There is a childhood illness called Erythema infectiosum or Fifth Disease. It is also known by the more common slang name of "slapped cheek syndrome". Yes...amazingly...it does almost exactly resemble someone who has been slapped across the face. So it is no surprise that Mr. W thought the worst of his child's situation.

Fifth disease is primarily an illness of children aged 5 to 15 years old--although it can affect other age groups but with different manifestations. It is caused by the erythrovirus and is easily spread by secretions from the respiratory tract or contaminated blood.

Usually, the time between actual infection and the first signs of the disease is about anywhere from 4 days to 21 days. The unfortunate part is that children who are infected are most contagious before any signs of the illness show up. This is one of the main reasons why schools can become victims to epidemics if left unchecked. Interestingly, once a person already has the rash, they are much less infectious.

What does it look like? In children, it literally looks like they have been slapped on the cheeks. Their cheeks have a bright red rash that can sometimes also cross the bridge of the nose. As the illness progresses, the rash may spread to the torso, arms, and legs. It may or may not be itchy and can last from a few days to several weeks. If adults or teens are affected, it is more likely to be manifested as a generalized joint arthritis instead of a rash.

The disease is usually self limited and resolves on its own. However, there are some medical conditions that can make certain people more likely to run into problems. Certain blood diseases like sickle-cell disease or some forms of anemia can become a serious medical problem if a person is infected. Women who are in their first trimester of pregnancy are especially at risk if they contract the illness as it can damage the fetus and cause spontaneous abortions.

Slapped cheek syndrome can often resemble other more serious childhood illnesses--so, as always, be sure to seek the advice of your personal physician.

So until next time.....Stay Healthy Hawaii!

GW

Actually, this article is in response to a patient of mine who asked me about this particular disease and wanted to know more for her own information. So I figured...the information would be great for everyone.

"A puff of smoke"....the meaning of a Japanese word that names a rather rare cerebrovascular condition...Moyamoya Disease. It is caused by the blockage of arteries (from both constriction or clots) at the base of the brain in affected individuals. The descriptive name is from the appearance of the tiny blood vessels that form in the body's attempt to bypass the blockage. The little tangle of new blood vessels resembles a puff of smoke on imaging.

The disease can affect adults (usually in the 30's to 40's), but it is primarily found in children. It often shows itself as unusual strokes or mini-strokes in an age group you would not expect them--children. The stroke symptoms can be accompanied by weakness and sensory loss on the affected side. Sometimes even seizures can result. Other findings that are associated with Moyamoya disease are speech difficulties, a decreased level of consciousness, vision problems, involuntary movements, disturbances in the ability to mentally function, migraine-like headaches, and possibly some other sensory deficits.

Interestingly, the condition often runs in families and is strongly believed to be an inherited disease. Current research has some evidence that the condition is linked to a particular position on a particular chromosome of the human DNA chain. In addition to its inherited potential, the disease can also be acquired. The most common conditions where Moyamoya type of lesions can be found are sickle cell disease, Down syndrome, and neurofibromatosis.

It is found that the vessel constrictions occur as the inner layer of the arteries in cerebrovascular system (arteries that feed the brain structures) begin to "overgrow" inward, slowly narrowing the available area for blood to freely flow. After a while, the vessel becomes so narrow and constricted that it either completely stops the flow of the blood to that area or a clot comes along and forms to finish the job. The result? A stroke...in fact, often there are other strokes that follow the initial insult. Sometimes the progression of the narrowing seems to be unaffected by the use of medical therapy and other methods need to be used.

How is this diagnosed? Usually by some type of imaging method--CT scan, angiogram, or MRI scan. Its name describes what is seen on these imaging studies near the areas where there are vascular constrictions--a "puff of smoke" seems to appear at these areas.

Moyamoya is usually treated by a few methods. Sometimes medications that prevent platelets (the clot forming cells in our blood) from working properly are used. In general, these classes of medications will make the blood harder to clot in hopes of preventing complete blockages at areas that are already constricted. However, the most effective treatments all involve some form or method of vascular surgery near the areas that are found to be blocked. The strategy is to bring a fresh blood supply to the area from outside of the skull from the vascular rich scalp areas to help form new pathways that will eventually bypass around the blood starved areas. In kind of a similar way as how heart vessel bypasses are used to get around clogged areas to help to feed the areas that were not getting much blood any more.

In general, patients who have this disease who are undiagnosed and remain untreated, usually go on to have recurrent strokes and will continue to suffer the consequence of these strokes. It is for this reason that this condition must be diagnosed and treated as soon as possible.

As always, if you have concerns or suspicions that you or someone you know may have these problems, make sure you discuss them with your personal physician.

So until next time....Stay Healthy Hawaii!

Ooops....almost forgot. One Doctor's Opinion will take a short breather for about two weeks...but don't forget to look for it right after that!

GW

Palpitations are noticeable, irregular heartbeats. In general, we all have occasional missed heartbeats or extra beats during the day. However, when we have many of them or prolonged episodes, we begin to become aware of them and feel them as a fluttering feeling in our chest.

What usually causes palpitations? There are many possible causes:

• Anemia
• Caffeine
• Other kinds of stimulants--cocaine, amphetamines
• "Diet" pills or weight loss medications with certain ingredients
• Other common substances--alcohol, nicotine
• Panic attacks or fear
• Thyroid problems
• Fever
• Pregnancy
• Low blood sugar
• Heart valve problems--more specifically mitral valve problems
• Low blood oxygen levels
• Blood electrolyte imbalance--abnormal blood chemistry studies
• Overexertion and fatigue
• Dehydration
• Lung disease or problems
• Situations of extreme pain
• Heart problems--including heart failure and heart attack
• Various types of heart conduction abnormalities
• Adrenaline from being physically stressed or overstimulated
• Asthma medication
• Hereditary abnormalities

So when do palpitations become worrisome? When palpitations are associated with these symptoms, always seek medical help immediately:

• Chest pain or chest heaviness
• Dizziness or feeling faint or light headed
• Having trouble breathing
• Having a loss of consciousness
• Excessive sweating
• Confusion or neurological problems

How are they diagnosed? Unfortunately, the exact cause of the problem is often not found at the office visit.  Most of the time, the palpitations are intermittent--and of course, they are not going to happen when the doctor is listening. Does a visit to your mechanic for an intermittent, weird car engine noise sound familiar here? The usual course of action is to first take a careful history--i.e. does it occur with drinking coffee or when the person is scared? Whenever they are overly tired?

The next steps usually include a heart tracing (electrocardiogram) and x-rays of the chest to see if anything really obvious is found. Blood tests can help to determine if something metabolic or hormone type of problems are present. Murmurs can be evaluated with a heart ultrasound (echocardiogram) to see if that may be a cause of the palpitations. For very elusive problems, a cardiologist may often use what is called a Holter Monitor (a prolonged heart tracing monitoring). There are several types of studies that vary according to the length of recording of heart activity that is done--for example, one day or one week long etc. These are more likely to capture the arrhythmia if it happens during the testing.

There are other methods of diagnosis that can be used by your personal physician or with the help of a cardiologist. As you can guess, the specific treatment of the disorder is best determined after the cause of the symptom is found.

As always, if you feel you are experiencing heart rhythm problems, make sure you discuss them with your personal physician so that he/she can investigate the cause of your symptoms.

So until next time.....Stay Healthy Hawaii!

GW

These health maintenance items are meant to be purely a guideline and should not be taken as the absolute law on what should be happening when you reach age 50. Your own physician is your best resource on what kinds of health maintenance you should receive around this age. Your individual situation will be different from anyone else's and your own physician may design a particular schedule of events according to what you need done. Some items may occur later and others may be done much earlier than other people for various reasons. Wow! There was the disclaimer. Got it?

So you find that you have reached the magic number of 50. The following is a general guide as to what you may expect as far as routine health maintenance in your coming years:

• A comprehensive health maintenance exam (physical exam) about every 1-2 years
• General health statistics (weight, body mass index, blood pressure) about every 1-2 years
• General exam for obvious signs of cancer (skin, mouth, lymph nodes, testicles) about every 1-2 years
• A complete breast exam by a physician yearly starting at about age 50
• Self testicular and breast exams every month
• For women, depending on your gynecologist's discretion, you may need a Pap Smear, Human Papilloma Virus, and Chlamydia screening between every 1-3 years according to your particular circumstances. Sometimes these exams can terminate at age 65 to 70--again at the discretion of your doctor
• For men, yearly Prostate Specific Antigen (PSA) testing and digital prostate exams
• For women, yearly mammogram
• For women, Dexa Scan (osteoporosis screening) with a baseline around age 50 or at menopause, then usually every 2 years or earlier at the discretion of the doctor or as circumstances require
• Screening for alcohol abuse, drug abuse, depression, smoking at every health maintenance exam
• Lipid panel (cholesterol screening) at least every 5 years unless needed earlier due to cholesterol problems
• Diabetes screening blood tests every 3 years or more often if there are diabetes or elevated blood sugar issues found
• Blood pressure screening at least every 1-2 years
• HIV screening should be done at least once along the way--more often if higher risk activity
• Annual stool occult blood screening
• Screening colonoscopy every 10 years or flexible sigmoidoscopy (shorter than a colonoscopy) every 5 years--either one might be done at a more frequent basis depending on findings or at the discretion of the physician
• Influenza vaccine every year unless contraindicated
• Pneumococcal vaccine at age 65 unless contraindicated. If high risk adult (cancer, lung disease, diabetes, heart disease, immune system problems) then revaccinate in 5 years. High risk groups may also be able to obtain vaccine at an earlier age
• Diphtheria/Tetanus/Pertussis vaccine every 10 years up to age 65. Over age 65--one dose...unless contraindicated
• Varicella-Zoster (Shingles) vaccine at age 60 unless contraindicated

There you have it... as straightforward as I can make a set of complicated recommendations.

As always, if you have questions about your health, seek the advice of your own physician as he/she knows your medical history the best. Your own doctor can help you design a health maintenance program that is just right for your particular situation.

So until next time.....Stay Healthy Hawaii!

GW

Most commonly, it is caused by plain old eating or drinking just regular food. Part of the normal mechanism of swallowing our food or liquids will also unavoidably involve the ingestion of air. As we continue to eat, the air pressure builds up in our stomach and out pops the embarrassing sound from our mouth--the other end is another story, but not today.

Here are some possible warning signs that should not be ignored if they happen with the burping (there are more, but these are important) and they should be discussed with your doctor:

• Any hint of chest pains with burping going on
• Dyspepsia or indigestion type of feeling
• Nausea or vomiting
• Dizziness or lightheadedness
• Heartburn
• Excessive sweating
• Abdominal pain
• Shortness of breath

Here's a partial list of some causes of belching--some common, others interesting:

• Being totally normal
• Chronic air swallowing--especially when eating
• Chewing gum
• Being a mouth breather
• Here is an important one--a certain type of heart attack that affects the underside or lower part of the heart--chest pain with belching
• Esophageal reflux disease
• Dentures that do not fit properly
• Stomach ulcer disease
• Food intolerances
• Drinking too many carbonated beverages
• Intestinal obstruction--may have abdominal pain with belching
• Tumors in the intestine or stomach
• Stress
• Pregnancy
• Gall bladder or pancreas disorders
• Obesity
• Dairy intolerance
• Hiatal hernia
• Just simply drinking and/or eating too fast

Wow! Long list....several "go figure" ones huh... Interestingly, the bottom line is that humans are generally a "gassy" species. Burping several times a day is part of a human's normal daily activities...not to mention gases that pass the other way several times a day.

How do we help to reduce our rudeness? First of all.....slow down....take it easy and slow....chew your food and stop gulping it down like you are at a race. The less air you swallow, the less problems you will have. Some problems may be mechanical or even hereditary and you have no control over them. Sometimes changing your dietary habits can help you to avoid foods that you know cause you to be excessively gassy. Other times, the cause of the belching needs to be addressed by a medical professional--ulcers, hernias, heart problems etc.

On a more serious note... In spite of belching being a normal part of all of our every day lives, we need to keep in mind that there are some conditions as listed above that fall outside the normal range when we should become concerned--especially those that are listed in the first list above that are warning signs.

As always, if you feel you are having these problems, make sure and discuss them with your personal doctor as he/she knows you best.

So until next time....slow down and enjoy your meals....and Stay Healthy Hawaii!

GW

One very common thing to have as a child--or even an adult, under the right conditions is Impetigo. This is a very contagious bacterial skin infection that is often found on pre-school aged children. It is usually caused by 2 major bugs. The primary pathogens can be Staphylococcus aureus or Streptococcus pyogenes.

Impetigo is not a common condition in adults of the general population. However, if you are a person who often engages in very close contact activities such as football, soccer, wrestling, rugby, etc.--you fall into the susceptible group. The bacteria is easily transmitted from one person who has it to another in these types of conditions. So we grownups are not immune to it....just depends on our activities. Impetigo is spread by direct contact with the lesions or the bacteria from the lesions.

What does it look like? On pre-school aged children, you will usually find water-filled blisters on the skin of the arms, legs, and trunk. These are often surrounded by a reddened area and can be painless--in fact, the reddened area can be quite itchy. The blisters can pop and form yellowish crusty lesions. This is known as bullous impetigo and is less serious than its sister infection--ecthyma.

Here are some things to look out for if your have the more serious form--ecthyma:

• Blistered lesions are now painful and can be filled with pus
• The blisters have a floor of a deep ulcer
• The blisters now involve the deeper layers of skin and not only the superficial layer
• Local area lymph nodes are now swollen and very tender
• When blisters pop, there is now a very thick crust that is often yellow-gray
• Once the crusting is gone, there is a deep ulcer left that tends to scar

There are several methods to manage impetigo depending on the circumstances and severity:

• Milder cases may only need good cleaning with soap and allowed to air-dry
• Topical antibiotic ointments that are available over the counter are sometimes used
• More severe cases may need oral antibiotics to clear and may sometimes need the assistance of a prescription grade topical antibiotic
• Hydrogen peroxide solution or cream has sometimes been used as an alternative treatment

What is the best treatment? Prevention!

• Good hygiene with good skin and hand washing with soap and water
• Those who have impetigo lesions should keep them covered to help decrease the exposure to others
• Do not share personal items with a person infected with impetigo--towels, bed linens, clothing
• Short fingernails help make hand washing more effective

As always, if you are worried that you or someone you know may have impetigo, consult your own personal physician as he/she knows your medical history the best. Your own doctor can help decide what management options are best for your particular situation as not all treatment methods are appropriate for everyone.

So until next time.....Stay Healthy Hawaii!

GW

Some are rather "benign" like the crinkled fingertips we get when we are in the water too long. That type of wrinkle is actually more of a temporary physiological happening due several factors. Some of which can be proven, others of which are not clearly proven. But the basic belief is somewhere in between the outer skin absorbing too much water and expanding therefore becoming too big for the tissue below it--so it wrinkles. The scientific explanation has to do with a neuro-vascular response to the condition. It is thought that the absorption of water causes the nervous system to react by sending signals to the blood vessels to constrict and reduce the blood flow to the skin in that area. Less blood to the area and electrolyte shifts are part of the picture that eventually results in less tissue tension below that part of the skin--so the outer skin wrinkles or becomes too loose for the tissue it covers.

Ok, ok... I know that is not the type of wrinkles you are interested in. So here is the real scoop. A real wrinkle is a crease, fold, or even a ridge that appears in the skin. It (unfortunately) is a part of natural aging in our bodies. However, there are some factors that enhance the process. Aging and wrinkling of the skin happens at an accelerated rate in areas that have exposure to the sun's radiation. An important thing to keep in mind.

Here are  factors that enhance the wrinkling process:

• The most important factor, as mentioned before, is exposure to the sun--areas that are exposed have the most likelihood of wrinkles
• Smoking is a big factor--want to reduce wrinkles...don't smoke
• People with fair skin are more likely to burn from the sun's energy and are therefore more likely to wrinkle in sun exposed areas
• The clothes you wear makes a difference--the less coverage from the sun, the more areas exposed for later wrinkling
• Genetics--there are some families that are prone to more wrinkling
• The way you wear you hair--for similar reasons as the clothes you wear
• Recreational habits--the more sun exposed activities....you know...
• Occupational conditions--office workers indoors all day less likely to have long sun exposure vs outdoor workers

Always remember...your very first line of defense in a good sunscreen that blocks both UV-A and UV-B rays. When used over all areas of the skin that are exposed, it will help to reduce your skin's damage from the sun.

Here are some helpful tips that can help to reduce wrinkles:

• The number 1 tip is to stay out of the sun when possible--for all of the reasons above
• No smoking--although the research is not conclusive, it is suspected that the main components that keep skin intact are broken down by an enzyme possibly released by exposure to smoke
• Sunscreen! Sunscreen! Sunscreen!
• Try to sleep on your back--sleeping on your face chronically can promote creases or "sleep lines" to form on your face
• If you need glasses...get some--squinting constantly helps to promote facial wrinkles
• Get enough sleep every day--when you don't get enough sleep and are tired all the time, your cortisol levels (a normal hormone) are higher. Cortisol is known to degrade the skin
• Essential fatty acids from eating fish can help nourish the skin
• Increase your intake of fruits and vegetables--the antioxidants they contain protect your skin
• Washing your face too often strips the skin of its protective oils
• Moisturize! Moisturize! Moisturize!

Are there topical treatments or other types of treatment for wrinkles? Yes. Do they work? All depends on your individual situation.

The following are thought to help decrease skin damage, protect, or repair damage:

• Topical retinoids--may help to reduce fine wrinkles and help repair sun damage
• Topical alpha-hydroxy acids--helps remove the top layer of dead skin cells
• Topical growth factors
• Topical vitamin C--can help with collagen production
• Topical idebenone--can help reduce dryness and increase hydration
• Topical pentapeptides--can possibly help with collagen production

The following treatments are also available, but more technically involved:

• Laser resurfacing
• Chemical peels (glycolic acid peels, salicylic acid peels)
• Wrinkle fillers
• Dermabrasion / microdermabrasion
• Heat and radio-frequency treatment
• Non-ablative laser resurfacing
• Fractional laser resurfacing
• The very famous botox injections
• And last, but definitely not least, (expense-wise that is...) plastic surgery

As always, if you feel you have skin care problems or concerns, seek out the advice of your own physician as he/she knows your medical history the best.

In a nutshell....the sun is the #1 villain in our war against wrinkles. Be sun-smart with it.

So until next time......Wear your sunscreen daily.....Stay Healthy Hawaii!

GW

A very common skin condition that many people may be diagnosed with at some time in their lives is eczema. This is a form of skin irritation or inflammation, usually more on the chronic side, that involves the outer skin layer.

Here are some usual descriptions of what eczema looks like:

• A persistent rash that tends to recur often
• Itchy redness of the skin
• Sometimes the skin is actually swollen and so irritated that it can be blistery
• Dry, flaky, crusty skin areas
• The skin may become so dry it peels and may crack and ooze or bleed

Unfortunately, there is a pretty complicated classification system for categorizing eczema. Most of the confusion seems to have come about by different naming systems that can involve labeling the condition by the part of the body it affects. Other names came about by how the rash looks.

Here are a few examples of the more commonly known forms of eczema (we will leave out the more complex ones):

• Contact dermatitis--this can be either irritant (due to a reaction to coming in contact with a substance) or allergic (more of a reaction to some sensitivity producing substance i.e. gold, mango sap) If the offending substance is removed, these usually resolve.
• Seborrheic dermatitis--more of a dry yet oily peeling of the skin. Commonly the scalp. This can usually be resolved with the right treatment.
• Atopic eczema--thought to have a genetic component to it and runs in families. Usually an allergic cause.
• Xerotic eczema--skin often becomes so extremely dry that it becomes tender and cracked. The dry and cold conditions of winter tend to make this much worse.

In general, there are several conflicting ideas of how eczema comes about or how it is caused. That being the case...it is not clear-cut what the actual cause is. So instead, we will touch on some of the methods of treating the condition. The main concept of treatment tends to center around control of the inflammation and itching.

Here are some ways eczema can be controlled and managed:

• Moisturize, moisturize, moisturize--eczema is almost always worsened by dryness of the skin
• Corticosteroids (topical, oral, injected)--effective in control and suppression of symptoms of inflammation
• Skin barriers--help to contain and preserve the moisture in the skin
• Suppression of the immune system and inhibiting its ability to cause inflammation--done with certain types of medications (usually topical but can be oral also)
• Anti-itch medications or antihistamines--helps to decrease the scratching due to itching, leading to less irritation
• Sometimes, light therapy with controlled doses of Ultra Violet exposure (administered by the dermatologist) can help
• Certain dietary changes can sometimes reduce a person's exposure to foods that he/she is sensitive to
• There are numerous alternative remedies--however, as they are not clearly proven, I will leave them out of this discussion

Unfortunately, there is no true and proven cure for eczema at this point in time....but genetic research and technological advances are steadily being made in the treatment of eczema. There is also some evidence that researchers may have identified or come very close to the identification of the human gene that is responsible for the transmission of eczema in families. So, hopefully, it will only be a matter of time before this puzzle is solved.

As always, if you have concerns or are worried that you may have skin problem issues--seek out the advice of your own personal physician as he/she knows your medical history best.

So until next time......Stay Healthy Hawaii!

GW

In our daily lives, Botulism is not a very common illness. However, when it does happen, it can be very dangerous. It is the classic "illness" everybody's folks used to talk about getting if you ate Aunty's homemade jam and she messed up with the careful home canning.

Botulism is caused by the botulinum toxin. And yup....the name sounds familiar because it is also very carefully used to take care of cosmetic issues also. The toxin is produced when Clostridium botulinum is allowed to grow in conditions of depleted oxygen content. It is typically, a paralyzing illness that usually starts in the face muscles. If allowed to progress, it then will affect the muscles of the body and limbs. The illness turns deadly when it continues on to paralyze the breathing muscles and the rest of that system.

The toxin from this nasty bug enters the body by a few routes:  It can occur in infancy and so is called Infant Botulism. This results from the baby ingesting the bacterium spores causing the colonization of the intestines. Eventually producing the toxin. This is the most common type of botulism illness in the US. A documented hiding place for the spores is honey. This is the backbone of why we do not give honey to children under 1 year of age.

Another route for botulism is from spore contaminated food where the bug has been allowed to grow in oxygen poor conditions. This is called Foodborne Botulism. Unfortunately, Aunty's homemade stuff canned at home is one of the prime targets for this. So are uncooked, fermented types of delicacies.

The last route of entry is Wound Botulism. This is when the bug spores enter through a break in the skin and deliver the dangerous toxin directly into the blood. This used to be very prevalent in IV heroin abusers.

Here are some symptoms and signs to look for if you suspect botulism:

• Loss of facial expression or ability to do so
• Both eyelids drooping or closing
• Double vision
• Difficulty with swallowing
• Problems with trying to talk
• Sometimes a weakness and lack of voluntary control of arms that begins from the shoulders and spreads outward toward fingers
• Similar weakness and lack of control of legs that begins at the hips and spreads downward to the toes
• Shortness of breath or difficulty breathing (by now the illness is becoming VERY serious)
• Nausea and vomiting
• Low blood pressure when upright--causing lightheadedness when standing
• Constipation
• Dry throat and mouth

Should you or anyone else start to experience any of these symptoms, you should immediately seek the help of your personal physician or obtain emergency assistance via the EMS system or the Emergency Room. These findings linked with a suspicion of possible botulism are considered a medical emergency.

How does the botulinum toxin work? Amazingly, it is one of the most potent neurotoxins known to man. It blocks the proper functioning of the nervous system's impulse conduction, leading to muscular paralysis. If you are really unlucky, it only takes less than 1 microgram to be fatal.

How do you help to prevent it? Heating and cooking food products to at least 250'F for 3 minutes. This destroys the botulinum toxin but not the spore itself. So, unfortunately, if the environment is just right once again, the spores can become active and more toxin will be produced. So be careful with home canned items. Also, avoiding feeding infants under 1 year old any honey is a good idea. Seek timely and prompt medical care for infected appearing wounds. Always avoid exposure to unsterile sharps.

The treatment for botulism involves rapid medical care and management. There are botulinum antitoxins available to help to reverse the damage from the toxin. These are used in the hospital setting at the time of treatment for the illness. In general, the acute illness is usually treated in the hospital as it is the best place to receive the needed medical support should the patient develop respiratory failure.

Here are some quick and easy tips to keep in mind when inspecting commercially packed cans:

• If the can is looking rusty--toss it out
• If the can appears to have been leaking--toss it out
• If the  can shows any sign of not being airtight--toss it out
• If the can looks like it was mechanically damaged and may possibly be compromised--toss it out
• If the can is bulging outwards as if from gas production inside--toss it out
• Be safe...When in doubt--toss it out

In a nutshell....the best treatment for botulism is prevention.

So until next time.....Stay Healthy Hawaii!

GW

Ever have a friend try to talk you into getting a 9-volt battery and touching the connectors to the tip of your tongue? Did you do it? Funny for them...and not for you yeah? Kind of hurt huh. That's because your tongue just had an electrical charge go through part of your tongue. If you did the same to your finger you may barely notice anything.

Why is that? Why would it make a difference? Well, first of all, your dry finger is not nearly as good a conductor as your wet, salty tongue. So it does not take much of a charge to give your tongue a good jolt because of this condition. Now imagine if you left that battery touching your tongue for a while...you would eventually end up with some tissue damage...not to mention pain. Tissue damage to your tongue would be uncomfortable and may require the intervention of a doctor--but most likely not life threatening in most cases.

So exactly why is swallowing a button battery so dangerous to people--especially children? Let's think about how fragile our tissues are inside our bodies. Our esophagus, stomach lining, intestine lining, the tissues surrounding our intestines, etc. They are all amazingly delicate for the amount of work they do all day long. To top it off, the moist internal parts are just as good an electrical current conductor as your tongue. Also, our gastrointestinal system is a partitioned system that keeps unwelcome substances and materials contained within it and out of the general areas of the rest of the abdomen where they would surely cause damage and harm. As long as these things do not escape the system into areas where they are not supposed to be, we have no problem.

Swallowing a button battery would be similar to putting your tongue on the 9-volt battery. Only with some important differences. First of all, if you wanted to stop licking the 9-volt battery, you just stop. This would be impossible with something traveling through your gastrointestinal system.

The scenario is especially dangerous when you combine those big flat lithium button batteries and children. The most common place for one of these batteries to get stuck is somewhere in the esophagus or food pipe. Why is this dangerous? As the battery sits there in that soft tissue, where electrical current is easily conducted, there is a strange electro-chemical phenomenon that can happen to the outside of the battery case as current passes around it. Hydroxide forms in the area. This is a dangerous and strong alkaline substance that is capable of quite a bit of damage to soft human tissue.

If the tissue near wherever this battery becomes lodged gets damaged by the chemical, it dies and can sometimes perforate into the surrounding internal areas. Not a good thing as these substances that are normally contained are not supposed to be released into the general open area of the abdomen. As a result, many different kinds of surrounding tissue damage can occur and even serious abdominal infections can happen that can be life threatening.

Also, another big difference, if a 9-volt battery were to leak its contents, no matter how corrosive, so what right? Just wash your hands and throw it away. Now imagine a small button battery that is usually composed of more than one type of heavy metal (mercury, lithium, silver oxide) along with some other potentially corrosive compounds begins to leak in your gastrointestinal tract. Just throw it away? I don't think so. Instead, it just starts to damage what is directly in contact around it. And we don't even want to think about the amount of heavy metals that could be quickly absorbed into your system if it was deposited right there directly and internally.

If button batteries remain in the strong stomach acid environment, they have a nasty habit of falling apart and releasing all their contents on the spot. Not good.

So what do you do if you or someone else ingests a button battery? Your first step would be to contact your doctor or go to the nearest emergency room immediately. A big percentage of these batteries can pass through your system into the stool safely. However, it is the ones that become trapped and stuck that are the ones that are potentially dangerous for all the above reasons. Those need to be removed quickly and safely before they do their damage.

The bottom line is that if a button battery ingestion is involved, emergent medical care is the safest course of action.

So until next time....Stay Healthy Hawaii!

GW