are important, he says.
While boys are more vulnerable to injury than girls during this time because of male hormone production, the same general precautions apply to girls, who will gain strength -- but not significant bulk -- from weight training after puberty. "Girls can benefit to some extent from weight training, particularly if they are engaging in sports such as basketball, wrestling or even soccer," Matheson says.
"But have your teen observe extra caution during the first two years of adolescence, when tendons and muscles are especially damage- prone."
BEWARE OF ONCE-EXOTIC BUGS THAT NOW CAN POP UP IN YOUR FOOD SUPPLY
A variety of dangerous organisms, once considered a threat only to travelers in exotic locations, are now found in the neighborhood grocery, warns a Stanford Medical Center infectious diseases specialist.
These "bugs," which typically lurk in Third World ponds, streams and other contaminated water sources, can be found on fruits and vegetables increasingly being brought to this country, says Dr. Lucy Tompkins, professor of medicine (infectious diseases) and director of Stanford Health Services' clinical microbiology lab.
The organisms range from almost-visible protozoa to microscopic bacteria and even tinier viruses. Their effects vary, but typically include acute or persistent diarrhea. The bacteria go by such names as E. coli or Salmonella. Some organisms, such as the hepatitis-A virus, attack the liver, and others attack the nervous system.
Tompkins doesn't suggest that most people give up eating fresh fruit, but she does offer a few thoughts about what to watch for:
* Keep up with the news. Often, outbreaks are widely reported. "If the news says an outbreak of diarrhea has been traced to, say, raspberries from Latin America, it would seem to be a good idea to give up raspberries from that part of the world for a while," she says.
* Wash your fresh fruit and vegetables thoroughly. This won't eliminate all troublesome organisms, but it will get many of them, reducing the risk.
* Cook your vegetables and as many fruits as possible. The cooking process almost always eliminates the danger, although you might have to make up for lower levels of nutrients due to the cooking process.
* Although it's not foolproof, eating U.S.-produced fruits and vegetables will substantially reduce the danger of microbial contamination.
* Certain high-risk individuals -- young children, the elderly and immunosuppressed people of any age -- might well avoid fresh fruits altogether and replace them with nutritious canned or pasteurized products.
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