Sunday, August 31, 2008

Skin cancer, eczema, pink eye, ear infection and Medicine.

Lomeli Clinical Images 82407

In clinical Medicine, so much remains undefined. The data in most textbooks are derived from various sources and written by authors who may not see patients. Looking back, I have been studying medicine, especially psychiatry, since I was just a boy.

There are great medical students who are unable to get the information I own. They write to me from other countries asking me to post more of my works. Had I committed myself to a publishing contract, I would not be able to do what I do today for the benefit of Medicine and Humanity.

There are many topics in the video. The first one is of an infant with widespread Seborrheic Dermatitis. This case was probably due to a hypersensitivity reaction to a fungus. He was well at 12 months of age.

Actinic Keratosis (AK) is simple to treat with liquid nitrogen. The clinician must make sure that the patient is not prone to Keloid formation. AK is a low-grade precancerous condition that might lead to a Basal Cell Carcinoma. These cancers are locally invasive and readily treatable. Squamous carcinoma of the face and neck are infrequent but are significantly more serious. Melanomas are relatively rare, and I am always looking for dysplastic lesions. I suspect that billions of dollars are spent yearly in biopsing moles that most often are benign, not melanoma.

Victoriano is my patient with the big tongue. He was born at the Los Angeles Children's Hospital and his Lymphangioma and Hemangioma were more extensive at birth and extended into his lungs. His tongue becomes swollen and infected when he accidentally bites it. The best treatment I developed was a mixture of Amoxicillin, Metronidazole and a short course of Prednisone. He is now 9 and the lesion is about 85% resolved.

My son was a mouth breather, and I never used over-the-counter drugs for his congestion. Mouth breathing may be useful in preventing the allergen from reaching the lungs and thus activating bronchial asthma in a susceptible patient. I have often seen pollen in the stools of children with hay fever. Parents worry that mouth breathing might cause harm or a lack of oxygen to the brain. It is not so. Allergic rhinitis is the most common cause of middle ear infections. Why is this important?

A year ago I saw a 23-pound, 1-year-old child with continuous otitis media for a month. He had been receiving toxic amounts of antibiotics (adult doses), but he had failed to respond. He developed diarrhea with yeast buds as seen in this video. Parents can help the doctor by simply observing that the child with recurrent middle ear infections is always rubbing his nose, is congested and often breaths through his mouth. My approach to middle ear infections has eliminated the need for "ear tubes" in 99% of my patients.

Dermatology, for the most part, is really psychiatry. In my medical career, I rarely needed to consult a dermatologist. The child with hand dermatitis (suctioning of area when stressed with secondary salivary/traumatic dermatitis) turned out to be highly complex psychologically. The skin part was the easiest part to treat. The man with the ear malformation was wearing a band-aid. His wife had been making comments about his "ugly ear." The young woman with eczema over arms with secondary infection required counseling which took me an hour. She has been my patient since, though she has insurance that I do not accept (it doesn't cover my costs).

Erythema annulare centificum is also spelled centrifigum according to another source. The patient in the view was 8-months pregnant and was otherwise healthy. I suspect that she developed a hypersensitivity reaction to a skin fungus (dermatophytes).

The lady with the Erythema Nodosum was well a month later after a short course of Prednisone. In Medicine, one must be cautious regarding cause and effect. In other words, if I had attributed her Erythema Nodosum to a positive skin test, I could have missed an alternative diagnosis.

The Jerusalem Cricket is of concern since many Latinos are horrified of it, though it causes no harm. Halitosis, or bad breath, is often attributed to liver disease, as is Melasma or Chloasma.

Nickel is a ubiquitous metal and is used in metal utensils, jewelry and is mixed with Gold in order to harden it. Regarding your eyes, before using Restasis®, you should consider the possible consequences.

Shingles over the ear/eye can be serious. The patient in the video recovered. Giardiasis may be difficult to diagnose and stool studies are often reported as falsely negative (not present). The clinical history is of utmost importance.


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