Rash Behavior

A reader asked a question about how to deal with heat rashes.

Now, a simple rash caused by friction and moisture is pretty easy to deal with. Clean the area thoroughly with soap and water or other cleanser, scrubbing off any easily removed dead skin in the process. Then disinfect the irritated and surrounding areas with a topical sanitizer like rubbing alcohol, witch hazel etc... (Some prefer non astringent sanitizers, personally I think they work better). Dry fully, and then dust with calamine powder, monkeybutt powder, extra strength gold bond etc...

Do not use cornstarch or other organic material containing carbohydrates (and if you wear makeup, either don't wear makeup on the irritated area, or use a mineral powder based makeup). Cornstarch is sometimes recommended for babies, as being gentle on the skin, and because some babies are irritated by talcum powder. However, cornstarch can actually feed infectious fungi and bacteria living on the skin (particularly candidensis), and make any existing infection worse, or even jumpsart an infection that wouldn't otherwise have taken hold.

Also, avoid anything which will tend to clog the pores (which means only applying powders when you are thoroughly dry, and only a light dusting. Don't use pore clogging creams or deodorants, like glide on sticks or gels. Alumina based sprays and alum crystals are fine so long as they are used lightly. They shrink the pores, but don't actually clog them so long as you wash them off every 8 to 16 hours). Clogged pores combined with bacteria or fungi, can turn a simple rash into a sebacious pustule, cyst, boil, or carbuncle.

If the irritation is really bad, but not blistered, oozing, cracking, or bleeding, you may want to use a topical antiinflammatory like cortisone cream.

BUT...

Its very easy for a simple "heat rash" to turn into a bacterial or fungal skin infection... Or it may have been a bacterial or fungal rash in the first place.

This is especially true if you do a lot of hot and heavy work or exercise, live in a tropical climate, use communal pools, gym, or shower facilities, swim or spend  a lot of time in the water, or have pets or contact with livestock.

If you are obese, diabetic, have liver or kidney problems, or are immunocompromised, its both far easier to get such an infection and far more dangerous to you when you do.

With all that in mind, here's some tips from a pro at dealing with this sort of stuff (military service in hot and humid climates, living in florida, Arizona, Georgia, Texas etc... Dealing with animals, and having been a competitive athlete; I've een a hell of a lot of it. Now that I'm a fat man, and immunocompromised to boot, they are something I personally deal with at least a few times a year); on how to avoid, and how to treat, most common mild infectious skin issues.

The first thing is the basic rash advice above. Keep things clean and dry, and help them to stay that way with judicious use of powders, and wearing clothing that allows airflow made from fabrics that breathe and wont hold moisture against the skin. Bathe frequently but not so frequently you dry your skin out and strip protective oils. When you do get damp, don't then put that skin through a lot of friction, and dry it off as quickly and completely as possible.

If you see a rash coming on, or have an active rash or mild infection that doesn't appear to be serious, isn't spreading, and isn't having systemic effects inflammation in other areas, fever etc...) here's how you slow it down, reduce its impact, and treat it.

You can get prescription creams and foams etc... That will help clear things up, but you can make some for yourself that will generally be just as effective... And a lot cheaper.

First, get a big squeeze bottle from your local Walmart or analog, in the hair and beauty products section. Then get yourself three different kinds of anti dandruff shampoo in the smaller non family size bottles.

Nizoral has ketoconazole, which will help with some kinds of skin fungus and bacteria (its an anti fungal specifically but also has antibacterial and antiinflammatory properties). Denorex has both fairly strong concentrations of salicylic acid, and menthol, both of which can help with skin inflammation and are antimicrobial. Finally, head and shoulders uses selenium (usually selenium sulfide, but there are other formulations out there), which can be effective against both some fungal, and some bacterial vectors.

Feel free to buy the generics, or other brands, just make sure you get the strongest concentrations of each ketoconazole, salicylic acid, and selenium. You can also get anti-acne body washes that have high concentrations of salicylic acid, which can work.

Dump the entire bottle of Nizoral (it only comes in small bottles) into the big squeeze bottle. Then fill the rest half and half with the other two, and shake to mix thoroughly.

Shower twice a day, and after any workout, other heavy exertion, or swimming; using the mix as a body wash.

Using your hands only, thoroughly wash and scrub the inflamed areas, as well as other susceptible areas (skin folds and creases, underarms, crotch, behind the ears, around the mouth, your face, your scalp etc...), keeping the wash lather on your skin in those areas for at least two minutes.

To avoid transferring bacteria or fungi between areas, save any inflamed or infected areas for last; and wash your hands thoroughly after cleaning the inflamed area, including getting under your nails.

The very last thing before leaving the shower, clean your feet, top and soles, and between the toes, very thoroughly, using the wash.

Step out only onto a cleaned and sanitized tile floor, or a clean and dry towel NOT onto a bath mat. Use shower shoes or flip flops which you can sanitize if you need to.

Dry off thoroughly and vigorously, in order to help get rid of any dead skin which may increase the risk of irritation and infection. Avoid drying off any already inflamed areas until the end (again, to avoid spreading infection).

When you're FULLY dry, use the gold bond on the irritated areas, and any of the susceptible areas that may stay moist or get chafed.

If you have an active minor infection or any raised or rough inflammation, use  an antimicrobial treatment (if surface/subsurface fungal or bacterial infection) such as ketoconazole cream (which can be effective for both fungi and some skin infection bacteria). If you are certain it is just skin irritation and not infected, a steroidal topical antiinflammatory cream like cortisone can help reduce irritation and itching.

If you have a bacterial or fungal infection, using a steroid cream alone may make it worse.

There are tradeoffs... They suppress inflammation and itching which reduces the risk of skin cracking, minor abrasions etc... thus reducing the likelihood of infection; but if there is already an infectious bacteria or fungal spore in the irritated area, a steroid may reduce your natural ability to resist infection).  The act of applying the cream may also possibly spread the infection wider... so be careful. If you suspect bacterial or fungal infection, only use a steroid in concert with an antifungal or antibacterial (or preferably one that has both properties such as ketoconazole or miconazole).

Finally, spray or wipe down your bathtub or shower, the bathroom floor, and if you used any, your footwear; with either a bleach solution or ammonia (or other strong sanitizing agent), and clean your towels with a strong sanitizing agent (do not use them more than once without sanitizing them).

Also, wash your linens and your clothes, particularly undergarments, socks, and swimsuits; with either chlorine bleach, an oxygen bleach (like oxy clean or color safe bleach), or other strong sanitizing agent.

Many shoes and socks say they are antibacterial, antifungal, or otherwise antimicrobial... Don't believe it.

Always wear socks with any footwear that can't be sanitized and which holds moisture against the feet.

If you wear sandals, surf shoes, crocs etc... Make sure you sanitize them before you put them on after showering, and either in the morning or before bed... Or both. Spray or wipe them with dilute bleach or an oxygen bleach solution, ammonia solution, or some other strong sanitizing agent (Lysol works for example). Make sure you wipe them off well before putting your bare feet into them however, to avoid potential contact dermatitis.

If you wear socks, dust them with a sanitizing foot powder or a strong mentholated drying powder like gold bond. Do the same with the inside of your shoes if they enclose the foot fully, or they have a fabric or leather inner lining.

You're going to want to do all this even if its "just a simple rash", because often " just a simple rash" isn't, and because even if it is just a simple rash this routine will help prevent it from becoming something much worse.

Now... Here's the kicker... If its just friction irritation, inflamed moist skin, or contact dermatitis, you can stop this routine the day after the irritation subsides. If however it's a bacterial infection you need to continue for a week after the irritation clears, and if its a fungal infection, or the irritation reappears within 7 days, you need to continue the regimen for FOUR FULL WEEKS after the apparent infection or inflammation subsides. Fungal infectious vectors are extremely persistent and can survive for a long time on towels, clothing, tiles, in tubs and showers etc..

In general, to help avoid such infections, you should clean and sanitize your bathing areas (wherever wet skin may touch a surface basically) at least once a week if not more frequently

Oh and if you have a persistent rash or any kind of skin infection, even with sanitizing, anyone who shares bathing facilities with you should wash with the mix, cleaning the susceptible areas at least once a day, and take particular care to avoid infecting their feet (for example, they may want to use shower shoes as well).

If your rash doesn't respond to this regimen at all within a few days, shows bullseye or expanding ring presentation, becomes seriously inflamed or discolored; bruising or subcutaneous bleeding or blood vessel discoloration or ruptures appear; the rash spreads over a large area or breaks out in widely separated unrelated areas of the body; it exhibits blistering, cracking, bleeding, or suppurating; or you experience any systemic symptoms such as diffuse pain or inflammation, inflammation or discoloration of mucous membranes or nail beds; joint pain, fever, or any respiratory or neurological symptoms; seek medical treatment IMMEDIATELY.

Changes - Part 1

Last Monday, I did something I haven't been able to do in over two years.

I worked out.

Actually, I worked out twice, once in the morning, and then again in the evening.

I haven't been able to, because the pain, inflammation, and dependent fluid retention in my joints was so sever that I simply could not do it. My body wouldn't support my weight, and the weight I wanted to lift. It wouldn't let me pedal the bike and then walk away...

And now, that's changed, because my doctors have finally found a good balance of medication for me.

For the past few years they've been... experimenting shall we say... with what medications actually help me, what does nothing, and what actually makes things worse.

I've been on almost every anti-inflammatory out there up til now; except lodine, celexa, and vioxx (which they pulled off the market a few years ago.

Most recently we were trying meloxicam (aka Mobic); and it did help, but only in very high doses (60mg daily. Normal is 15mg). That said, if taken in combination with Ibuprofen or Naproxen, it made them more effective.

It wasn't enough, but it took the edge off.

The problem with strong prescription anti-inflammatories, is that they all tend to have nasty side effects; including ones that make my other symptoms worse (like edema, and gastrointestinal difficulties). Some of them also interact badly, or are at least partially counteracted with testosterone, and somebadly with strong diuretics).

Given that, my normal docs were very leery of prescribing anything "stronger" than Naproxen. My GP only agreed to prescribe Meloxicam on an "as needed" basis, for when the inflammation got so severe I had trouble walking.

Which, unfortunately, it had been since fourth of July weekend (I slipped and fell on the dock while swimming, and torqued something. I couldn't walk at all the next few days).

Then, two weeks ago, I finally had my appointment with my new orthopedist. He listened to my history, examined my joints, and immediately sent me down for x-rays (same office visit, came right back up with them 30 minutes later).

And he said something that surprised me.

He said I don't need knee replacements yet.

That yes, they're both in rough shape ( I have osteo-arthritis, synovitis, and cartilage and tendon damage in both; and I may be developing rheumatoid arthritis, but it's too early to tell); I can regain much of my mobility with proper drug treatment and the right exercise regime.

Because I have been in so much pain for so long, my supporting muscles have atrophied and tendons and ligaments have lost flexibility(because the joints hurt so much, I try to avoid moving in the ways that make them hurt worse, which means I don't exercise those muscles and stretch those tendons enough). This in turn made the joints less stable, which made them hurt worse and so on, in a vicious circle.

That day, he started me on Lodine (aka Etodolac), 400mg twice a day (1200mg is the highest daily dose allowed. They make it in 400, 500, and 600mg tabs).

The next day, I was able to walk up and down the stairs in my house without pain, for the first time, ever.

I wasn't flexible... I was stiff, and slow... but I wasn't actually hurting when I started, or when I finished.

Thing is...

I haven't used a flight of stairs without pain in 10 years.

I should be clear... The pain isn't GONE by any stretch of the imagination; but it's so reduced as to be nothing in comparison. I went from a level 4 constant background pain with spikes to level 7; down to a 1, with spikes to a 2 or 3.

And walking up and down the stairs, doesn't really aggravate it. I can go up and down the stairs a half dozen times in a couple hours now, and be fine; whereas before more than two or three times a day and I wouldn't be able to move for hours.

It's not perfect of course. It works a lot better when I double them up to 800mg, and its peak effects only last for two hours or so; but two of them, timed properly, cut the pain and improve my mobility dramatically all day long.

I've asked the doc to up me to two 500s a day and see how that works (the 600mg is extended release only; and ER formulations don't work well for me; plus diuretics tend to make them much less effective).

The next thing the doc wants to do hasn't happened yet; but the medication is ordered (should be here next week actually).

Instead of cortisone injections in the knees (which only last a few weeks, and have their own side effects, like accelerating joint degeneration), he wants to try my out with injections of Synvisc (hylauronic acid in an oil based lubricating transport).

It's supposed to both lubricate the joint, and reduce inflammation dramatically.

Unfortunately my copay is $400 a piece for the injections, even after my out of pocket max for the year (yeah I know... insane). Apparently this stuff is also popular in cosmetic surgery (where it's sold under the trade name Restalyn), so they can charge a fortune for it; and they won't price the orthopedic version any less so it won't be used cosmetically, off label.

Also, it doesn't work for everyone; and for a small percentage, it actually causes a bad histamine reaction (like a nasty bee sting, only inside the joint). So, he wants to try me out and see how it works for me on one knee, wait a few weeks then do the other one.

If it works, I would need to get a series of shots in each knee; but the inflammation should be dramatically reduced for several years, delaying, or even eliminating, the need for surgery (at least until my mid 40s to early 50s. The doc is pretty sure by then I will need the knee replacements).

The final thing the doc ordered (other than losing weight of course), is that I absolutely MUST work out again (particularly with the testosterone).

Of course I knew that already, and it was part of the plan; but the pain was in the way.

Now the pain isn't in the way (or at least not enough to stop me).

I am under strict order to exercise my legs, and in particular my knee joint, and the supporting muscled and tendons. Not to overstrain them, but to give them frequent, repetitive, no impact tension and stress. I.E. the exercise, and leg extensions and thigh curls at high reps and low weight.

So, last weekend I snagged myself this:

Which, after a couple hours of effort became this:

And along with this (325lbs on a weight tree):

and this (which I already had):

And I'm working out again, finally.

20 minutes on the bike in the morning, followed by 40 minutes on light to moderate weight and high reps; then 20 more minutes on the bike in the evening.

At least when I have the time, which starting this week is a lot less (more on that in a later post).