Archive | April 2016


“In 2014, the 55 U.S. poison control centers provided telephone guidance for nearly 2.2 million human poison exposures.1 That’s about:

  • 6.7 poison exposures/1000 population,
  • 42.6 poison exposures in children younger than 6 years/1000 children,
  • 1 poison exposure reported to U.S. poison control centers every 15 seconds.”

Poison Control – National Capital Poison Center


“Acne is the most common skin condition in the United States. Although it’s common, accurate information about acne can be scarce.”

American Academy of Dermatology





Acne is a skin condition that occurs when your hair follicles become plugged with oil and dead skin cells. Acne usually appears on your face, neck, chest, back and shoulders. Effective treatments are available, but acne can be persistent. The pimples and bumps heal slowly, and when one begins to go away, others seem to crop up.

Acne is most common among teenagers, with a reported prevalence of 70 to 87 percent. Increasingly, younger children are getting acne as well.

Depending on its severity, acne can cause emotional distress and scar the skin. The earlier you start treatment, the lower your risk of lasting physical and emotional damage.

Acne signs and symptoms vary depending on the severity of your condition:

  • Whiteheads (closed plugged pores)
  • Blackheads (open plugged pores — the oil turns brown when it is exposed to air)
  • Small red, tender bumps (papules)
  • Pimples (pustules), which are papules with pus at their tips
  • Large, solid, painful lumps beneath the surface of the skin (nodules)
  • Painful, pus-filled lumps beneath the surface of the skin (cystic lesions) If home care remedies don’t work to clear up your acne, see your primary care doctor. He or she can prescribe stronger medications. If acne persists or is severe, you may want to seek medical treatment from a doctor who specializes in the skin (dermatologist).     Seek emergency medical help if after using a nonprescription skin product you experience:
  • The Food and Drug Administration warns that some popular nonprescription acne lotions, cleansers and other skin products can cause a serious reaction. This type of reaction is quite rare, so don’t confuse it with the redness, irritation or itchiness where you’ve applied medications or products.

    When to see a doctor:

  • Faintness
  • Difficulty breathing
  • Swelling of the eyes, face, lips or tongue
  • Tightness of the throat

    Four main factors cause acne:

  • Oil production
  • Dead skin cells
  • Clogged pores
  • BacteriaHair follicles are connected to oil glands. These glands secrete an oily substance (sebum) to lubricate your hair and skin. Sebum normally travels along the hair shafts and through the openings of the hair follicles onto the surface of your skin.
  • Acne typically appears on your face, neck, chest, back and shoulders. These areas of skin have the most oil (sebaceous) glands. Acne occurs when hair follicles become plugged with oil and dead skin cells.

 When your body produces an excess amount of sebum and dead skin cells, the two can build up in the hair follicles. They form a soft plug, creating an environment where bacteria can thrive. If the clogged pore becomes infected with bacteria, inflammation results.

The plugged pore may cause the follicle wall to bulge and produce a whitehead. Or the plug may be open to the surface and may darken, causing a blackhead. A blackhead may look like dirt stuck in pores. But actually the pore is congested with bacteria and oil, which turns brown when it’s exposed to the air.

Pimples are raised red spots with a white center that develop when blocked hair follicles become inflamed or infected. Blockages and inflammation that develop deep inside hair follicles produce cyst-like lumps beneath the surface of your skin. Other pores in your skin, which are the openings of the sweat glands, aren’t usually involved in acne.

Factors that may worsen acne.

These factors can trigger or aggravate an existing case of acne:

  • Hormones. Androgens are hormones that increase in boys and girls during puberty and cause the sebaceous glands to enlarge and make more sebum. Hormonal changes related to pregnancy and the use of oral contraceptives also can affect sebum production. And low amounts of androgens circulate in the blood of women and can worsen acne.
  • Certain medications. Drugs containing corticosteroids, androgens or lithium can worsen acne.
  • Diet. Studies indicate that certain dietary factors, including dairy products and carbohydrate-rich foods — such as bread, bagels and chips — may trigger acne. Chocolate has long been suspected of making acne worse. A recent study of 14 men with acne showed that eating chocolate was related to an increase in acne. Further study is needed to examine why this happens or whether acne patients need to follow specific dietary restrictions.
  • Stress. Stress can make acne worse.

Acne myths

These factors have little effect on acne:

  • Greasy foods. Eating greasy food has little to no effect on acne. Though working in a greasy area, such as a kitchen with fry vats, does because the oil can stick to the skin and block the hair follicles. This further irritates the skin or promotes acne.
  • Dirty skin. Acne isn’t caused by dirt. In fact, scrubbing the skin too hard or cleansing with harsh soaps or chemicals irritates the skin and can make acne worse. Though it does help to gently remove oil, dead skin and other substances.
  • Cosmetics. Cosmetics don’t necessarily worsen acne, especially if you use oil-free makeup that doesn’t clog pores (non-comedogenics) and remove makeup regularly. Non-oily cosmetics don’t interfere with the effectiveness of acne drugs.

Risk factors for acne include:

  • Hormonal changes. Such changes are common in teenagers, women and girls, and people using certain medications, including those containing corticosteroids, androgens or lithium.
  • Family history. Genetics plays a role in acne. If both parents had acne, you’re likely to develop it, too.
  • Greasy or oily substances. You may develop acne where your skin comes into contact with oily lotions and creams or with grease in a work area, such as a kitchen with fry vats.
  • Friction or pressure on your skin. This can be caused by items such as telephones, cellphones, helmets, tight collars and backpacks.
  • Stress. This doesn’t cause acne, but if you have acne already, stress may make it worse.  Acne is the most common skin condition in the United States.
  • Although it’s common, accurate information about acne can be scarce.


“Bees, wasps, and hornets can quickly take the fun out of summer activities, especially if an allergy makes an insect encounter a potentially life-threatening event. It’s best to “bee” prepared for whatever buzzes your way.”

Insect allergy expert David B.K. Golden, MD,Guest on (when the doctor bring the knowledge to you).

Go to and learn in Part 3 about our spring and summer friends who sting especially regarding how to treat it.


“Bees, wasps, and hornets can quickly take the fun out of summer activities, especially if an allergy makes an insect encounter a potentially life-threatening event. It’s best to “bee” prepared for whatever buzzes your way.”

Insect allergy expert David B.K. Golden, MD,Guest on (when the doctor bring the knowledge to you).



Honey Bee             Bumble Bee        Solitary Bees

honey bees bumble bees2solitarybees1

Part II.)  Types of Bees

A.) Honeybees

Honey bees have been around longer than humans; there is fossil evidence from 150 million years ago! Honeybees are highly social insects. Honeybees can contain up to 60,000 bees in its colony at its peak. Honeybees can fly up to 15 miles an hour. Worker bees are sexually undeveloped females. They build hives, forage for pollen and nectar for food and circulate air within the hive by beating their wings, among other tasks. The queen’s main job is to lay eggs, though she also directs activity within the hive. Male bees are called drones. In winter months when the hive needs to conserve resources, drones are expelled. Honeybees can only sting once, causing the

bee to die, as the stinger and the venom sack get stuck in the victim’s flesh after use.

Many people are afraid of bees because they think they will be stung by them, but bees are far more interested in going about their business foraging for pollen and nectar than they are in ‘stinging’ human beings. It actually takes a lot to provoke a bee to sting you – and many of our UK bees don’t sting at all.

Honey Bees will sting if defending their honey stores or their queen, or if they think you are threatening their life by standing or sitting on them.  Honeybees have a barb at the end of their sting which remains under your skin after they have stung.  When a honey bee stings a person, it cannot pull the barbed stinger back out. It leaves behind not only the stinger, but also part of its abdomen and digestive tract, plus muscles and nerves. Honey bees, including killer bees, have barbed stingers that tear off when they try to fly away after stinging, so these bees die after the sting and thus can sting only one time. In this case the stinger and venom sac typically remain embedded in the skin of the victim.This massive abdominal rupture kills the honey bee. Honey bees are the one of the few species of bees to die after stinging. They usually die right after they have stung.  It is worth noting that honeybees have a somewhat variable temperament, from extremely docile to quite tetchy. This is down to genetics: certain crosses can be hard to handle, even by experienced beekeepers. The good news is that honeybees almost never sting anyone who is not close to their nest/hive, so don’t worry about being stung whilst gardening or walking through a field.

****You are less likely to be stung when honeybees are swarming than at any other time.  Male honeybees have no sting If you have reason to think you may be allergic to bee venom, you should carry an Epipen (A PREPARED EPINEPHRINE DOSE WITH A NEEDLE to prevent anaphylactic reaction.)*****

B.) Bumblebees Like their relatives the honey bees, bumblebees feed on nectar, using the long hairy tongue (proboscis) to lap up the liquid; the proboscis is folded under the head for flight. Bumblebees gather pollen to feed their young

They will only sting if their nest is threatened or if you squeeze them, sit on them or stand on them. They are not naturally aggressive and it takes a lot to provoke them. If they feel threatened by you they will ‘tell’ you. They do this by raising one of their middle legs in the air. When you move away they will put their leg back down again – but if you go closer (and if they are unhappy about this) they will lift another leg in the air. If you go closer still – they will lift two legs up vertically in the air or turn on their back and show you their sting! This is called ‘posturing’ but very rarely leads to them actually stinging you.  If bumblebees DO ever sting, their sting has no barb like the honeybee, so they will not die afterwards 🙂

Male bumblebees do not have a sting.  You can identify the males of some species quite easily by their pale yellow facial hair and little yellow moustaches. Also, male bumblebees are in less hurry than the females when foraging and have thin hairy legs (females have a wide shiny, smooth top corbicula on their back legs and are often carrying pollen)

C.) Solitary bees

There are over 230 species of solitary bee in the UK and it is VERY rare for anyone to be stung by one of these bees. As solitary bees have no honey stores to protect, there is no reason for nature to have provided them with a good defence weapon like the honeybee. The females are equipped with tiny stings but rarely, if ever, do they use them. You would have to be squashing them to provoke them to sting – and even then, the sting is so insignificant that it cannot pierce human skin. There are just one or two exceptions. Although the effect is not as severe as a honeybee sting, our tiniest species of ground nesting solitary bee, Lasioglossum and Halictus, both have fully functioning stings capable of penetrating human skin.  None of the male solitary bees have stings.



“Most stings arise because an insect perceives a threat to their colony. Bees and wasps commonly sting because an intruder has neared the hive or nest.”

MEDICINENET.COM 12/11/2013 Bee and Wasp Sting


“It is a major cause of stroke, especially in the elderly. Although the causes are diverse, hypertension is common.”

AHA (American Heart Association)

Atrial Fibrillation with Rapid Ventricular Rate

afib  afib

Working of the heart:

 To easily identify atrial fibrillation with RVR, it is vital to understand the working of the heart. The atrium or atria (plural) is the upper chamber of the heart, bigger in size compared to the lower chambers known as the ventricles. The atria function by gathering blood as it flows into the heart and shrinking to forward the blood into the ventricles. At the very moment, the smaller ventricle must shrink to forward the blood to all parts of the body. This rhythm of blood flow creates a heart signature voice referred to as the Sinus rhythm. It is important that the sinus rhythm is synchronized so that the atrium does not send blood into the ventricle out of cue. To achieve this, an electric signal is generated to ensure the atrium contracts. When this signal short circuits (bypasses) the atrium, atrial fibrillation with RVR occurs, and the atrium is seen to vibrate just like jelly on a flat surface.

Atrial fib with RVR refers to atrial fibrillation with rapid ventricular rate. Usually the heart is like clockwork, the top (collecting) chambers beat then the bottom (main pumping) chambers sense this and also beat, and so on, in a nice regular fashion just like a clock ticking second after second. Usually the heart beats at about 60-80 beats per minute.

In atrial fibrillation the top chamber basically goes crazy often firing off over 400 beats per minute! Atrial fibrillation with RVR (Rapid Ventricular Response) is a heart condition caused by irregular electrical activity that results in irregular contractions of the 2 top heart chambers fibrillating. This means the heart (atriums), shakes with a rapid tremulous movement or makes fine irregular twitching movements, generally referred to as fibrillating causing little control in the heart output of blood by the heart but the lower chambers called the ventricles take over.

These bottom chambers don’t allow all those impulses through but it does let every second or third one through. This can give a heart rate of 100-180 beats per minute at rest, still too many beats, known as Afib with RVR, leading to symptoms and problems with heart function. Afib does not necessarily lead to Afib with RVR however, Afib can be rate controlled, sometimes naturally, sometimes using medications and sometimes requiring procedures as discussed below.

In most people with AFib although symptoms can sometimes be unpleasant it is generally not harmful as long as the afib is controlled, meaning the heart in the afib rhythm with the pulse under 100. The main concern is stroke, but that can be treated with the use of blood thinning medications in people at risk. In Afib with RVR, basically the heart is beating too fast. Of course palpitations are the most common symptom. Other symptoms of AFib with RVR may include dizziness, lack of energy, exercise intolerance and shortness of breath. If Afib with RVR goes on for too long then this may result in heart failure and of course worsening of existing heart failure. Control of the heart rate in patients with Afib with RVR often causes these symptoms to improve, again meaning the HR is under 100 with the heart rhythm in afib.

A major indication of atrial fibrillation with RVR is a very rapid heartbeat rate, although some patients are known to have the condition without showing symptoms. Atrial fibrillation with RVR may occur when cardiac muscle cells overcome their intrinsic pacemaker’s signals and fire rapidly differently from their normal pattern spreading the abnormal activity to the ventricles. The rapid heart rate can strain the heart, developing a situation referred to as Tachycardia (meaning a pulse greater than 100). Atrial fibrillation with RVR can be detected from the various symptoms though it is important to remember that some patients have experienced the condition without symptoms.


 Some of the symptoms of this disease include heart palpitations (described as unnoticed skipped beats or skipped beats noticed from experienced dizziness or difficulty in breathing), shortness of breath when lying flat (orthopnea), shortness of breath (dyspnea after exertion) sudden onset of short breath during the night (also called paroxysmal nocturnal dyspnea) and gradual swelling of lower extremities. As a result of inadequate blood flow, some patients complain of light headedness and may feel like they are about to faint, a condition referred to as presyncope and may actually lose consciousness (syncope). Some patients experience respiratory distress that results in them appearing blue. A close examination of jugular veins usually reveals elevated pressure in some patients (jugular venous distention). When some patients are subjected to lung examinations, crackles and rales may be observed pointing to possible lung edema.

Importance of proper diagnosis:

A good diagnosis of the symptoms shown by patients is important to ascertain that the patient is suffering from atrial fibrillation with RVR.  This is because some forms or irregular and rapid heart rates, tachyarrhythmia, are dangerous and must be ruled out as they are life threatening – such as ventricular tachycardia. Some patients are usually placed on continuous cardio respiratory monitoring, but an electrocardiogram ECG is vital for correct diagnosis.

 How is it diagnosed?

 Simple, a typical 12 lead electrocardiogram (ECG). This test shows cardiac rhythms which atrial fibrillation is. Rhythms are made up of types of waves that the ECG shows which are P waves, QRS waves, T waves and U waves.

The QRS complexes should be narrow, to signify that they are being initiated by normal conduction of atrial electrical activity through the Intra-ventricular conduction system, or heart conduction system. Wide QRS complexes could point to ventricular tachycardia, although wide complexes may also be an indication of disease processes in the Intra-ventricular conduction system. The R-R internal will also likely be irregular. Meaning measuring from each R section of the QRS rhythm. It is also important to find out if there are triggering causes for the tachycardia which include dehydration, Hypovolemia – a decrease in blood volume, and more specifically decrease in blood plasma volume. You can go ahead to eliminate Acute coronary syndrome – which refers to any diseases that are directly attributed to the obstruction of coronary arteries.


A Shock

This is known as cardioversion and is used typically either when an immediate result is required or used when the Afib is of relatively recent onset or only intermittent, and so has more chance of staying in normal rhythm. In cardioversion a small shock is given using defibrillation pads. It is done under light anesthesia therefore it doesn’t hurt. The Afib may return however.

Rate Control Drugs

The biggest problem in Afib with RVR is too fast a heart rate. In a rhythm control strategy we use drugs such as beta-blockers to slow the heart rate down. These drugs typically will leave the patient in AF. For many people with AF it turns out that a rate control strategy is preferred as it is considered less risky than the rhythm control drugs used to get rid of the AF while being just as effective. In Afib with RVR rate control drugs can often slow the heart rate down fairly quickly and improve symptoms.

Rhythm Control Drugs

These medications are generally more powerful than the rate control drugs and attempt to convert the Afib back in to a normal rhythm. They are often given after a shock treatment to try and help the heart stay in normal rhythm. These drugs are also commonly used in hospitalized Afib with RVR patients. The problem with these drugs is that they may have side effects and associated risks. Many patients simply cannot tolerate Afib even if the rate is controlled and therefore require rhythm control drugs. They may be safe and effective however if used in selected patients. In cases of Afib with RVR these medications may need to be used if patients cannot tolerate other rate control medications.

Ablation Procedures

Ablation procedures are minimally invasive procedures typically done through the groin. They are typically used in patients that have tried, or cannot tolerate medicines for control of AFib. Ablation is typically not used as an emergency treatment of Afib with RVR, rather it is used for stable patients in AF, or those with intermittent AFib that wish to remain in normal rhythm. In patients that have had persistent Afib for a long time these procedures are not likely to be successful in the long term.


This is typically the last throw of the dice for AF control. In some patients, drugs can either not control the rate in AFib with RVR, or the drugs can simply not be tolerated. In these patients who have no other choice, and in whom it is determined the Afib is causing harmful effects, a procedure called AV node ablation and pacemaker is done. In a relatively minor procedure, a small burn is made to the connection that connects the top and bottom chambers of the heart. A pacemaker is then inserted. This prevents Afib with RVR as although the top chambers continue to fire at a fast rate, the pacemaker now controls the bottom chamber, in a nice regular way. The downside of course is that now although the patient cannot have Afib with RVR, they have a pacemaker.

Acute afib RVR patients are more likely to be converted to Normal Sinus Rhythm (the best rhythm you could be in) as opposed to patients with chronic afib. There are complete resolutions for both kind of afib but atrial fibrillation in RVR the heart can handle for only so long and remembering the engine of our body is the heart so take good care of it for if you don’t it could allow you to die.