This eczematous condition is frequently seen among persons whose occupations demand repeated and frequent hand washing. "Overwashing" the hands, allergies or contact with irritants all can contribute to hand dermatitis. In the case of hand overwashing, prolonged and extended washing with soap causes inflammation of the skin of the hand through friction in scrubbing and removal of the protective skin barrier by soaps. Contributing factors include the frequent and alternating wetting and drying, sweating, contact allergies or sometimes a reaction to a skin fungal infection may play important and different roles in precipitating and propagating this condition . Home healthcare givers, doctors, and nurses etc are particularly at occupational risk for this condition. In addition, persons with obsessive compulsive hand washing and germaphobic tendencies, or autism spectrum disorders are equally at risk and can end up developing a rash in the palm of their hands as severe or even worse than the one depicted in the picture. This eczema can constitute an unpleasant sight, can be extremely itchy with tiny bubbles and bumps on the sides of the fingers and palms. These hands can be a source of undue anxiety in a handshake, and worse still, for a patient being nursed with them.

Prevention requires that persons in direct patient and bedside care, and all those who's job require repeated hand washing, incorporate the use of hand moisturizers to reduce chances of developing hand dermatitis. Hand dermatitis that does not respond to such conservative measures require treatment directed at some of the contributing factors already described.

Patients who invite conversations on decreasing sexual performance are always welcome. This one like most enjoys a good relationship with his partner and would like to maintain their strong interest in having sexual intercourse. He is happily married and in a stable relationship, has never suffered from depression. He has however noticed increasing difficulty initiating and maintaining erection and he no longer experiences the usual nighttime and early morning kick and spontaneous erection. The loss of the usual morning erection did not go unnoticed by his very attentive partner of 34 years. All these experiences and symptoms are consistent with Erectile Dysfucntion (ED). He nevertheless has always been in good health, except for the usual mild hypertension and borderline cholesterol. With this current erectile difficulty, we are both eager to try some viagra. Well not so fast I would like to caution.

Erectile dysfunction (ED) itself happens to be an independent risk factor for heart disease, cardiovascular event and heart attacks. Hence clinical assessment for co-occurring heart problem is warranted before handing over a prescription of viagra or other similar medicines for the treatment of Erectile Dysfunction. Sexual activity can be unsafe in the face of underlying cardiovascular disease. Even worse, jumping into treating ED when there is a likelyhood of an unattended underlying cardiovascular disease is an invitation for serious problems such as a heart attack and sudden death. Deaths have been known to occur right in the middle of sexual activity. ED is a risk that equals moderate tobacco use, for cardiovascular disease. Performance enhancement may well precipitate a cardiac event in a high risk individual. It is prudent to rule out and manage co-occurring heart disease in select individuals before prescribing and or encouraging continued sexual activity.

In primary care it is good practice to have a high index of suspicion, in select individuals when appropriate, to search, uncover and treat co-occurring coronary heart disease before giving out viagra, cialis or their like prescriptions, the so called phosphodiesterase type 5 (PDE-5) inhibitor therapy. Fortunately, first-line treatment for ED includes lifestyle modification (smoking cessation, exercise, and weight loss). 

For example, nearly 30% of obese men will have improvement in ED symptoms by just exercising regularly and losing weight in efforts to bring the BMI below 30.

Managing joint disease and pain.

Help your arthritis symptoms with exercises, healthy diet and supplements.

Glucosamine sulfate and chondroitin sulfate are the most commonly recommended dietary supplements in our practice. Next is Omega-3 fatty acids derived from fish oil. These have been proven scientifically to reduce inflammation. Omega-3 fatty acids reduce inflammation by blocking production of initiators and triggers of inflammation in the joint like the prostaglandins and leukotrienes. In rheumatoid arthritis clinical trials Omega-3 fatty acids show modest benefit.

Other less proven herbal products for arthritis are available over the counter such as the ever present ginger, curcumin, bromelain, evening primrose and borage oils, feverfew, willow bark, cat's claw, and Boswellia. These are natural products that have helped patients with arthritis .

Additionally, we would refer select patients for therapy - physical and occupational therapy. Physical therapy can be an adjunct to pain control and management at various stages of a joint disease process, reducing pain and disability in many instances. Occupational therapy tailored to improving and restoring function with a goal of full or partial rehabilitation of the affected joint and limbs has the added benefit of putting patients back to purpose driven activities for a healthy productive living .

Tai chi, Yoga and acupuncture acupuncture, meditation, deep-breathing exercises, guided imagery, hypnotherapy, progressive relaxation, and qi gong have found various utility in managing disease.Tai chi have been proven to reduce pain and disability, improve functions in a subset of patients

Lastly when disease is unmanageable with different combinations of the above and medications, when joint diseases is end-stage and pain  unbearable, when pain occurs even at rest and interrupts sleep, accompanied with significant disability and dysfunction, surgery such as a total joint replacement may be the only intervention that can bring relief to such patients.

 Tip: Are you on a cholesterol lowering medication and have to take medicine like colchicine because of a new diagnosis of gout ?