How safe is petroleum jelly near eyes?

Q: Every night I use a name brand of petroleum jelly (quite a bit) to take off my mascara. Do I understand we don’t know how pure this product really is?

Thank you for your common sense column. You are great.

A: Thank you.

The primary ingredient in the brand you mention that I have intentionally omitted is petroleum jelly, a derivative of oil refining. It is commonly used topically to cure almost anything – from dry skin to diaper rash. In October 2013 the Huffington Post covered the topic following enlisting a New York based dermatologist Dr. Alan Dattner who is the founder of HolisticDermatology.com. The article indicated that though generally regarded as safe, the components that are removed from the oil during the refining process of petroleum jelly are carcinogenic IN SOME CASES. The physician pointed out that different grades of purity can be found in petroleum jelly, so we don’t always know how non-toxic products with this base really are. Keep in mind, however, the article went on to indicate the brand to which you refer is highly refined, triple purified and is regarded as non-carcinogenic.

When applied to skin, petroleum jelly can create an illusion of moisturized, hydrated skin that suffocates pores. It is water repellent, not water soluble, implying it seals the barrier so moisture doesn’t leave the skin. While immediate moisturizing may be felt, the pores are actually drying out because of keeping out air and moisture. What’s more, the thick texture makes it difficult to cleanse the skin, so never slather petroleum jelly on an unwashed face because it essentially seals in the dirt.

Individuals that suffer from acne, rosacea and some other skin conditions should stay away from the product altogether, since the thick emollients can aggravate these conditions. Those who rub the product on dry, cracked noses from a cold might want to think twice also because if petroleum jelly gets into the lungs, it can cause lipid pneumonia. The practice can be used now and then, but Dr. Dattner recommends not making a daily habit of it.

So, why do people use it? It’s inexpensive and provides the perception of instant relief. Dr. Dattner indicates that an alternative is to opt for more natural alternatives but it is imperative to check labels first. He suggests products that contain beeswax, coconut oil, olive oil, shea butter and cocoa butter – all which seal in moisture and don’t carry the risks of petroleum jelly. Surprisingly, there are countless brands available in most pharmacies and large chains that advertise “non-petroleum jelly” on the labels.

It appears petroleum jelly is safe, yet I cannot determine if you are doing any harm by cleansing with a petroleum product so close to your eyes. Still, there are numerous mascara and makeup removal products that might be easier to use without questions of safety. I must point out, however, that you should extensively research the ingredients in any product before you decide to make a purchase. There is no point in substituting one less than optimal product for another. One last option is to contact a local dermatologist for his or her recommendation on something that may be as safe. Good luck.

Medical condition stagnates 15 year-old

Q: My 15 year-old daughter has had costochondritis for more than three months and has seen four doctors and is now seeing a rheumatologist. Nothing we have tried has helped her, we only seem to be barely managing her pain. She cannot attend school or do any activities, she is just in bed all day. I do a little physical therapy with her just to move her arms and legs but would like to find some treatment that will help her have a normal life again.

A: Costochondritis is inflammation of cartilage that connects a rib to the breastbone. The condition may result from strenuous exercise or movements that include lifting a heavy object, trauma to the chest, infection from a virus, bacteria or fungi, some forms of arthritis and ankylosing spondylitis, and even benign or malignant tumors. Interestingly, most cases have no apparent cause, making it extremely difficult to determine how to treat the condition, since the pain mimics that of a heart attack or other cardiac conditions, commonly occurs on the left side of the breastbone, worsens when coughing, taking a deep breath, or sometimes simply from moving or stretching in a particular way. The peak age for costochondritis is ages 12-14.

A related condition is known as Tietze’s syndrome that involves the same area of the chest but presents with swelling. Tietze’s signs and symptoms include localized pain and tenderness but also with swelling over the ribs and cartilage near the sternum. Redness, pain and warmth may be determined that might last for hours to weeks. In the case of this syndrome, lab testing that includes a sedimentation rate or C-reactive protein test will reveal information necessary to diagnose a patient.

There is no lab testing or X-ray imaging available for confirmation of costochondritis as there is for Tietze’s; however, a physician may palpate the rib area to trigger symptoms, order an electrocardiogram (EKG) and order X-rays so other suspected conditions can be confirmed or ruled out.

Treatment may begin with over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) such as Aleve, Advil, Motrin and a host of other products. Prescription NSAIDs are stronger and may follow if no relief is found. Severe pain may warrant narcotic medications. Unfortunately, narcotics can be habit forming and are avoided whenever possible. And, along with narcotics, if they are prescribed, a physician might prescribe gabapentin or amitriptyline for pain management. Gabapentin is a drug ordinarily used to control epilepsy, while amitriptyline is an antidepressant, yet both have been found to decrease the pain of costochondritis. Transcutaneous electrical nerve stimulation (TENS) may be recommended which has the ability to interfere with pain signals prior to reaching the brain, and gentle physical therapy stretching exercises may be appropriate. Ice and/or heat applied to the site may reduce the pain experienced. It goes without saying that rest should allow the inflammation to dissipate and the pain to disappear. Both conditions may respond favorably to cortisone injections or lidocaine analgesic patches.

Your daughter’s physician was definitely on the right track referring her to a rheumatologist. I must admit, however, that I am perplexed as to what disorder would only affect the anterior chest wall. Perhaps you should speak with the rheumatologist regarding such possible conditions as slipping rib syndrome or a precordial catch. If they have not been ruled out at this juncture, your daughter may be better served by having either condition evaluated in depth at a major academic medical center.

Frozen snack helps prevent weight loss

Q: I am a female in my 90s and suffer from pulmonary hypertension. Often I have no appetite, so our son made a healthy drink for me that I would like to share with you. It consists of Ensure, milk, fresh fruit, and ice cream. Then it is frozen and eaten like a sherbet. He spent a great deal of time working on the right amounts and for me, it serves as a morning snack and helps me to maintain my weight. I find it almost an addiction since I enjoy it so much and think it would be helpful for patients who find it hard to eat or swallow. Neither he nor I want anything but to share this with people who would benefit from it or just enjoy it. We can be reached at nsinton@wildblue.net.

A: So all readers will understand what you are coping with, I will touch on pulmonary hypertension (PH), which is an increased pressure within the pulmonary arteries. Pulmonary arteries transport blood from the heart to the lungs where oxygen is received. The condition generally causes shortness of breath during normal activity, chest pain, fatigue, and a rapid heart beat. In order to fully understand the condition, it may help to know how the heart and lungs work together, so I will keep it brief and simple. The heart has two sides, each side has an upper and lower chamber. The lower right chamber known as the right ventricle pumps blood to the pulmonary arteries. The blood then moves on to the lungs where it receives much-needed oxygen. The upper left chamber of the heart (the left atrium) then receives the oxygen-rich blood and pumps it into the lower left heart chamber (the left ventricle) and ultimately travels throughout the balance of the body through the aorta.

There are several other less common reasons for PH to occur as well, that may include blood clots that form in the arteries, arterial wall tightening, and arterial walls that may be either stiff at birth or become stiff from cell overgrowth. Whatever the cause for the PH, the heart must work harder to push blood into the lungs. That overwork causes the pressure within the arteries to rise. The excess of work placed on the heart causes the right ventricle to become weaker and may lead to heart failure.

There is no cure for pulmonary hypertension. On the positive side, however, advances in research are ongoing and very promising. Treatment including therapy, medical procedures and medication have proven to provide very positive results in relieving symptoms and slowing the progression of the disease.

Enough said and now onto your tasty addiction! As we age, there appears to be less interest in meals and weight loss often follows. And, as we all know, diet and exercise are very important for maintaining good health. Ensure is well-known as a good source of protein, essential vitamins and minerals and omega-3 fatty acids that is gluten free. I have a feeling you may receive a lot of response from his master blending, so thank you for sharing this success story.

Man finds cure for bad breath

Q: You have had a couple of columns about bad breath in the past. About four years ago some people said in you column they used hydrogen peroxide in a gargle of 50/50 with water. I have used this since then. No more lumps in the tonsils for me, and no more complaints of bad breath. My concern is if this is safe. If it is, let people know about it.

A: Halitosis (bad breath) occurs because of poor dental hygiene, specific foods, and even because of some health conditions or personal habits. If an individual tends to skip daily tooth brushing and flossing, the food particles that remain in the mouth can cause bad breath. Bacteria may form on the teeth, plaque can irritate the gums, and over time, periodontitis may result. While brushing, readers should remember to brush their tongue as well, since the bumpy surface of the tongue can produce odors. Specific foods such as onions, garlic, anchovies and certain spices can cause bad breath. Further, some cancers, metabolic disorders, gastroesophageal reflux disease (GERD), tonsil stones, mouth infections and dry mouth may be to blame for halitosis. The smoking habit is evident to most non-smokers who are more aware of the odor than smokers are. It’s easy for us to understand that smoke can linger on clothing and we don’t think too much of it, so it’s logical the mouth can harbor tobacco odors, also.

The cause of the bad breath should be addressed and the place to begin is with good dental hygiene. Brush regularly, floss daily and gargle. If at all possible, brush after eating. Toothpastes with antibacterial properties are known to reduce odors. Those rinses that contain chlorhexidine and cetylpyridium chloride can prevent the production of unwanted odors. As a plus, choose one with fluoride that has American Dental Association approval on the label. Avoid those foods known to cause bad breath and reserve them for times when you might be at home and not out in public. Avoid dry mouth by drinking lots of water. Coffee, alcohol and soft drinks might be refreshing initially; however, they can lead to dry mouth so opt for water. Stimulate the production of saliva by chewing gum or sucking on sugarless hard candy. It’s not only the teeth we have, but also false teeth that can harbor food particles, so those individuals with a bridge, partial or full plate should clean the appliance(s) at least once each day to avoid halitosis.

This issue and real concern is not new. According to the Academy of General Dentistry, ancient Greeks treated themselves with white wine rinses, anise seed and myrrh, while Italians produced a mouthwash that contained rosemary leaves, cinnamon, juniper seeds, and root of cypress. Americans today lean toward mouthwashes as the answer in the majority of cases. Well, rinses mask and are temporary, lasting from 20 minutes to about two hours before bad breath returns.

There are several home remedies that might be considered. For example, begin by using plain water. Swish the water around in your mouth for 15 to 20 seconds to loosen food particles. Then dip a dampened tooth brush in baking soda and continue as you would with any toothpaste.

One clinical professor in pediatric dentistry at the University of Florida has been recommending diluted peroxide to his patients for years and the ratio of water and hydrogen peroxide is half of each. While there is some controversy, it appears you are safe in using this home remedy. The water is good for refreshing the mouth and the oxygen in the hydrogen peroxide kills mouth bacteria that cause bad breath. The product should not be swallowed. If anyone has a fear of swallowing the product, do a test run by gargling with a mouthwash and spitting it out without swallowing. If readers can accomplish that, they can feel comfortable using hydrogen peroxide diluted with water.

Biannual hand pain puzzles reader

Q: About every six to nine months I get a pain in my left hand. It’s now on the right hand also that persists in spite of taking ibuprofen. A few years ago my family doctor diagnosed it as pseudo gout. Nothing seems to help reduce the swelling, in spite of cold compresses. I cannot touch the fingers and the rest of the hand and sometimes even my shoulder gets a little painful. The pain in my hands could be considered a 9 on a scale of one to ten where it is unbearable.

A: There are many reasons for hand pain to occur, including arthritis, tendinitis, rheumatoid arthritis, and carpal tunnel syndrome; however, most are present much more frequently than every six to nine months.

One condition known as De Quervain’s tendinitis presents with pain on the thumb-side of the wrist. The pain can travel from the thumb up to the forearm, causing difficulties with holding objects, making a fist, or even rotating or flexing the wrist. The pain stems from swelling of the tendons in the wrist at the base of the thumb and is often triggered by over-use and repetitive activities. Cortisone injections, OTC or prescription anti-inflammatories, or the use of a splint may lessen the pain, followed by surgery as a last option.

Carpal tunnel syndrome causes pain in the palm and some fingers of the hand/wrist/forearm and cause numbness, tingling, weakness, and difficulties holding on to objects. The pain is the result of swelling against the median nerve that controls impulses in the thumb and next three fingers (not the small finger). Pain is commonly worse at night than it is during the day. Treatment may include physical therapy, a wrist splint, anti-inflammatories or pain medication, or a steroid injection.

Arthritis causes a loss of cartilage in the joints that can cause pain and swelling. The areas of the hand most commonly affected include the base of the thumb, the end joint closest to the finger tip, or middle joint of one or more fingers. Osteoarthritis, the most common type of arthritis may cause progressive degeneration of the cartilage, resulting in pain at the base of the thumb, stiffness and inflammation. Treatment may include physical therapy, the application of heat, anti-inflammatories or pain medication, and the use of a splint.

The pseudo gout your doctor mentioned is a form of arthritis that results from crystal deposits within the joint, resulting in extreme pain, and swelling. The joint will be warm to the touch. The joints most commonly affected are the knees; however, the wrists and ankles can also be involved. Conditions that may place individuals at risk for development include the aging process, having an under active thyroid gland, joint trauma, and having too little magnesium or too much calcium or iron in the blood. Testing for the condition may include lab work and X-rays. Treatment may include indomethacin , naproxen, ibuprofen, Colchicine and/or corticosteroids. Aspiration of fluid from the affected joint(s) will remove some of the crystals present and should result in decreased inflammation.

Another strong possibility is a pinched nerve in your neck. Pinched nerves occur when excessive pressure is applied to a nerve by surrounding tissues. Symptoms may come and go; however, over time they will become more persistent. The pressure applied disrupts nerve function and causes pain, tingling, and numbness. Testing for a nerve in the neck being the culprit may require an MRI which can help determine if arthritis, a bulging disc or other problem is the cause. Treatment will depend on the cause and will likely begin with conservative measures such as over-the-counter anti-inflammatory medications, followed by corticosteroid injections if the OTCs fail to diminish symptoms.

Should plates and screws be removed from man’s leg?

Q: My husband has two plates and 15 screws in his lower left leg from an accident in the early 90s. He is now experiencing severe itching in this area. He has blamed it on my laundry detergent, his socks, and anything else that touches his leg. The other leg is not bothered at all, nor is any other part of his body. I think that all that metal in his leg is causing the itching and needs to come out. Your thoughts, please. Thank you very much.

A: In most instances, it is not necessary for implants to be removed. While they don’t help a bone heal faster, they can help stabilize the bone or bones in proper alignment during the healing process. There are some instances when a physician may choose to remove implants because of such things as irritation to the tissue that surrounds the site, pain, because of a loose screw, and for other reasons. Irritation may result in bursitis or tendinitis, yet there is no guarantee the irritation will dissipate if the plates and screws are removed. If the itching or other irritation is caused by the metal, the probability of a reduction of symptoms with removal will likely occur, yet looking at the whole picture, if the itching is generalized the chance of resolution of itching/pain and other symptoms is extremely difficult to predict.

I can appreciate that you initially leaned toward an allergy which can develop from clothing, sheets, laundry detergents, fabric softeners, and for countless other reasons but in this instance as I see it, the itching would not only be on the leg of the former trauma site but would appear on other areas of the body. Therefore, you and your husband must take into consideration that there could be a low-grade infection, or another abnormality may simply have popped up all these years later.

Your husband had a procedure done many years ago. There is always a risk of complications when metal implants are removed, particularly when the implants have been in place for an extended period of time. And, we can’t ignore that there can be a weakening of the “healed” bone at the implant site following the removal, since fractures through holes where the screws were implanted are not uncommon.

If his orthopedic surgeon is still in practice and you live in the same area as you did 20 odd years ago, I recommend you make another appointment with him or her to review the case, essentially because a review of the records will identify the type of screws and metal used. With research over the years, there may be updated information regarding procedures from the 90s that might trigger some answers as to why he is having symptoms so many years later. If you need to select a new specialist, do so. Plate insertion doesn’t ordinarily exhibit symptoms years later unless there is a reason. An examination, X-rays and possibly lab work should help identify what’s going on. You need to be able to put your minds at rest and to get the appropriate help, so don’t wait any longer. Good luck.

Uneducated parents may be harming their infants

Q: What’s your opinion of young parents today using cough meds as sleep aides to get their young to sleep? I guess you might say I’m old school and believe this to be a dangerous practice. I sometimes overhear young mothers casually talking about how they use Benadryl and even adult dosages of NyQuil to help their sometimes only months old sleep at night. Isn’t this a dangerous practice? What about the long term effects and possible organ damage?

From the way these young mothers talk, they do this on a routine basis. And with so many children being diagnosed with ADD and ADHD these days, I often find myself wondering if there might be a connection in some cases that they may have been drugged with meds earlier in their lives. These young parents seem to have the belief that just because these medicines can be purchased over the counter, they must be safe. I’m of the belief that most all over the counter meds at one time could only be obtained with a prescription and should be treated as such even if they can be purchased without a prescription.

No name please. Just sign me Old School Parenting!

A: Well, Old School Parent, you’ve just met someone who is in your corner of the boxing ring. There have been concerns for years regarding over-the-counter cough and cold remedies for children. In fact, in January 2008 the FDA warned against giving them to babies younger than two years of age because of the possibility of serious harm and even death. When it comes to children between the ages of 2 and 11, the Consumer Healthcare Products Association indicated they would voluntarily change the labeling on such products to indicate they should not be used in children younger than 4. Following that, an FDA advisory panel made a similar recommendation stating non-prescription cold medicines should not be given to children ages 2 to 5. When it comes to relieving a cough or cold, no remedies will make symptoms disappear any faster. As I’ve said in the past, if you don’t treat cold symptoms, they will take a week to dissipate. If you do treat with home remedies or OTCs, it will take 7 days. And that’s for colds, not to help an infant or young child sleep. Most non-prescription remedies contain antihistamines, decongestants, cough suppressants, and expectorants. In my opinion, babies should not be given such products.

An ABC News report from July 22, 2012 reported that “giving a cranky child cough medicine to put him or her to sleep may not seem like child abuse, but it can be dangerous or even deadly for the child.” A mother gave her infant one dose of cough medicine in the afternoon and one in the evening to put the baby to sleep so she wouldn’t disturb them. It was unclear whether the infant got an adult or pediatric dose, according to the toxicologist called in to Children’s Memorial in Texas to consult on the case. The baby became unresponsive and almost died from an overdose of dextromethorphan, a common ingredient in cough medicine.

Benadryl for children (recommended for children 6 and older) contains diphenhydramine HCI 25 mg in pill form. Liquids have different strengths.The product is an antihistamine. The instructions indicate it should not be used to make a child sleepy. Children’s NyQuil contains dextromethorphan, a cough suppressant that affects a certain part of the brain, reducing the urge to cough. “Cough and cold products have not been shown to be safe or effective in children younger than 6 years.” Labeling goes on to state “do not use this product to make a child sleepy…. Improper use of this medication (abuse) may result in serious harm (e.g.: brain damage, seizure, death)”.

What more needs to be said? Parents of all ages need to be educated on the devastating effects of using medications improperly, even if they are purchased over-the-counter. I don’t know how you can get your message across but it is an important one. Perhaps speaking with a teacher or nurse in your local school or day care center may help spread the word, or suggest a PTO program covering the topic. Good luck.

Head to toe rash troubles patient

Q: For a couple of years now I have suffered from what looks like very dry skin all over my body. Now, however, the skin is beet red, dry, flaking, itchy beyond imagination and looks as if I have been burned in a fire – head to toe. I’ve been treated by a dermatologist with cortisone creams that have been ineffective. I went back to my dermatologist and he put me on an antibiotic for a month. That was a waste of time and money. I went back again last week and he wants to prescribe Soriatane 25 mg for a month. That sounded good until I found out my local pharmacy wanted to charge me a whopping $1,000 for a 30 day supply of the medication. I can’t use a topical ointment – I’d have to buy it by the gallon bucket to cover everything.

I’m a senior citizen living on Social Security and I just can’t afford anything that costs so much and may not even work. The skin all over my body is beet red and flaking off like you wouldn’t believe. If I rub my arms or stomach, the floor beneath me looks as if I have been standing in the middle of a snow storm from the dead skin that flakes off. I don’t just want to get a prescription but really want to know what this terrible rash is and get rid of it once and for all. I’ve never had anything as serious and frightening as this one. I really need help – and a correct diagnosis my dermatologist in a pretty large facility can’t provide. A friend told me I might have scalded skin syndrome. Is that possible and can you offer any insight?

A: I can only assume your dermatologist considered allergies, psoriasis, icthiosis, drug reactions and the more general possibilities for the rash, so I’d investigate an undiagnosed autoimmune disorder in which a person’s immune system mistakenly attacks and destroys its own healthy body tissue. There are more than 80 known autoimmune disorders and finding the cause of any disorder may be difficult to zero in on but can hopefully be determined through testing.

While I don’t believe it to be your problem, I will briefly discuss scalded skin syndrome, a condition that results from a staphylococcus aureus infection that most often appears in newborns and young children; however, individuals of any age may be affected, particularly those adults who suffer from renal failure or immune deficiency disorders. The symptoms can resemble those of other skin conditions but having a skin biopsy and bacterial culture for identification should assist.

Staph infections are caused by different strains of the same bacteria. Interestingly, as many as 40% of healthy adults may have staph on their skin or in their body, yet not have any symptoms at all. Carriers may not exhibit symptoms, yet they can pass the bacteria on to others. Some strains, such as the one that causes scalded skin syndrome, produce toxins and cause the symptoms to occur when the bacteria release two different exotoxins — epidermolytic toxins A and B. These exotoxins cause blisters to form and skin to slough off, producing an appearance of severely burned skin. The blisters are generally fluid-filled, large and may rupture, leaving the skin moist and painful. The skin will ultimately peel off in large sheets, not in snowflake form. Because skin helps protect us from infection, scalded skin syndrome may put a patient at risk of developing sepsis, a very serious bacterial infection of the bloodstream. If a patient carries the diagnosis, treatment will begin with intravenous fluids to help to combat fluid loss and prevent dehydration. Staph is typically immune to penicillin, so other antibiotics will be included in the IV treatment. While the condition may require hospitalization for a few days, proper treatment should allow the condition to clear within a week, yet in the case of scalded skin syndrome, the condition is extremely severe and would not likely follow the same recuperation period of some other conditions and would last much longer because of its severity.

The medication you have been prescribed treats psoriasis, a chronic, autoimmune disease that affects the skin. It occurs when the immune system incorrectly sends faulty messages to speed up the growth cycle of skin cells. There are five types of psoriasis, the most common type being plaque psoriasis that appears as a raised, silvery white buildup of dead skin cells. The lesions are commonly found on the elbows, knees, scalp and lower back. Treatment will likely begin with steroids to slow skin cell growth, while reducing inflammation; exposing the lesions to ultraviolet light; and systemic prescription medication taken either orally, through injection or infusion.

I could continue but my ultimate response will remain the same. You need a skin biopsy to hopefully put a name to the condition you have. If you are dissatisfied with your current dermatologist, request a referral from your primary care physician to another top-notch specialist in the field. You need to get to the bottom of this problem quickly, so don’t hesitate. And, were I you, I’d probably hold off on the expensive medication until you can put a name to the disorder.

Is it hyper or hypothyroidism?

Q: I’m a 59-year old female. Two years ago I began to lose weight unintentionally, eventually losing 35 pounds. I also had bouts of frequent bowel movements and nausea. A year and a half later after having many tests run and seeing a number of doctors, I was diagnosed with Hashimoto’s thyroiditis. From my research, I believe I have been experiencing Hashitoxicosis. Is this an unusual health problem doctors don’t know about? What is the best treatment for it?

A: Graves’ disease is the most common cause of hyperthyroidism and Hashimoto’s thyroiditis is a cause of hypothyroidism. Hashimoto’s is an autoimmune condition in which a person’s immune system incorrectly attacks the thyroid gland at the base of the neck. The thyroid is a part of the endocrine system that produces hormones and coordinates numerous bodily activities.

Signs and symptoms of hypothyroidism may include constipation, unexplained weight gain, muscles aches and pain, stiffness of the shoulders, hips and other areas of the body, menorrhagia for women (prolonged menstrual bleeding), fatigue, and more. These characteristics certainly don’t sound similar to what you have experienced, so I can only assume your thyroiditis was discovered when your physician did routine laboratory testing on you.

Chronic thyroiditis is a very common cause of hypothyroidism. Sometimes it is associated with a transient hyperthyroid phase known as Hashitoxicosis – a seemingly perfect blend of both hyperthyroid and hypothyroid at the same time in the setting of autoimmune thyroiditis. Some individuals can actually determine which state they are about to undergo because of palpitations, night sweats and a jittery feeling. The heart may beat up to 120 times per minute, blood pressure readings may rise, and the mind appears to fire more rapidly. The feelings will pass reasonably quickly, only to be replaced by dizziness, insomnia, light sensitivity, muscle weakness, and more. Both feelings create confusing and sometimes scary phases. Depending on the phase, the thyroid may be without pain, while at other times, pain and a perception of difficulty swallowing may occur. Each phase may last a few hours or days, during which symptoms of mild/moderate hyperthyroidism may exist with a diffuse, painless goiter. On some days the blood will contain lots of thyroid hormone, while at others there will be very little. Since the hormone may be within limits when blood is drawn, everything will appear normal. The free T3 and T4 levels will likely fluctuate slightly or be very close to normal. Lab testing can be extremely confusing, even to a physician, because of the almost constant seesaw effect from hyper to hypo phases, depending on when the testing is performed. Hashitoxicosis literally can wreak havoc with a person’s metabolic system and may cause a person to be extremely thin or very overweight with variations depending on the symptoms experienced.

As you can determine, the condition may be misdiagnosed and attributed to anxiety, stress, a pituitary or adrenal disorder, and more. Therefore, and while I certainly cannot indicate you suffer from Hashitoxicosis, I recommend you return to your primary care physician or thyroid specialist. Present your symptoms for his or her consideration and ask if you are among the less than 4.5% of thyroid patients who may have this somewhat unheard of disorder. It may be that you started out with hyperthyroidism and as it matured, you developed hypothyroidism.

Other readers who would like related information can order Dr. Gott’s Health Report “The Thyroid Gland” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order payable to Peter H. Gott, MD Health Report, PO Box 433, Lakeville, CT 06039. Be sure to mention the title or print an order form from www.AskDrGottMD.com.

Avoiding food poisoning

Q: I’m wondering if you can clear up a perplexing incident for me. On more than one occasion my husband and I have eaten the same seafood dish (literally sharing the same food) both at a restaurant and at home with fish purchased from a market. A few hours later I became violently ill while my husband experienced no adverse effects at all.

My symptoms included sharp stomach pains, diarrhea, vomiting, a feeling of intense cold, and blacking out. We are completely baffled as to why I would be ill but he wouldn’t. Thank you in advance for your help.

A: It is estimated that 48 million people in our country get sick each year from consuming contaminated foods that may result from parasites, bacteria or viruses. Symptoms of food poisoning may include diarrhea, nausea, vomiting, abdominal pain, upset stomach, fever, and even dehydration. Less commonly, dizziness, blurred vision, arm tingling and neurological symptoms may develop. Those individuals at a higher risk include the young, the elderly, and those with a compromised immune system. Interestingly, although signs and symptoms typically present within two to six hours, some cases may take two weeks or more to surface, making it extremely difficult for a person to think back as to where and what he or she might have eaten. Some of the more common foods to present problems may include raw or undercooked poultry, unpasteurized milk, contaminated drinking water, berries, and lettuce. Sadly, many foods are not cooked sufficiently, cooled properly, or may be left out on a counter unrefrigerated.

The leading cause of food-borne illness leading to hospitalization is salmonella, a microorganism that is common in the intestines of animals and reptiles. Most cases of salmonella are due to either under-cooking of raw meat or poultry, or from contamination of fresh produce.

Escherichia coli, a/k/a E. coli is another common cause of food poisoning and also of traveler’s diarrhea. This infection can occur when food or water becomes contaminated with bacteria from infected feces – either prior to arriving at a store or restaurant, or because the individuals who prepare the foods in a kitchen have a contaminant on their hands. .

Norovirus infection is acquired when infected individuals contaminate the foods they are preparing. This virus is easily passed from person to person, with symptoms presenting within 48 hours of exposure. Most cases of norovirus resolve without medical intervention.

Listeria is a bacteria found in some dairy products, contaminated or unpasteurized milk and soft cheeses, hot dogs and smoked seafood. If the bacteria invades a person’s bloodstream, a condition known as listeriosis may occur. Those at an increased risk include pregnant women, the elderly, and those with a compromised immune system.

I am not implying that you ate contaminated food. It may simply be that you are allergic to the particular fish you shared, to the spices/herbs or other ingredients the kitchen staff put on the fish. However, if it only shows up on rare occasions and there are no other signs or symptoms, this is unlikely. Another possibility causing a reaction could be scombroid poisoning, a histamine reaction thought to cause 40% of seaborne-food outbreaks in the US and in Europe. It is not directly an infection, but the result of improperly stored fish and the formation of a histamine-like substance. There are times when all of us experience foods that just don’t seem to settle well but considering that this has happened twice to you, play it safe and avoid purchasing that specific type of fish in the future.

Improper storage and handling of poultry, meats, fish and produce will increase the risk of developing food poisoning. Foods should never be left out at room temperature for more than two hours. Be sure to keep your cutting board and counter clean to prevent cross contamination, wash your hands prior to handling the food.

In most cases of food poisoning or an allergy to a specific food will dissipate without medical intervention. Those with persistent vomiting and/or diarrhea may appear dehydrated and might respond well to Pedialyte or other drinks that contain electrolytes to gain a proper electrolyte balance. While it isn’t always possible to avoid exposure to a microbe that can cause food poisoning, you can increase your chances of staying healthy by avoiding unpasteurized milk, by washing all fruits and vegetables prior co eating them, by storing foods at a proper refrigerator temperature of 40 degrees or lower, thoroughly cooking raw meats, poultry or fish, and avoiding deli prepared salads such as egg, tuna, or seafood. A food thermometer may be a good addition to your kitchen. One will allow you to cook ground beef to 160 degrees, chicken and turkey to 165 degrees, and pork to 145 degrees. Become a savvy shopper and a guru in your kitchen to avoid problems in the future.