Medicine Simply Author

My Winter Skincare Routine

Is winter starting to make your skin dry and your lips chapped? Below is my winter skincare regimen as well as tips for keeping your skin glowing all year long.

The first tool I find extremely versatile is Aquaphor. It is an ointment made of 41% petrolatum that serves as a semi-occlusive barrier on the skin. This keeps water and oxygen from being pulled from the skin by the elements, which helps with wound healing and creates a protective moist environment. It does not contain fragrances, preservatives, or dyes so it is good for even the most sensitive skin. It is non-comedogenic so it won’t clog up your pores. I use it on my face, my lips, my hands, and any other dry areas in the evening.

Vaseline is also made of petrolatum but it is 100% petrolatum, so it forms an occlusive barrier and is a lot thicker and stickier.

Some people prefer moisturizing with a cream or lotion rather than an ointment. The difference is that an ointment contains around 80-100% oil and up to 20% water, so an ointment feels oily on your skin and doesn’t “rub in.” A cream, on the other hand, is about 50% oil and 50% water so you will still have an oily layer that doesn’t fully rub in but it is less greasy. Make note, however, that creams often contain emulsifiers and preservatives which can be irritating to the skin. A lotion is similar to a cream but it is an even lighter or less thick formulation and can sometimes contain alcohols for faster drying. Gels and foams are the lightest, so to speak, and they also dry faster the the aid of alcohols. One cream that I find to be non-irritating to my skin and a great moisturizer is Cetaphil Cream. Some providers recommend CeraVe Moisturizing Cream but when I have tried it myself a felt a stinging sensation on my skin, body and face.

Another part of my skincare regimen that I use at night is Differin Adapalene Gel 0.1%. I had mild acne in college and used adapalene (Differin) gel, which at that time required a prescription (now it is over-the-counter!), along with an antibiotic cream called clindamycin. Differin is a topical retinoid that increases skin turnover and wards away acne including blackheads and whiteheads. Retinoids are also anti-aging (you may have heard of prescription Retin-A). I still use a pea-size amount of Differin gel about once every 3-4 nights to maintain clear skin. However, retinoids can be very drying so be sure to moisturize aggressively. Also, wait at least 30 minutes after applying Differin to apply moisturizer as you want to avoid getting retinoid on the sensitive skin around the eyes.

In the morning, I use a tinted CC cream that contains SPF 50. I am currently using IT cosmetics’ Your Skin but Better CC Cream with SPF 50 Plus (Medium) – 1.08 Ounces. I really like the way it gives me a smooth, even skin tone without feeling heavy at all. I use this in the morning with some Aquaphor on my lips. I even use it at night as my foundation and then use a contour stick over it plus mascara, lipstick, and bronzer or blush. I love the fact that it includes SPF for daytime. Protecting my skin from UVA and UVB rays is a priority in order to prevent skin cancer as well as aging and discoloration (and yes, you do need SPF in the winter time too! You can get your Vitamin D from food or a supplement). I will admit, on rotations where I have to wake up at the crack of dawn, I often roll out of bed, brush my teeth, throw on scrubs, and go to work bare-faced, as evidenced in this photo from my intern year.

However, lately I have been making an effort to effort to wear SPF, and to look a little more polished. Also to floss my teeth nightly, but that’s a story for another day.

Lastly, I am a lifelong user of Dove soap. It is the only soap that does not dry out my skin. Because I use Dove I do not have to regularly moisturize my body skin.

And that sums it up. I like to keep my skincare regimen simple and effective. Moisturize at night, preferably with ointment or a non-irritating cream, and wear SPF in the morning.

Hand Washing

How To Avoid Cold and Flu

The winter chill is in the air and everyone around you is sneezing. What can you do to steer clear of cold and flu viruses this season?

Hand Washing
Prevent illness by washing hands frequently!

The best medicine is prevention.

The first step is to avoid getting sick in the first place. Here are my tips:

  • Wash and sanitize your hands frequently. This is the best way to avoid getting sick. In the hospital there are Purell dispensers in front of every patient room and sinks easily accessible. I sanitize my hands before and after every patient encounter. I also wash my hands before eating or before touching my face. I carry hand sanitizer in my purse and in my car.
  • In fact, I avoid putting my hands near my face unless freshly washed. (This is no easy task for a former nail biter!)
  • Avoid people who are sick, especially if you are immunocompromised. If you must come in to close contact with someone who is sick (e.g. your child), wash your hands after any contact with them and before eating or putting your hands near your face. Consider wearing a mask.
    • If you are in close contact with someone with documented influenza, discuss with your PCP whether you should take prophylactic oseltamivir (Tamiflu) medication.
  • GET YOUR INFLUENZA VACCINE! Everyone. Even if you have never had the flu. Even if you are otherwise healthy. I cannot stress this enough to my patients. The influenza vaccine saves lives. Some myth busting:
    • You cannot get influenza from the injected influenza vaccine. You may develop a day or two of malaise and even a low-grade fever as your body creates antibodies to the vaccine. However, you cannot develop influenza.
    • Vaccines do NOT cause autism. More on this in a later post, but read this for more.
    • The vaccine is not 100% effective (nothing is in medicine). However, it significantly reduces the incidence of influenza.
    • See the CDC website for more.
  • Get your pneumococcal (“pneumonia”) vaccine if you meet criteria (eg. if you are above the age of 65 or if you smoke, have diabetes, or a variety of other chronic illnesses). This will help protect you from one of the common causes of bacterial pneumonia. Discuss with your PCP.

But why should I care about avoiding getting a respiratory infection in the first place?

  • According to the CDC, about 36,000 people die of influenza each year.
    • In my ICU rotation my intern year, I took care of an otherwise healthy 45 year old man who developed acute respiratory distress syndrome from the flu and was on a ventilator for 5 weeks.
    • I personally got the H1N1 flu in 2009 and, though I was otherwise perfectly healthy at the time, I was completely out of commission with a high fever for 11 days. This was followed by another week of so of pneumonia and a pleural effusion. The flu is no joke!
  • It’s bad for the economy. No, seriously. According to the CDC, influenza alone causes workers in the US to lose up to 111 million workdays, totaling to an estimated $7 billion per year in sick days and lost productivity.
  • Even a simple “cold” (a viral upper respiratory infection) can be fatal for people with chronic conditions such as asthma and COPD, people who are immunosuppressed (eg. people with cancer on chemotherapy, people with autoimmune disorders on immunosuppressing medications, people with HIV/AIDS).
  • You can pass it on to other people, including people with the above conditions.
  • It’s a hassle! Whether you are the one who is sick or your child, spouse, or loved one is, respiratory infections are a nuisance.

I’ve caught a cold (or flu)! Now what?

  • If you have a fever (temp > 100.5F), consider getting tested for influenza with your PCP or at an urgent care center, as you may qualify for receiving oseltamivir (Tamiflu). You must present within 48hr of symptoms to have any benefit from Tamiflu. This medication can reduce symptoms and shorten duration of illness by 1-2 days.
  • If you have fever and cough productive of sputum (of any color), or symptoms that do not get better within a week, seek medical examination as you could have a lower respiratory infection such as pneumonia.
  • For all other viral upper respiratory infections (symptoms such as sore throat, runny or stuffed nose, runny eyes, sneezing), no medication is needed. You may take supportive medications (i.e., medications to make you feel better). Your body will fight the virus on it’s own.
  • Get rest, drink plenty of fluids, and avoid close contact with other people in order to prevent passing the virus on.
  • If you have malaise, muscle aches, headache, or fever, ibuprofen (the active ingredient in Advil and Motrin) and/or Acetaminophen (the active ingredient in Tylenol) can help relieve those symptoms.
    • Discuss with your doctor whether these medications are safe for you. For example, those with kidney problems and those at increased risk of bleeding should not take ibuprofen without OK from your doctor. Those with liver problems should check with doctor before taking acetaminophen.
    • Seek medical care if you have a severe headache, especially if you do not typically have headaches or if it is the worst headache of your life.
  • If you have a stuffy or runny nose, consider saline nasal spray or using a Neti Pot. Decongestants such as DayQuil can help (contains 3 ingredients: acetaminophen, a cough suppressant, and a nasal decongestant) though I personally never use these myself. Ask your doctor before using decongestants (ingredients such as phenylephrine) especially if you are prone to a racing heart, high blood pressure, or glaucoma.
  • If you primarily have phlegm and a productive cough, you may benefit from a cough suppressant such as Mucinex (tablets) or Robitussin (liquid). I order them frequently in hospitalized patients.

Using these tips I have avoided getting sick so far this season (knocking on wood!). Stay healthy and be well!

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How to Stop Nosebleeds

*Buzzzz* My pager buzzes with the following message: “patient in 233 having a severe nosebleed, come now.” The patient is a 72yo woman on aspirin (an antiplatelet drug) and warfarin (an anticoagulant). When I walk into the room, multiple staff members are surrounding the patient. One is holding gauze under her nostrils as bright red blood is dripping down. I see that the patient is breathing normally and thinking clearly and is not in distress.

I instructed the nurses to hold firm pressure at the tip of her nose for 5 minutes without letting go. Also to keep the patient’s chin close to her chest in order to prevent blood from going into her trachea. Instead any blood would drip back into her esophagus or out her mouth. However, sensing the nurse’s reluctance, I placed my gloved hand over the patient’s nose and pinched firmly for 5 entire minutes without stopping. It must be a firm hold, to the point of slight discomfort to the patient. During the hold, the patient had some clots come out of her mouth during the first minute or so, but the bleed seemed to be slowing down. I timed the 5 minutes on the wall clock and then examined the patient’s nose.

When I let go, there was no further obvious bleeding. On exam with a light, there was an oozing spot visible in her right nostril. I ordered oxymetazoline (Afrin) nasal spray and had her RN apply two sprays to each nostril in order to cause constriction of the blood vessels in the patient’s nose. The patient had no further bleeding.

Most (about 90%) of the time, epistaxis (aka a nosebleed) comes from the front or anterior part of the nose; specifically, from a group of blood vessels called Kiesselbach’s plexus, as shown in the photo below. Compressing them can stop this kind of bleed.

©2017 UpToDate, Inc. and/or its affiliates.

If a nosebleed happens to you or a loved one at home,

  • 1. the first step is to make sure that the person bleeding has a pulse, is breathing, speaking, thinking clearly and able to protect their airway; if any doubt on their ability to protect their airway, call 911.
  • 2. The next step for those who are safely protecting their airway is to begin by applying firm pressure as such, with the chin tucked close to the chest:
Anterior nasal pressure and chin tuck. Copyright Medicine Simply.
Anterior pressure, side view. Copyright Medicine Simply.
  • 3. Do not let go for a minimum of 5 minutes.

During the process of holding you may see some clots come out of your mouth or feel them go down your throat. However, if you continue to have unchanged, profuse bleeding, in particular down the back of the throat, despite firm anterior pressure, call 911 and go to your closest hospital emergency department as you may have a posterior nasal bleed. Posterior bleed tend to be dramatic–they don’t drip, they run like an open faucet. For anterior bleeds, however, firm pressure should noticeably dampen the bleed.

  • 4. After 5 full minutes of firm pressure, let go and inspect the nose for bleeding. If any further bleeding, apply two sprays of Afrin to each nostril and continue to hold firm pressure for another 5 to 10 minutes. If after 15 total minutes the bleeding has not stopped, seek emergency medical care, as you may need nasal cautery or packing by an ENT or emergency room physician or advanced provider.
  • 5. If bleeding has stopped but there is some oozing at the source, it is reasonable to apply two sprays of Afrin in the nare. Watch carefully for at least 30 minutes to ensure no recurrence of bleeding. Make note that Afrin is a great vasoconstrictor and decongestant but it should only be used for more than three days in a row as it can cause rebound nasal congestion.
  • 6. Once the bleeding stops, care for the site of bleeding by gently applying an antibiotic ointment such as bacitracin three times daily for three days.

If nosebleeds happen to you frequently, discuss them with your primary care provider (PCP) in order to discover why they may be happening.

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