Skin Cancer Awareness

What to Know About Sunscreens

Because May is Skin Cancer Awareness Month, our primary care doctors in Jupiter want to remind you of the dangers of sun exposure and remind you of the best way to avoid it.

It’s important to know the facts about skin cancer and the sun, along with exposure to tanning beds, because the National Cancer Institute (NCI) estimates that this year 99,780 people in the U.S. will be diagnosed with melanomas of the skin, and that 7,650 people will die from this most deadly form of cancer.

But a proper use of an effective sunscreen can prevent most skin cancers.

About sunscreen

“Unfortunately, skin cancer rates are still rising, and we do everything we can to try to minimize that, and using sunscreen is one component of that,” Darrell Rigel, clinical professor of dermatology at Mount Sinai Icahn School of Medicine in New York City, told CNN earlier this month.

Exposure to the ultraviolet (UV) rays of the sun is the leading cause of both skin cancer and premature wrinkling of the skin. There are two main types of sunscreens used to protect yourself from UV rays: chemical and mineral-based.

When they were first manufactured, most sunscreens had a sun-protection factor (SPF) of 15. That means that if you’d normally burn with ten minutes’ exposure to the sun, an SPF of 15 would allow you to safely stay in the sun for 15 times longer than that, or 150 minutes. As more research was done on sun exposure’s effect on the skin, researchers recognized the need for greater protection, so SPF factors were boosted to 30 and higher.

Chemical issues

There are some problems with chemical sunscreens.

First, because they break down when exposed to the sun, they lose their protective ability after less than two hours, and must be reapplied frequently. They can also be affected by excessive heat exposure, which means if you store them in hot places like a car or beach bag, they can lose effectiveness well before their expiration dates. But there’s no way to tell this just by looking at the product.

Another problem with chemical sunscreens is that, when applied, they are absorbed into the skin.

This is concerning because the active ingredients in many sunscreens, especially oxybenzone, may cause endocrine disruption in the body. That is, once absorbed into the bloodstream they may disrupt normal functioning of the hormones, including thyroid, estrogen, progesterone, and testosterone.

In addition, some studies have linked oxybenzone to harm in marine life when it gets into the water, leading some regions and countries to ban it. And the U.S. Food and Drug Administration (FDA) cautions that the ingredient may not be safe for use in children “because of the higher potential for higher absorption and bioaccumulation.”

A better alternative

The other main type of sunscreen is mineral-based, containing either zinc oxide or titanium dioxide or a combination of both. Comprising these crushed minerals, the sunscreen remains on top of the skin, forming a barrier against the sun’s rays. And unlike chemical sunscreens, these do not break down in the sun. Proposed regulations from the FDA say that these two ingredients are the only sunscreen ingredients that are considered to be both safe and effective.

In the past, these types of sunscreens left a telltale white coating on the skin.

But a newer generation of mineral sunscreen has addressed this problem by crushing the minerals into even smaller particles, which makes the whitening effect negligible. Mineral sunscreens also are better tolerated by far more users, including those with sensitive skin.

The non-profit Environmental Working Group (EWG) released its annual list of recommended sunscreens this month, including options for kids.

So which one should you use?

“There’s not one product that is going to be appropriate for everyone,” Adam Friedman, professor and chair of the department of dermatology at the George Washington School of Medicine and Health Sciences, told CNN.

“The best sunscreen is the one you will use again and again and again,” he said.

The right way to apply sunscreens

Whichever type you select, it’s important to use it correctly.

The American Academy of Dermatology (AAD) offers the following tips for applying sunscreen:

1. Your sunscreen should have an SPF of at least 30 and say “broad-spectrum protection” on the label. If your skin is sensitive to sunscreen, use one that is free of all preservatives, para-aminobenzoic acid (PABA), chemicals, perfumes, and alcohol.

2. Apply sunscreen generously before going outdoors.  It takes approximately 15 minutes for your skin to absorb it enough to protect you.

3. Apply enough sunscreen to cover all exposed skin. Most adults need about one ounce—enough to fill a shot glass—to fully cover their body. Rub the sunscreen thoroughly into your skin.

4. Apply sunscreen to all bare skin. Remember your neck, face, ears, tops of your feet, and legs. For hard-to-reach places, ask someone to help or use a spray sunscreen. If you have thinning hair, either apply sunscreen to your scalp or wear a wide-brimmed hat. To protect your lips, apply a lip balm with an SPF of at least 15.

5. Reapply sunscreen every two hours, or immediately after swimming or sweating.

6. Sunscreen stored in hot areas like a car can lose potency more quickly. The ideal storage temperature is 77 degrees Fahrenheit.

pandemic over

Is the Pandemic Over? Not Quite

Dr. Anthony Fauci’s comment that we are “certainly, right now, in this country, out of the pandemic phase” of COVID-19 sparked numerous questions to our primary care concierge doctors in Jupiter.

It also seemed to cause a great deal of confusion and misconceptions around the country at large, at least until he clarified his statement the following day.

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What to Know About Infant Vaccines

The Centers for Disease Control and Prevention (CDC) has designated this week National Infant Immunization Week (April 25-May 2) to raise awareness of the importance of childhood vaccines. This annual observance highlights the importance of protecting children two years and younger from vaccine-preventable diseases.

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ibs

IBS: Don’t Be Embarrassed About This Common Disorder

From the time we’re little kids, any mention of bowel habits can trigger giggling embarrassment. We’re not sure why that is, because the intestine is simply another organ in the body. Nevertheless, our concierge primary care doctors in Jupiter know that talking about bowel disorders can be uncomfortable for our patients.

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To Mask or Not to Mask is Still a Question

Mask mandates are dropping rapidly across the country. It’s becoming unusual these days to see someone wearing a face mask for protection against COVID-19.

But is universal unmasking a good idea at this point? That’s what many of our patients have been asking, so our primary concierge doctors in Jupiter want to explore the pros and cons.

Latest research

One study, published earlier this month in the journal The Lancet Public Health, suggests that erring on the side of caution when it comes to masking could not only prevent a large number of COVID-19 cases, hospitalizations, and deaths, but also save a substantial amount of money for businesses, the healthcare system, insurance companies, taxpayers, and others.

The study was led by the Public Health Informatics, Computational, and Operations Research (PHICOR) team at the City University of New York Graduate School of Public Health and Health Policy (CUNY SPH), along with a team from the National School of Tropical Medicine at Baylor College of Medicine. The team based their projections on the delta variant of the virus, but found even greater savings with the more infectious variants such as omicron and the newer BA.2.

Using a computer simulation model of the entire country, researchers projected a total savings of $2.9 billion in direct medical costs for anyone paying for health care if universal masking continued beyond certain thresholds. This includes individuals, insurance companies, and the healthcare system. They also projected a cost savings of $20.1 billion in productivity losses to employers and taxpayers.

The thresholds included in the study were an 80 percent vaccination rate across the population and a viral reproductive rate of five (that is, how contagious and infectious the current variant is). The researchers included a cushion of two to 10 weeks beyond achieving those two thresholds as optimal benchmarks to achieve their projected savings.

Mixed messaging

“The messaging about face mask use has been inconsistent throughout the pandemic as there has been back and forth about the use of face masks,” Bruce Y. Lee, CUNY SPH professor, executive director of PHICOR and the study’s lead author said in a statement. “First there was a focus on social distancing and then the focus turned to face mask-wearing. Then attention turned towards the COVID-19 vaccines once they came out.

“Instead, as long as the pandemic is continuing, there’s a need to consistently layer multiple interventions on top of each other, since each complement and enhance each other.”

Yet still only 65 percent of Americans are fully vaccinated, 66.2 percent of Floridians. Only 18 percent of children between the ages of five and 11 are fully vaccinated, and only 44 percent of Americans have received a booster vaccine (38.4 percent in Florida).

Therefore, continued widespread use of masks in the U.S. would appear to be beneficial, even though few seem to be doing so now.

Unpredictable virus

The problem with the SARS-CoV-2 coronavirus is being able to predict what it will do next. Every time health officials believe it is under control or on the run, it pops up again in a slightly different form.

The latest entrant in the COVID-19 version of whack-a-mole is the even more contagious BA.2 subvariant of the omicron variant. In several Western European nations that have relaxed their various mitigation measures, BA.2 has caused as much as a 50 percent spike in cases within a matter of weeks once it appears.

So far, what happens in Europe doesn’t stay in Europe, at least as far as COVID-19 goes. Our case increases have been following theirs by a few weeks each time a new variant arises, and we’ve already seen several thousand cases of BA.2 infection here, the White House announced earlier this month.

While early indications are that it’s not hitting our population as hard as Europe’s, health experts are concerned because our vaccination rates are lower than theirs. This might mean we’ll see cases, hospitalizations, and deaths begin to increase again, possibly surpassing the case numbers seen in Europe.

Weighing the risks

So should you keep wearing a mask in indoor spaces? 

With every state either rescinding mask orders or planning to do so, it’s up to individuals to decide for themselves. If you’ve been fully vaccinated, aren’t in any of the high-risk categories for severe illness or live with someone who is, and are in an area of low transmission such as Florida is at the moment, you may feel comfortable in not wearing one, at least until another variant such as BA.2 begins to spread more widely.

If you prefer to err on the side of caution, however, wearing a mask indoors might protect you from becoming infected. Remember that the SARS-CoV-2 coronavirus—regardless of variant—is transmitted primarily through aerosols that linger for hours in the air. The vaccines offer one layer of protection, masks another.

“Why wouldn’t [the BA.2 subvariant of omicron] come here?” Kimberly Prather, a professor of atmospheric chemistry and an expert on aerosol transmission at the University of California at San Diego, asked The Washington Post recently.

“Are we vaccinated enough? I don’t know. So I’m wearing my mask still. I am the only person indoors [wearing a mask] and people look at me funny, and I don’t care,” she added.

omicron news

What We’ve Learned About the Omicron Variant

As we’ve just passed the second-year anniversary of the SARS-CoV-2 pandemic, our concierge primary care doctors in Jupiter think we should take a moment to reflect on how far we’ve come in dealing with this often-deadly disease.

It may not seem like it, because we still have to wear masks many places and haven’t fully returned to pre-pandemic life, but we have made progress.

For instance, we know more about how it spreads (through the air, especially in enclosed spaces), and how to protect ourselves (safe, effective vaccines and high-quality masks). And even though we’re still in the grip of of this still-relatively new coronavirus, and we’ve also found effective ways to treat it (monoclonal antibodies and anti-viral drugs).

Omicron a good thing?

And, believe it or not, the omicron variant of the virus may have turned out to be relatively good news, even though over 2,000 Americans a day are still dying from it.

But because it appears less lethal than its predecessors, omicron may make the pandemic more manageable.

The Centers for Disease Control and Prevention (CDC) released the results of a study late last month showing that the omicron variant—which is now the dominant variant both here in the U.S. and around the world—causes less severe illness, fewer hospitalizations, and requires less time in isolation following exposure.

This is partly due to the large numbers of people who have been vaccinated and/or infected with COVID-19, as well as to the fact that the virus appears to concentrate its effects in the upper airways instead of settling deep in the lungs.

The downside is that omicron is far more transmissible than earlier variants or the original virus. This is why so many people are catching it, and why—due to the sheer numbers of infections— hospitals are still being overwhelmed and an average of 2,200 people a day are still dying from the coronavirus.

Light at the end of the tunnel?

But an NBC News analysis of COVID-19 case numbers at the end of January showed that Florida is one of the many states where omicron is no longer surging.

And chief White House medical advisor Anthony Fauci said in an interview with ABC’s “This Week” that he expects the wave to subside in “most” states by the end of February.”

“As we get into February . . . it is very likely that most of the states in the country will have turned around with their peak and are starting to come down with regard to cases and then obviously hospitalizations,” he said.

While cautioning that “our work is not done,” Hans Kluge, regional director of the World Health Organization (WHO) for Europe, released a statement two weeks ago that offered a glimmer of hope to a pandemic-weary world.

“The pandemic is far from over, but I am hopeful we can end the emergency phase in 2022 and address other health threats that urgently require our attention,” he said in a statement.

“This pandemic, like all other pandemics before it, will end, but it is far too early to relax,” he added.

Effective weapons

One recent setback in the fight against SARS-CoV-2 was the finding from the CDC, confirmed by the drugs’ manufacturers, that two of the most common monoclonal antibodies used to keep at-risk individuals out of the hospital do not work against the omicron variant.

But again, there’s good news on that front, as well, because one monoclonal antibody—sotrovimab—is effective, and is still available at most hospitals even though Florida’s outpatient centers have closed.

Those who have mild to moderate symptoms of COVID-19 (fatigue, cough, loss of smell or taste, fever) or have underlying risk factors (those over 65, diabetes, obesity, kidney, heart, or lung disease or those who are immunocompromised) can check with area hospitals to see whether they’re offering this treatment.

In addition, other effective weapons in the arsenal against COVID-19 include the intravenous antiviral treatment remdesivir and the newly authorized oral antiviral drugs, Paxlovid or molnupiravir.

Still work to do

Two years in, we still don’t have all the answers, and until more people in this country and around the world are fully vaccinated, SARS-CoV-2 will not be fully manageable.

Each person who remains unvaccinated not only puts themselves at risk, but others around them, as well. And each infection offers the virus another chance to mutate.

Speaking of mutations, you may have heard of another new mutation of the omicron virus that some are calling “son of omicron” or “stealth omicron” because it’s so difficult to detect in PCR tests.

The new variant, designated BA.2 (omicron is BA.1), was first reported in California in November. It has since been seen in isolated cases in Texas as well as other countries. However, while remaining cautious, at this point most virologists don’t think it’s more dangerous or more transmissible than omicron BA.1. We’ll let you know if we learn otherwise.

healthy resolutions

7 Healthy New Year’s Resolutions You Can Keep

It’s easy to make healthy resolutions for the New Year. We’re almost compelled to, because the flip of the calendar offers the promise of wiping the slate clean and starting a whole new life for ourselves.

But often, our best intentions fall by the wayside by the end of January. So our concierge primary care doctors in Jupiter would like to suggest a few healthy resolutions you can make that will be easy to stick to but can still make a significant difference in your health in the coming year.

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