Monthly Archives: February 2016

Dog Heals Family… And Vice Versa

by on February 23, 2016

pets rescue spca
By Debbie Goren

2013 was a tough year for the Goren family. We had lost my beloved father to brain cancer after six grueling months of slowly watching this wonderful father and grandfather slip away. His passing left a hole in our hearts and our healing would be slow.

2013 was also a tough year for a stray dog who was dumped in Half Moon Bay without a collar, microchip, or any signs of his owner. The unkempt black-and white mutt was taken to the Peninsula Humane Society in Burlingame, where it was found that his right eye was so severely infected and swollen it no longer served any purpose but pain, and had to be removed. In addition, the little guy was sick with a stomach bug he had picked up from drinking gutter water.

Our lives aligned the day my family decided that in order to continue our healing, we needed love and needed to give love. We went to the SPCA where we sighted the one-eyed dog and were intrigued. Could we get to know him better? In the greeting room, he was scampering round, giving kisses, and rolling over for belly scratches, ecstatic over the affection and attention our boys were heaping on him. As I watched and fell in love, I realized it was no accident that we had found each other. We both needed healing.

We kept his shelter name, Thomas, and made it official by engraving it on a shiny, new bone-shaped doggie tag. To say this former stray helped our family emerge from a dark time would be an understatement. Our boys, 12-year old Jonathan and 9-year-old Zach, love Thomas so much that we have a written schedule for who gets to sleep with him each night. After a long day at work, he welcomes my husband at the door, and I see the stress melt away as David bends down to return the enthusiastic canine greeting. When my mother visits, she cuddles her furry grandpuppy in her arms and serenades him with Yiddish lullabies, while the other doggie grandparents are always volunteering as “Thomas-sitters.” Our boy has also become the unofficial class mascot for Jonathan’s 7th grade class.

When I can steal Thomas from other family members, I take him with me everywhere. At night, Thomas nestles next to one of us in bed and we listen to him snore. We feel comforted by the sound, even if others might be bothered by the wheezing, snorts, and snuffles. Instead, we hear something else: contentment, love, and healing.

 

Why Is It so Hard To Ask For Help?

by on February 9, 2016

asking for help

By Koko Kaasaki, PJCC Adult Program Coordinator

Being independent and self-sufficient are positive attributes, however, we all need help from time to time. But, do you ever struggle to ask for help? M. Nora Klaver, a life coach and author of Mayday! Asking for Help in Times of Need, states that 70 percent of people confessed to having needed help in the previous week but did not ask for it. There are many reasons why we do not ask for help including not knowing how to ask; not thinking to ask; wanting to be self-reliant; and believing it’s easier to do it ourselves. Often underlying the myriad reasons are the fear of being vulnerable and the shame of being burdensome.

Motivational speaker Mike Robins assures us that it’s not uncommon to feel discomfort in asking for help. We may think that we should be able to do everything on our own, or that asking for help can set us up for rejection and disappointment. When we can get beyond the initial discomfort, however, Robbins states that asking others for assistance may strengthen the networks of friendship and community. Furthermore, asking for and receiving help validates that we are worthy of others’ support. Asking for help, therefore, is an act of self-compassion.

Some people have no difficulties in asking for help. Others can develop this skill through taking small steps every week. M. Nora Klaver suggests that regularly making small requests, such as borrowing a cup of sugar from a neighbor, develops our “muscles” so we don’t feel desperate and overwhelmed when bigger situation arise where needing help is unavoidable.

Additionally, psychologist Dr. Deborah Serani provides the useful acronym HELP when seeking others’ assistance:

  • Have realistic expectations for the kind of help you are seeking
  • Express your needs simply and clearly
  • Let others know you are there to help them as well
  • Praise your pals for their assistance and pat yourself for asking for help

And, here is some food for thought: Klaver suggests that the independent, self-sufficient American is a cultural myth. She asserts that all great endeavors are founded upon the spirit of team work and helping each other in times of need. Our endeavors may be great or not so great (or somewhere in-between). Nonetheless, this practical viewpoint provides a positive argument for why we needn’t shy away from asking for help.

 

Koko Kaasaki is the PJCC Adult Program Coordinator and has a Masters in Gerontology.

See upcoming programs at the PJCC.

 

 

What if Rapunzel Lost Her Hair?

by on February 3, 2016

hair loss

The other day I was reading the story of Rapunzel to my granddaughter, and I started to wonder what would have happened if Rapunzel had a hair loss disorder. The plot of the story hinges on the prince being able to climb up Rapunzel’s hair to meet her since she was locked in a castle tower with only one window and no door. “Rapunzel, Rapunzel, let down your hair so that I may climb the golden stair.”

We often take the amount of hair on our heads for granted, that is until we start losing it. One of the most common complaints I hear from patients of any age, almost as an afterthought, is “Doctor, I seem to be losing my hair.” Normal hair loss is anywhere from 50-100 hairs per day. Hair grows in cycles, and typically lasts 2-6 years. At any given time, 90% of hair is in a growth phase, growing at one-half inch a month, and 10% of the time it’s in resting phase. After 3-4 months the hair in the resting phase falls out, and new hair grows to replace it. The glitch can be when more hair falls out than grows back in. As I was reading the story, I wondered how exceptional was Rapunzel’s hair? Let’s presume that she lived in castle five stories high (50 feet), and her hair grew at the normal rate of one-half inch a month, (or one-half foot a year), and that her hair was always in a growth phase. A quick calculation indicates that in order for Rapunzel’s hair to reach the prince on the ground, she would have to be 100 years old! She clearly lived in a fairy tale.

When patients ask about unusual hair loss, I inspect the scalp. Men sustain hair loss in two places – a pattern of receding hair line, and balding at the top of the head or crown. When women lose hair, typically the frontal hairline is preserved, and there is diffuse hair thinning of the top of the head. (If a woman sustains male pattern baldness, this leads me to suspect a medical condition where there is an excess of male hormones such as in polycystic ovary syndrome.) Around two-thirds of men develop some balding during their lifetime, but women’s hair loss is common too. Over 50% of women over the age of 80 have hair loss. Hair loss in women can be particularly devastating since it can result in low self-esteem. Perhaps the one thing that helped Rapunzel’s confidence despite her lonely imprisonment was her bountiful head of hair.

The other thing I do to evaluate hair loss is the “hair pull test.” (Unlike many medical tests which are named after obscure medical scientists, this test has an easy name to remember!) I learned this test from a dermatologist colleague, and it’s performed by grasping a lock of hair and pulling gently. As mentioned earlier, normally no more than 10% of hairs are in a resting phase at a given time, so if I pull on 20 hairs on the scalp, I should not expect more than 2 hairs to be removed. For this test to be done accurately, it’s important that the patient be instructed to not wash his/her hair for at least 24 hours before the visit, and the test should be performed over various places of the scalp.

What Are Some Of The Causes Of Hair Loss?
Other than hereditary hair loss triggered by the interplay of genes and hormones, sudden hair loss has many causes. Stress from a major illness, surgery, or fever can result in hair loss 3-4 months later, but fortunately this is temporary. Overactive or underactive thyroid disease can result in hair loss, and improves with proper treatment. “Traction alopecia” can result in hair being pulled too tightly from wearing braids or ponytails. Hair can be damaged with other manipulations such as from bad brushes, blow dryers, and brushing aggressively when the hair is wet. In most of these cases, hair grows back after the offending behavior is stopped.

It is common for women to lose significant hair three months after childbirth due to changes in hormones – one would hope that Rapunzel’s obstetrician would warn her of this possibility. Imagine Rapunzel’s surprise if she awakens from sleep three months after a pregnancy and discovers a huge pile of hair on her pillow!

Lack of iron, inadequate protein in the diet, or eating disorders such as anorexia or bulimia may result in hair loss. Fad diets or ingesting large doses of Vitamin A may also cause a problem.
Most people are aware that radiation and chemotherapy can result in hair loss, but many common medications can cause hair loss as well. The long list of medicines that can result in hair loss include anti-clotting drugs, antidepressants, birth control pills, anticonvulsants, nonsteroidal anti-inflammatory drugs, cholesterol lowering drugs, and blood pressure medications. (If you don’t do so already, read the prescription information enclosure when you get medication to see about potential side effects.) The most common medication hair loss culprit that I have seen has been due to a beta-blocker called atenolol. When hair loss does occur from a medicine, it usually starts within a few weeks of taking the medicine, and hair typically grows back on its own after the medicine is stopped.

One serious cause of hair loss is alopecia areata meaning “area baldness.” Hair is lost in patches, but may proceed to complete baldness. It can be diagnosed by inspection and positive “pull test.” This is thought to be an autoimmune disorder and affects around five million people in the United States. Anyone who has this should see a dermatologist, but fortunately the condition resolves by itself in many cases.

In children, tinea capitis, or ringworm presents with a round patch of hair loss due to a fungal infection. Careful examination reveals scaling and redness around the rim of the patch, and localized enlarged lymph nodes. If the diagnosis is obscure, a skin scraping from the border of the patch can be looked at under the microscope.

Trichotillomania is a compulsive disorder involving repetitive plucking and pulling of hair in children, but may progress into adulthood. This condition results in patchy hair loss which may become permanent due to scarring.

Medical Treatment For Hair Loss
It’s virtually impossible to prevent hereditary baldness. However, there are two medicines that have been approved by the FDA to treat hair loss. Topical minoxidil (brand name Rogaine) can be purchased over the counter for use in women and men; it should be massaged into the scalp twice a day, and has to be applied indefinitely to maintain its benefits. Minoxidil helps only the crown of the head, and the new hair is like baby hair, thin and light. In one study, 20% of women reported moderate hair growth after using it for 32 weeks. Side effects may include unwanted hair growth on the adjacent skin of the face and rapid heart rate.

The other treatment is finasteride (Propecia), a prescription medicine for men only. It is a pill taken once a day, works best on men who are starting to lose hair, acts better for the crown of the head than receding hairline, and may take at least six months to see results. Side effects may include loss of sex drive and sexual function. It needs to be taken indefinitely to maintain its benefits, and there is concern how it affects the risk of developing prostate cancer.
A novel treatment for preventing hair loss in patients undergoing chemotherapy is using scalp hypothermia, or “cold caps.” The theory behind this is by cooling the scalp, blood vessels become constricted, hair follicles receive less chemo, and hair loss is prevented. The downside may be that stray cancer cells lurking in the scalp could survive so the long term safety of this technique is unknown.

A laser device called HairMax Laser Comb has been approved by the FDA for use in men, but published research on the effectiveness is lacking. Don’t waste your money since it’s too early to tell if it actually helps.

Common Sense Things To Do For Your Hair
Choose a gentle shampoo. “Revitalizing” shampoos which promise to restore hair do not regrow hair. If you use a hair dryer, use the low setting. Use a comb rather than a brush, particularly if your hair is thinning. If you do use a brush, do so when hair is dry. Avoid any brush or comb that pulls your hair, and preferably find one that has rounded edges or natural bristles. Avoid bleaching, straightening, excessive sun exposure, or anything else that can damage your hair. Consult with a hair stylist to camouflage or hide thinning hair. Perms and hair coloring are thought to be safe as long as no bleach is used. Hair transplantation surgery is an option for both men and women after thorough pre-operative assessment and discussion of realistic expectations.

Summary
It is extremely unlikely that any of us will ever have hair like Rapunzel. However, with better understanding of some of the conditions which can result in hair loss, and knowledge of how to care for our hair properly, it’s possible to enjoy the way we look for many years.

Jerry Saliman, MD is a volunteer internist at Samaritan House Medical Clinic in San Mateo. He retired from Kaiser South San Francisco after working there more than 30 years. While at Kaiser SSF, Dr. Saliman was also Chief of Patient Education. He received the 2012 “Lifetime Achievement Award” given by the Kaiser SSF Medical Staff.

Editing acknowledgement: Ellen Saliman

Neither the PJCC or our guest columnists provide medical advice, diagnosis, or treatment. Please make your health care decisions in partnership with your health care provider.