Rmapril2016

April 2016

Âť Spring: more than sunshine, page 3 Âť Maintaining mental health in pregnancy, page 5 Âť Finding hope and healing for children, page 6

April is Alcohol Awareness month.

Helping an alcoholic family member or a friend Helping a loved one struggling with alcoholism can be heartbreakingly painful, but with help, it can be remarkably rewarding. At times, it can seem so overwhelming that it would be easier to ignore it, pretend that nothing is wrong and hope it just goes away. But in the long run, denying it or minimizing it will be more damaging to you, other family members, and the person you are concerned about. Don’t wait, now is the time.

Alcoholism is a complex problem, with many related issues. And, although there is no magic formula to help someone stop his or her drinking, here are some important suggestions:

Speak up, offer support Talk to the person about your concerns, and offer your help and support, including your willingness to go with them to get help. Like other chronic diseases, the earlier addiction is treated, the better.

Express love and concern Don’t wait for your loved one to “hit bottom.”

You may be met with excuses, denial or anger, but be prepared to respond with specific examples of behavior that has you worried.

Don’t expect the person to stop without help No doubt, you have heard it before — promises to cut down, to stop, but it doesn’t work.

Treatment, support, and new coping skills are needed to overcome addiction to alcohol.

Support recovery as an ongoing process Once your friend or family member is receiving treatment, or going to meetings, remain involved.

While maintaining your own commitment to getting help for yourself, continue to support their participation in ongoing care, meetings and recovery support groups. Continue to show that you are concerned about their successful long-term recovery.

Some things not to do • Don’t preach: Don’t lecture, threaten, bribe.

• Don’t be a martyr: Avoid emotional appeals that may only increase feelings of guilt and the compulsion to drink or use other drugs.

• Don’t cover up, lie or make excuses for them and their behavior.

• Don’t assume their responsibilities: Taking over their responsibilities protects them from the consequences of their behavior.

• Don’t argue when using: Arguing with the person when they are using alcohol or drugs is not helpful; at that point they can’t have a rational conversation.

• Don’t feel guilty or responsible for their behavior, it’s not your fault.

• Don’t join them: Don’t try to keep up with them by drinking or using yourself.

Source: National Council of Alcoholism and Drug Dependence

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More than sunshine awaits during spring

By Dr. Christine Kimler

Despite the surprising “can you believe it’s snowing?” start to April, we did have a relatively mild winter in South Jersey. And after months of staying indoors, it’s easy to forget that there are lots of wonderful – and not so wonderful – things waiting for you in the natural world, including some that bite, sting and itch.

The absence of a deep freeze and the damp late-winter weather means that ticks could be abundant this spring. Ticks lurk in woodlands, leaf litter and the dense ground cover of landscaped areas. Ticks can transmit Lyme disease, and New Jersey is one of the 14 states that combine to account for 96 percent of all reported Lyme disease cases in the U.S. When you go outside, wearing lightcolored clothes will make it easier to spot any ticks that have crawled onto you. You can also use an insect repellent, but please read and follow label directions carefully.

If you find a tick attached to your skin, firmly grasp it (preferably with tweezers) as close to the skin as possible and apply firm, backward pressure to remove it. Then clean the area with soap, water and a topical antiseptic.

Afterwards, keep an eye out for the telltale “bulls-eye” rash of Lyme disease – a pale center surrounded by a bright red rim.

However, not everyone with Lyme disease will develop this rash, so watch out for

other symptoms, such as fatigue, headache, stiff neck, fever, muscle aches and joint pain, particularly if a joint becomes red or swollen. If you have any concerns, see your physician immediately. Early treatment with antibiotics is usually effective against Lyme disease.

The recent news of the Zika virus has raised awareness about mosquitoes, another pesky insect that will soon be out in great numbers. Although most people infected with the virus have few or no symptoms, Zika appears to cause certain birth defects.

So, pregnant women and women planning to become pregnant are being cautioned to avoid areas of the globe where Zika is prevalent. There is also evidence that the virus can be transmitted through sexual contact with someone who has been bitten by an infected mosquito.

Be aware that mosquitoes can transmit other illnesses, including West Nile virus.

To limit your risk, check your yard for any standing water in tires, pots, bird baths, gutters, etc., where mosquitoes can breed.

Also, use insect repellent to ward off the buzzing bugs and avoid being outside at dusk and dawn, the two times when mosquitoes are most active.

Stinging insects can present a more urgent health issue for those who are sensitive to the venom of bees, wasps or yellow jackets. Remove stingers by scraping

across (not squeezing) the spot with an index card or thick piece of paper. Apply ice to reduce swelling. Seek medical help for anyone who receives multiple stings at the same time, develops hives or experiences swelling beyond the immediate sting area that continues to spread after 24 hours.

Any breathing difficulties or throat closing sensation following a sting should prompt an immediate call to 911.

Barely visible to the eye, chiggers are biting bugs that inhabit grassy fields and moist areas throughout the world. Contrary to Dr. Christine Kimler is a popular belief, chiggers do not burrow under the Rowan Medicine family skin. Their bite, however, physician and a faculty member at the Rowan injects enzymes that University School of cause intense itching.

Osteopathic Medicine. To Treat chigger bites contact Rowan Family with calamine lotion Medicine or to schedule an or over-the-counter appointment, please medications, including call 856-566-7020. corticosteroid creams or oral antihistamines.

Enjoy the lovely spring weather that New Jersey offers…and don’t forget to wear sunscreen (at least SPF 30 that is water resistant with protection against UVA and UVB rays according the American Academy of Dermatology)!

PROTECT YOURSELF FROM INSECT BITES

USE REPELLENT

COVER UP

KEEP WINDOWS CLOSED

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A Personalized Approach to Care Rowan Medicine is proud to welcome Dr. Christine Kimler and Dr. Claudine De Dan to our Family Medicine team. Both Dr. Kimler and Dr. De Dan are board certified in Family Medicine, and are skilled in the diagnosis and treatment of common illnesses, as well as chronic conditions.

To schedule an appointment with Dr. Christine Kimler in our Stratford Family Medicine office, please call 856-566-7020.

42 East Laurel Road, Suite 2100 Stratford, NJ To schedule an appointment with Dr. Claudine De Dan in our Sewell Family Medicine office, please call 856-218-0300.

570 Egg Harbor Road, Suite C2, Sewell, NJ

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Baby on board: treating mental health disorders in pregnancy

By Dr. Rachel Shmuts

For many years, pregnancy was thought to protect women from mental health disorders. We now know that isn’t true. New or re-occurring psychiatric illnesses, such as depression, anxiety or bipolar disorder, occur with the same or higher frequency during pregnancy as they do during any other time in a woman’s life.

Depression is a common mental health condition among women of childbearing age.

According to national survey data, in any given year, about 10 percent of women between the ages of 18 to 44 years will experience symptoms of major depression.

Pregnancy, like many other health conditions, has mental health manifestations that can and should be treated. Too often, women who are taking medication to treat a condition like depression or bipolar disorder will suddenly stop taking their medication when they find out they are pregnant. Their reason, which is sometimes on the advice of Dr. Rachel Shmuts is a psychiatrist with the Rowan Medicine Department of Psychiatry and an assistant clinical professor at the Rowan University School of Osteopathic Medicine.

To schedule an appointment with Dr. Shmuts, please call 856-566-7090 or 856-482-9000.

their physician, is concern for potential harm to their unborn child.

While a cautious and conservative approach can be beneficial, it is important for women and health care providers to understand that not treating psychiatric conditions during pregnancy can lead to poor outcomes, including low birth weight babies and preterm delivery. Untreated depression or anxiety during pregnancy has also been shown to contribute to a higher rate of marital discord and to increase behaviors, such as tobacco or alcohol use, that can have a harmful effect on an unborn child.

Like many other medications, those used to treat a mental health condition can lead to complications during pregnancy. Whenever a woman with a medical condition becomes pregnant, there is a need to weigh the benefits against the risks of stopping any medications she takes. Ultimately, the outcome should yield the highest benefit, but lowest risk treatment option. As a physician, my goal is always to prescribe the lowest effective dose of the medication that my patients can take for the shortest possible duration.

Deciding if a pregnant woman should continue with medication for depression begins with understanding the severity of her

illness. If her symptoms are mild, she may be able to stop taking medication while pregnant and rely on psychotherapy alone. On the other hand, a history of severe depression, including hospitalization or attempts at selfharm, would indicate the need for continued use of medication throughout the pregnancy.

A final factor to consider is any experience the woman has had when she stopped taking that medication. At times, it may be possible to adjust dosages or change medications as an alternative to stopping all together.

While medications and talk therapy can help women cope with mental illness during pregnancy, a good support system is a positive predictive factor for a healthy delivery and successful post-partum experience.

Pregnancy can, at times, feel isolating. Having a supportive partner or family members who understand the challenges or who are alert to warning signs of acute episodes of mental illness can be invaluable.

Successfully treating mental illness during pregnancy is possible. If you are a woman of childbearing age who is currently taking medication for anxiety, depression, bipolar disorder or any mental health reason, talk proactively to your physician about your options for treatment during pregnancy.

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Rowan CARES: Hope and healing

V

iewed from a distance, the quilt hanging in the center hallway of the CARES Institute is a mix of vibrantly colored panels. But, draw closer and words and images slowly come into focus, and each section begins to tell a child’s personal story of horror and hope. The quilt and dozens of framed drawings, paintings and poems adorn the CARES hallways. All were created by children who formerly were patients at CARES. Together, they tell stories not easily told – stories of neglect, sexual and physical abuse, and, ultimately, the hope of children who began their healing process at the CARES (Child Abuse Research, Education and Services) Institute of the Rowan University School of Osteopathic Medicine.

Every year, an estimated 906,000 children in America experience sexual abuse, inappropriate or excessive physical discipline or neglect. Every day, four of those children die. Sexual abuse alone victimizes one out of every four girls and one out of every six boys before they reach the age of 18.

Child abuse happens every day, in every community, without regard to race, religion or socio-economic status.

A model for the world to follow As the only dedicated child abuse and neglect diagnostic and treatment center in South Jersey, CARES sees more than 2,000 children annually who are referred by child protective services or other professionals. According Dr. Martin Finkel, a pediatrician and CARES Institute co-director, approximately 40 percent of the children referred to CARES for suspected sexual abuse are under six years old. Most perpetrators – perhaps as high as 98 percent – are not strangers; they are individuals who are well known and trusted by the child.

“We see children who have experienced multiple traumas in childhood,” said Dr. Esther Deblinger, a psychologist who, with Finkel, co-founded and co-directs CARES. “And not surprisingly, the more traumas experienced, the greater the psychological difficulties suffered by the child.”

Finkel is the author of the first scientific paper published on the healing and interpretation of acute trauma related to child sexual abuse. His textbook on the medical evaluation of child sexual abuse is in its third U.S. printing and has been translated into Chinese, Japanese and Spanish.

Translations are currently under way so the text can also be available in Pakistan and several mid-Eastern countries.

Deblinger collaborated with Drs. Judith Cohen and Anthony Mannarino from Allegheny Hospital in Pittsburgh to create Trauma Focused–Cognitive Behavioral Therapy (TF-CBT), one of the world’s most successful approaches to helping children recover from trauma. Using games, art, role-playing and trauma narration, TF-CBT gradually guides children and their parents, helping them to process the trauma(s) they experienced.

“Although we originally developed TF-CBT to help children recover from sexual abuse, it is highly effective in addressing the emotional and behavioral difficulties caused by a wide range of traumas,” Deblinger said. “Through this process, children and their caregivers overcome their fears, sadness and anger, as they build on their personal strengths and develop positive expectations for the future. It is a short term approach with long-lasting impact.”

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Validated by 20 randomized scientific studies over the past two decades, TF-CBT is practiced in more than 90 countries. It has been used successfully to help American children after Hurricanes Katrina and Sandy, Japanese children affected by the tsunami, Tanzanian AIDS orphans, multiply-traumatized girls in Zambia, Burmese and Ugandan refugee children, Iraqi torture survivors and former child soldiers in Africa.

Healing through art The artwork hanging on the walls of CARES weaves a story that leads to the hope and recovery that children have found there.

“Drawing and artwork can be a vehicle that allows children to relax and express the things they don’t have the words for initially,” Deblinger said. “Art may be a first step towards healing, especially for children who suffered in silence for years.”

The hope and recovery evidenced in those images takes root as “Art may be a first step soon as a child arrives for an initial examination by a pediatrician. towards healing, especially “We see children and adolescents of all ages,” said Dr. Monique Higginbotham, a pediatrician at CARES for the past for children who suffered three years. “The goal is to create a setting where children can in silence for years.” tell their story to a doctor in their own words. We are not only gathering information about a traumatizing experience; we are engaging the child in a healing dialogue. This dialogue serves to validate the child’s personhood, to address any bodily concerns the child may have, and to restore the child’s sense of security and hope. The doctor visit is the first step in the healing process.”

“Sometimes, kids don’t want to say what happened; sometimes they just want to whisper it,” Finkel added. “If they don’t want to say something, I’ll ask if they want to write it down. One little girl wrote ‘sex’ on the paper and then crossed it out repeatedly, showing the anger she felt over what happened.”

Higginbotham’s first exposure to working with children who had suffered abuse occurred when she covered shifts for the child protection team at a children’s hospital.

“I didn’t choose to specialize in child abuse pediatrics – it chose me,” she said. “Seeing children in the outpatient setting, the emergency room, and medical and intensive care units, I quickly became aware of the magnitude of the problem. Every week I was seeing children who had been neglected, physically abused or sexually abused. I knew I had to be part of the solution.”

Because the CARES Institute is part of the Rowan University School of Osteopathic Medicine, faculty have a unique opportunity to raise awareness among the next generation of physicians.

Nicole Zamkoff, a third-year Rowan School of Osteopathic Medicine student, noted how hard it can be for children to talk about the abuse they experienced.

“The most important awe-inspiring lessons I learned at CARES were how to gain the trust of a child in a time when they trust no one,” Zamkoff said. “I knew this experience would be emotionally taxing, and it was. But, when I would get upset, I would remind myself that these children were extremely brave and, in a sense, they were fortunate. Only a fraction of the children who are abused tell someone who can help them.”

Fear, embarrassment, confusion and shame can all conspire to make it difficult for children to explain what happened to them. Compassionate communication during the child’s initial medical assessment at CARES makes the telling easier. Then, TF-CBT completes that story and helps guide children back to a life brightly lit by hope for the future.

“CARES is a place of healing,” Deblinger said. “Children leave here more confident than when they came in, even those who are here for their first visit. That’s because they know right away that each and every member of the CARES team is here to help.”

April in National Donate Life Month

Paying for kidneys may boost donor rate

By STEVEN REINBERG HealthDay

If offered $50,000, nearly three out of five Americans would part with a kidney, a new study finds.

“It appears that American society is ready to accept the concept of paying kidney donors,” said lead researcher Dr. Thomas Peters, an emeritus professor of surgery at the University of Florida College of Medicine.

However, Peters isn’t suggesting that a paid market for kidneys start anytime soon, only that the idea be studied to see if it might increase the supply of kidneys.

Paying for organs is illegal under the U.S. National Organ Transplant Act. When the law was enacted, “the feeling was that altruism should prevail,” Peters said. “Organs should not become a commodity, and the giving was as important as receiving.

“Laws should be amended or changed, so at least pilot studies regarding this question could be carried out to see if kidney donation would increase,” he added.

More than 100,000 Americans need kidney transplants, and donors are in chronically short supply, the study noted. The survey results suggest it might be time to consider sweetening the deal for living donors, Peters said.

When surveyed, 91 percent of more than 1,000 respondents said they would be willing to donate one of their kidneys to a stranger or a loved one. And 59 percent said $50,000 would increase their willingness, the researchers found.

The study authors chose $50,000 because prior studies had shown that that was an ethically acceptable amount

THE NEED IS REAL

Each day, about 79 people receive organ transplants. However, 22 people die each day waiting for transplants that can’t take place because of the shortage of donated organs.

Source: U.S. Department of Health and Human Services

of money that wouldn’t coerce people into donating an organ.

Also, it’s a little less than the cost of keeping a patient on kidney dialysis — the treatment for kidney failure — for one year, Peters said.

People are already paid for other medical donations, he said, mentioning surrogate mothers, egg and sperm donors and, in some cases, blood donors.

“Kidney donation isn’t increasing in the United States,” Peters said. And living kidney donation is decreasing, he added.

From 2004 to 2013, more than 63,000 Americans died or became too sick for transplantation while waiting for a kidney, the study authors said.

“There are now so many deaths and the number of people awaiting a kidney is so large that it’s a very strong ethical reason to at least study this concept,” he said.

The study findings were published online in the March journal JAMA Surgery.

The researchers found that of the 1,011 registered voters

surveyed, 68 percent would donate a kidney to anyone, 23 percent would donate only to certain persons, and 9 percent would not donate at all.

While 59 percent said that $50,000 would make them more likely to donate a kidney, 32 percent were unmoved by compensation. And 9 percent said they would be less likely to donate if they were paid.

Younger people supported payment more than older adults, the researchers said.

The concept of paying kidney donors merits some consideration, another transplant expert agreed.

“There aren’t enough kidneys available to transplant all the people on the waiting list,” said Dr. Marco Del Chiaro, an associate professor of surgery at the Karolinska University Hospital in Stockholm, Sweden.

“Living kidney donation is important and should be promoted,” he said. But selling kidneys raises ethical questions and “remains very debatable,” said Del Chiaro, co-author of an accompanying journal editorial.

However, Del Chiaro did say donating a kidney is safe, and that a kidney from a living donor is preferable.

But he believes more can be done to increase kidney donations within existing laws before starting to pay donors.

“There is a lot to do in using the laws we have now to improve kidney donation, which is more ethical in my point of view,” Del Chiaro said. “If that is not enough, then we need to think of a new solution.”

New IBS drug eases stomach pain and diarrhea for some

By STEVEN REINBERG HealthDay

A new drug for irritable bowel syndrome with diarrhea seems to reduce symptoms for some patients for at least six months, two clinical trials found.

Based on these findings, the drug Viberzi (eluxadoline) was approved recently by the U.S. Food and Drug Administration. In the threephase trials, more than 30 percent of patients experienced improvement in their symptoms at least half of the time they were taking the drug. This compared to about a 20 percent improvement in those taking a placebo, the study authors said.

“This drug offers another option for patients who have IBS (irritable bowel syndrome) with diarrhea who have not found relief with currently available treatment,” said lead researcher Dr. Anthony Lembo, an associate professor of medicine at Harvard Medical School in Boston.

This drug, taken twice daily, should only be used for IBS with diarrhea as the predominant symptom, not for those whose main symptom is constipation.

The drug treats the diarrhea and reduces stomach pain, Lembo said.

However, Dr. Arun Swaminath, director of the inflammatory bowel disease program at Lenox Hill Hospital in New York City, said, “Viberzi is not a silver bullet.”

The drug helps only about onethird of patients, Swaminath said.

“And if you look at the difference between the placebo group and

the group taking the drug, there is only a 10 percent benefit,” he said.

That means 10 patients need to get the drug to find the one patient it will help, he explained.

Swaminath also said that those who benefit from the drug feel about 30 percent better on 50 percent of the days they take Viberzi. “So this is hardly going from feeling abnormal to completely normal,” he added.

Results from the trials were published in the Jan. 21 issue of the New England Journal of Medicine. Funding for the studies was provided by Furiex Pharmaceuticals, maker of the drug.

Irritable bowel syndrome causes pain or discomfort in the abdomen and changes in bowel movement patterns. IBS affects 10 to 15 percent of adults in the United States, according to the U.S. National Institutes of Health.

For the new study, researchers randomly assigned nearly 2,500 adults with IBS with diarrhea to one of two doses of Viberzi or a placebo. In one trial, patients took Viberzi twice a day for 26 weeks, and in the other trial they took the drug for 52 weeks.

The researchers found that by the 12th week of the trials, almost 30 percent of patients taking the highest dose of the drug (100 milligrams twice daily) saw improvement in their symptoms, compared with less than 20 percent of those taking the placebo. These results remained

similar when assessed again at 26 weeks, the researchers said.

The most common side effects of Viberzi were nausea, constipation and abdominal pain, the study found. These side effects were mild and passed quickly, Lembo said.

The most serious side effect of Viberzi was pancreatitis, which is inflammation in the pancreas, the study found.

Although rare, pancreatitis can develop in people with pancreatic problems, and therefore Viberzi isn’t recommended for anyone with known pancreatic problems, Lembo said.

In addition, Viberzi shouldn’t be used in patients with a history of bile duct obstruction, severe liver impairment or severe constipation, or in patients who drink more than three alcoholic beverages a day, according to the FDA. Swaminath doesn’t think he would prescribe Viberzi as a first-line treatment, but would reserve it for people who aren’t responding to other treatments.

The basics of IBS treatment, according to Swaminath, are changes in diet to increase fiber, and using prescription drugs and over-the-counter drugs to control diarrhea. If these approaches don’t work, then he would try other drugs, including Viberzi.

“If patients have been on the standard medications and they didn’t work or they couldn’t tolerate the side effects, then we have a new option,” Swaminath said.

What's triggering your IBS? The Mayo Clinic says these factors may trigger IBS symptoms: • Certain foods, particularly dairy, chocolate, cabbage, cauliflower, beans, fruit, broccoli, high-fat foods, alcohol and carbonated beverages • Emotional stress can worsen IBS symptoms, but may not cause them • Changes in hormone levels, such as during menstruation • Conditions such as gastroenteritis or excess bacteria in the gut

Decoding your headache: Migraine vs. Cluster “My head is pounding.” It’s a complaint so common that it’s often not taken seriously. For the 29.5 million Americans— three times as many women as men— plagued with migraines, the gripe is also undertreated.

Half of those with migraines have never been diagnosed because they haven’t sought medical help, they have more than one type of headache, or their primary care doctor missed the diagnosis.

What is a migraine?

A migraine is what’s called a primary headache, meaning it’s not just a symptom of another disorder such as a sinus condition or a head injury. Scientists still aren’t sure what’s behind migraines, but they do know that in people who get these headaches, sensory nerves overreact to various triggers, first causing constriction and then dilation of the blood vessels in the brain. The result is pulsing, often incapacitating head pain that typically lasts a day and is often accompanied by nausea and extreme sensitivity to light and sound.

There are two subsets of migraines— migraines with auras (also called classic migraines) and migraines without auras (common migraines). They both feel the same, but the former arrives after a warning. The term aura comes from the Greek word for wind. Just as wind may pick up before a storm, an aura of neurological symptoms (such as flashing lights, zigzag patterns, blind spots in your vision, or, less frequently, tingling or pins and needles in your limbs) may show up 15 minutes to an hour prior to a migraine.

What is a cluster?

Cluster headaches (also referred to as alarm clock headache due to its interval occurrence, and suicide headache due to the intense pain) are a rare primary headache disorder, affecting only 0.1 to 0.4 percent of the adult population.

They are an extremely painful and disabling headache that is one-sided and

occurs around the eye or temple. It is often described as intensely sharp, burning, or piercing.

They are accompanied by at least one autonomic symptom on the same side of the head pain. These autonomic symptoms include: nasal discharge, tearing of the eye, miosis, and facial swelling. Most individuals suffering from cluster headaches are agitated and unable to lie down.

According to the third edition of the International Classification of Headache Disorders, a cluster headache is divided into episodic vs chronic headache, with episodic being the more common.

Individuals who suffer from chronic cluster headaches have attacks that last for more than one year without a break, or if they do have a headache break, it’s for less than one month.

An untreated cluster headache lasts anywhere from 15 to 180 minutes. A sufferer can experience multiple cluster headache attacks in one day—typically up to eight.

Source: National Headache Foundation and American Academy of Neurology.

“Headaches are divided into two basic categories: primary/benign (tension-type, migraine, cluster) and secondary (organically caused). All headaches fall into one of these two categories depending on their causes and symptoms."

Source: National Headache Foundation

Nails: A window on your health Tips for A person’s nails can reveal much about their overall health.

Many diseases and serious conditions can be detected by changes in the nails. Most doctors will check the nails carefully during a physical examination. The most common health conditions and their effect on the nails are listed below.

White spots White spots on the nails are very common and usually recur.

These small, semi-circular spots result from injury to the base (matrix) of the nail, where nail cells are produced. They are not a cause for concern, and will eventually grow out.

Splinter hemorrhages A disruption of blood vessels in the nail bed can cause fine, splinter-like vertical lines to appear under the nail plate.

Splinter hemorrhages are caused by injury to the nail or by certain drugs and diseases. However, trauma is the most common cause. Splinter hemorrhages resolve spontaneously.

Ingrown nails Ingrown toenails are a common nail problem. Improper nail trimming, tight shoes, or poor posture can cause a corner of the nail to curve downward into the skin. Ingrown nails can be painful and sometimes even lead to infection. Seek treatment for the condition rather than attempting to cut away the nail yourself, as infection may result.

Fungal infections Fungal infections make up approximately 50 percent of all nail disorders and can be difficult to treat. More common in toenails than fingernails, they often cause the end of the nail to separate from the nail bed.

Additionally, debris (white,

green, yellow, or black) may build up under the nail plate and discolor the nail bed. The top of the nail or the skin at the base of the nail can also be affected.

Toenails are more susceptible to fungal infections because they are confined in a warm, moist, weight-bearing environment.

Candida or yeast infections are common in fingernails especially if the hands are always in water or if the patient is diabetic.

Bacterial infections Redness, swelling, and pain of the nail skin folds often indicate a bacterial infection. The most common cause is trauma to the nail or surrounding skin, or frequent exposure to water and chemicals.

Tumors and warts Tumors and warts can be found near any portion of the nail unit. However, the nail plate can change shape or be destroyed as a result of the tumor or wart growth. Tumors of the nail unit are classified as cancerous or non-cancerous (benign). The most common non-cancerous tumors are warts. Warts are viral infections that affect the skin surrounding or underneath the nail. They are painful and can sometimes cause limited use of the affected finger or toe. Treatment of warts usually involves freezing or chemical application for removal.

If the wart or tumor extends into the nail folds or is located under the nail plate itself, dermatologic surgery may be necessary to remove it.

Psoriasis Psoriasis is a chronic skin disease characterized by red, scaly patches.

Approximately 10 to 50 percent of people with psoriasis, and 80 percent of people who suffer from inflammatory arthritis associated with psoriasis, also have nail problems. The most common nail problems include pitting, rippling, or discoloration of the nail, reddish-brown discoloration of the skin under the nail, separation of the nail from the nail bed, splinter hemorrhages, crumbling and/or splitting of the nail, as well as swelling and redness of the skin surrounding the base of the nail. The signs of psoriatic nail are usually most noticeable on the fingernails.

Source: American Academy of Dermatology

healthy nails

Nails reflect our overall health, which is why proper nail care is so important. Here are dermatologists’ tips for keeping your nails healthy: • •

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Keep nails clean and dry.

Cut nails straight across. Use sharp nail scissors or clippers. Round the nails slightly at the tips for maximum strength.

Keep nails shaped and free of snags by filing with an emery board.

Do not bite fingernails or remove the cuticle. Doing so can damage the nail.

Do not use your nails as a tool, such as opening pop cans.

Trim toenails regularly.

Keeping them short will minimize the risk of trauma and injury.

When toenails are thick and difficult to cut, soak your feet in warm salt water. Mix one teaspoon of salt per pint of water and soak for five to 10 minutes.

Avoid “digging out” ingrown toenails, especially if they are infected and sore. If you are suffering from an ingrown toenail, see a dermatologist for treatment.

Wear shoes that fit properly.

Also alternate which pair of shoes you wear each day.

Wear flip flops at the pool and in public showers. This reduces the risk of infections caused by a fungus that can get in your toenails.

Source: American Academy of Dermatology

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Count on Rowan Medicine for the best choice for your child’s care. With two locations in South Jersey, access to our teaching physicians and health care providers at the acclaimed Rowan University School of Osteopathic Medicine is only a phone call away.

Sewell 856-582-0033 | Stratford 856-566-7040 rowanmedicine.com Kennedy Health is the principal hospital of the Rowan University School of Osteopathic Medicine. Other affiliated hospitals and health systems include Lourdes Health System, Inspira Health Network, Cooper University Hospital, Meridian Health System, Christ Hospital and Atlantic Health System.