The Integumentary System

The integumentary system, compromised of the skin and its appendages such as hair, nails and exocrine glands, is responsible for acting as a barrier and protecting our bodies from any damage or disease, in addition to regulating body temperature. The skin consists of three layers: the top layer of skin known as the epidermis, the middle layer of skin known as the dermis, and the deepest layer of skin known as the hypodermis or subcutaneous tissue. 

In this article, Dr. Ali Ghahary will discuss the common disorders associated with the integumentary system, including the signs and symptoms to watch for.

Skin Cancer

Skin cancer is one of the leading types of cancers in the world today, affecting more than 80,000 Canadians each year. Skin cancer occurs when normal skin cells change and form a mass known as a tumor. 

There are three major types of skin cancer:

1. Basal Cell Carcinoma

This is the most common form of skin cancer, accounting for 80 to 90 percent of diagnoses. Basal Cell Carcinoma is usually a result of overexposure to the sun or ultraviolet (UV) radiation. With BCC, patients may first notice changes in their skin such as an odd growth, changes in appearance of moles, skin wounds that do not heal and/or skin irritation. Basal Cell Carcinoma commonly affects the nose but it can also affect other areas of the body including the back, beck, chest, shoulders and head.

2. Squamous Cell Carcinoma

Squamous Cell Carcinoma is the formation of a malignant tumour affecting the middle layer of skin, also known as the dermis. Similar to Basal Cell Carcinoma, you may notice changes to the skin including growths on the lips, mouth, tongue or genitals. Neglect of this condition can cause the cancer to spread. Treatment of Squamous Cell Carcinoma is depending on the size of the tumour…however, the cure rate is high if treated early.

3. Malignant Melanoma

This is a less common form of skin cancer – however, it is the most aggressive and can be fatal due to its high tendency to spread to various parts of the body. Malignant Melanoma occurs when cells called the melanocytes grow out of control and form tumours.

Other diseases and disorders of the skin include congenital skin conditions such as eczema, psoriasis and dermatitis, bacterial skin conditions such as rosacea and impetigo, viral skin conditions such as warts and herpes zoster (also known as shingles), and fungal conditions such as boils and folliculitis. For more information on skin conditions and diseases, visit the Canadian Skin Patient Alliance website at http://www.canadianskin.ca.

You can also follow Dr. Ali Ghahary on Twitter at @DrAliGhahary.

Disorders of the Urinary System

The urinary system, also known as the genitourinary system, consists of various organs that are responsible for producing urine and excreting it from the body. Urine is a transparent, yellow fluid that contains unwanted waste such as excess water, salt, nitrogen and other compounds.

The central organs of the urinary system are the kidneys. Other organs and components of the urinary system include the ureters, two muscular tubes that carry urine from the kidneys into the bladder. The urinary bladder, a muscular sad found in the pelvic cavity that stores the urine, and the urethra, a tube that expands from the bladder to the external opening of the urinary system known as the urinary meatus.

Cystitis, commonly known as a bladder infection or UTI, is a common disorder of the urinary system. Cystitis occurs when bacteria infects the urinary tract, resulting in inflammation and irritation. A UTI can affect any individual, male or female, of any age. However, they are more predominant in sexually active women between the ages of 20 and 50. While bacteria found in the bladder can be removed by urination, the bacterial will occasionally reproduce quicker than it can be removed, resulting in infection.

In order to treat a UTI, Dr. Ali Ghahary will run a urinalysis. This is done by a patient urinating into a small cup. The urine is then tested for the presence of any disease or bacteria/infection by examining the physical, microscopic and chemical characteristics of the urine. A urinalysis can show the presence of protein, glucose, blood, ketones and leukocytes.

There are also many other disorders that are also associated with the urinary tract, such as:

Interstitial Cystitis

This is another common disorder of the urinary system. Interstitial cystitis is when the wall of the bladder to become inflamed. 90% of individuals with this condition are women. Symptoms of interstitial cystitis can range in severity and include frequent or painful urination and abdominal pain. Unlike cystitis, it does not respond to antibiotic treatment. 

Polycystic Kidney Disease

Affecting over 12 million people worldwide, PKD is a disorder where clusters of cysts form in the kidneys. Symptoms include high blood pressure, back or abdominal pain, blood in the urine, kidney stones and headaches.

Pyelonephritis

Pyelonephritis is an infection of the kidney that causes scarring which, if left untreated, can be fatal. Symptoms include back, side or groin pain, frequent urination or the need to urinate urgently, painful urination, blood in the urine, nausea and vomiting.

Renal Failure

Also known as kidney failure, this occurs when the functioning of the kidneys changes. Acute kidney failure does not always have immediate symptoms. However, over time a patient may notice that their urine output decreases. The treatment for renal failure is kidney dialysis. 

Health Dangers of Mold

Do you have a chronic cough? Do you experience unusual shortness of breath? Frequent headaches? What about recurrent sinus and respiratory infections or flu-like symptoms? These could all be indicative of exposure to mold, which can cause many of the aforementioned symptoms and pose other serious risks to your health.

Moisture is the key cause of mold. Certain molds produce mycotoxins, a toxic secondary metabolite that is produced by fungus, also known as fungal poisons. Exposure to high levels of these mycotoxins can be harmful to both humans and animals, leading to disease, neurological problems, and even death. 

Mold

Mold can be found indoors and tends to grow in places with lots of moisture. This can result from leaks in roofs, windows, and/or pipes. Mold can also enter your home from outside through open windows, doors, vents, and even heating or air conditioning systems, and can attach itself to clothing, shoes and pets. Mold can also grow in insulation, drywall, carpeting, wallpaper, paint and cardboard. While mold can be seen – usually appearing as spots – it can also be described as having a musty smell. 

Symptoms of mold exposure/sensitivity include the following:

• Chronic cough

• Sinus congestion

• Recurrent respiratory infections

• Wheezing

• Shortness of breath

• Red or itchy eyes

• Skin rash

• Headache

• Feeling lightheaded

• Joint pain

• Poor memory

• Trouble concentrating

Dr. Ali Ghahary, a family physician in Vancouver, recommends seeking medical attention if you have any of these persisting symptoms. If you are in need of the advice of a physician, Dr. Ghahary is available to see patients at Brentwood Medical Clinic on a walk-in basis every Monday, Wednesday, Friday and Sunday. You can find Dr. Ghahary's full walk-in schedule by visiting the clinic’s website at http://brentwoodwalk-inclinic.com or http://www.alighahary.ca.

There are also certain tips you can follow to prevent the growth of mold and the symptoms associated to it. First and foremost, fix any leaks. As mentioned, mold likes moisture. If your home has flooded, always clean and dry the home promptly – preferably within 24 to 48 hours. It’s also important to control humidity levels and keep them as low as possible, ensuring that they do not go higher than 50%. If you see mold growth, it can be removed with household products, i.e. soap and water. You can also remove mold with a bleach solution that consists of 1 cup of bleach mixed into 1 gallon of water.

For more great health tips, follow Dr. Ali Ghahary on Twitter at @DrAliGhahary. He is also on Instagram, Facebook and Pinterest. Additionally, Dr. Ghahary's Ask.fm page is frequently updated with health Q&A on a weekly basis and is another great source for health information.

Early Signs of Appendicitis

Abdominal pain, nausea, vomiting, fever or chills, loss of appetite, constipation or diarrhea…these are all symptoms that may be suggestive of appendicitis. While these symptoms could also be indicative of other health problems such as IBS (Irritable Bowel Syndrome), Diverticulitis, or Pelvic Inflammatory Disease, they are not symptoms that should be ignored. In this article we’re going to take a closer look at appendicitis, why it occurs, and what can be done in terms of treatment.

Appendicitis occurs when the appendix, a narrow, tube-shaped organ that is attached to the large intestine on the right side of the lower abdomen, becomes inflamed and causes pain as a result. Appendicitis typically occurs in individuals who are between the ages of 10 and 40. 

As mentioned in the beginning of this article, abdominal pain, nausea, vomiting, fever, chills and loss of appetite are all symptoms that are indicative of appendicitis. However, the symptoms of appendicitis can differ in children than adults. While abdominal pain is the classic symptom that a child with appendicitis will complain of, it is not uncommon for that pain to also be associated with the flu, food poisoning, or constipation. Another telltale sign of appendicitis is sharp pain that occurs when pressure is placed onto the abdominal area and worsens when that pressure is released. An individual with appendicitis may also have an elevated white blood cell count. If white blood cells are elevated, this suggests that an infection is present. If abdominal pain persists for longer than a day or worsens in a short period of time, it is important that you do not ignore it and instead seek the opinion of a physician immediately. Walk-in clinics like Brentwood Medical Clinic in Burnaby, British Columbia, where Dr. Ali Ghahary practices, are well-equipped to deal with patients who may be experiencing these symptoms. In addition, emergency rooms in and around Vancouver also treat acute cases of appendicitis, and patients may be referred by their physician to an ER for further treatment if it is a suspected emergency. It is important to note that symptoms of appendicitis may not always present immediately or as they normally should, sometimes making it a difficult condition to diagnose.

Patients with appendicitis commonly experience LRQ (lower right quadrant) pain

If left untreated, appendicitis can become a life-threatening condition. When the appendix becomes infected or inflamed, bacteria begins to multiply rapidly until the muscular wall of your appendix becomes to thin that it eventually ruptures, resulting in bacteria-laden pus to ooze into your abdomen. If your appendix ruptures, doctors will try to treat it by draining pus from the abdomen as well as prescribing a course of antibiotics for 6 to 8 weeks. However, in most cases, the appendix will need to be surgically removed to avoid further complications – this is known as an appendectomy. An appendectomy can be performed two different ways – as an open surgery, which is done by cutting 2 to 4 inch incision into the abdomen, or via laparoscopic surgery, which is done through a few smaller incisions and guided via a video camera into the abdomen.

Chronic Sinusitis

Scan showing sinuses/sinusitis

Chronic Sinusitis, also commonly referred to as Rhinosinusitis, is a recurring condition causing inflammation of the nasal passages in addition to mucus buildup, causing a vast array of symptoms. Chronic sinusitis has a reported prevalence of 5% in Canada, which increases with age, as well an increased prevalence in individuals with other chronic health conditions such as asthma and COPD (Chronic Obstructive Pulmonary Disease.) 

The symptoms of chronic sinusitis, the common cold and allergies can all be similar. Each of these conditions can cause the patient to have a congested or runny nose, headache, cough, ear pain/pressure, and even fatigue. When trying to determine whether you have chronic sinusitis, Vancouver physicians like Dr. Ali Ghahary will perform routine examinations by checking to see if you have tenderness in the nose or face and will also ask if you have discolouration of nasal discharge or nasal obstruction, which may oftentimes be indicative of a sinus infection. To confirm a suspect sinus infection, your physician may give you a requisition for an X-Ray, which can often be done by walking into any Radiology clinic without any appointment necessary, or send you for a CT Scan or MRI, which is typically done by appointment at any Vancouver or Lower Mainland hospital. These kinds of imaging scans will help to detect deep inflammation within the sinuses as well as confirm whether or not any infection is present, and will help guide your physician on the appropriate treatment required.

Nasal Polyps

Causes of chronic sinusitis include nasal polyps (growth of tissue that blocks the sinuses and/or nasal passages), a deviated or damaged septum (restricts or blocks the nasal passages), and respiratory infections (can be viral, bacterial or fungal.) Other medical conditions such as gastroesophageal reflux and other immune system related disorders have also been linked to the development of chronic sinusitis. You are also at a greater risk of developing chronic sinusitis if you have asthma or are exposed to pollutants such as smoke (or secondhand smoke.) Serious complications of chronic sinusitis include vision problems, potential or complete loss of your sense of smell, and meningitis.

Treatment of chronic sinusitis is dependent on the symptoms and their level of severity. If less than 7 days, chronic sinusitis is typically treated symptomatically; with intranasal corticosteroids (such as Nasonex) being prescribed in effort to help reduce inflammation and alleviate the symptoms you may be experiencing. Other treatment may include immunotherapy (allergy shots) to decrease the body’s reaction to certain allergens. If you are non-responsive to treatment or if the duration of symptoms is greater than 7 days (in addition to imaging showing a present infection), the likelihood of a bacterial infection increases and physicians like Dr. Ali Ghahary will then consider prescribing antibiotics to the patient. In recurring cases, as well as with persisting severe symptoms, a referral to an Ear, Nose and Throat specialist in Vancouver (or the surrounding area) may be required to determine if any further treatment, such as Endoscopic sinus surgery, is necessary. Endoscopic sinus surgery is usually done as a last resort when treatment has not been effective, and will remove any inflamed tissue or nasal polyps, as well as enlarge narrow sinus openings to help sinus drainage.

Cancer Statistics and Chemotherapy

On average, nearly 600 Canadians will be diagnosed with cancer each day, with an estimated 200,000 new cases diagnosed in 2016 alone. Cancer is the leading cause of death in Canada and accounts for over 30% of all deaths in the country. The most common forms of cancer in Canada are lung, breast, prostate and colorectal. While cancer typically affects individuals over the age of 50, it can occur at any age. It is important to keep in mind that having regular checkups with your physician is vital for your health and can help in early detection of cancer.

Chemotherapy, commonly referred to as "chemo", is the use of cytotoxic drugs. These drugs work to kill cancer cells in the body and stops them from growing or reproducing. There are various types of chemotherapy drugs available and they will oftentimes be used in combination with one another in effort to lead to a better outcome for the patient. Chemotherapy treatment also reduces the chances of cancer cells mutating and becoming resistant to certain drugs.

The dose, schedule and length of chemotherapy treatment is decided by an oncologist, a doctor that specializes in the prevention, detection and treatment of cancer, and is dependent on the type of cancer the patient is diagnosed with, its stage, the patient’s age, as well as the patient’s overall health. Chemotherapy is usually given in cycles – lasting one or two days and one to four weeks long. The cycle will then be followed by a rest period to allow the body’s normal cells to recover before chemotherapy treatment is once again resumed.

Side effects can occur with every type of chemotherapy treatment. However, not every patient will experience side effects in the same way. The side effects a patient will experience depend on the type of chemotherapy drug administered, how it is administered, the dose, and the patient’s general health. The most common side effects that patients undergoing chemotherapy treatment will develop is fatigue, nausea and vomiting. Fatigue occurs as the result of healthy cells being destroyed and can last throughout the treatment process. Nausea and vomiting can occur within the first several hours of chemotherapy and can last up to 24 hours after, and in some cases even longer. Nausea and vomiting is managed by anti-emetic drugs such as Zofran (Ondansetron) and Aloxi (Palonosetron).

Loss of appetite can also occur in patients undergoing chemotherapy. This is due to the chemotherapy causing temporary changes in smell and taste, making food seem less appealing. Still, it is important to maintain good nutrition throughout your treatment to avoid malnutrition and weight loss. Several patients find that speaking to a nutritionist is beneficial.

Chemotherapy can also affect the cells in the GI tract. This can result in diarrhea that may last as long as 2 weeks. Alternatively, constipation may also occur and can start 3 days after treatment.

Hair loss is also another common side effect of chemotherapy treatment, but does not occur with all chemotherapy drugs.

For a complete list of side effects related to chemotherapy and other information on cancer, visit Cancer.ca. Also be sure to follow Dr. Ali Ghahary on Twitter, Instagram and Facebook for continued updates on the latest health news in Canada.

Seasonal Allergies

With spring right around the corner, this also means the start of nasal congestion, a runny nose, sneezing, and sore or puffy eyes. These symptoms are usually the result of allergies, otherwise known as allergic rhinitis or hay fever. 

Hay fever affects millions of Canadians and occurs when the mucous membranes become irritated or inflamed by an irritant such as pollen (grass, trees, flowers), causing the aforementioned symptoms. While hay fever typically occurs during the spring, people can also experience perennial allergic rhinitis, which can occur year round. Perennial allergic rhinitis is caused by exposure to mold, dust, pet dander or other irritants.

To avoid allergies, it is important to evade certain triggers. You can do this by making a few changes to your home and your daily routine, as outlined below:

• During high-pollen seasons, keep all windows in your home and vehicle closed and opt for air conditioning instead; stay indoors whenever possible. This will help to limit your exposure to pollen and other outdoor irritants. Note: Do not use window fans as these can actually draw irritants into your home.

• Wear sunglasses. Not only will this protect your eyes from UV damage, but sunglasses will also keep pollen from entering your eyes.

• Clean floors and surfaces with a damp (not dry) mop or cloth.

• Use a dehumidifier in damp or humid areas of your home and make sure it is cleaned often. If you notice mold in areas if your home, clean it by using a mild detergent, bleach, vinegar or baking soda.

• If you have a known pet allergy, avoid contact with animals you are allergic to. If you move into a home that was previously occupied by any animals, you may need to clean or replace the carpeting with hardwood or tile flooring.

To treat allergic rhinitis, the most common medications prescribed by general practitioners in Vancouver such as Dr. Ali Ghahary, are intranasal corticosteroids. These include Nasonex, Nasocort and Flonase, just to name a few. Intranasal corticosteroids work to reduce nasal congestion, inflammation and sneezing associated with allergic rhinitis. Antihistamines such as Benadryl, Allegra and Reactine are also affective in providing more immediate relief to symptoms of allergic rhinitis such as hives, sore or itchy eyes, sneezing, and nasal congestion.

If you would like further insight into what you may or may not be allergic to, request a referral to an allergist from your family physician.