♪ ♪ DR. HARDEN: GOOD EVENING AND WELCOME TO "DOCTORS ON CALL."

I'M DR. RYAN HARDEN, FACULTY MEMBER AT THE UNIVERSITY OF MINNESOTA MEDICAL SCHOOL, DULUTH CAMPUS, AND I AM YOUR HOST FOR YOUR PROGRAM TONIGHT ON LYME DISEASE, RASHES, AND ACNE.

THE SUCCESS OF THIS PROGRAM IS VERY DEPENDENT ON OUR VIEWERS.

PLEASE CALL OR EMAIL YOUR QUESTIONS AND WE WILL DO OUR BEST TO ADDRESS THEM.

THE TELEPHONE NUMBERS AND EMAIL ADDRESS CAN BE FOUND AT THE BOTTOM OF YOUR SCREEN.

OUR PANELISTS THIS EVENING INCLUDE DR. HILLARY REICH, A DERMATOLOGIST WITH GATEWAY FAMILY HEALTH CLINIC, AND DR. PAUL SANFORD, AN INTERNAL MEDICINE SPECIALIST WITH ST. LUKE'S INTERNAL MEDICINE ASSOCIATES.

VOLUNTEERS FROM "THE GREAT GARDENING SHOW" ARE ANSWERING OUR PHONES AND NOW, ONTO TONIGHT'S PROGRAM.

DR. SANFORD, GIVEN THAT LYME'S DISEASE IS SO COMMON IN OUR STATE, HOW DOES ONE GO ABOUT AVOIDING GETTING LIMES -- GETTING LIMES DISEASE?

DR. SANFORD: THE TRICK IS IF YOU HAVE TO BE OUT IN THE WOODS WITH THE DOG, YOU WILL BE EXPOSED TO THE LITTLE TICK SO YOU WANT TO USE A GOOD AND HEAVY DEET REPELLENT AND MOST IMPORTANTLY, WHEN YOU GET HOME CHECK YOUR SKIN AND GET YOUR BODY TO CHECK YOUR BACKSIDE IN PLACES THAT ARE HARD TO SEE.

IT IS ALL WE CAN DO.

PEOPLE JUST HAVE TO BE CONSCIOUSLY LOOKING FOR THE TICKS.

DR. HARDEN: DR. REICH, CAN YOU TALK A LITTLE BIT ABOUT THE RASH THAT IS ASSOCIATED WITH LYME'S DISEASE LOOKS LIKE AND IS THERE ANY OTHER RASHES THAT CAN BE MISTAKEN FOR THAT?

DR. REICH: THE RASH IS CALLED ECM AND, IT IS A VERY CLASSIC, TARGET TOYED -- TARGETOID.

THE WHITE AREA IS LESS CONSISTENT BUT THERE IS ALWAYS A RED CENTER.

THE RED CENTER CAN LOOK LIKE A COUPLE OF OTHER THINGS.

IT CAN LOOK LIKE A BACTERIAL SKIN INFECTION OR CELLULITIS.

IF IT IS A LITTLE SCALY AND OLDER, SOMETIMES, WHEN A RED RASH GETS A LITTLE OLDER, IT CAN LOOK LIKE ECZEMA.

IT CAN ALWAYS -- THE OTHER THING TO KNOW ABOUT IT IS THAT IT DOES NOT ALWAYS OCCUR RIGHT AFTER THE TICK BITE.

YOU MAY NOT ASSOCIATE IT WITH THE BITE BECAUSE IT IS SEPARATED IN TIME BY DAYS OR WEEKS.

DR. HARDEN: THANK YOU.

DR. SANFORD, THERE ARE MULTIPLE TYPES OF TICKS IN MINNESOTA AND WISCONSIN.

HOW DOES ONE IDENTIFY THE ONE THAT CAUSES LYME'S DISEASE?

DR. SANFORD: GREAT QUESTION.

IF YOU CAN SEE IT, IT IS NOT THE TICK.

IF YOU ARE LOOKING AT A BEAUTIFUL POPPYSEED MUFFIN, THE LITTLE SPOTS, THOSE ARE THE TICKS.

YOU CAN SEE ON YOUR TV SCREEN RIGHT NOW THE ITSY-BITSY ONE MILLIMETER TICK COMPARED TO THE OLD-FASHIONED WOOD TICK.

SO DO NOT EXPECT TO SEE THEM.

DR. HARDEN: DR. SANFORD, I ACTUALLY HAD LYME'S DISEASE AND IT DID NOT PRESENT AS A RASH.

CAN YOU TALK ABOUT OTHER WAYS THAT THEY CAN PRESENT?

DR. SANFORD: ALL OF THE TICK BOURNE DISORDERS, THERE ARE SO MANY, THEY WILL USUALLY PRESENT WITH FEVERS.

SOMETIMES, REALLY WICKED FEVERS, SHAKING CHILLS.

WICKED SWEATS.

WITH LYME'S DISEASE, YOU COULD HAVE REALLY PAINFUL JOINTS.

THOSE ARE THINGS TO WATCH FOR.

DR. HARDEN: ONTO A DIFFERENT TOPIC, DR. REICH, I SEE A LOT OF PATIENTS IN MY PRACTICE THAT COME IN BECAUSE THEY HAVE CONCERNS ABOUT ACNE AND THEY HAVE NOT TRIED ANYTHING OVER-THE-COUNTER OR NONPRESCRIPTION.

WHAT ARE SOME TREATMENTS FOR ACNE THAT PEOPLE CAN TRY BEFORE THEY COME TO SEE THEIR DOCTOR?

DR. REICH: THERE ARE SO MANY GOOD PRODUCTS AVAILABLE OVER-THE-COUNTER RIGHT NOW.

ONE OF OUR MAINSTAYS OF ACNE TREATMENT IS OR HAS RECENTLY BECOME OVER-THE-COUNTER PRODUCT.

THE BRAND NAME IS DIFFERENT BUT THE PRODUCT IS ADAPALINE.

IT IS A TOPICAL, VITAMIN A CREAM THAT IS A GOOD STARTING POINT.

PEOPLE ALSO SHOULD TRY DENZEL PEROXIDE.

THE CLASSIC TEENAGE ACNE WASH. A LOT OF PEOPLE SHY AWAY FROM IT BECAUSE THEY ARE WORRIED THAT IT CAN BE TOO DRYING.

BUT CHOOSING A LOWER STRENGTH PRODUCT AND NOT USING IT EVERY DAY CAN MAKE A DIFFERENCE.

DR. HARDEN: THANK YOU, DR. REICH.

ANOTHER THING THAT IS IMPORTANT TO TALK ABOUT IS HOW DOES SOMEONE KNOW IF IT IS -- IF THERE IS A MOLE THAT SHOULD BE EVALUATED OR REMOVED BY A PHYSICIAN?

DR. REICH: WE USE SOMETHING CALLED THE ABC'S OF MELANOMA.

THEY ARE NOT AN ABSOLUTE BUT THEY CAN BE A GUIDELINE.

A FOR ASYMMETRY.

IF A LESION IS ASYMMETRIC, THAT CAN BE CONCERNING.

B IS FOR BORDERS.

BORDERS THAT ARE CHANGING ARE CONCERNING.

C IS FOR COLOR, A MELANOMA CAN BE ANY COLOR BUT THE COLOR ARE YOU MOST WORRIED ABOUT IS BLACK, BLACK OR GRAY, OR A BLACK THAT IS SO BLACK IT IS BLUE.

A NORMAL MOLE CAN BE ANY OF THOSE THINGS BUT IF YOU HAVE A MOLE THAT IS MULTIPLE, IT HAS MULTIPLE ATYPICAL CHARACTERISTICS OR THAT IS RAPIDLY CHANGING, THAT IS WHEN IT NEEDS TO BE EVALUATED.

DR. HARDEN: THANK YOU.

ACT ONTO THE TOPIC OF LYME'S DISEASE, DR. SANFORD, ONE OF THE THINGS THAT LYME'S DISEASE CAN CAUSE IS ARTHRITIS OR JOINT PAIN.

CAN YOU EXPLAIN HOW THAT KIND OF JOINT PAIN MIGHT DIFFER FROM OTHER KINDS OF JOINT PAIN LIKE RHEUMATOID ARTHRITIS?

DR. SANFORD: LYME'S DISEASE ARTHRITIS WILL MOVE AROUND AND AFFECT MULTIPLE, DIFFERENT JOINTS WITH RHEUMATOID ARTHRITIS, IT IS USUALLY THE FINGERS.

WITH PSORIATIC ARTHRITIS, IT CAN BE ANY JOINT LIKE THE WRIST OR THE END JOINT OF A FINGER.

OSTEOARTHRITIS IS USUALLY IN STRESS BEARING JOINTS LIKE THE KNEES, THE BASE OF THE THUMB, RESTS.

BUT, LYME'S DISEASE CAN BE IN ANY JOINT.

DR. HARDEN: THANK YOU.

AND A FOLLOW-UP QUESTION, A CALLER FROM SUPERIOR WONDERS HOW LONG DOES IT TAKE TO GET RESULTS FROM A LYME'S DISEASE TEST?

DR. SANFORD: A WESTERN BLOT TEST, IT CAN BE ANYWHERE FROM 2-5 DAYS DEPENDING ON THE LAB.

I THINK ST. LUKE'S HAS ITS OWN TEMPLATED WESTERN BLOT BUT DON'T QUOTE ME ON THAT.

AND I'M NOT SURE ABOUT YOUR CLINIC IN WESTLAKE.

BUT IT IS A FEW DAYS.

THERE IS NOT A GOOD RAPID TEST I WOULD TRUST.

WESTERN BLOT WILL NOT ONLY TEST YOU HOW MANY BANDS OF IMMUNOGLOBULINS ARE AFFECTED.

DR. HARDEN: DR. REICH, FROM A COLOR, IS THERE ANY TREATMENT FOR ROSACEA?

DR. REICH: IT WOULD BE INTERESTING TO KNOW WHAT THE CALLER HAS TRIED SO FAR.

THERE ARE A LOT OF TREATMENTS.

SOMETHING PEOPLE HAVE NOT HAD IS LASER TREATMENT.

IT IS NOT ALWAYS COVERED BY INSURANCE BUT IT CAN OFTEN MAKE A BIG DIFFERENCE IN THE BACKGROUND REDNESS AND OVERALL INFLAMMATION OF THEIR SKIN.

THAT IS SOMETHING THAT THE CALLER MAY NOT HAVE TRIED YET.

DR. HARDEN: AND ANOTHER DERMATOLOGY QUESTION FROM A CALLER IN SUDAN, WHAT CAN BE DONE FOR WARTS ON THE FACE AND WHAT CAUSES THEM?

DR. REICH: WARTS ARE A VIRUS.

A TYPE OF HUMAN PAPILLOMA VIRUS THAT ARE VERY COMMON.

THEY ARE NOT A DANGEROUS TYPE OF HPV VIRUS OVERWHELMINGLY.

WARTS ON THE FACE ARE OFTEN CALLED FLAT WARTS.

I SOMETIMES LIKE TO START WITH A TOPICAL MEDICINE FOR THE TREATMENT OF FLAT WARTS.

IT IS A VITAMIN A TYPE MEDICINE THAT HELPS TO SLOUGH THE TOP PART OF THE WORT AND ASSIST YOUR IMMUNE SYSTEM IN TREATING THEM.

DR. HARDEN: DR. SANFORD, I WAS THINKING THIS QUESTION MIGHT COME UP ASH WILL THERE EVER BE A VACCINATION FOR LYME'S DISEASE?

DR. SANFORD: GREAT QUESTION.

10 OR 15 YEARS AGO, AS YOU WERE DRIVING SOUTH TOWARDS SANDSTONE, THERE WAS A BIG BILLBOARD UP THERE SAYING, I CAN GET VACCINATED AGAINST LYME'S DISEASE.

AND THEY DID HAVE A VACCINE FOR A WHILE BUT IT KIND OF WENT AWAY.

BECAUSE WHAT HAPPENED WAS A LOT OF PEOPLE HAD RESIDUAL ACHINESS IN THE JOINTS.

ESSENTIALLY, SYMPTOMS OF LYME'S DISEASE.

SO THEY TOOK AWAY ITS APPROVAL BY THE FDA TO GIVE TO PEOPLE THAT YOU CAN STILL GET IT FOR YOUR PETS.

I WOULD NOT HOLD YOUR BREATH ABOUT GETTING A LYME'S DISEASE VACCINE.

DR. HARDEN: THANK YOU.

ANOTHER QUESTION ABOUT LYME'S DISEASE FROM ONE OF OUR CALLERS, DR. SANFORD, CAN A PERSON GET LYME'S DISEASE MORE THAN ONE TIME?

DR. SANFORD: MY UNDERSTANDING IS THAT THERE ARE VARIANTS ON THE BACTERIA THAT CAUSES THIS AND YOU CAN ALSO GET A DOUBLEHEADER.

AND SOMETIMES, A TRIPLE HEADER.

I REMEMBER ONE PATIENT WHO HAD ALL THREE, A TRIPLE HEADER AT ONCE AND MAN, WERE THEY SICK.

DR. HARDEN: THANK YOU.

ANOTHER DERM QUESTION, DR. REICH, IS THERE ANY TREATMENT FOR LINCOLN -- LINCOLN SCLEROSIS?

DR. REICH: IT IS AN INFLAMMATORY CONDITION IN THIS SKIN IN WHICH THERE IS SOME SCAR CHANGE FOR THE OUTER LAYER OF THE SKIN AND AN INNER LAYER.

THE SKIN THAT, UNDER THE MICROSCOPE WE CAN SEE THAT IT IS THINNER BUT IT CAN GET A WOODY OR FIRM FEELING AND IT CAN TURN A VIOLENT, WHITE, SCAR LIKE APPEARANCE.

IT CAN FOUND -- IT CAN BE FOUND ANYWHERE ON THE BODY BUT IT IS OFTEN FOUND ON THE GENITAL SKIN AND SO CAN BE UNCOMFORTABLE FOR PATIENTS.

A TOPICAL TREATMENT CAN HELP TO NORMALIZE THE TISSUE.

WE CANNOT ALWAYS MAKE IT ALL THE WAY NORMAL.

A NEW TREATMENT IS USING FRACTIONATED CO2 LASERS TO ACTUALLY HELP BREAK DOWN SOME OF THE SCAR TISSUE AND ENCOURAGE DEVELOPMENT OF NEW AND HEALTHY TISSUE IN THAT AREA.

DR. HARDEN: THANK YOU.

ANOTHER QUESTION ABOUT DERMATOLOGY FROM ONE OF OUR CALLERS, DR. REICH, IS ACNE CONTAGIOUS?

DR. REICH: IT IS NOT CONTAGIOUS.

ACNE IS AN INFLAMMATORY REACTION IN THE HAIR FOLLICLE AREA OF THE SKIN AND IT IS REALLY LARGELY BECAUSE OF HORMONES IN A PERSON.

THINGS ABOUT ACNE THAT CAN BE, MAYBE NOT CONTAGIOUS, BUT COULD BE SHARED BY A FAMILY GROUP OR A PEER GROUP IS A FAMILY COULD SHARE A TENDENCY TOWARDS ACNE BECAUSE OF THE WAY THEIR HORMONES DEVELOP.

AS YOUNG PEOPLE GO INTO ADULTHOOD.

FOR A LONG TIME, WE WERE TELLING PATIENTS THAT FOOD AND CHOCOLATE HAD NOTHING TO DO WITH ACNE BUT IN REALITY, WE ARE LEARNING THAT EATING PRO-INFLAMMATORY FOODS WITH HIGH GLYCERIN INDEX CAN MAKE A DIFFERENCE IN MAKING YOUR ACNE A LOT WORSE.

IT IS A CHARACTERISTIC THAT COULD BE SHARED BY A FAMILY OR A PEER GROUP.

DR. HARDEN: THANK YOU.

DR. SANFORD, A QUESTION FROM ONE OF OUR CALLERS ABOUT LYME'S DISEASE, ONCE YOU HAVE HAD IT AND ARE TREATED FOR IT, DOES IT TOTALLY AWAY OR CAN IT LINGER AND HIDE INSIDE THE BODY?

DR. SANFORD: THAT IS A WONDERFUL AND IMPORTANT TOPIC.

IT HAS BEEN SUCH A PAINFUL THING FOR SO MANY PEOPLE THAT HAVE THEIR PRIMARY LYME INFECTION.

THE PROBLEM IS THAT THE NATIONAL INSTITUTES OF HEALTH AND CENTERS FOR DISEASE CONTROL DO NOT RECOGNIZE CHRONIC LYME.

THERE IS DEFINITELY SOME TYPE OF INFLAMMATION THAT HAPPENS AFTER LYME'S DISEASE WHERE PEOPLE JUST FEEL -- AFTER THEY GET LYME'S DISEASE.

BUT, WHEN YOU LOOK AT THEIR BLOOD TESTS AND WHEN WE DO CULTURES, I HAVE YET TO SEE SOMEONE ACTUALLY HAVE THE BACTERIA IN THEIR SYSTEM.

AND UNFORTUNATELY, MORE OFTEN THAN NOT, PEOPLE HAVE SOME OTHER UNDERLYING PROBLEM THERE IT IS -- OR LIKE LINDA RONSTADT WHO HAD MULTIPLE SCLEROSIS THAT HAD BEEN LABELED AS CHRONIC LIMES DISEASE.

THERE ARE A LOT OF PEOPLE THAT ARE SUFFERING AND IT IS JUST A MATTER OF BEING ABLE TO DO CAREFUL AND DIAGNOSTIC WORK.

DR. HARDEN: DR. SANFORD, A FOLLOW-UP TO THAT QUESTION --HOW IS LYME'S DISEASE TREATED?

DR. SANFORD: GOOD QUESTION.

IF YOU ARE A KID, I DON'T KNOW.

MY AVERAGE PATIENT IS 100 YEARS OLD.

I TREAT ALL -- I TREAT ELDERLY ADULTS.

BUT FOR ADULTS WHO HAVE DONE GROWING AND THEIR TEETH ARE FORMED, DOXYCYCLINE WORKS BEAUTIFULLY.

IT IS A THREE WEEK COURSE OF 100 MILLIGRAMS TWICE A DAY.

IF PEOPLE CANNOT TOLERATE IT, SOME OF THE OTHER MEDICINES THAT ARE CHEMICALLY RELATED TO THE PENICILLINS CAN BE HELPFUL.

BUT IT JUST REALLY DEPENDS ON THE PERSON AND WHAT THEIR SENSITIVITIES ARE.

THERE ARE LOTS OF WAYS TO TREAT RHYMES DISEASE.

WE SEE A TON OF THEM.

DR. HARDEN: THANK YOU.

ANOTHER QUESTION ABOUT MOLES, DR. REICH.

HOW CAN MOLES ON THE FACE BE REMOVED?

DR. REICH: MOLES ON THE FACE ARE CHALLENGING BECAUSE THE VAST MAJORITY ARE BENIGN.

WHILE I AM NOT WORRIED ABOUT THEM, PEOPLE MIGHT FIND THEM COSMETICALLY UNPLEASANT.

THERE ARE A COUPLE OF WAYS OF TAKING THEM OFF.

THE FIRST THING I COULD DO WOULD BE TO SHAVE IT FLAT USING A SCALPEL.

THE DOWNSIDE OF THAT IS THAT A MOLE CAN BE SHAPED UNDER THE MICROSCOPE MUCH LIKE AN ICEBERG WHERE THERE IS A COMPONENT ABOVE THE SKIN AND A COMPONENT BELOW THE SKIN.

IF I SHAVE IT FLAT, THERE IS NO GUARANTEE THAT THE PORTION BELOW WILL MAKE PIGMENT OR IT COULD EVEN GROW BACK.

TO MAKE IT GONE PERMANENTLY AND FOREVER, I HAVE TO CUT THE WHOLE THING OUT AND CLOSE IT UP WITH SUTURES AND THEN YOU ARE TREATING A BENIGN LESION THAT MAY BE COSMETICALLY BOTHERSOME ONLY TO THE PATIENT FOR A SCAR THAT IS GOING TO ATTRACT A STRANGER AS I MORE STRONGLY.

-- A STRANGER'S EYE MORE STRONGLY.

DR. HARDEN: THANK YOU.

SOMEWHAT OF A FOLLOW-UP QUESTION TO THAT, A CALLER FROM DULUTH WANTS TO KNOW HOW EFFECTIVE ARE DERMAL FILLERS FOR WRINKLES.

A-- FOR WRINKLES?

DR. REICH: THEY ARE NOT FOR EVERY PATIENT.

ON A SCALE OF WRINKLES, SOME PEOPLE HAVE WRINKLES ONLY WHEN THEY FROWNED OR ONLY WHEN THEY RAISED THEIR EYEBROWS.

SOME PEOPLE HAVE SOME LINES THAT ARE VERY FAINT AND ETCHED IN.

AND IF YOU THINK OF AN ELDERLY PERSON, THEY HAVE WRINKLES ALL THE TIME REGARDLESS OF WHAT THEY ARE DOING WITH THEIR FACE.

DERMAL FILLERS ARE BEST USED IN A PATIENT WHO DOES NOT HAVE THE VERY DEEPLY AT WRINKLES AND WHERE THEY ARE USED THOUGHTFULLY TO REPLACE A VOLUME THAT IS LOST AS A PART OF NORMAL HUMAN AGING.

DR. HARDEN: THANK YOU.

I THINK THIS IS ANOTHER VERY IMPORTANT DERMATOLOGY TOPIC TO TALK ABOUT.

WHAT ARE THE THREE DIFFERENT TYPES OF SKIN CANCER?

AND WHICH IS THE LEAST INVASIVE?

DR. REICH: THERE ARE THREE VERY COMMON TYPES OF SKIN CANCER.

MOST COMMON IS SOMETHING CALLED BASAL CELL CARCINOMA.

NOT ONLY IS IT THE MOST COMMON SKIN CANCER, IT IS THE MOST COMMON CANCER HUMANS GET PERIOD.

THE SECOND TYPE OF SKIN CANCER IS CALLED SEQUIM A CELL.

THEY ARE RELATED.

IT IS SLIGHTLY LESS COMMON THAN BASAL CELL CARCINOMA AND HAS A SLIGHTLY HIGHER CHANCE OF TURNING INTO SOMETHING BAD.

IT WILL LEAVE THE SKIN AND GO INTO THE BODY.

WHEREAS BASAL CELL CARCINOMA, IT IS NOT THAT IT NEVER HAPPENS, IT IS THAT IT ALMOST NEVER HAPPENS.

THE INCIDENCE OF A BASAL CELL CARCINOMA OF GOING INTO A PATIENT IN MAKING THEM STICK IS ON THE ORDER OF 0.0 PERCENT CHANCE.

AND THEN MELANOMA.

ON AVERAGE, WE HAVE A ONE PERCENT CHANCE OF GETTING A MELON NOVA -- A MELANOMA OVER OUR LIFETIME.

WE RANK ITS RELATIVE BADNESS BY HOW DEEPLY IT PENETRATES INTO THE SKIN.

THAT IS WHY EARLY DETECTION IS REALLY IMPORTANT AND GETTING IT BEFORE IT HAS A CHANCE TO GO DEEP.

DR. HARDEN: THANK YOU.

DR. SANFORD, I THINK THIS IS ANOTHER IMPORTANT THING I THINK WE NEED TO ADDRESS ABOUT LYME'S DISEASE.

A CALLER FROM DULUTH SAYS HIS DOG OR WAS BITTEN BY A -- HIS DAUGHTER WAS BITTEN BY A TICK, AND HER TEST WAS NEGATIVE.

CAN YOU TALK ABOUT WHEN YOU SHOULD DO THE TEST RELATIVE TO WHEN YOU HAVE THE RASH FROM LYME'S DISEASE?

DR. SANFORD: OFF THE TOP OF MY HEAD, I DON'T KNOW THE SENSITIVITY AND SPECIFICITY OF A WESTERN BLOT.

I THINK THEY'RE PRETTY GOOD.

YOU HAVE TO WONDER IS IT POSSIBLE THAT IT WAS A DIFFERENT TYPE OF RASH?

DID SHE HAVE SOME TYPE OF AN ABRASION?

WAS IT A BACTERIAL INFECTION OF THE SKIN CALLED CELLULITIS?

IT WOULD REALLY DEPEND ON THE PERSON AND SHE WOULD NEED TO BE EXAMINED WITH A FEW QUESTIONS ASKED.

DR. HARDEN: BUT IF THERE WAS CONCERN FOR LYME'S DISEASE, IT WOULD BE REASONABLE TO REPEAT THE TEST?

DR. SANFORD: YOU CERTAINLY CAN.

ESPECIALLY IF THEY ARE HAVING FEVERS, CHILLS, MIGRAINES, OR ARTHRITIS.

NOT EVERYONE WITH LYME'S DISEASE HAS A RASH.

DR. HARDEN: A COLOR FROM DULUTH HAS A QUESTION ABOUT HOW IS THE BEST WAY TO MANAGE -- DERMATITIS?

DR. REICH: IT IS A CONDITION IN WHICH A PERSON'S IMMUNE SYSTEM IS UPSET AND REACTING TO A NORMAL YEAST ON EVERY PERSON'S SKIN.

WE MANAGE IT IN TWO WAYS.

WE REDUCE THE AMOUNT OF YEAST ON THE SKIN AND WE REDUCE THE AMOUNT OF INFLAMMATION THE BODY IS GENERATING.

STARTING WITH SOMETHING LIKE A SPECIAL SHAMPOO OR CREAM IS OFTEN A GO TO STARTING POINT.

AND THEN USING SOMETHING LIKE AN OVER-THE-COUNTER 1% HYDROCORTISONE CREAM CAN ALSO BE HELPFUL, LOW-TECH, AND LOW COST.

DR. HARDEN: THANK YOU, DR. SANFORD, A GREAT QUESTION ABOUT LYME'S DISEASE.

IS IT POSSIBLE FOR THE BODY TO FIGHT LYME'S DISEASE BY ITSELF WITHOUT USING ANTIBIOTICS?

DR. SANFORD: YES, IT IS PROBABLY BEEN GOING ON FOR MILLIONS OF YEARS.

TIMES DISEASE WAS IDENTIFIED IN LYME, CONNECTICUT AND THAT IS WHEN THEY PUT THE NAME ON IT BUT FOR THOUSANDS OF YEARS, PEOPLE HAVE PROBABLY BEEN HAVING THIS ILLNESS WITH THE ACHINESS IN THE JOINTS THAT MOVES AROUND AND SOMEONE FINALLY PUT A NAME ON IT.

BUT YOU HAVE THAT INTERESTING MAP SHOWING THE DISTRIBUTION OF WHERE YOU WOULD SEE LYME'S DISEASE IN THIS COUNTRY.

IF SOMEONE COULD BRING THE MAP UP ON THE SCREEN YOU CAN SEE IT THERE IN CONNECTICUT AND MASSACHUSETTS.

AND THEN YOU GET INTO MICHIGAN AND WISCONSIN AND MINNESOTA.

IF SOMEONE TELLS YOU THEY HAVE LYME'S DISEASE IN ARIZONA OR HAWAII, THEY HAVE BEEN SMOKING SOMETHING.

DR. HARDEN: THANK YOU, DR. SANFORD.

AFTER REICH, -- DR. REICH, IS THERE A CURE FOR TOENAIL FUNGUS?

AND WHAT IS THE BEST OVER-THE-COUNTER TREATMENT?

DR. REICH: THERE IS NO GOOD OVER-THE-COUNTER TREATMENT FOR TOENAIL FUNGUS.

SADLY, THERE JUST IS NOT.

THE BEST WAY TO TREAT TOENAIL FUNGUS IF YOU REALLY NEED TO KILL IT IS WITH AN ORAL ANTIFUNGAL.

A LOT OF PEOPLE HAVE HEARD THE ORAL ANTIFUNGAL WILL GIVE THEM -- WILL TAKE THEIR LIVER OUT FOREVER AND SO IT IS A DANGEROUS THING TO DO.

WITH APPROPRIATE LAB MONITORING, IT CAN BE VERY SAFE IN THE RIGHT PATIENT.

WHAT IT IS THE ONLY WAY TO GET ANY CERTAINTY THAT YOU ARE TREATING THE TOENAIL FUNGUS.

IF THEY REALLY WANT TO DO AN OVER-THE-COUNTER THING, THERE ARE SOME STUDIES WITH TREATING THE TOENAILS WITH VIC'S AND SOAKING IT IN VINEGAR NIGHTLY FOR A YEAR AND IT MIGHT GIVE YOU A 50%, 20% CHANCE OF TREATING IT AND I DON'T LIKE THOSE ODDS.

DR. HARDEN: THANK YOU.

DR. SANFORD, ANOTHER QUESTION THAT COMES UP A LOT IN MY PRACTICE.

IS IT POSSIBLE TO WARD OFF LYME'S DISEASE AFTER BEING BITTEN BY A TICK BY TAKING AN ANTIBIOTIC IMMEDIATELY WITHOUT A BLOOD TEST.

DR. SANFORD: IT CAN BE DONE.

PEOPLE HAVE DOCUMENTED IT ONCE IT IS EMBEDDED FOR MORE THAN 48 HOURS, I HAVE BEEN GUILTY OF GIVING PEOPLE DOXYCYCLINE PROACTIVELY.

THEY CAN BE DONE THAT WAY PRUDE WE TRY TO AVOID ANTIBIOTICS AS MUCH AS POSSIBLE BECAUSE THEY MESS WITH OTHER BACTERIA THAT IS SO IMPORTANT FOR DIGESTION.

THE MICRO BILE OF THE INTESTINES.

AND ANTIBIOTICS KILL A LOT OF PEOPLE EVERY YEAR PEOPLE WORRY ABOUT SIX PEOPLE DYING OF THE COVID JOHNSON & JOHNSON VACCINE AND BLESS THEIR HEARTS, IT IS VERY SAD THAT THEY DIED BUT WE ARE TALKING TENS OF THOUSANDS OF AMERICANS WHO PERISH FROM ANTIBIOTIC ASSOCIATED COMPLICATIONS EVERY YEAR IN AMERICA.

SO, I AM NOT A BIG FAN OF USING ANTIBIOTICS PRO FREE -- PROACTIVELY.

DR. HARDEN: AS SOMEWHAT OF A FOLLOW-UP TO THAT QUESTION, AND YOU HAD MENTIONED THIS EARLIER, DR. SANFORD, CAN YOU REVISIT THE ROLE THAT DEET PLAYS IN PREVENTING LYME'S DISEASE?

DR. SANFORD: THAT IS A GOOD QUESTION.

I DON'T KNOW ITS ACTUAL FUNCTION.

DR. REICH, DO YOU KNOW?

DR. REICH: I JUST KNOW THAT IT IS TOXIC TO THE TICKS AND SO THEY DO NOT ATTACH.

DR. SANFORD: IN THE OLD DAYS, AND THIS WILL SOUND AWFUL, BUT PEOPLE WILL TAKE THEIR EARWAX AND RUB IT ON THEIR SKIN.

THERE IS SOMETHING ABOUT THE POLYMER OF OUR EARWAX THAT IS AN INCREDIBLE BUG REPELLENT.

DR. HARDEN: BUT DEET IS AN EFFECTIVE WAY OF PREVENTING TICKS.

DR. SANFORD: AND THERE IS SOME ANECDOTAL STORIES ABOUT NOT WEARING BLUE.

DR. HARDEN: I WANT TO THANK OUR PANELISTS, DR. HILLARY REICH AND DR. PAUL SANFORD AND OUR PHONE VOLUNTEERS FROM "THE GREAT GARDENING SHOW."

PLEASE JOIN DR. RAY CHRISTIANSEN NEXT WEEK FOR A PROGRAM ON CATARACTS AND EYE PROBLEMS WHEN HIS PANELISTS WILL BE DR. TODD BRITTON AND DR. KEVIN TRACY.

THANK YOU FOR WATCHING AND GOOD NIGHT.

♪ ♪ WDSE