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Dermatology
How Seasonal Viral Infections Can Affect Your Skin
While we all find ways to emotionally cope with the coldest time of year, local dermatologists recommend prioritizing your physical well-being, too.
Viral infections, more common in winter, can cause dry, flaky skin; hair loss; cold sores; and more.
“Skin rashes from viruses occur as your immune system detects the virus and triggers the release of different immune cells in the body to fight it off,” says Dr. Bethany Cook of Dermatology Consultants. “This can be a very effective way for the body to fight off the virus, but these reactions can also cause skin inflammation in the form of rashes, bumps, or even blistering. In some cases, this can be a delayed effect, as with hives that may occur even after a viral infection has been cleared.”
COVID-19 isn’t the only virus to impact your skin; even common colds and flus can wear down your skin’s natural luster. Here’s how to take care of yourself—and your skin—when you’re feeling under the weather.
Moisturize often. While you’re coughing, sneezing, blowing your nose, and feeling bleh, it’s easy for your skin to dry out or become irritated. Wash your face using a gentle cleanser and follow with a fragrance-free moisturizer twice a day. Need an extra boost? Try an advanced-healing ointment where needed. “Using an emollient around your nose, such as Vaseline, can help prevent chafing from using tissues frequently,” says Dr. Nora Ali of Dermatology Consultants. And don’t forget lip balm!
Wear sunscreen. Sun exposure can lead to even more dry, flaky, and itchy skin. Aim for SPF 30 for your face, and reapply every two hours (yes, even if it’s cloudy).
Consider taking a vitamin D supplement. “Getting enough sleep, eating a varied diet full of fruits and vegetables, and managing stress by exercising or meditating are some ways to keep your immune system strong,” Ali says. “I always recommend vitamin D supplementation to support the immune system, as many of us in the Upper Midwest are vitamin D deficient at baseline.”
Handle your hair with care. If you’re struggling with hair loss post-infection, don’t panic. “Similar to rashes, your immune system can react to an illness and cause hair loss,” Ali says. “Two types of hair loss we have been seeing more frequently in response to COVID-19 and other viral infections include telogen effluvium and alopecia areata. Telogen effluvium is a type of hair loss in response to stress on the body—for example, after having a baby or getting sick. Alopecia areata is a type of hair loss that can cause bald patches or, if severe, loss of all the hair on the head or even the entire body.” Be gentle: Don’t tug on your hair when combing, and use conditioner. Avoid heating tools such as curling and straightening irons, which can damage your hair follicles.
Drink lots of water throughout the day. Adequate hydration flushes toxins from your body, ensuring you’re less susceptible to a variety of skin disorders.
Pull out your humidifier. Especially in wintertime, check that your house is adequately humidified, as this can help prevent dry skin when you’re sick. Stick to around 30 to 40 percent moisture, but watch out for signs of too much humidity (like mold!).
Get plenty of Zs. Aim for at least seven to nine hours of sleep every night. If that doesn’t help prevent dark circles under your eyes, look for an under-eye cream dedicated to correcting eye bags.
Cleanse, cleanse, cleanse! If you’re feeling under the weather, wear a face mask when you go out in public—but watch out for acne! Wash your face before and after wearing a mask, and wash your face masks after every use with a fragrance-free, non-irritating laundry detergent. Avoid wearing makeup (unless it’s noncomedogenic) to avoid blocking pores. If acne persists, try using a cleanser with glycolic acid, salicylic acid, or benzoyl peroxide. If those pesky zits still stick around, make an appointment with your dermatologist.
Sleep
Dreams Are Like Built-In Therapy
Recounting last night’s dreams to others may be considered a conversational faux pas, but sometimes it’s hard to contain the sheer astonishment of just how lifelike they felt. (The technicolor effects, if you’re lucky enough to dream in tones other than black and white, make it particularly convincing.) No one cares more about your dreams than you do—sorry!—but that doesn’t make them any less important. The pandemic caused a 35 percent rise in dream recall among participants, according to a survey by the Lyon Neuroscience Research Center. Respondents also reported having more nightmares than in the past. The ways in which we sleep are indicative of the times we live in.
“Early in the pandemic, many of us were sleeping more and moving less,” says Dr. Kim Ledermann of Minnesota Craniofacial Center for TMJ and Sleep Treatment. “The longer we sleep, the greater the likelihood is that we will recall our dreams.”
While we’re confecting one outlandish plotline after another in our unconscious mind, other parts of us are literally, physically moving in time with our brain waves. In a way, Ledermann says, our dream state is the most awake we are during the stages of sleep. Just because you dreamed hard last night (and very distinctly remember the part where Elvis took you for a spin in his pink Cadillac) doesn’t necessarily mean you had a good night’s rest.
“Early in the pandemic, many of us were sleeping more and moving less. The longer we sleep, the greater the likelihood is that we will recall our dreams.”
Dr. Kim Ledermann / Minnesota Craniofacial center
“An EEG recording of REM [rapid eye movement] sleep shows beta waves that look similar to brain waves during wakefulness,” she says. “REM is associated with dreaming and is not considered a restful sleep stage. While the EEG is similar to an awake individual, the skeletal muscles are atonic and without movement.” In the midst of this skeletal “stillness,” we experience rapid eye movement and irregular or erratic breathing patterns. Our heart, diaphragm, and smooth muscles continue to put in the work, too. This stage of sleep, Ledermann says, usually starts 90 minutes after falling asleep, with each REM cycle getting longer throughout the night.
“The first period typically lasts ten minutes, with the final one lasting up to an hour. REM is when dreaming, nightmares, and tumescence occur,” she says.
Scholars and scientists for centuries theorized that dreaming was merely the result of random electrical brain impulses—our brain’s way of clearing out the daily clutter. But Kelsey Sharma, a certified family nurse practitioner at Minnesota Craniofacial Center for TMJ and Sleep Treatment, says the latest research shows a critical connection between dreaming and our emotional and mental well-being.
“Certain parts of the brain, including the visual, motor, memory, and emotional areas, are more active during REM than during other stages of sleep or during wakefulness, and other parts of the brain that control executive function and reasoning are diminished. Notably, the neurotransmitter norepinephrine, which can induce stress, is suppressed during REM.”
She adds that researchers have recently found that dreaming can help your brain reprocess traumatic events without the stress response—a critical piece in resolving PTSD and other emotional events. “While NREM [non-rapid eye movement] sleep is important for memory consolidation, REM takes it a step further,” she says. “The increased creativity and problem-solving is especially present immediately after an individual wakes from REM sleep, and some musicians, scholars, and inventors have used this to their advantage and kept notepads or recording devices next to their beds.”
Having to “sleep on it” proves to be a constructive approach in finding solutions to problems we find intractable in our waking life.
Your body on REM Sleep
- REM sleep is associated with dreaming and irregular muscle movements.
- A person is more difficult to arouse by sensory stimuli than during slow-wave sleep.
- People tend to awaken spontaneously in the morning during an episode of REM sleep.
- REM sleep is characterized by a loss of voluntary motor tone, increased brain oxygen use, increased and variable pulse and blood pressure.
- Acetylcholine (ACh), a neurotransmitter, is at its peak levels during REM sleep and when you’re awake.
Orthopedics
Five Common Winter Injuries, and How to Avoid Them
It’s the most wonderful time of winter: when our 10,000 lakes freeze over for skating and snowmobiling, fresh snow coats our driveways and walkways, and there’s a sense of tranquility that comes with slowing down—especially when it comes to I-94. Seriously, take those turns slowly.
But with winter come a host of other problems, including freezing ice, dangerous road conditions, and an increase in injuries. Specialists from Summit Orthopedics share some of the most common winter injuries and how to prevent them.
1. Slips, trips, and falls
Wear footwear with good traction, and watch out for slippery ice on your sidewalks and driveways and in parking lots. According to Cory Absey, a physical therapist at Summit Orthopedics, having good balance can help you avoid wintertime slips. Additionally, take the necessary precautions to clear your walkways—whether that’s with a shovel, salt, or sand.
Here’s how to better your balance:
- Practice standing with one leg in front of another in alignment.
- Stand on one leg for thirty seconds to one minute. Then, switch.
- Do exercises to engage your abdominal and glute muscles.
2. Sports injuries
Watch out for wintertime sports, as they’re a leading cause of injuries in winter—especially for kids and teens, according to Dr. Edward Su, a hand surgeon specializing in hand, wrist, and elbow care at Summit Orthopedics. The most common sports-related injuries include hand and wrist fractures, so prepare ahead by wearing standard protective gear, including helmets, gloves, and safety padding.
3. Arthritis and joint pain
Cold weather can slow blood circulation and heighten pain sensitivity, according to the Arthritis Foundation. Our joints are especially sensitive to changes in barometric pressure. To avoid joint pain in winter, Dr. Daniel Probst, a sports medicine physician at Summit Orthopedics, recommends finding ways to stay active and be warm. Go for a walk, take a bath, and check in with your mental health.
4. Hand injuries
If you’re like most Minnesotans, shoveling snow is more like shoveling no. That’s where snowblowers come in clutch. But they are also a leading cause of hand injuries in winter. According to Su, snowblowers often get clogged up with ice, snow, and debris, and well-intentioned Minnesotans use their hands to clear any jams. But once the blade isn’t jammed, and the snowblower gets back into gear, you won’t want your hands anywhere near the blade. If your snowblower gets clogged, use a large stick to try and clear it out, even if your snowblower is turned off. If you choose to shovel, be sure to use safe lifting methods, don’t twist your back or wrists, and take your time.
5. Head injuries
Don’t forget to protect the most important part of your body: your noggin. This is especially true for sledders of all ages. Be sure to never sled headfirst; instead, sit facing forward so you can better steer. Parents should consider having children 12 and younger wear a helmet while sledding to prevent head injuries. And make sure to only sled in designated areas—this will help you avoid other hazards, such as streets, parking lots, and bodies of water.
Dental
Newly Crowned
…And no, we’re not talking about King Charles or the British monarchy. New innovations in dental technology mean getting crowns and bridges replaced is easier than ever. Dr. Walter Palmer of River Bluff Dental in Bloomington says crowns and bridges are usually replaced in 20 to 25 years, depending on how regularly you receive dental care. Good habits and regular dental visits can extend the life of your bridge or crown. If you need a new one, it will be a different experience than when you got it a decade or more ago. Now, specialists can usually replace a crown or bridge in one visit, Palmer says. Using technology like the CEREC computer-aided design and milling, dentists can create crowns in a day that are still long-lasting and look natural. “The technological advantage today is these can be done in one appointment with no goopy impression or the need to wear a temporary crown,” he says. “Patients can leave their dental appointment with a completed, tooth-colored restoration.”
Ophthalmology
Blink and You’ll Miss It
We’re all blinking a lot less these days, thanks to our always-online WFH lifestyle. It sounds innocent enough—just step away from the computer if your eyes are buggin’, right?—but it turns out that there’s a developing correlation between decreased blinking and the onset of dry eye disease, according to Dr. Ahmad Fahmy of Minnesota Eye Consultants.
“This [correlation] is an important and common reason for ocular surface compromise,” he says. “Our patients are just not aware of this link, and it is critical to discuss treatments and strategies to limit negative effects of prolonged screen use.” Dry eye is a condition where people feel grittiness or a stinging sensation in their eyes. Other hallmark symptoms include excessive watering, eye redness, and blurred vision.
Maintaining a healthy ocular surface—which comprises the outer layer of the cornea, tears, and the conjunctiva—helps to preserve our visual acuity. When that gets compromised, we become susceptible to various injuries and ocular diseases. Dr. David Hardten, also of Minnesota Eye Consultants, says that reading has always been an exacerbating factor for dry eye, but when we turn the page on a book, there’s a natural time to blink. With scrolling, there is no natural blink time, “so it tends to be a bigger trigger for poor-blink-related dry eye symptoms.”
Our risk of developing dry eye, collectively as a society, has gone up in our digital age, but if you’re a woman, your risk is even greater. Dr. Jessica Heckman, vice president of clinical affairs at Chu Vision Institute, chalks it up to the hormonal fluctuations that take place throughout a woman’s life. “The [fluctuations] in testosterone, estrogen, and progesterone all have an effect on tear production and tear quality,” she says. “In particular, low levels of testosterone and high levels of estrogen are most likely to cause an increase in dry eye.” Other risk factors unique to women: menopause, oral contraceptives, and pregnancy. Women are also more likely to use cosmetic products, which can introduce chemical irritants that can be drying to the eye.
Dry eye can be a real nuisance, but symptoms can sometimes be assuaged through artificial tears, nasal spray, anti-inflammatory topical medications, punctal plugs (small devices that are inserted in the tear ducts to maintain moisture), and thermal pulsation or intense pulsed light sessions. Establishing a treatment plan can vary from individual to individual. “[Dry eye] is manageable, not curable. Many patients find the effort frustrating,” says Hardten. “Many of the drops are expensive, and insurance coverage can be frustrating. The in-office treatments aren’t covered by insurance, so many patients aren’t able to take advantage of their benefits to the full degree.” Despite all of this, he says, the medical field has made significant strides in the understanding and management of dry eye.
If you suspect you have dry eye, the sooner you are seen, the better your outcomes may be. Heckman says that there can be long-term repercussions for untreated dry eye, like loss of vision. “The cornea is the front surface of the eye and relies on a good tear film to stay healthy. When it is chronically dry, scarring can develop and result in blurred vision or even loss of best corrected vision.” Addressing dry eye at an earlier stage can help reduce other issues later in life.
Are Artificial Tears a Long-Term Solution?
“I recommend patients use non-preserved artificial tears. There are many excellent over-the-counter options now. But I also think we should be careful to avoid overprescribing artificial tears, as they do not address the underlying cause of dry eye. By definition, dry eye disease is an immunological inflammatory condition. Treating inflammation and obstruction of important meibomian glands is key to delivering improved patient outcomes.” –Dr. Ahmad Fahmy, Minnesota Eye Consultants
Pain Management
Mind Your FAQs
Pain management has been a hot topic in the past few decades, with the advent of the opioid epidemic and the development of cutting-edge technologies. Here, local specialists answer some of the most burning questions about chronic pain.
What are some of the most common types of chronic pain?
Although pain specialists can treat nearly any type of chronic pain, some types of pain—including lower back, neck, nerve, and arthritis pain—are more common than others. “We’re there for chronic pain that the primary care providers try to fix and help, and they have failed,” says Dr. David Schultz of Nura Pain Clinic. “We’ve focused more on: What is the physical source of pain? What’s the physical pain generator? We try to figure that out and either modulate it or ablate it or somehow fix it.”
How has treatment for pain evolved in recent years?
The field of pain management has taken enormous strides in recent years with innovations that advance treatments, including spinal cord stimulation, radiofrequency ablation, and nerve blocks. Only a year ago, the FDA approved the use of spinal cord stimulation to treat diabetic peripheral neuropathy—a painful condition resulting from the deterioration of nerve fibers in those diagnosed with type 1 and type 2 diabetes. “That’s an exciting area where we’re really starting to see a lot of benefit for patients,” says Dr. Andrew Pisansky, a pain management specialist at Twin Cities Pain Clinic.
What’s the status of prescribing opioids?
The CDC released new guidelines in November regarding opioid prescription, as new research has shed light on how opioids can be effective up to a certain dosage; then, they tend to cause more harm than good. But many patients—including those undergoing cancer and palliative care—respond well to low doses of opioid medications. “It’s really unfortunate that the 20 percent of folks that are prone to addiction kind of ruined it for the 80 percent of people who are not prone to that,” says Schultz, who specializes in the use of targeted drug delivery—an effective treatment for otherwise untreatable chronic pain.
Who treats pain? Is it only interventional pain specialists?
Pain management is a multidisciplinary field that encompasses how a patient’s thoughts, attitudes, behaviors, and physical experiences inform their sense of chronic pain. Pain clinics such as Nura Pain Clinic offer a comprehensive plan of care that includes medication management, physical therapy, and behavioral health counseling in addition to interventional procedures aimed to address pain generators. “We’re very multidisciplinary,” Schultz says. “I work very closely with our physical therapists and our psychologists because there’s more to it.”
This article originally appeared in the February 2023 issue of Mpls.St.Paul Magazine.