Corns

Corns are basically calluses on your feet. Nothing more, nothing less. They result from pressure on your toes and feet from day to day activity, and are therefore treatable but not permanently curable. Or, at least no more curable than calluses on the palms of your hands.

Invasive or surgical treatment is rarely needed.

Home treatment is effective, but takes weeks to resolve a corn.

First, keep pressure off it by wearing a doughnut-shaped corn pad around it. It should be soft, but high enough so that when you walk you don't feel your other toes or the shoe against the corn. You may need to stack several pads to do this. You don't need to wear one at night, but you should wear one every day until the corn goes away.

Also, you can buff them off slowly. After every bath or shower, while the corn is still a little softer you can painlessly take a little off with a pumice stone, nail file or emery board.

Feel free to see me if you have one so large that you feel it needs to be pared down a bit. This is painless and does not bleed, since corns are dead skin and have no blood vessels or nerve endings!

MediCare coverage of lab tests

A number of folks (especially diabetics) have expressed concerns that Marshall Lab is saying that routine lab tests are not covered. I have discussed the matter with the Lab Services Director there, and have the following comments to make by way of clarification:

1. MediCare has always, and continues to cover medically needed lab tests.
2. Medically needed with respect to glyco-hemoglobin tests in diabetics (quarterly average blood sugar tests) are:
1. Every 90 days, if stable/well-controlled
2. As often as ordered by doctor if not well-controlled, doctor defines not well-controlled.

So, what's the to-do and what are all those threatening-sounding forms about?

1. Marshall got tired of being burned on lab tests.
2. They got a computer software program that automatically generates a form warning you that MediCare may not pay for a test for any and every test where MediCare defines a time limit.
3. This form is generated for the front-desk people at the lab, who will ask that you sign it whether you are at the time limit or not.
4. This is not meant to say that you will be billed, it is a CYA measure in case MediCare doesn't pay them.
5. The front-desk people have not been educated in the finer points of law and insurance regulations, they are "just following orders".

BOTTOM LINE:

If it concerns you, do "every 3 month" diabetes labs a 90 days or more apart.

If you have been asked to do labs at closer time intervals, don't worry about it. We are careful to complete the paperwork in such a way that it will be covered.

Sunscreen

Gardening season is definitely here, even for those who don't dare to plant before Mother's Day (which is this weekend!).

The active ingredient is the key factor in a good sunscreen, more so than the Solar Protection Factor (SPF).

Micronized zinc as the active ingredient (read the fine print on the container) is overall the best in preventing sunburns and also preventing skin cancer. It lasts longer and is less expensive than other agents, and goes on just like any other sunscreen.

Remember that any sunscreen will oxidize and will need to be replenished every 3-4 hours!

SPF 15 is good for most days, SPF 30 if you will be near snow or water (which reflect sunlight) or at higher elevations. SPF 45 is more expensive, but no more effective than SPF 30.

As an extra bonus, applying micronized zinc oxide once a day (even if you are not going outdoors) can reduce the number of age-related skin spots on your skin by half within a year.

Allergy Medicines

'Tis the season!

Prescription nasal steroid sprays such as fluticasone or Nasonex are the most effective single medication in relieving allergy symptoms. The absorption into bloodstream is so low (about 0.03%) that long-term adverse effects do not occur. However, they therefore have to be used every day during allergy season and can take a week or two to start working.

Antihistamine pills work by blocking allergy reactions. Benadryl works very well, but makes most people feel drowsy. As a rule, the more effectively an antihistamine works in relieving symptoms, the more likely it is to cause drowsiness. That being said, over-the-counter Zyrtec is stronger than Claritin.

Decongestants such as phenylephrine and pseudoephedrine may also help, and they are often added to over-the-counter remedies so check the labeling carefully! Some people have an elevation in blood pressure with them, so use with caution if you have heart disease.

Do not use decongestant nose sprays (Afrin, Neo-Synephrine, 4-Way, etc.) for over 3-5 days. Rebound is common with these, which means you can develop dependency on it because you get more congested every time you stop using it.

NasalCrom nose spray is very safe and effective if used 3-4 times a day every day for mild allergic nose symptoms.

Naphcon-A eye drops are a great anti-allergy eye drop for itchy watery eyes, and went over-the-counter a few years ago.

Allergy de-sensitization shots improve allergy in around 30% of folks who go through the every 2-4 week shots for about 2-3 years.