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From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … http://www.LegacyEducators.org and click on “Cancer Information”

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MANAGEMENT 

Keloids and hypertrophic scars are conditions that may require treatment if symptomatic. Pain, pruritus (itching), hyperhidrosis (sweating too much), functional impairment, and cosmetic disfigurement are examples of comorbidities. Although multiple medical and surgical therapies have been used for the treatment of keloids and hypertrophic scars, none of these treatments has been adequately evaluated in high-quality studies and there is no universally accepted treatment approach.

Patient evaluation and counseling — The evaluation of the patient with a symptomatic scar involves a detailed scar history, family history of keloids, and scar assessment. The scar location, size, contour, color, pliability, and presence of subjective symptoms such as pain and itching should be recorded. Baseline photographs may be useful for comparison after treatment completion.

Patients should let their physicians know their perception about the scar and subjective symptoms (your account of what you are feeling – pain, itching, shame, sensitivities, etc.,), as these will be documented as reasons for chosing a particular type of treatment and what expectations are from treatments.

Patients should know that there is a high recurrence risk associated with all treatment options and that repeated treatments or multiple treatment combinations may be necessary to achieve satisfactory results.

Post-Incisional/Surgery keloids

Post-Incisional/Surgery keloids

Goals of therapy — A frank discussion with your physician will determine the goals of therapy should be based on the patient’s complaints and desire for treatment. They may include one or more of the following:

  • Relief of symptoms (eg, pain, pruritus)
  • Reduction of the scar volume
  • Functional improvement
  • Cosmetic improvement

Patient AND Physician should accept their “pre-established” definition of success. For example, for conservative treatments volume reduction by 30% to 50%, symptom reduction by >50%, and may be acceptable after three to six treatments or after three to six months

Treatment options

An overall recommendation for the treatment of keloids based on size is first listed, followed by explanation of each treatment modality. Please note the “warnings” and possible side effects of each, especially as it pertains to Radiation Therapy (though highly effective, the long term side effects warrants consideration). Intralesional = injection of medication directly into the keloid

  • For linear or small hypertrophic scars resulting from surgery or trauma, silicone gel sheeting may be used as initial treatment. Pressure therapy, if feasible and tolerated by the patient, may be an alternative first-line treatment. Second-line therapies include intralesional corticosteroids, laser therapy, and surgical excision.
  • Keloid-of-chestFor minor keloids (<0.5 cm), intralesional corticosteroids is suggested as the first-line therapy. Silicone gel sheeting or pressure therapy may be used as adjunctive therapies. Second-line therapies include intralesional corticosteroids in combination with intralesional 5-FU, contact or intralesional cryotherapy, or laser therapy.
  • For major keloids (>0.5 cm), intralesional triamcinolone acetonide is the first-line therapy to control pruritus (itching) and pain, increase scar pliability, and reduce volume. Adjunctive (follow-up) treatments include intralesional 5-FU and contact or intralesional cryotherapy. For large earlobe keloids that cause considerable cosmetic disfigurement, the initial treatment is often surgical excision in combination with perioperative intralesional corticosteroids, compression, or radiation therapy.
  • For linear or small hypertrophic scars resulting from surgery or trauma, silicone gel sheeting may be used as initial treatment. Pressure therapy, if feasible and tolerated by the patient, may be an alternative first-line treatment. Second-line therapies include intralesional corticosteroids, laser therapy, and surgical excision

Description of each treatment modality

Intralesional corticosteroids (injection directly into the keloid) – Intralesional  triamcinolone acetonide is the most commonly used treatment for hypertrophic scars and keloids. Corticosteroids soften and flatten the scar. Treatment is usually repeated several times at four to six-week intervals, but the optimal concentration and number of treatments has not been determined.  Intralesional corticosteroid injections are painful. Other adverse effects include dermal atrophy, skin ulceration, hypo- or hyperpigmentation, and development of telangiectasias.

Intralesional 5-fluorouracil (5-FU is also used a chemotherapy agent to treat cancer) — Intralesional 5-fluorouracil (5-FU) has been used for scars that do not respond to intralesional corticosteroids.  Adverse effects of this treatment include pain and hyperpigmentation (darkening spots). Intralesional 5-FU can be used in combination with intralesional corticosteroids.

Silicone gel sheets — Silicone gel sheeting is frequently used for the treatment and prevention of hypertrophic scars and keloids. The mechanism by which silicone gel sheeting might exert an anti-scarring effect is unknown. Evidence showed that silicone gel sheeting may reduce the thickness and improve the appearance of hypertrophic scars and keloids.

Pressure therapy — Pressure therapy is usually performed with pressure garments, bandages, or special devices for certain locations such as the ear. A type of pressure earrings for earlobe keloids called Zimmer splints can be molded to the appropriate size and cosmetically altered to appear as earrings. Other devices using magnets with or without silicone sheeting have also been used as post-surgery adjuvant therapy for ear keloids.  Observational studies of patients with ear keloids have shown that custom-made pressure devices may be beneficial to reduce the risk of recurrence after surgical excision.

Cryotherapy (see video below) — Cryotherapy is most useful in combination with other treatments for keloids, although up to 50% of patients may respond to cryotherapy alone. A 10- to 30-second freeze-thaw cycle is used and can be repeated up to three times per treatment session. Treatment is repeated at intervals of four to six weeks until response occurs. The major side effects are pain and permanent hypo-pigmentation (lightening of the skin), the latter of which limits its use in patients with darker skin.

Intralesional cryotherapy is a newer technique that allows the focused destruction of keloid scar tissue with minimal surface damage. Delivery of liquid nitrogen to the scar tissue is performed under local anesthesia using a special cryosurgery needle probe. Treatments can be repeated at two- to three-week intervals. In contrast with conventional cryotherapy, postinflammatory hypopigmentation is infrequent after intralesional cryotherapy.

Laser therapy — Pulsed dye laser (PDL) and neodymium-yttrium-aluminum-garnet (Nd:YAG) laser treatment has been reported to be beneficial for hypertrophic scars and keloids. The underlying mechanism of laser therapy involves the destruction of small blood vessels, which leads to improved scar color, height, pliability, and texture.

Evidence from high-quality studies to support the use of lasers for the treatment of hypertrophic scars and keloids is limited. Therefore, the efficacy of laser treatment for hypertrophic scars remains uncertain.

Surgery/Excision — Surgical excision of hypertrophic scars and keloids may be indicated if conservative therapies alone are unsuccessful or unlikely to result in significant improvement. Surgical excision of keloids is associated with recurrence rates of up to 100%. (Surgery SHOULD be combined with other treatments). The combination of surgery with other types of treatments previously mentioned, may significantly lower the risk of recurrence:

  • Intralesional corticosteroids
  • Intralesional 5-fluorouracil (5-FU)
  • Cryotherapy
  • Radiation therapy– Brachytherapy or external beam radiotherapy administered after surgical excision appear to be highly effective in reducing keloid recurrence.

Radiation therapy after surgery — Several studies have found radiation therapy to be highly effective in reducing keloid recurrence when administered immediately after surgical excision.  A variety of techniques, doses, and schedules of radiation have been used in the treatment of keloids.

Treatment with superficial X-rays

Treatment with superficial X-rays

The control of keloids using postoperative radiation is illustrated by several studies with recurrent rates of 4% in 18months, 3% at 34 months,  another report of 1/45 pt recurring at 2yrs, and yet another study with use of brachytherapy that showed recurrence of 12% at 61 month follow-up. Radiation therapy may occasionally be indicated for lesions that are not amenable to resection.

Though these results are GREAT when compared to 50-100% likelihood of recurrence, please note: “Concerns regarding the potential long-term risks associated with the use of radiation therapy limit its utilization for these lesions. Several cases of malignancy that may have been associated with radiation therapy for keloids have been reported. Although causation cannot be confirmed in these cases, caution should still be used when prescribing adjuvant radiation therapy for keloids, particularly when treating younger patients.”

Combination treatments — Recalcitrant (hard to treat) keloids that do not respond to intralesional corticosteroids alone may be treated with a combination of intralesional triamcinolone acetonide and 5-FU.

Limited evidence from small retrospective studies supports the use of pulsed dye laser (PDL) or fractional ablative laser treatment in combination with postoperative intralesional triamcinolone.

SURGERY – Interview with patient

VERY GRAPHIC! Intralesional corticosteroids and cryotherapy

Patients are encouraged to discuss these treatment options with their primary care, and when indicated, a consultation with another specialty is highly encouraged!

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … http://www.LegacyEducators.org and click on “Cancer Information”

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Keloid associated w/ear piercing

Keloid associated w/ear piercing

“What is that behind your earlobe?” Are you brave enough to ask? What if that “thing” is located on other parts of the body? Can something be done to treat it? Will discuss over the next 2 weeks. First, let’s discuss what that abnormal growth actually is…

A keloid  is the formation of a type of scar tissue that can occur at the site of skin injury or previous trauma. The injury can be that of surgery, ear piercing, tattoos, trauma from shaving, etc., A hypertrophic scar looks similar to a keloid and are more common. However, hypertrophic scars do not get as big as keloids, and may fade with time – Keloids do not fade away!

  • Keloids are firm, rubbery lesions or shiny, fibrous nodules, and can vary from pink to the color of the patient’s flesh, or red to dark brown in color.
  • A keloid scar is benign (non-cancerous) and not contagious
  • Keloids can be associated with severe itchiness, pain, and changes in texture.

In severe cases, and depending on location, it can affect movement of skin. A large keloid in the skin over a joint may interfere with joint function. Unfortunately, keloids tend to grow and extend beyond the area of initial trauma and become unsightly and uncomfortable.

  • Keloids1Keloids are equally common in women and men, although more women developed them because of a greater degree of earlobe and body piercing among them.
  • Keloids are less common in children and the elderly.
  • People with darker skin are more likely to develop them, but keloids can occur in people of all skin types.
  • Keloid scars are seen 15 times more frequently in highly pigmented ethnic groups than in Caucasians.
Keloid-of-the-sternum-1

Keloid on chest from procedure

Doctors do not understand exactly why keloids form in certain people, or situations and not in others.
The best way to deal with a keloid is not to get one (really *smile*).

A person who has had a keloid should discuss with physicians before undergoing elective or cosmetic skin surgeries, or procedures such as piercing. When it comes to keloids, prevention is crucial, because current treatments leave a lot to be desired.

Next week – Keloid Treatments

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

 

From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … http://www.LegacyEducators.org and click on “Cancer Information”

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With Mother’s Day just around the corner, I cannot help but think about all the remaining women and “mother figures” in my life – My mom and my Paternal Grandmother, who is now 91yo, are gratefully still with us. I never miss a moment to say to my mom, “Love you!”  Even after a disagreement or heated argument. I’d say something along the line of, “I have to get off the phone now to calm down…ok? Love you…bye.” And yes, I would follow-up afterwards as well. How is your relationship with your mom? Hang out with her recently? Spoke with her recently? It is a worthwhile relationship to work at improving

Memory of MomSome are not so fortunate…and will be celebrating Mother’s Day…in memory of their love one. My friend’s mom Lilly, was a great women, mother and wife. I know that she is sorely missed.

It is my hope that all your memories of your mom are filled with smiles and happy recollections!

Ms. Lilly, Teresa, and all the Moms are looking down from Heaven…smiling, pleased with all their children…pleased with you.

Cheers!

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … www.LegacyEducators.org and click on “Cancer Information”

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Why is there such an obsession over good health? Even more so over aging or getting old? I do not have the answer or formula, as there is a billion dollar anti-aging industry searching for that as well. What I do know, is that aging gracefully is quite possible for everyone – Love Yourself, Love Others, Be Kind, Be Grateful, Stay Active, Laugh a lot and LIVE for the moment…that is a GREAT start and canvas quite a bit!

Example:  To quit smoking is a part of loving and being kind to oneself…and by so doing improve one’s health!

It is not just to live longer either, but to enjoy a better, healthy life NOW, that will also be beneficial much later… to have something to look back at…when you are 80, 90, or 102 yo! Aging gracefully is … priceless! As Dr. Charles Stanley would say, “We reap what sow, more than we sow, and later than we sow.” …. sow wisely!

Stay Active!

Stay Active!

Staying Active: If dancing is not your thing, maybe daily walking after dinner, playing tennis, gardening, or anything else that is enjoyable and settles your mind – may do the trick. Don’t forget to exercise the brain too!

Laughing/smiling does the heart good! This video brought a smile to my face and lightens my heart…here’s hoping it does the same for you also!

Start practicing the “aging gracefully” process today…

102 yo DANCER… sees herself dancing for the FIRST time!

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … www.LegacyEducators.org and click on “Cancer Information”

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APRIL IS IRRITABLE  BOWEL SYNDROME (IBS) AWARENESS MONTH!

The symptoms of IBS can vary widely from person to person and may even recognize other common disorders/diseases of the gastrointestinal (GI) tract. A “loud/grumbling” stomach, does not mean you have IBS, but it is worth learning more about – just in case!!

IBSAbdominal pain is often described as:

  • Crampy
  • Generalized ache with periods of cramps
  • Sharp, dull, gas-like
  • Modest pains are common
  • Increased gas
  • Altered bowel habits
  • Food intolerance
  • Bloating (distention)

The IBS discomfort or pain usually feels better after a bowel movement.  IBS is a “functional” disorder. Some risk factors for IBS include (but is not limited to): diet low in fiber, excessive use of laxative, longterm use of analgesics (pain medications), etc.,

DO YOU HAVE IBS?  Click  HERE and read page and pdf at bottom left of page.

TREATMENT

  • Though irritable bowel syndrome (IBS) doesn’t have a cure, your doctor can manage the symptoms with a combination of diet, medicines, probiotics, and therapies for mental health problems (anxiety or depression)
  • Traditional drugs include; fiber supplement, anti-diarrheal, anti-flatuents (decrease gas), anti-spasmodic drugs.
  • Eating smaller meals more often, or eating smaller portions, may help your IBS symptoms. You should avoid foods and drinks that make your symptoms worse.

Disclaimer: Use of these videos are for information purposes only and not a form of endorsement.

IBS

For more information please see below

Irritable Bowel Syndrome Awareness Month

International Foundation for Functional Gastrointestinal Disorders
700 W. Virginia Street, #201
Milwaukee, WI 53204
(888) 964-2001
(414) 964-1799
(414) 964-7176 Fax
iffgd@iffgd.org
www.aboutibs.org/site/about-ibs/april-ibs-awareness-month External Links Disclaimer Logo
Materials available
Contact: Nancy Norton

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … www.LegacyEducators.org and click on “Cancer Information”

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Last week, we discussed/reviewed the basics of Acetaminophen (Tylenol). Now, you are able to take this drug without fear!

Let’s discuss Ibuprofen this week.

Ibuprofen-DosageAs you may recall, Non-Steroidal Anti-inflammatory drugs (NSAIDs) are a group of OTC medications used to decrease mild-moderate pain, reduce fever, and decrease inflammation without the worrisome effect of steroids.  Ibuprofen (Advil, Motrin, Caldolor, Midol, etc.,), Naproxen (Aleve, Naprosyn, Anaprox, etc.,), Aspirin (Zorprin, Bayer aspirin, St. Joseph aspirin, etc.,), among others are in this class of drug. Acetaminophen is NOT a NSAID.

Ibuprofen overdose occurs when someone accidentally or intentionally takes more than the normal recommended amount of this medication. Your ibuprofen dosage will depend on various factors, including age, weight, and what is being treated.  Below are the generally recommended dosages listed by age.  However, be sure to read the cautions below, and remember to take the minimum dosage that is effective. Be sure to take with a glass of milk or food, to protect your stomach from bleeding (see video below for more info)

motrin1Children under 12: Motrin is generally used for fever, pain and/or arthritis. Please consult with a Pediatrician and follow guideline chart given.

Adult (12 and up):

Fever:  200-400mg orally every 4-6 hours as needed.
Pain:  200-400mg every 4-6 hours as needed.  There is no evidence that a higher dosage will provide more relief.
Arthritis:  Be sure to talk to a doctor who knows your medical history.  The usual dose is 400-800mg every 6-8 hours initially, increased to a maximum of 3200mg per day divided into 3-4 equal doses.

  • Be sure to read labels carefully.
  • Adults should never take more than 800mg per dose or 3200mg per day.
  • Ongoing or regular use carries its own risks.
  • Again, Be sure to take with a glass of milk or with food.

Please see video below.

Ibuprofen (Motrin)

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

From the Physician’s Desk … Weekly Blog!

Don’t forget to visit … www.LegacyEducators.org and click on “Cancer Information”

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Have a headache? Grab some Motrin (Ibuprofen).

Knee pain? Use some Tylenol (Acetaminophen)

Headache persists? Take more Tylenol? Hip now hurting too. Can you take more Motrin?

Having pain medications available over-the-counter (OTC) is a good thing. But too often, many are not aware of some of the necessary, basic, associated precautions.  Recently, while visiting my Dad, he jokingly noted the ever growing, long list of “side-effects” spewed about medications in commercials.  Like most he wondered, “why take the medication, if the side effects seem to cause more harm?” But, that is for another blog *smile* Let’s tackle the pain medications that millions DO use daily! Let’s define NSAIDs and then we will start with Acetaminophen (Tylenol).

JUST THE BASICS

tylenol1Non-Steroidal Anti-inflammatory drugs (NSAIDs) are a group of OTC medications use to decrease mild-moderate pain, reduce fever, and decrease inflammation without the worrisome effect of steroids.  Ibuprofen (Advil, Motrin, Caldolor, Midol, etc.,), Naproxen (Aleve, Naprosyn, Anaprox, etc.,), Aspirin (Zorprin, Bayer aspirin, St. Joseph aspirin, etc.,), among others. Acetaminophen is NOT a NSAID.

  • The primary difference between NSAIDs and acetaminophen (Actamin, Pandadol, Tylenol) lies in the way each relieves pain. Acetaminophen works primarily in the brain to block pain messages and seems to influence the parts of the brain that help reduce fever. That means it can help relieve headaches and minor pains. But it’s not as effective against pain associated with inflammation.
  • Inflammation is a common feature of many chronic conditions and injuries. NSAIDs reduce the level of chemicals that are involved in inflammation. Treatment with NSAIDs can lead to less swelling and less pain.
  • Some pain pills, such as Excedrin Migraine, combine an NSAID — in this case aspirin – with acetaminophen

ACETAMINOPHEN

Acetaminophen (Tylenol) overdose is one of the most common poisoning worldwide! Why? Because taking too much pain reliever can cause liver failure or even death! YES…sudden liver failure (see videos below).

The FDA has set the recommended maximum for adults at 4,000 milligram (mg) per day. It is quite easy to hit this max though!  One gel tablet of extra strength Tylenol, for example, contains 500mg. Do you ever take just ONE Tylenol though? My colleague just indicated that he never takes less than 3 extra-strength pills at a time! That’s 1500 mg at one time…do this 3 times in one day and will be above the max!

tylenolOverdoses from acetaminophen send 55,000 to 80,000 people in the U.S. to the emergency room each year and kill at least 500, according to the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA).

Acetaminophen can be found in more than 600 over-the-counter and prescription products used by nearly one in four American adults every week, including household brands like Nyquil cold formula, Excedrin pain tablets, Theraflu and Sudafed sinus pills.

So how do these accidental acetaminophen deaths occur?

Imagine you’ve had major dental surgery, and your dentist prescribes a five-day supply of Percocet.

  • You take the recommended 2 pills every six hours for 2,600 mg of acetaminophen, well below the 4,000-mg-a-day safety threshold.
  • But you’re still experiencing pain, so you decide to add Extra Strength Tylenol, six caplets a day for another 3,000 milligrams.
  • Now you’re feeling better but you still have trouble sleeping, so you take Nyquil, for another 650 milligrams (unaware of the acetaminophen content of the other medications).

After a few days on this 6,250 milligram regimen, experts say acute liver damage is a real risk. Add a couple beers or wine to this…and, well, you get the picture! (Alcohol affects the liver also…)

DOSES:

  • Normal/Regular dose of Tylenol ~325mg
  • Extra-Strength 500mg to 650mg
  • MAX daily recommended dose 4,000mg

PLEASE continue to use Acetaminophen and Acetaminophen products, as needed. Just be aware of the dose limits and use wisely!

Now you know…

CNN REVIEW

ACCIDENTAL OVERDOSE 

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Remember …

Ipsa Scientia Potestas est    ———  Knowledge itself is power!

Don’t forget to visit my website … www.LegacyEducators.org 

Your Family Friendly Doc … Dr McGann!  

See you next week…

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