So here I am again waiting for something interesting to walk in worthy of me telling you about, and lo and behold, a behemoth of a guy walks by. You know, one of those guys who works out way too much for it to be just about health. In any event, the nurse tells me the gentleman has ear pain, and she thinks it’s an infection. Well, that’s odd. Otitis media (middle ear infections) and otitis externa (external ear infections) usually happen in kids. So I get up to see him, and I see something that looks like an early version of Randy Couture’s ear… 
…and I immediately think of you.
A ‘cauliflower ear’ is something you should be aware of because it’s easily obtained, and it has very bad consequences if not addressed in a timely manner. It’s a deformity of the ear (usually the upper outer portion) mostly caused by blunt trauma. It happens a lot to wrestlers, boxers, MMA fighters and rugby players, but it’s also seen in those with infected high ear-piercings. It occurs when the ear gets hit, causing a hematoma (collection of clotting blood) to form. The hematoma prevents normal flow of blood through the ear. The problem with this is the ear is made of cartilage (a less sturdy form of tissue) than bone. No blood flow and the presence of clots cause the cartilage to wilt and deform, giving the lumpy appearance shown in the picture. This can be treated with drainage of the blood and clot from the ear, but if it’s not done early enough, the ear will become permanently deformed.
If you have trauma or infection to the upper ear, be on the lookout for redness or swelling. Don’t ignore it like you might be inclined to do elsewhere. Get it evaluated promptly, even if it seems minor because… Time is tissue.
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Tag Archives: Infection
Straight, No Chaser: Emergency Room Adventures – The Cauliflower Ear
Straight, No Chaser: Syphilis – The Great Mimicker
Today, you will learn two phrases that you may not have previously heard: The Great Mimicker and MSM. Regarding another word you definitely should know, I’ll touch on it and will save for a separate post: Tuskegee.
Historically, syphilis really is the most important sexually transmitted disease (For what it’s worth, it’s thought that Columbus’ crew spread the disease from the Americas to Europe.). The great mimicker nickname as applied to syphilis exists because syphilis has many general symptoms that resemble and are often confused with other diseases. MSM points to the fact that treatment in the early stages is so complete that syphilis had been rapidly in decline – until it’s reemergence in a specific population. It is estimated that well over 60% of reported early stage cases of syphilis occurs in men who have sex with men (MSM).
In the first part of this review, I want to specifically address the symptoms, which are impressively and dramatically different depending on the stage.
Stage I – Primary Syphilis: Primary syphilis usually presents with the presence of a single, painless sore (a chancre), located wherever it was contracted. As pictured above, the head (glans) of the penis is a typical site. The sore disappears in 3-6 weeks (with or without treatment), and if treatment wasn’t received, the disease progresses. Herein lies the problems. Because it’s painless, you ignore it, perhaps thinking it was a friction sore, or you never gave it much of a thought. Because it went away on its own, you forget about it, thinking that it got better. So sad, so wrong…
Stage II – Secondary Syphilis: When syphilis returns days to weeks (more typically) after the primary infection, it does so quite dramatically. Rashes can appear everywhere, including across your back (as noted above) and chest to on your palms and soles, in your mouth, groin, vagina, anus, or armpits. The rash could be warts (condyloma lata) or flat. You should be scared, but you might not be because… the rash and the other symptoms again will disappear on its own. Despite what you may think intuitively, you really don’t want that to happen.
Latent Syphilis: Dormant syphilis can stay that way for decades after secondary syphilis has occurred. What you don’t know can hurt you. Syphilis can be transmitted during the earlier portion of latent phases, including to an unborn child.
Tertiary Syphilis: Late stage syphilis is a disturbing thing to see (and obviously experience). The disease can result in death, causing damage to the brain, heart, liver, bones, joints, eyes, the nervous system and blood vessels. Before it kills you, it can result in blindness, paralysis, dementia and loss of motor control. If you don’t know how the research discovering all of this was conducted, for now I’ll just say it was one of the most shameful acts of medical history. I’ll blog on it later. The individuals in the above picture were alive when these pictures were taken, by the way.
A special note: The bacteria causing syphilis is rather aggressive, so much so that it can be transmitted by oral, anal or genital sexual contact. By oral, I also mean kissing. Pay attention to those oral sores. Furthermore, syphilis gets transmitted from mother to unborn child. This is a devastating occurrence – if untreated, a child may be born prematurely, with low birth weight or even stillborn. If untreated, once born, a child may suffer deafness, seizures and cataracts before death.
All of the pictures in this posts are typical representations of the various stages of syphilis, and I’ve seen them all. These are not meant to provide any shock value other than demonstrating what occurs with progression of the disease. Later, I will discuss treatment, risks and other considerations. I don’t think you’ll want to miss the rest of the story. That really is shocking – and horrible.
Feel free to offer comments or ask questions.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Today, you will learn two phrases that you may not have previously heard: The Great Mimicker and MSM. Regarding another word you definitely should know, I’ll touch on it and will save for a separate post: Tuskegee.
Historically, syphilis really is the most important sexually transmitted disease (For what it’s worth, it’s thought that Columbus’ crew spread the disease from the Americas to Europe.). The great mimicker nickname as applied to syphilis exists because syphilis has many general symptoms that resemble and are often confused with other diseases. MSM points to the fact that treatment in the early stages is so complete that syphilis had been rapidly in decline – until it’s reemergence in a specific population. It is estimated that well over 60% of reported early stage cases of syphilis occurs in men who have sex with men (MSM).
In the first part of this review, I want to specifically address the symptoms, which are impressively and dramatically different depending on the stage.
Stage I – Primary Syphilis: Primary syphilis usually presents with the presence of a single, painless sore (a chancre), located wherever it was contracted. As pictured above, the head (glans) of the penis is a typical site. The sore disappears in 3-6 weeks (with or without treatment), and if treatment wasn’t received, the disease progresses. Herein lies the problems. Because it’s painless, you ignore it, perhaps thinking it was a friction sore, or you never gave it much of a thought. Because it went away on its own, you forget about it, thinking that it got better. So sad, so wrong…
Stage II – Secondary Syphilis: When syphilis returns days to weeks (more typically) after the primary infection, it does so quite dramatically. Rashes can appear everywhere, including across your back (as noted above) and chest to on your palms and soles, in your mouth, groin, vagina, anus, or armpits. The rash could be warts (condyloma lata) or flat. You should be scared, but you might not be because… the rash and the other symptoms again will disappear on its own. Despite what you may think intuitively, you really don’t want that to happen.
Latent Syphilis: Dormant syphilis can stay that way for decades after secondary syphilis has occurred. What you don’t know can hurt you. Syphilis can be transmitted during the earlier portion of latent phases, including to an unborn child.
Tertiary Syphilis: Late stage syphilis is a disturbing thing to see (and obviously experience). The disease can result in death, causing damage to the brain, heart, liver, bones, joints, eyes, the nervous system and blood vessels. Before it kills you, it can result in blindness, paralysis, dementia and loss of motor control. If you don’t know how the research discovering all of this was conducted, for now I’ll just say it was one of the most shameful acts of medical history. I’ll blog on it later. The individuals in the above picture were alive when these pictures were taken, by the way.
A special note: The bacteria causing syphilis is rather aggressive, so much so that it can be transmitted by oral, anal or genital sexual contact. By oral, I also mean kissing. Pay attention to those oral sores. Furthermore, syphilis gets transmitted from mother to unborn child. This is a devastating occurrence – if untreated, a child may be born prematurely, with low birth weight or even stillborn. If untreated, once born, a child may suffer deafness, seizures and cataracts before death.
All of the pictures in this posts are typical representations of the various stages of syphilis, and I’ve seen them all. These are not meant to provide any shock value other than demonstrating what occurs with progression of the disease. Later, I will discuss treatment, risks and other considerations. I don’t think you’ll want to miss the rest of the story. That really is shocking – and horrible.
Feel free to offer comments or ask questions.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Straight, No Chaser: The Most Common STD – Chlamydia
For most people, NGU isn’t a college in South Carolina. In fact, non-gonococcal urethritis isn’t really even that anymore, meaning it doesn’t need to be defined by the fact that it’s not gonorrhea. Chlamydia (the most common cause of NGU) by itself causes an estimated 3 million sexually transmitted infections a year. It is the most likely reason you’re coming into the emergency department when someone’s been behaving badly.
Here’s what I want you to know about Chlamydia:
1. It’s a real good reason to wear condoms. Chlamydia most commonly presents with no symptoms but may present with burning with urination, having to go more often (that’s the urethritis; the urethra is the tube through which urine flows) and a cloudy discharge. Less commonly, it can affect the rectum (proctitis) or a portion of the testicles (epidydimitis).
2. It’s contagious. If you’re sexually active with someone infected, odds are you’ll get it. It can be acquired via oral, vaginal or anal sex, and ejaculation isn’t required for transmission. Even worse, that means you can pass it to your newborn child (to disastrous effects to the baby, as noted in the lead picture of the newborn; Chlamydia has long been a significant cause of blindness worldwide, though thankfully the rate is decreasing).
2. Treatment doesn’t prevent you from reacquiring it. If you don’t change the behavior, you won’t change the future risk.
3. If both partners aren’t treated, then neither is treated. This can just get passed back and forth like a ping-pong ball. If you have several sexual partners, you’ll manage to introduce a lot of drama into a lot of lives. If you are treated, you should not engage in sexual activity until one week after your partner(s) have completed treatment.
4. It causes serious damage to females. PID (pelvic inflammatory disease – a complication of untreated Chlamydia) is a serious enough topic to warrant its own post, but untreated infections lead to infertility, an increased rate of tubal (ectopic) pregnancies and other complications. This needs to be identified and treated.
5. STDs hang out together. Chlamydia that goes untreated increases the chances of acquiring or transmitting HIV/AIDS. An infection with Chlamydia should prompt treatment for other STDs and testing for HIV.
6. It is easily prevented and treated. Wear condoms each time, every time. Get evaluated early with development of signs or symptoms. Discuss the discovery of Chlamydia with all sexual contacts from the last several months. This is an infection you don’t have to catch.
Let me know if you have any questions or comments.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
For most people, NGU isn’t a college in South Carolina. In fact, non-gonococcal urethritis isn’t really even that anymore, meaning it doesn’t need to be defined by the fact that it’s not gonorrhea. Chlamydia (the most common cause of NGU) by itself causes an estimated 3 million sexually transmitted infections a year. It is the most likely reason you’re coming into the emergency department when someone’s been behaving badly.
Here’s what I want you to know about Chlamydia:
1. It’s a real good reason to wear condoms. Chlamydia most commonly presents with no symptoms but may present with burning with urination, having to go more often (that’s the urethritis; the urethra is the tube through which urine flows) and a cloudy discharge. Less commonly, it can affect the rectum (proctitis) or a portion of the testicles (epidydimitis).
2. It’s contagious. If you’re sexually active with someone infected, odds are you’ll get it. It can be acquired via oral, vaginal or anal sex, and ejaculation isn’t required for transmission. Even worse, that means you can pass it to your newborn child (to disastrous effects to the baby, as noted in the lead picture of the newborn; Chlamydia has long been a significant cause of blindness worldwide, though thankfully the rate is decreasing).
2. Treatment doesn’t prevent you from reacquiring it. If you don’t change the behavior, you won’t change the future risk.
3. If both partners aren’t treated, then neither is treated. This can just get passed back and forth like a ping-pong ball. If you have several sexual partners, you’ll manage to introduce a lot of drama into a lot of lives. If you are treated, you should not engage in sexual activity until one week after your partner(s) have completed treatment.
4. It causes serious damage to females. PID (pelvic inflammatory disease – a complication of untreated Chlamydia) is a serious enough topic to warrant its own post, but untreated infections lead to infertility, an increased rate of tubal (ectopic) pregnancies and other complications. This needs to be identified and treated.
5. STDs hang out together. Chlamydia that goes untreated increases the chances of acquiring or transmitting HIV/AIDS. An infection with Chlamydia should prompt treatment for other STDs and testing for HIV.
6. It is easily prevented and treated. Wear condoms each time, every time. Get evaluated early with development of signs or symptoms. Discuss the discovery of Chlamydia with all sexual contacts from the last several months. This is an infection you don’t have to catch.
Let me know if you have any questions or comments.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Straight, No Chaser: Bacterial Vaginosis – No, That's Not an STD
I try to give you straight talk but never crudely. Therefore as I wade into conditions involving the genitalia, I’ll be sure to respect various sensitivities. That doesn’t mean I’m sugar-coating your information, it just means I am aware that you’re suffering and concerned by different scenarios.
One of those is bacterial vaginosis. There is an age after which women invariably start discovering that various things they do can disrupt the appearance, smell and content of their vaginal fluid. It’s certainly human nature to wonder if something has gone terribly wrong. Let’s pick up our Doctor-Couple conversation from earlier…
Patient: Yep! I have this grayish/whitish discharge that only happens after sex. And sometimes it itches around there. And it burns when I pee! No rashes or that other stuff, though.
Doctor: Ok. Let’s examine you…
All humans have various microorganisms that normally reside inside us at relatively low levels; different microorganisms inhabit different part of the body. They’ve set up a delicate balance (like an ecosystem, if you will) that, once settled doesn’t disturb us (their hosts) at all. If external or internal circumstances disturb that balance such that one set of organisms is disproportionately affected, overgrowth of the other organisms may occur. Many of you will recognize this as happening when you get a ‘yeast’ infection. It’s also what occurs when you develop bacterial vaginosis (BV). BV is the most common vaginal infection in the U.S. It’s more likely to be seen when you start having unprotected sex with a new partner, have multiple sex partners, are pregnant or douche (therefore, women who are not sexually active can have BV also). By the way, you don’t get BV from toilet seats or swimming pools.
The question everyone always has is “What’s the role of sex, especially sperm, in it?”. That’s asked because BV is often noticed after unprotected sex that includes ejaculation. Here’s where you learn the difference between ‘sexually transmitted’ and ‘sexually associated’. It is unclear what role sex has in the development of BV, but common thoughts include alterations in the pH of the vaginal fluid based on interactions with sperm/semen. It is known that the pH of women become more alkaline (less acidic) after exposure to semen, and that environment produces compounds causing the ‘fishy smell’. Yes, that’s real. We even have a real thing call a ‘whiff test’ as part of making the diagnosis.
The good news is BV is easily treated. The bad news is it needs to be treated, and it can recur even if it’s treated. Remember, it’s just an overgrowth syndrome. There are complications to not getting BV treated, especially if you’re pregnant. This makes it especially important that medication be taken to completion, even though you may feel better prior to that. Male partners do not need to be treated.
So this couple gets ‘off the hook’, even though they may decide to start using condoms. Unfortunately, some of the next sets of couples aren’t so lucky.
I welcome any questions or comments.
I try to give you straight talk but never crudely. Therefore as I wade into conditions involving the genitalia, I’ll be sure to respect various sensitivities. That doesn’t mean I’m sugar-coating your information, it just means I am aware that you’re suffering and concerned by different scenarios.
One of those is bacterial vaginosis. There is an age after which women invariably start discovering that various things they do can disrupt the appearance, smell and content of their vaginal fluid. It’s certainly human nature to wonder if something has gone terribly wrong. Let’s pick up our Doctor-Couple conversation from earlier…
Patient: Yep! I have this grayish/whitish discharge that only happens after sex. And sometimes it itches around there. And it burns when I pee! No rashes or that other stuff, though.
Doctor: Ok. Let’s examine you…
All humans have various microorganisms that normally reside inside us at relatively low levels; different microorganisms inhabit different part of the body. They’ve set up a delicate balance (like an ecosystem, if you will) that, once settled doesn’t disturb us (their hosts) at all. If external or internal circumstances disturb that balance such that one set of organisms is disproportionately affected, overgrowth of the other organisms may occur. Many of you will recognize this as happening when you get a ‘yeast’ infection. It’s also what occurs when you develop bacterial vaginosis (BV). BV is the most common vaginal infection in the U.S. It’s more likely to be seen when you start having unprotected sex with a new partner, have multiple sex partners, are pregnant or douche (therefore, women who are not sexually active can have BV also). By the way, you don’t get BV from toilet seats or swimming pools.
The question everyone always has is “What’s the role of sex, especially sperm, in it?”. That’s asked because BV is often noticed after unprotected sex that includes ejaculation. Here’s where you learn the difference between ‘sexually transmitted’ and ‘sexually associated’. It is unclear what role sex has in the development of BV, but common thoughts include alterations in the pH of the vaginal fluid based on interactions with sperm/semen. It is known that the pH of women become more alkaline (less acidic) after exposure to semen, and that environment produces compounds causing the ‘fishy smell’. Yes, that’s real. We even have a real thing call a ‘whiff test’ as part of making the diagnosis.
The good news is BV is easily treated. The bad news is it needs to be treated, and it can recur even if it’s treated. Remember, it’s just an overgrowth syndrome. There are complications to not getting BV treated, especially if you’re pregnant. This makes it especially important that medication be taken to completion, even though you may feel better prior to that. Male partners do not need to be treated.
So this couple gets ‘off the hook’, even though they may decide to start using condoms. Unfortunately, some of the next sets of couples aren’t so lucky.
I welcome any questions or comments.
Straight, No Chaser: MRSA, the Big, Bad Staph Infection
One of the things that’s changed a lot from when I first started practicing medicine is people show up every day to the emergency room for mosquito and spider bites. The local news has done a number on you, as now everyone is afraid of MRSA.
Methicillin-resistant Staph Aureus (MRSA) is a bacterial infection that’s resistant to the penicillin family of drugs that we used for decades to treat many infections. Staph Aureus itself is a bacteria akin to flipping a light switch. Normally, it resides within us (approximately 30% of us have it in our nostrils but only 2% of us carry the MRSA variety), not causing any problems, but it is also the source of many dangerous and life-threatening illnesses if it enters your bloodstream.
Over the last 50 years of treating Staph infections, resistance to many different antibiotics has occurred, meaning that when a serious infection occurs, it’s potentially very harmful. The emphasis there should be on potentially. Most MRSA infections are community-acquired skin infections that resemble a spider or other insect bite but are still mild and are treatable with different antibiotics than historically used. Regular Staph and MRSA infections are even more likely to occur in those institutionalized (i.e. in hospitals, nursing homes, etc.) and have tubes and wounds. Consider and discuss the risk with your physician when you see someone on a breathing device, a urinary catheter, needing gauze for surgical wounds or on feeding tubes. Amazingly, MRSA causes approximately 60% of hospital-acquired Staph infections now.
My primary goal today is to inform you of what you need to know to prevent obtaining these infections and when to be especially diligent in seeking treatment. It’s really a simple task of maintaining hygiene. Just prevent that ‘light-switch’ from flipping to the on position and most times you’ll be ok.
1. Staph is everywhere. You can best protect yourself by simply practicing good hygiene. Wash your hands early and often.
2. MRSA is spread by contact. Don’t be so quick to feel and squeeze on someone’s (or your own) boil. Wash your hands before and after such contact. Don’t share towels or razors.
3. Keep any cuts, scratches, nicks or scrapes covered until healed.
If you do see or develop signs of a skin infection (redness, warmth, tenderness, pain and possibly discharge from the wound site), it’s worth contacting your physician to see if s/he’d like to start antibiotics or drain a possible abscess.
So… don’t be afraid, be smart. Prevention is key.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
One of the things that’s changed a lot from when I first started practicing medicine is people show up every day to the emergency room for mosquito and spider bites. The local news has done a number on you, as now everyone is afraid of MRSA.
Methicillin-resistant Staph Aureus (MRSA) is a bacterial infection that’s resistant to the penicillin family of drugs that we used for decades to treat many infections. Staph Aureus itself is a bacteria akin to flipping a light switch. Normally, it resides within us (approximately 30% of us have it in our nostrils but only 2% of us carry the MRSA variety), not causing any problems, but it is also the source of many dangerous and life-threatening illnesses if it enters your bloodstream.
Over the last 50 years of treating Staph infections, resistance to many different antibiotics has occurred, meaning that when a serious infection occurs, it’s potentially very harmful. The emphasis there should be on potentially. Most MRSA infections are community-acquired skin infections that resemble a spider or other insect bite but are still mild and are treatable with different antibiotics than historically used. Regular Staph and MRSA infections are even more likely to occur in those institutionalized (i.e. in hospitals, nursing homes, etc.) and have tubes and wounds. Consider and discuss the risk with your physician when you see someone on a breathing device, a urinary catheter, needing gauze for surgical wounds or on feeding tubes. Amazingly, MRSA causes approximately 60% of hospital-acquired Staph infections now.
My primary goal today is to inform you of what you need to know to prevent obtaining these infections and when to be especially diligent in seeking treatment. It’s really a simple task of maintaining hygiene. Just prevent that ‘light-switch’ from flipping to the on position and most times you’ll be ok.
1. Staph is everywhere. You can best protect yourself by simply practicing good hygiene. Wash your hands early and often.
2. MRSA is spread by contact. Don’t be so quick to feel and squeeze on someone’s (or your own) boil. Wash your hands before and after such contact. Don’t share towels or razors.
3. Keep any cuts, scratches, nicks or scrapes covered until healed.
If you do see or develop signs of a skin infection (redness, warmth, tenderness, pain and possibly discharge from the wound site), it’s worth contacting your physician to see if s/he’d like to start antibiotics or drain a possible abscess.
So… don’t be afraid, be smart. Prevention is key.
Copyright © 2013 · Sterling Initiatives, LLC · Powered by WordPress
Straight, No Chaser: Find Something Better to Chew On! Ingrown Toenails
The overwhelming majority of cases of ingrown toenails I see come from people chewing on their toenails. So the really, really Quick Tip is keep your feet out of your mouth. If only it was that simple.
Ingrown toenails themselves aren’t the problem. The resulting skin infection and pain are what bring you in to see me. Remember that the ingrown toenail is caused by the nail burrowing into the skin of the toe instead of growing out and over it. I’ve always found it interesting that people wait so long for such things, but in this instance, if you are going to wait, there actually are things you can do to potentially make it better. You’ll know you need to do this if you have a red, swollen, painful toe and especially short toenails.
- Soak your feet two-three times a day for 15 minutes at a time.
- Attempt to lift the nail by placing cotton or dental floss under the toenail after you soak. The goal is to get that nail corner above the skin.
- Wear open-toed shoes. This is not the time when you’d want to have any pressure on your toes.
- Place a topical antibiotic on the area.
Have you ever seen a bad ingrown toenail get removed? If you have, you’ll likely agree that it’s a deterrent to having another one. Treatment usually involves lots of local anesthesia (i.e. needles) and partial manual removal of the toenail. It’s not a good day when this has to happen.
So, you can avoid this fate. Just follow a few simple steps to avoid it in the first place.
- Don’t bite your nails. As discussed in the human bites blog post, you’ve just added really bad bacterial to the mix for when the infection occurs.
- Don’t cut your toenail so short that you can’t see some of the white tips. Be sure to let the corners extend past the skin.
- Don’t wear excessively tight shoes that literally smash your toes onto themselves.
Here’s a final note: if you’re diabetic or otherwise immunocompromised, these infections can spread rapidly and extend into the bone – these infections are very serious. In some cases this has led to amputated toes. If an ingrown toenail happens to you, I’d suggest getting seen sooner rather than later.
The overwhelming majority of cases of ingrown toenails I see come from people chewing on their toenails. So the really, really Quick Tip is keep your feet out of your mouth. If only it was that simple.
Ingrown toenails themselves aren’t the problem. The resulting skin infection and pain are what bring you in to see me. Remember that the ingrown toenail is caused by the nail burrowing into the skin of the toe instead of growing out and over it. I’ve always found it interesting that people wait so long for such things, but in this instance, if you are going to wait, there actually are things you can do to potentially make it better. You’ll know you need to do this if you have a red, swollen, painful toe and especially short toenails.
- Soak your feet two-three times a day for 15 minutes at a time.
- Attempt to lift the nail by placing cotton or dental floss under the toenail after you soak. The goal is to get that nail corner above the skin.
- Wear open-toed shoes. This is not the time when you’d want to have any pressure on your toes.
- Place a topical antibiotic on the area.
Have you ever seen a bad ingrown toenail get removed? If you have, you’ll likely agree that it’s a deterrent to having another one. Treatment usually involves lots of local anesthesia (i.e. needles) and partial manual removal of the toenail. It’s not a good day when this has to happen.
So, you can avoid this fate. Just follow a few simple steps to avoid it in the first place.
- Don’t bite your nails. As discussed in the human bites blog post, you’ve just added really bad bacterial to the mix for when the infection occurs.
- Don’t cut your toenail so short that you can’t see some of the white tips. Be sure to let the corners extend past the skin.
- Don’t wear excessively tight shoes that literally smash your toes onto themselves.
Here’s a final note: if you’re diabetic or otherwise immunocompromised, these infections can spread rapidly and extend into the bone – these infections are very serious. In some cases this has led to amputated toes. If an ingrown toenail happens to you, I’d suggest getting seen sooner rather than later.
Straight, No Chaser: Your Questions about Human Bites
It seems that you found today’s post, well… biting. Here’s your questions and answers about human bites:
1) If human bites are so dangerous, why do women love Dracula so much?
- Seriously? Let’s just ascribe it to the neck being an erogenous zone and move on…
2) What’s a Boxer’s Fracture?
- A boxer’s fracture is a misnomer because boxers don’t get them. This describes a fracture at the base of the small finger (5th metacarpal), often caused from poor form throwing a punch. If you take one hand and move the pinky finger portion of the palm (the metacarpal bone), you’ll notice how movable it is (i.e. unstable) compared with the same efforts on the index and middle fingers at the level of the palm, which is what should deliver the blow. A boxer’s fracture and a human bite together makes for a very bad day.
3) Is a human’s mouth really dirtier than a goat’s mouth?
- It’s correct to say the bacteria in a human’s mouth cause more disease.
4) Is a bite the same as a puncture wound?
- The difference between a puncture wound and a laceration is you can identify the bottom (base) of the wound in a laceration, and you can’t in a puncture wound. Regarding bites: cats, snakes and the aforementioned Dracula are more likely to cause puncture wounds. Puncture wounds may or may not be caused by a bite (e.g. knife wounds are punctures).
5) I received a bite and didn’t get stitched up. Why?
- This could be for several reasons. Puncture wounds don’t receive stitches because you don’t want to seal off the infection. That’s a really good way to develop an abscess.
- Sometimes we will opt for ‘delayed closure’, waiting 3-5 days to ensure no infection has occurred before placing stitches.
- It’s really about the risk/benefit ratio. A laceration to a face is more likely to be repaired because of the risk of disfigurement and scarring, plus the face is a relatively low infection area anyway.
6) Why didn’t Dracula ever get Hepatitis or HIV?
- Even though Dracula’s the undead, one would think he’d be the world’s single greatest transmitter of both HIV and the blood transmitted forms of Hepatitis. HIV is viable for awhile in dead tissue, but it can’t multiply, which would explain why Dracula doesn’t show signs of the diseases. On that note, I’m done.
It seems that you found today’s post, well… biting. Here’s your questions and answers about human bites:
1) If human bites are so dangerous, why do women love Dracula so much?
- Seriously? Let’s just ascribe it to the neck being an erogenous zone and move on…
2) What’s a Boxer’s Fracture?
- A boxer’s fracture is a misnomer because boxers don’t get them. This describes a fracture at the base of the small finger (5th metacarpal), often caused from poor form throwing a punch. If you take one hand and move the pinky finger portion of the palm (the metacarpal bone), you’ll notice how movable it is (i.e. unstable) compared with the same efforts on the index and middle fingers at the level of the palm, which is what should deliver the blow. A boxer’s fracture and a human bite together makes for a very bad day.
3) Is a human’s mouth really dirtier than a goat’s mouth?
- It’s correct to say the bacteria in a human’s mouth cause more disease.
4) Is a bite the same as a puncture wound?
- The difference between a puncture wound and a laceration is you can identify the bottom (base) of the wound in a laceration, and you can’t in a puncture wound. Regarding bites: cats, snakes and the aforementioned Dracula are more likely to cause puncture wounds. Puncture wounds may or may not be caused by a bite (e.g. knife wounds are punctures).
5) I received a bite and didn’t get stitched up. Why?
- This could be for several reasons. Puncture wounds don’t receive stitches because you don’t want to seal off the infection. That’s a really good way to develop an abscess.
- Sometimes we will opt for ‘delayed closure’, waiting 3-5 days to ensure no infection has occurred before placing stitches.
- It’s really about the risk/benefit ratio. A laceration to a face is more likely to be repaired because of the risk of disfigurement and scarring, plus the face is a relatively low infection area anyway.
6) Why didn’t Dracula ever get Hepatitis or HIV?
- Even though Dracula’s the undead, one would think he’d be the world’s single greatest transmitter of both HIV and the blood transmitted forms of Hepatitis. HIV is viable for awhile in dead tissue, but it can’t multiply, which would explain why Dracula doesn’t show signs of the diseases. On that note, I’m done.
Straight No Chaser: Human Bites
I have had weird experiences with humans biting humans, as have most physicians. There are several different types of human bites, which can range from harmless to surgically serious, but as an emergency physician knowing the dangers of the bacteria inhabiting your mouth, I tend to assume the worst until proven otherwise. Your first Quick Tip is to do the same.
Maybe it’s where I’m located, but I tend to see way more ‘fight bites’ than anything else; these specifically refer to someone getting hit in the mouth. It’s always interesting to see the guy who ‘won’ the fight being the one who has to come in for medical treatment. He will have cut his hand on someone’s tooth and really doesn’t think much of it. He just wants the laceration sewn. Little does he realize how concentrated all of the structures (tendons, blood vessels, muscles and bones) are in the hand. He also doesn’t know that they’re confined to a very limited space, and seeding an infection in that space makes things really bad really quick. These guys are very dangerous because they tend to deny ever getting into the fight, ascribing the injury to something else (like punching a tree) – at least until I ask him why a tooth is inside his hand.
Then there’s the “Yes, I was bitten” variety, including activity where the teeth engaged the victim instead of the fist engaging a tooth. Think of the above Tyson vs. Holyfield bite as an example. Sometimes parts get bitten off (fingers, nose, ears and other unmentionables)! Children sometimes need to learn to stop biting as a behavior. Biting is sometimes seen in sexual assault, physical abuse and in self-mutilating behavior or with mentally handicapped individuals.
A third type is the ‘We love too much!’ variety. These may include hickeys (that actually break the skin), folks biting off their hangnails, and individuals who create skin infections by biting their toenails and fingernails. Yes, it happens more than you’d think.
The commonality to all of these scenarios is saliva found its way through the skin. Because of the virulence of those bacteria contained within, an infection will be forthcoming. You’ll know soon enough when the redness, warmth, tenderness and possibly pus from the wound and fever develop.
The easy recommendation to make is anytime a wound involving someone’s mouth breaks your skin, you need to be evaluated. Some wounds are much more dangerous than others. Teeth get dislodged into wounds, hand tendons get cut, bones get broken, and serious infections develop, and in fact these bites require immunization for tetanus. Bottom line: there’s no reason not to get evaluated if you develop those signs of infection I mentioned, if any injury to your hand occurs, or if any breakage of your skin has occurred. You’ll need antibiotics and wound cleaning in all probability, with a tetanus shot if you’re not up to date. If you’re unlucky, you may end up in the operating room.
So here’s your duty if you haven’t successfully avoided the bite:
1) At home, only clean the open wound by running water over the area. Avoid the home remedies, peroxide, alcohol and anything else that burns. You’re making things worse for yourself (those agents cause skin damage more than they’re ‘cleaning’ the area).
2) Apply ice – never directly to the wound, but in a towel. Use for 15 minutes off then 15 minutes on.
3) Retrieve any displaced skin tissue, place it in a bag of cold water, place that bag on ice, and bring it with you. We’ll decide if it’s salvageable.
4) Get in to be evaluated. Be forthcoming about whether or not it was a bite.
I have had weird experiences with humans biting humans, as have most physicians. There are several different types of human bites, which can range from harmless to surgically serious, but as an emergency physician knowing the dangers of the bacteria inhabiting your mouth, I tend to assume the worst until proven otherwise. Your first Quick Tip is to do the same.
Maybe it’s where I’m located, but I tend to see way more ‘fight bites’ than anything else; these specifically refer to someone getting hit in the mouth. It’s always interesting to see the guy who ‘won’ the fight being the one who has to come in for medical treatment. He will have cut his hand on someone’s tooth and really doesn’t think much of it. He just wants the laceration sewn. Little does he realize how concentrated all of the structures (tendons, blood vessels, muscles and bones) are in the hand. He also doesn’t know that they’re confined to a very limited space, and seeding an infection in that space makes things really bad really quick. These guys are very dangerous because they tend to deny ever getting into the fight, ascribing the injury to something else (like punching a tree) – at least until I ask him why a tooth is inside his hand.
Then there’s the “Yes, I was bitten” variety, including activity where the teeth engaged the victim instead of the fist engaging a tooth. Think of the above Tyson vs. Holyfield bite as an example. Sometimes parts get bitten off (fingers, nose, ears and other unmentionables)! Children sometimes need to learn to stop biting as a behavior. Biting is sometimes seen in sexual assault, physical abuse and in self-mutilating behavior or with mentally handicapped individuals.
A third type is the ‘We love too much!’ variety. These may include hickeys (that actually break the skin), folks biting off their hangnails, and individuals who create skin infections by biting their toenails and fingernails. Yes, it happens more than you’d think.
The commonality to all of these scenarios is saliva found its way through the skin. Because of the virulence of those bacteria contained within, an infection will be forthcoming. You’ll know soon enough when the redness, warmth, tenderness and possibly pus from the wound and fever develop.
The easy recommendation to make is anytime a wound involving someone’s mouth breaks your skin, you need to be evaluated. Some wounds are much more dangerous than others. Teeth get dislodged into wounds, hand tendons get cut, bones get broken, and serious infections develop, and in fact these bites require immunization for tetanus. Bottom line: there’s no reason not to get evaluated if you develop those signs of infection I mentioned, if any injury to your hand occurs, or if any breakage of your skin has occurred. You’ll need antibiotics and wound cleaning in all probability, with a tetanus shot if you’re not up to date. If you’re unlucky, you may end up in the operating room.
So here’s your duty if you haven’t successfully avoided the bite:
1) At home, only clean the open wound by running water over the area. Avoid the home remedies, peroxide, alcohol and anything else that burns. You’re making things worse for yourself (those agents cause skin damage more than they’re ‘cleaning’ the area).
2) Apply ice – never directly to the wound, but in a towel. Use for 15 minutes off then 15 minutes on.
3) Retrieve any displaced skin tissue, place it in a bag of cold water, place that bag on ice, and bring it with you. We’ll decide if it’s salvageable.
4) Get in to be evaluated. Be forthcoming about whether or not it was a bite.
Straight, No Chaser: Who Let The Dogs Out? Animal Bites
Human Shark Week wouldn’t be complete without reviewing something getting bitten.
Bow-Wow Ows
Dogs bite almost 5 million people yearly, resulting in 800,000 visits to a healthcare provider. Injuries are highest for kids between ages 5-9.
Most dog bites are to the upper extremities (imagine yourself reaching out, petting or slapping a dog), but in kids most injuries are to the head and neck (they’re smaller). Here’s some tips to avoid getting bitten.
- If you’re considering bringing a dog into your family, remember that dogs or dog breeds with histories of aggression are inappropriate in households with children (I’m talking to you, pit bull owner.). Also, spend time with a dog before committing. If your kids are afraid of any individual dog, hold off. That fear may create cues the dog will pick up on and create a self-fulfilling prophecy. Spaying/neutering a dog actually reduces aggressive tenderness (no puns necessary).
- Once you’ve acquired a pet dog, please never leave infants or young children alone with the dog. Train your dogs, focusing on submissive behaviors. Do not wrestle or otherwise become overly aggressive with your dog. If your dog develops aggressive tendencies, either get better training, or remove the pet from the household before it’s too late. Don’t disturb your pet if sleeping, eating or caring for puppies. Also avoid staring down your or any dog.
- Do not approach an unfamiliar dog.
- Regarding dogs you don’t know: Don’t pet any new dog without allowing it to see your hand and smell you beforehand. Do not run away screaming from a dog and scream; in fact, if you’re approached by an unfamiliar dog, your best move is to remain motionless. If you trip or fall over, roll into a ball and lie still.
Mee-Ow Ows
In general, cat bites and scratches are much worse than dog bites. Cat bites and scratches are more of the puncture wound variety, seeding and walling off very infectious bacteria deep inside of you, which then grow and cause infections. Dog bites are more of the ripping, tearing variety, which poses different problems, but they aren’t as dangerous from an infectious disease standpoint. Cat bites cause skin and blood infections. You’ll know this by warmth, redness, pain, and pus from the wound site. Fever may also be present if the infection is severe enough, and yes, cat bites can be fatal if untreated. You may have heard of ‘cat-scratch fever’. It’s a real phenomenon.
All bite wounds should immediately be washed under high pressure running water but you want to avoid any scrubbing. Pressure to bleeding wounds is important. Time is also important. Both cat and dog bites need to get evaluated. Expect to receive antibiotics in the vast majority of cases. Some bites will require stitches; others will not. That’s a decision for the medical professionals. Treatment may include tetanus and rabies vaccines.
Get in and be seen, especially with cat bites/scratches, which can cause loss of life and limb if not dealt with rapidly and effectively.
By the way, since this is my blog, I’ll just say stop it with letting your dogs lick you and kiss you in the mouth. That’s just nasty (and that’s medically speaking). Don’t you know where their mouths have been?
The Big Yow Wow! Ow
Shark bites are the things of legends, thanks to movies like Jaws and The Deep Blue Sea, which gives the impression that sharks are serial human killers. In fact, there are about 100 shark attacks worldwide yearly, with about 15-20% of attacks being fatal. I doubt that most Straight, No Chaser readers will be shark bait anytime soon, but the first thing I will mention that’s important to know is unlike other attacks by potential predators, playing possum doesn’t work with sharks. Fight back and fight dirty, attacking the eyes and gills. Apparently, sharks like easy food. In case you’ve ever wondered, sharks aren’t biting you because they’re hungry but because they’re curious. They don’t encounter humans often and similar to how a baby puts about anything in its mouth, sharks will take an ‘exploratory bite’. The typical human who swims frequently enough to be in shark infested waters isn’t obese enough to keep sharks’ interest and be a focus of their diets, particularly with so many other options. The other curiosity about sharks is after that first nibble, they tend to back off and wait for prey to die before returning for the kill. They don’t seem to like fighting wounded and aggressive victims. Rather lazy, I’d say.
The real danger in shark bites is the amputation. Single bites of arms and leg can cause enough blood loss and subsequent infection to kill you, just like any other amputation. Obviously a bite to your skull, chest or abdomen can kill instantly. Treatment primarily involves aggressive fluid resuscitation and other life-supportive measures, along with assessment of infection risk with antibiotics as necessary.
The Most Dangerous Animal of Them All
I’ll blog on human bites as a separate topic; it’s that frequent and important. For now, understanding that the human mouth is especially dirty and dangerous should hold you over. In the meantime, pay attention to your household pets and use the tips mentioned to avoid infection.
Human Shark Week wouldn’t be complete without reviewing something getting bitten.
Bow-Wow Ows
Dogs bite almost 5 million people yearly, resulting in 800,000 visits to a healthcare provider. Injuries are highest for kids between ages 5-9.
Most dog bites are to the upper extremities (imagine yourself reaching out, petting or slapping a dog), but in kids most injuries are to the head and neck (they’re smaller). Here’s some tips to avoid getting bitten.
- If you’re considering bringing a dog into your family, remember that dogs or dog breeds with histories of aggression are inappropriate in households with children (I’m talking to you, pit bull owner.). Also, spend time with a dog before committing. If your kids are afraid of any individual dog, hold off. That fear may create cues the dog will pick up on and create a self-fulfilling prophecy. Spaying/neutering a dog actually reduces aggressive tenderness (no puns necessary).
- Once you’ve acquired a pet dog, please never leave infants or young children alone with the dog. Train your dogs, focusing on submissive behaviors. Do not wrestle or otherwise become overly aggressive with your dog. If your dog develops aggressive tendencies, either get better training, or remove the pet from the household before it’s too late. Don’t disturb your pet if sleeping, eating or caring for puppies. Also avoid staring down your or any dog.
- Do not approach an unfamiliar dog.
- Regarding dogs you don’t know: Don’t pet any new dog without allowing it to see your hand and smell you beforehand. Do not run away screaming from a dog and scream; in fact, if you’re approached by an unfamiliar dog, your best move is to remain motionless. If you trip or fall over, roll into a ball and lie still.
Mee-Ow Ows
In general, cat bites and scratches are much worse than dog bites. Cat bites and scratches are more of the puncture wound variety, seeding and walling off very infectious bacteria deep inside of you, which then grow and cause infections. Dog bites are more of the ripping, tearing variety, which poses different problems, but they aren’t as dangerous from an infectious disease standpoint. Cat bites cause skin and blood infections. You’ll know this by warmth, redness, pain, and pus from the wound site. Fever may also be present if the infection is severe enough, and yes, cat bites can be fatal if untreated. You may have heard of ‘cat-scratch fever’. It’s a real phenomenon.
All bite wounds should immediately be washed under high pressure running water but you want to avoid any scrubbing. Pressure to bleeding wounds is important. Time is also important. Both cat and dog bites need to get evaluated. Expect to receive antibiotics in the vast majority of cases. Some bites will require stitches; others will not. That’s a decision for the medical professionals. Treatment may include tetanus and rabies vaccines.
Get in and be seen, especially with cat bites/scratches, which can cause loss of life and limb if not dealt with rapidly and effectively.
By the way, since this is my blog, I’ll just say stop it with letting your dogs lick you and kiss you in the mouth. That’s just nasty (and that’s medically speaking). Don’t you know where their mouths have been?
The Big Yow Wow! Ow
Shark bites are the things of legends, thanks to movies like Jaws and The Deep Blue Sea, which gives the impression that sharks are serial human killers. In fact, there are about 100 shark attacks worldwide yearly, with about 15-20% of attacks being fatal. I doubt that most Straight, No Chaser readers will be shark bait anytime soon, but the first thing I will mention that’s important to know is unlike other attacks by potential predators, playing possum doesn’t work with sharks. Fight back and fight dirty, attacking the eyes and gills. Apparently, sharks like easy food. In case you’ve ever wondered, sharks aren’t biting you because they’re hungry but because they’re curious. They don’t encounter humans often and similar to how a baby puts about anything in its mouth, sharks will take an ‘exploratory bite’. The typical human who swims frequently enough to be in shark infested waters isn’t obese enough to keep sharks’ interest and be a focus of their diets, particularly with so many other options. The other curiosity about sharks is after that first nibble, they tend to back off and wait for prey to die before returning for the kill. They don’t seem to like fighting wounded and aggressive victims. Rather lazy, I’d say.
The real danger in shark bites is the amputation. Single bites of arms and leg can cause enough blood loss and subsequent infection to kill you, just like any other amputation. Obviously a bite to your skull, chest or abdomen can kill instantly. Treatment primarily involves aggressive fluid resuscitation and other life-supportive measures, along with assessment of infection risk with antibiotics as necessary.
The Most Dangerous Animal of Them All
I’ll blog on human bites as a separate topic; it’s that frequent and important. For now, understanding that the human mouth is especially dirty and dangerous should hold you over. In the meantime, pay attention to your household pets and use the tips mentioned to avoid infection.
