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Author: Stephen J. Klemawesch, MD

Pepper trees also get a bad rap

Pepper trees also get a bad rap

The Brazilian Pepper tree – also known as the Florida Holly – is an invasive species from South America that has spread throughout Florida and the Southeastern U.S. Many Floridians hate it because it is a common source of contact dermatitis similar in nature to poison ivy.

Despite this mischievous aspect of the plant, immunologists have discovered it has incredible antibiotic properties. Amazonian native healers have used the plant for hundreds of years for its medicinal value. Now modern science is jumping on board.

It turns out the berries and leaves contain a variety of flavonoids and terpenoids — especially thymol, carvacrol and myrcenol – which have proven effective against “super germs,” namely E. coli and the dreaded multi-drug-resistant Staph aureus (MRSA).

The plant enzymes work by several mechanisms, one of which is to destabilize the germ’s plasma membrane, causing it to rupture. Two others work through gene repression in the bacteria. Specifically, the Brazilian Pepper represses the gene that transfers antibiotic resistance, and the one that controls the production of bacterial toxins, thus lessening the virulence of the germ.

Veterinarians have started to use the plant extract to treat certain infections in dogs.

These ulcers probably not caused by allergy

These ulcers probably not caused by allergy

Dear Dr. K:  Dear Dr. K: I get recurrent aphthous ulcers in my mouth and on my tongue. Is this an allergic problem?

Known by various names, including canker sores, this condition of recurrent aphthous stomatitis (RAS) can be due to allergy, but that is one of the least frequent causes. Several systemic illnesses have RAS as part of their disease complex, including Behcet’s disease with RAS, genital ulcers, eye disease and neurologic symptoms; MAGIC syndrome with RAS, genital ulcers and inflamed cartilage; PFAPA syndrome with RAS, periodic fever and swollen lymph nodes; SWEET syndrome with RAS, periodic fever and significant skin rash, and Cyclic neutropenia with RAS, fever every 15 to 24 days and a low white blood count.

In terms of allergy, RAS is very rarely seen as a response to food allergy, but more commonly as an allergy to tooth paste – especially kinds that contain sodium lauryl sulfate. Very rarely it occurs from chewing gums that contain balsam of Peru.

Factors that predispose to, but don’t cause RAS are mouth trauma, tobacco, alcohol and poor nutrition. Occasionally RAS is seen from vitamin deficiencies including B1, B2, B6 and B12, folic acid and zinc. Another uncommon cause is Herpes virus that causes internal sores instead of the usual external fever blisters.

Some medicines can also cause RAS: Beta-blockers, ACE-inhibitors, antibiotics, some anti-arrhythmic drugs, NSAIDs and nicorandil. And there’s more: although uncommon, RAS can be a manifestation of celiac disease (gluten sensitivity). Whew! Pesky ulcers can have many causes!

Therapies vary depending on the cause and severity of the condition. Deficiencies in zinc, folic acid, iron and vitamins can be treated with replacement supplements. Avoiding foods that are irritating, such as alcohol, carbonated drinks, spicy foods and acidic foods can help keep the mucous membranes healthy.

Topical steroids in an oral base can be applied to the ulcers, and mouth rinses with the antibiotic tetracycline help some patients. Application of silver nitrate can cauterize and heal resistant ulcers. Medicated tooth pastes also can help healing.

Q – Tips: ionizers and ozone

Q – Tips: ionizers and ozone

Several local businesses recently have advertised installation of ionizers to central air-conditioning systems to improve air quality and reduce infections. The CDC (Centers for Disease Control and Prevention), however, recommends that ionizers only be used temporarily to clear contaminated air, but not on a permanent basis because they produce ozone.

Don’t blame the goldenrod — blame prolific ragweed

Don’t blame the goldenrod — blame prolific ragweed

When allergic people hear the word goldenrod, it makes them want to sneeze. But if truth be told, these plants have been victims of a bad rap.

Goldenrod blooms at the same time (late summer and fall) as ragweed, and because of its bright yellow flowers, it has been blamed for fall allergy symptoms.

But this plant produces a very heavy and sticky pollen that relies on insect transfer for pollination. It’s too heavy to fly in the wind. Ragweed pollen, on the other hand, is tiny and light, plus a single plant can release as many as a million pollen grains.

And goldenrod is not only friendly to humans, but also to insects. There are more than 100 species of goldenrod native to North America and their pollen feeds countless bees, butterflies and hummingbirds.

Take a much-deserved bow, noble goldenrod.

Not just face lifts with Botox

Not just face lifts with Botox

By Sasha Klemawesch, M.D.

When a patient recently told me that she was getting Botox for her depression, not for cosmetics, my initial reaction was: “Sure, and your rhinoplasty was for a deviated septum.” But is turns out the joke was on me.

Botox has been explored as an alternate therapy (to drugs) for clinical depression. Charles Darwin was one of the earliest with the theory that facial expressions are not only manifestations of emotions, but also have a direct impact on them. This “Facial Feedback Hypothesis” is now widely established by modern psychiatry.

As it turns out, the part of the brain responsible for fear, anger, sadness and other negative difficult emotions is part of a feedback loop that includes facial muscles – especially the glabella (spot between your eyebrows that scrunches up when you frown.) Using Botox in this area has led to 60 percent of patients in a clinical trial having marked reduction in depression after a single treatment. Of note, the benefit from a single treatment lasted three to six months, independent of the cosmetic benefits.

The trial included a number of severely depressed individuals who seemed resistant to various medications. New trials are underway addressing depression, plus expanding to social anxiety and bipolar disorders.

Child’s fear of choking again can lead to weight loss and eating issues

Child’s fear of choking again can lead to weight loss and eating issues

Some children who have endured a scary choking incident may suffer from what’s called Avoidant-Restrictive Food Intake Disorder. The disorder was recently reviewed in The New England Journal of Medicine and presents as a condition associated with weight loss due to eating difficulties following a choking incident.

The child basically fears having another choking episode. This leads to avoiding solid food, preferring or demanding only soft food or liquids such as milkshakes, puddings and oatmeal. Weight loss follows because the child also restricts the quantity consumed and receives inadequate calories.

This is a different condition than anorexia because its cause is the antecedent choking, but the result can be the same.

It seems that children who were “picky eaters” as toddlers are more prone to this condition if they choke. The condition is most commonly seen between the ages of 4 and 16.

More than weather events, summer storms can trigger allergic asthma

More than weather events, summer storms can trigger allergic asthma

Nine people died and 8,500 more recently were hospitalized with severe asthma in Australia in a single week of thunderstorms. Said storms occurred during the peak of rye grass pollen season. The rain caused the pollen to become saturated, and the electrical discharges caused fragmentation of the pollen grains into tiny particles.  More typically, pollen grains are filtered out by the nose/sinus area, leading to hay fever symptoms. But tiny fragments created by the storms were able to slip right through the upper airways, landing in the lungs, precipitating sudden, severe allergic asthma. In addition, many of the victims had no prior history of asthma, just allergic hay fever.

Dear Dr. Sasha K: Do I really need my appendix out?

Dear Dr. Sasha K: Do I really need my appendix out?

First of all, we don’t really need an appendix, which is why it is often removed as a precaution against future appendicitis during other abdominal surgery. However, appendectomy for appendicitis is still the most common surgery done by acute-care surgeons, and has been the mainstay for centuries for treating appendicitis. The first appendectomy was in 1735. In fact, ask any physician, surgeon or non-surgeon how to treat appendicitis and the universal answer will be, “cut it out.” But that response may be changing. Already in Europe several research trials have looked at the use of antibiotics for unruptured appendicitis. The rationale for these trials is that appendicitis is much akin to another intestinal malady – diverticulitis, which in most cases can be treated with antibiotics. In these trials 75% of the patients recovered without needing surgery. A large-scale, randomized trial is also underway in the U.S. If results are similar, it may give patients a new option — perhaps one especially useful for high-surgery-risk patients with appendicitis who have severe pulmonary or cardiovascular disease. So, if you see me in the ER at Tampa General and I’m calling for a surgeon for your acute appendicitis, don’t be afraid to ask me for a Plan B.