Redness of the skin or mucous membranes
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2 episodes with Erythema
2 episodes with Erythema
2 episodes with Erythema
2 episodes with Erythema
2 episodes with Erythema
3 episodes with Erythema
3 episodes with Erythema
2 episodes with Erythema
Is your baby struggling with baby acne, allergies or rashes? Trying to understand the root cause and treat it? Dr. Elana Roumell from the Doctor Mom Podcast breaks down how to identify different types of baby rashes, the root causes behind them, and effective natural remedies to help your little one find relief.In This Episode, We Cover:The most common baby rashes: baby acne, eczema, diaper rash, heat rash, and moreHow to tell if your baby's rash is something more seriousNatural remedies for baby skin issues, including the power of breastmilkWhen to see a doctor for your baby's rash or eczemaThe connection between gut health and skin conditionsDietary and environmental triggers that can worsen eczemaHow to safely manage allergies and food sensitivities in babiesDr. Elana shares practical, evidence-based advice to help you navigate these common baby skin concerns with confidence. Whether you're dealing with persistent eczema, mysterious rashes, or potential food allergies, this episode will empower you with the knowledge and tools you need!and more!!-------------------------------------------------------------------------------------------------------------IMPORTANT LINKS:- Sign up for the newsletter: HERE- Confidently Therapy - DM Alexis 'LTM' at @confidently.therapy on Instagram for your free strategy call.- Non-Toxic Laundry Detergent HERE - code LEARNINGTOMOM for 30% off!-Tighten Your Tinkler: Signature Pelvic Floor Program HERE - code LEARNINGTOMOM saves you $50 off their signature plan- Connect with Dr. Elana Roumell HERE- The Mom's DIY Medicine Kit Guide she mentioned linked HERE-------------------------------------------------------------------------------------------------------------doctor roumell, doctor mom podcast, med school for moms, alana roumel, baby skin issues, rash on baby, eczema on baby, rash on newborn, newborn rash, baby acne, acne on baby, baby gut health, gut health for babies, Dermatitis on baby, cradle cap, milia, heat rash, diaper rash, Erythema toxicum, Fifth disease, infantigo, Imeptigo, Petechiae, breastmilk for rashes, neonatal cephalic pustulosis, rash behind neck, rash on knees, Newborn skin care tips, Understanding common toddler rashes, Holistic skin care strategies , Chicken Skin/Keratosis Pilaris and what to do about it, Eczema root causes and cures, Sunscreen pros and cons, - Newborn care podcast, Postpartum podcast, Infant podcast, New baby podcast, Baby podcast, Motherhood podcast, First time mom, Best motherhood podcast, Best parenting podcast, Holistic parenting podcast, Holistic newborn, Crunchy mom podcast, Mom podcast, parenting podcast, First time mom podcast, motherhood podcast, postpartum podcast, infant podcast, newborn care podcast, new baby podcast, pregnancy podcast, how to parent, parenting tips, parenting advice, 2 month old, 3 month old, 4 month old, 5 month old, 6 month old, 7 month old, 8 month old, 9 month old, 10 month old, 11 month old, 12 month old, Postpartum tips, Baby's first wellness check, Postpartum workouts, 3 month old nap schedule, 4 month old sleep regression, How to help a colicky baby, Wake windows explained, Breastfeeding tips, Newborn sleep schedule, Introducing solids to baby, Baby growth milestones, Postpartum recovery,
This podcast is a collaboration of Sephora University EME and Erborian. This episode is skin education oriented. You will get pro tips & tricks about skin & advice to adopt for yourself and clients!
Welcome! Today, we're discussing the unexpected and unusual presentations of Lyme disease that I've encountered in my practice.Case Study: Unexplained Foot Pain One of my patients experienced severe foot pain, even while walking to the bathroom. A podiatrist diagnosed him with plantar fasciitis, and he tried various treatments including icing, NSAIDs, stretching, iontophoresis, shoe inserts, and cortisone injections. Despite these efforts, his foot pain persisted. In addition to foot pain, he suffered from exhaustion, poor sleep, impaired concentration, neck and back pain, mood disturbances, palpitations, lightheadedness, migratory pains, and sensitivity to light and sound. Remarkably, his foot pain and other symptoms resolved following treatment for Lyme disease. Expected Lyme Disease Presentations In my practice, the expected presentations of Lyme disease include:- Erythema migrans- Bell's palsy- Chronic Neurologic Lyme disease- Neuropsychiatric Lyme- Postural Orthostatic Tachycardia Syndrome (POTS)- Pediatric Acute-onset Neuropsychiatric Syndrome (PANS)- Lyme carditis- Lyme arthritis Unusual Lyme Disease Presentations However, I've also encountered several unusual presentations of Lyme disease that resolved with treatment. These include:- Thumb pain- Intermittent blue color of the hands and feet- Distorted vision and floaters- Uveitis- Atypical seizures- Temporomandibular joint (TMJ) disorder- Tinnitus- Movement disorders- ALS-like and MS-like presentations- Parkinsonian symptoms- Dementia- Gastroparesis- Mold sensitivity- Small intestinal bacterial overgrowth (SIBO)- Mast cell activation syndrome (MCAS)- Ehlers-Danlos syndrome (EDS)- Median arcuate ligament syndrome (MALS)- Fibromyalgia- Chronic fatigue syndrome- Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)- Functional and somatic disorders- Anxiety, depression, OCD, and ADHD The Challenge of Diagnosis It can be challenging to determine whether Lyme disease is the cause of these unusual presentations, as patients may have multiple conditions. Proper diagnosis and treatment are crucial for resolving these complex symptoms. Conclusion Understanding the wide range of Lyme disease presentations helps us better identify and treat this complex illness. If you or someone you know has unexplained symptoms, consider consulting a Lyme-literate doctor. Thank you for watching, and stay tuned for more insights on Lyme disease.
Erythema multiforme (EM) is an uncommon inflammatory skin disease. The onset is often very sudden and concerning and can affect the skin and mucous membranes leading to other issues (anorexia, difficulty defecating, etc.). The condition can require anywhere from no treatment to immunosuppressive drugs. Learn more about this disease in this week's episode of The Derm Vet podcast! TIMESTAMPSIntro 00:00Erythema Multiforme In Humans 02:16What Erythema Multiforme Looks Like 03:12Treatment For Erythema Multiforme 05:44Outro 10:32
In this episode, we review the high-yield topic of Terminology of Skin Lesions from the Dermatology section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets
On this episode of the Sales Gravy Podcast, we are switching things up to take on a very important topic— Chronic Lyme Disease. Jeb Blount (Sales Gravy) and Fred Diamond, co-founder of the Institute for Excellence in Sales (IES) discuss Fred's latest book, Love, Hope, Lyme and his personal journey supporting a loved one with Chronic Lyme Disease. You'll learn what Lyme Disease is, the devastating effects that Chronic Lyme Disease has on hundreds of thousands of people each year, why prevention is key, and how you can support anyone in your life who is battling a chronic illness. Living With Chronic Lyme Disease Living with loved one who has Chronic Lyme Disease can be emotionally and mentally challenging, as the condition can cause a wide range of symptoms that can affect the person's physical, emotional, and mental well-being. Your loved one may experience depression, anxiety, and irritability as a result of their condition. Fred discusses how important it is to be supportive, patience, and understanding. He explains that everyone's experience with Chronic Lyme Disease is different, so it's important to be flexible and open to different approaches to treatment and care. One of the most difficult aspects of living with someone who has Chronic Lyme Disease is dealing with the person's ongoing fatigue and pain. These symptoms can make it difficult for the person to perform daily tasks and can also affect their mood and ability to socialize. But, as Fred says, where there is love, there is hope. What is Lyme Disease Lyme disease is an infectious disease caused by a bacteria called Borrelia burgdorferi. It is primarily spread through the bite of infected black-legged ticks, also known as deer ticks. The black-legged tick is found in wooded, brushy, and grassy areas, and when it bites, it can transmit the bacteria to the person. The most common early symptoms of Lyme disease include fever, fatigue, headache, muscle and joint pain, and a bull's-eye rash. The rash, called erythema migraines (EM), usually appears at the site of the tick bite and can expand to become a large red area. Chronic Lyme Disease Chronic Lyme disease, also known as post-treatment Lyme disease syndrome (PTLDS), is a condition that can occur after a person has been treated for an initial infection with the bacteria that causes Lyme disease. People with PTLDS may continue to experience symptoms, such as fatigue, pain, and cognitive difficulties, long after the bacteria have been cleared from their body. Fred explains that this is why it is difficult and frustrating for people who are living with Chronic Lyme disease to get physicians and loved ones to believe them. The cause of PTLDS is not fully understood, but it is thought that it may be related to ongoing inflammation or damage to tissues caused by the initial infection. Some researchers also believe that the bacteria may persist in the body, despite treatment, and continue to cause symptoms. Lyme Disease Symptoms The symptoms of Lyme disease can vary widely and may be different for each person. The most common symptoms include: Erythema migrans (EM) rash: A bull's-eye rash that appears at the site of the tick bite, usually within 3 to 30 days after the tick bite. The rash can expand to become a large red area and may or may not be itchy or painful. Flu-like symptoms: fever, chills, fatigue, headache, muscle and joint aches, and swollen lymph nodes. Neurological symptoms: difficulty concentrating, memory problems, and headaches. Some people may also experience facial palsy, which is a temporary weakness or drooping of the facial muscles. Cardiovascular symptoms: irregular heartbeats, or chest pain. Arthritis: joint pain and swelling, especially in the knees. Bell's palsy: It is a sudden weakness or paralysis of the muscles on one side of the face. Symptoms of Lyme disease can appear in stages.
In this episode, we review the high-yield topic of Erythema Infectiousum (Fifth Disease) from the Pediatrics section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets
In this episode Karen Arthur chats with Mrs Amanda Allen, Specialist Oncology Dietician (and Karens younger sister) Amanda shares whole her hormonal journey started with a mystery illness when she was young through two years feeling out of touch with her body. We talk about sleep deprivation affecting work/life balance and the decisions leading to menopause care that made a huge difference in her mid 50s. Notes: Henoch-Schlonlein purpura affecting blood vessels and Erythema nodosum causing swelling under the skin. Socials: Contact Amanda via email allena907@live.com or Linkedin Join us on The Joy Retreat Barbados in May 2023. for Black people experiencing any stage of menopause. We hope you find something that resonates. Remember to consult a qualified health professional before trying any of the steps mentioned within this episode. Opinions are speakers own. Edited by: Erin Maguire Artwork: K. Arthur Music: Garden State - Audiobinger Follow @Menopausewhilstblack on socials . Dance to our Spotify playlist featuring guests fave tunes. Email thekarenarthur@mail.com to say hi/thank you/I love you or if you'd like to find out more on how to sponsor an episode. And don't forget to subscribe, rate and review on this platform so that we can reach the people who need to hear us. Be gentle with yourself ok? x
Why is it bug-related episodes that make us feel the itchiest? This week, Alex tackles the weird conspiracy theory involving ticks, Lyme disease, and the Plum Island Animal Centre. Did the centre really create Lyme disease infested ticks? What is Lyme disease? How many science related words can Alex mess up? Tune in to hear more. Need a distraction? I got you. Lyme disease support link: https://www.lymedisease.org/lyme-disease-support-groups/ (https://www.lymedisease.org/lyme-disease-support-groups/) Listener discretion is advised. Shout out to our Patrons Tom, Bailey, Angela, Jon, Alicia, Lynn, Sissy, Shadow, Courtney & Cheryl! Thank you for supporting Weird Distractions on Patreon. You can also support the show on Patreon and get monthly bonus episodes, behind the scenes footage, and more! Weird Distractions is also on Buy Me a Coffee if you want to support the show with a one-time donation. You can also find WDP merch on Redbubble. If you want to provide feedback or even your own weird story to be read on air in an upcoming Listener Distractions episode - please email: weirddistractionspodcast@outlook.com. If you're listening on Apple Podcasts, please consider rating & reviewing. It's the best way to support the show (for free). Thanks for listening! Weird Distractions is a proud member of the Cultiv8 network: https://www.patreon.com/cultiv8podcastnetwork/ (https://www.patreon.com/cultiv8podcastnetwork/) Resources: Centers for Disease Control and Prevention website - Lyme disease - Last reviewed: January 19, 2022 - https://www.cdc.gov/lyme/index.html#:~:text=Lyme%20disease%20is%20caused%20by,skin%20rash%20called%20erythema%20migrans (https://www.cdc.gov/lyme/index.html#:~:text=Lyme%20disease%20is%20caused%20by,skin%20rash%20called%20erythema%20migrans) Web MD website - “What to Know About Erythema Migrans” - By WebMD Editorial Contributors - Medically Reviewed by Dan Brennan, MD - April 14, 2021 - https://www.webmd.com/skin-problems-and-treatments/what-to-know-erythema-migrans#:~:text=Erythema%20migrans%20is%20a%20rash,be%20warm%20to%20the%20touch (https://www.webmd.com/skin-problems-and-treatments/what-to-know-erythema-migrans#:~:text=Erythema%20migrans%20is%20a%20rash,be%20warm%20to%20the%20touch) Bay Area Lyme website - “HISTORY OF LYME DISEASE” - by Bay Area Lyme Foundation - https://www.bayarealyme.org/about-lyme/history-lyme-disease/#:~:text=In%201981%2C%20a%20scientist%20who,by%20ticks%2C%20was%20causing%20Lyme (https://www.bayarealyme.org/about-lyme/history-lyme-disease/#:~:text=In%201981%2C%20a%20scientist%20who,by%20ticks%2C%20was%20causing%20Lyme) Delaware Government website - “Lyme disease” - https://dhss.delaware.gov/dph/epi/lyme.html#:~:text=Lyme%20disease%20gets%20its%20name,the%20attention%20of%20Yale%20researchers (https://dhss.delaware.gov/dph/epi/lyme.html#:~:text=Lyme%20disease%20gets%20its%20name,the%20attention%20of%20Yale%20researchers) Wikipedia - Tick - https://en.wikipedia.org/wiki/Tick (https://en.wikipedia.org/wiki/Tick) Mayo Clinic website - “Tick Bites: First Aid” - By Mayo Clinic Staff - https://www.mayoclinic.org/first-aid/first-aid-tick-bites/basics/art-20056671 (https://www.mayoclinic.org/first-aid/first-aid-tick-bites/basics/art-20056671) Science VS podcast - “Lyme Disease: How Scary Is It?” - Gimlet - June 2018 - https://open.spotify.com/episode/2Mb67OumbO9r0AVYyKQeQ1?si=S8WzE1GaQjm_Yshnv2UfaQ&nd=1 (https://open.spotify.com/episode/2Mb67OumbO9r0AVYyKQeQ1?si=S8WzE1GaQjm_Yshnv2UfaQ&nd=1) How Stuff Works website - “The Mystery, Myth and Reality of Plum Island” - by Patrick J Tiger - April 19th, 2021 - https://science.howstuffworks.com/life/biology-fields/mystery-myth-reality-plum-island.htm (https://science.howstuffworks.com/life/biology-fields/mystery-myth-reality-plum-island.htm) United States Department of Homeland Security website - “Plum Island Animal Disease Centre” -...
Join us as we go through the JEADV Editor's Picks of April 2022: (1) Vaccination safety: a case of self-limiting lichenoid drug eruption after non-mRNA vaccination (2) Erythema gyratum repens: beneficial effect of acitretin after thorough diagnostic work-up (3) Living with self-improving collodion or congenital ichthyosis (4) Covid-19 vaccination, psoriasis and biologics: do they impair the immune response? Read the Editor's Picks here: https://onlinelibrary.wiley.com/doi/10.1111/jdv.18011
REFERENCES CITED IN THIS EPISODE (and TIME STAMP) TELOGEN EFFLUVIUM Monari et al (starts at 4:20). Post-SARS-CoV-2 Acute Telogen Effluvium: An Expected Complication. J Clin Med. 2022 Feb 24;11(5):1234. Muller-Ramos P et al. Post-COVID-19 hair loss: prevalence and associated factors among 5,891 patients. Int J Dermatol 2022 Jan 26. Guarnieri G et al (starts at 9:07). Relationship between hair shedding and systemic inflammation in COVID-19 pneumonia. Ann Med. 2022;54(1):869-874. Wong-Chew RM et al (starts at 13:11). Symptom cluster analysis of long COVID-19 in patients discharged from the Temporary COVID-19 Hospital in Mexico City. Ther Adv Infect Dis. 2022 Jan 11;9:20499361211069264. Fernandez-de-Las-Penas et al. Female Sex Is a Risk Factor Associated with Long-Term Post-COVID Related-Symptoms but Not with COVID-19 Symptoms: The LONG-COVID-EXP-CM Multicenter Study. J Clin Med. 2022 Jan 14;11(2):413. Ali MD (starts at 18:49). Proton pump inhibitors' use and risk of iron deficiency anaemia: a systematic review and meta-analysis. Curr Rev Clin Exp Pharmacol. 2022 Mar 7. TRICHOTILLOMANIA AND PEDIATRIC EMOTIONAL HEALTH Wang et al (starts at 24:29). Trichotillomania occurs during the COVID-19 pandemic in an adolescent. World J Pediatr. 2022 Feb 28;1-2. Saunders NR et al. Utilization of Physician-Based Mental Health Care Services Among Children and Adolescents Before and During the COVID-19 Pandemic in Ontario, Canada. April 2022 JAMA Pediatrics.2022 Apr 1;176(4):e216298. Racine N et al. Global Prevalence of Depressive and Anxiety Symptoms in Children and Adolescents During COVID-19: A Meta-analysis JAMA Pediatr. 2021;175(11):1142-1150. Pathoulas et al. Cross-sectional survey examining skin picking and hair pulling disorders during the COVID-19 pandemic. J Am Acad Dermatol. 2021 Mar;84(3):771-773. Öner Ü. Children with trichotillomania in COVID-19 outbreak. J Cosmet Dermatol. 2021;20(7):1967–8. TINEA CAPITIS Salah NB et al (starts at 31:19). Erythema nodosum in patients with kerion of scalp. Clin Exp Dermatol. 2021 Dec;46(8):1577-1578. Blake T et al. Erythema nodosum - a review of an uncommon panniculitis. Dermatol Online J. 2014 Apr 16;20(4):22376. Kumar P and Pandhi D (starts at 41:09). Role of Trichoscopy in the Management of Tinea Capitis in Two Infants: A Case Report. J Cutan Aesthet Surg. Oct-Dec 2021;14(4):443-445.
Lyme disease is an infectious disease transmitted to humans through the bite of infected ticks. Erythema migrans develops at the site of tick bite usually within 1 to 2 weeks and is a pathognomic feature. Constitutional symptoms such as fever, headache, myalgias, fatigue, and arthralgias may occur. In this podcast, Janak Koirala, Professor of Medicine and Infectious Diseases, Division of Infectious Diseases, Southern Illinois University School of Medicine, gives us an overview of the condition. For more on lyme disease, visit BMJ Best Practice: bestpractice.bmj.com/topics/en-gb/224 - The purpose of this podcast is to educate and to inform. The content of this podcast does not constitute medical advice and it is not intended to function as a substitute for a healthcare practitioner's judgement, patient care or treatment. The views expressed by contributors are those of the speakers. BMJ does not endorse any views or recommendations discussed or expressed on this podcast. Listeners should also be aware that professionals in the field may have different opinions. By listening to this podcast, listeners agree not to use its content as the basis for their own medical treatment or for the medical treatment of others.
Good morning and welcome to your Tuesday dose of Your Daily Meds.Bonus Review: What are some functions of the Hypothalamus.Answer: It does a few things -Control of water balanceTemperature regulationControl of anterior pituitary hormones (neuroendocrine function)Production of posterior pituitary hormones (more neuroendocrine function)Appetite and satietyRole in behaviour and emotionsQuick Question:In the physical examination of the neonate, which of the following describes a common newborn rash, manifesting as pustules with an erythematous base, often with a widespread distribution?Erythema toxicumMiliaPustulesLanugoNaevus simplexHave a think.Scroll for the chat.Ethics Case:You are a motivated little Emergency Department Doctor.You have just met a 15-year-old female who attempted suicide last night by swallowing button batteries.The girl was brought to the Emergency Department under the Mental Health Act’s Emergency Examination Authority, so if she had tried to leave during the morning, she would have been detained. But she had not tried to leave, she was calm and cooperative.Her parents are completely uncontactable.You know that these button batteries are very corrosive so you erect x-ray the abdomen.The batteries are still in the region of the stomach. They are potentially retrievable endoscopically before they can cause harm.You discuss all this with your ED Consultant, then you call the Gastroenterologist on call.“Sure!” she says, “If you could consent her for the Endoscopy, I’ll do it on my morning list within the next couple of hours.”You discuss the risks of Endoscopy and Sedation with the young girl versus the risks of leaving the batteries in situ and watching and waiting.The girl is receptive to your explanation, she seems to be able to understand, retain, consider, use and communicate her wishes and consents for Endoscopy.You take the signed consent forms to the Day Procedure Unit.“No”, says the Nurse in charge. “She is under sixteen - you will need to contact the Child Guardian.”Now, I ask you. What are your thoughts here?Do you punch on with this Nurse, or do you go and jump into the pre-recorded telephone cue of another government bureaucracy?Or do you do something else?Scroll for the chat.Bumpy Babies:Erythema toxicum is a common newborn rash manifesting with pustules with an erythematous base. The rash can have a widespread distribution that may change over a period of several hours. Differentiating infected lesions can be accomplished by microscopic examination of the vesicle contents which contain eosinophils in cases of erythema toxicum. Milia occur particularly over the neonatal nose and are small sebaceous cysts that disappear by several months of age.Pustules may be present from birth in congenital candida infection or may appear later with Staphylococcus aureus skin infections. Erythema toxicum is a more common differential diagnosis. Lanugo is the fine downy hair covering the skin of the shoulders, upper arms and thighs of the neonate. It may be more evident in premature babies.Naevus simplex, birth marks, are superficial vascular naevi commonly found on the occiput, over the eyelids or between the eyebrows of the neonate. They tend to fade over several months, often disappearing in the second year of life.What To Do…?:Well, you could calmly explain the concept of Gillick Competence to the Nurse.But that did not go down so well.You could tell on that Nurse to your boss.That works better.But the best result was to have the Gastroenterologist, the actual proceduralist doing the procedure, to consent the patient again in Endoscopy suite, just to be sure.Remember, just because you happen to be a medico-legal-ethics nerd, doesn’t mean that other people are. And when you are having a busy day in the ED, you can’t be having stand up arguments citing decisions from the House of Lords when you have other jobs piling up.Remember more that people who have tried to kill themselves can still have capacity to make the decision for life saving or condition-altering treatment. Like it or not.Because capacity is context-dependent. And someone with “…sufficient understanding and intelligence to understand fully what is proposed” has capacity to make their decision, wether you agree with that decision or not; regardless of arbitrary age cutoffs.(Also, just quietly, a 103-year old fellow with an acute delirium on top of his dementia very likely does not have capacity to consent for an Endoscopy……..even though he is over the age of sixteen…but I didn’t drop that bomb…)Anyway this was a real case. So there.Bottom line: People that have done silly things are still autonomous individuals (once particular conditions that would actively hinder their autonomy have been excluded) so are free to make their own decisions, in so far as they have the capacity to do so.Bonus: Why is it that the posterior pituitary has neural connections with the hypothalamus, but the anterior pituitary has vascular connections with the hypothalamus?Answer in tomorrow’s dose.Closing:Thank you for taking your Meds and we will see you tomorrow for your MANE dose. As always, please contact us with any questions, concerns, tips or suggestions. Have a great day!Luke.Remember, you are free to rip these questions and answers and use them for your own flashcards, study and question banks. Just credit us where credit is due. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit yourdailymeds.substack.com
In this episode, we review the high-yield topic of Erythema Multiforme from the Dermatology section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets --- Send in a voice message: https://anchor.fm/medbulletsstep1/message
In episode 9 of Derms and Conditions, James Del Rosso, DO speaks with Emmy Graber, MD, MBA regarding acne and rosacea. Dr. Graber provides tips on how to manage persistent erythema associated with acne using a pulsed-dye laser. Treatment for acne scarring is also discussed and Dr. Graber shares some tips and tricks for treating sequelae of acne. Dr. Del Rosso asks Dr. Graber how she integrates physical and medical treatments for rosacea and residual erythema associated with rosacea. Finally, Dr. Graber shares an in office pearl which involves the use of a hair dryer and a pulsed dye laser.
This episode covers erythema multiforme.Written notes can be found at https://zerotofinals.com/paediatrics/dermatology/erythemamultiforme/ or in the dermatology section of the Zero to Finals paediatrics book.The audio in the episode was expertly edited by Harry Watchman.
I will be discussing findings from a study which examined 271 Lyme disease patients with erythema migrans (EM) rashes. This article was written by Rebman and colleagues in the journal Infection.The authors concluded “Given that EM remains a clinical diagnosis, it is essential that both physicians and the general public are aware of its varied manifestations.”"1. Rebman AW, Yang T, Mihm EA, et al. The presenting characteristics of erythema migrans vary by age, sex, duration, and body location. Infection. Mar 7 2021 .You can hear more about these cases through his blogs, social media, and YouTube. Sign up for our newsletter to keep up with these cases.How to Connect with Dr. Daniel Cameron:Check out his website: https://www.DanielCameronMD.com/Call his office: 914-666-4665Email him: DCameron@DanielCameronMD.com Send him a request: https://danielcameronmd.com/contact-daniel-cameron-md/Like him on Instagram: https://www.instagram.com/drdanielcameron/Join his Facebook group: https://www.facebook.com/danielcameronmd/Follow him on Twitter: https://twitter.com/DrDanielCameronSign up for his newsletter: https://www.DanielCameronMD.com/Subscribe and ring the bell: https://www.youtube.com/user/danielcameronmd/ Leave a review on iTunes or wherever else you get your podcasts.We, of course, hope you’ll join the conversation, connect with us and other readers, ask questions, and share your insights. Dr. Cameron is a Lyme disease expert and the author "Inside Lyme: An expert's guide to the science of Lyme disease." He has been treating adolescents and adults for more than 30 years.Please remember that the advice given is general and not intended as specific advice as to any particular patient. If you require specific advice, then please seek that advice from an experienced professional.
Contributor: Peter Bakes, MD Educational Pearls: Lyme disease gives a single expanding target lesion with central clearing called erythema chronicum migrans Erythema multiforme is another targetoid rash that presents with multiple target lesions Characterized into erythema minor and major based on severity but typically resolves More severe hypersensitivity reactions include Stevens-Johnson Syndrome (30% skin involvement) SJS and TEN is associated with NSAIDS including aspirin, antiemetics like phenergan, anticonvulsants like dilantin or phenobarbital, and antibiotics like penicillin or sulfa drugs Other causes include viral illnesses like Herpes simplex virus or mycoplasma pneumoniae Treat by removing offending agent and treat supportively with monitoring for rash progression to SJS or TEN References Trayes KP, Love G, Studdiford JS. Erythema Multiforme: Recognition and Management. Am Fam Physician. 2019 Jul 15;100(2):82-88. PMID: 31305041. Read J, Keijzers GB. Pediatric Erythema Multiforme in the Emergency Department: More Than "Just a Rash". Pediatr Emerg Care. 2017 May;33(5):320-324. doi: 10.1097/PEC.0000000000000618. PMID: 26555305. Summarized by John Spartz, MS3 | Edited by Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at www.emergencymedicalminute.com/cme-courses/ and create an account. Donate to EMM today!
This mini episode covers erythema toxicum, AKA erythema toxicum neonatorum, toxic erythema of the newborn, and newborn rash. Erythema toxicum is a very common rash in newborns, especially term babies, and is benign and self resolving. In this episode, we discuss: Typical features of the newborn rash Differential diagnoses to consider How to describe newborn rash to parents Histological features of newborn rash Investigations that clinicians may consider if diagnosis if unclear Links and resources: Follow us on Instagram: https://www.instagram.com/yourekiddingright.pod/ and Facebook: https://www.facebook.com/yourekiddingrightpod-107273607638323/ Our email is yourekiddingrightpod@gmail.com Make sure you hit SUBSCRIBE/FOLLOW so you don’t miss out on any pearls of wisdom and RATE if you can to help other people find us! (This isn’t individual medical advice, please use your own clinical judgement and local guidelines when caring for your patients)
Climate change and dermatology – Midazolam for procedures – Biologics don’t worsen Covid in psoriasis - Hydroxychloroquine for rosacea - Timolol for post-acne erythema – Dermasphere clip show! Luke’s atopic dermatitis CME activity: https://bit.ly/2SY5TiY https://dermaspherepodcast.com/ Luke and Michelle have no conflicts of interest
This episode covers erythema toxicum neonatorum!
This episode covers erythema multiforme and stevens johnson syndrome! --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app
Erythema nodosum is a symptom complex characterized by tender erythematous nodules that typically appear on the extensor surfaces of the lower legs (but can appear on the arms, face, and trunk). The lesions should range in color from pink to red and be between 1-10 centimeters in diameter. The malady usually lasts for six weeks and can be associated with pregnancy, oral contraceptive use, primary coccidioidomycosis, streptococcosis, tuberculosis, syphilis, diverticulitis, Y enterocolitica, Yersinia pseudotuberculosis, and other deep fungal infections. Erythema nodosum can also be accompanied by inflammatory bowel disease, Behcet disease, or sarcoidosis. The tender erythematous nodules can be preceded by arthralgia, malaise, and fever. The practitioner should evaluate the patient's medication exposure history, and conduct a physical examination for a chest radiograph, a PPD, two consecutive ASO/DNAse B titers at 2 to 4 week intervals, diarrheal illness, symptoms of any deep fungal infection specific to the area, and prior upper respiratory infection. In its late stages, erythema nodosum must be distinguished from simple contusions and bruises. The patient can be treated with NSAIDs which typically takes the form of potassium iodide (5-15 drops three times daily), corticosteroid therapy, dapsone, colchicine, or hydroxychloroquine. Complete bed rest should be ordered if the lesions are painful. The reader should note that erythema nodosum differs from other forms of panniculitis in that it does not ulcerate. Erythema induratum from tuberculosis, though, does create lesions on the posterior surface of the legs and can ulcerate. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app
Are you a business owner who wants to get good at financial decision making and CEO-level accounting? How can you build a runway to opportunities? By navigating mindset, expenses, and cash. Today’s guest is Tim Francis from Great Assistant and Profit Factory. Tim’s training, Know Your Numbers, shows how businesses can deal with cash crunch and cash flow. You’ll Learn... [02:48] Free Upcoming Event: Navigate the Cash Crunch. [03:20] Entrepreneurs: Like Indiana Jones, running as fast as possible from expenses. [06:00] Pre-built Spreadsheet: Adding and subtracting, red boxes and green boxes. [06:40] Beyond Profit First: In motion and cutting expenses when DoorGrow sales stop. [10:23] 3-Step Method: Navigating mindset, navigating expenses, and navigating cash. [11:29] Mistakes of sloth, and mistakes of ambition. [12:19] Step 1 - Navigating Mindset: Be good to your body, protect personal and professional relationships, and early action is crucial. [22:51] Step 2 - Navigating Expenses: Business's profit margin and bloat factor involves how many dollars to be sold at top line for $1 at bottom line to spend/buy something. [30:08] Survive and Thrive: When sales go down, create a situation where you don't have to sell as much. You can meet it at a lower sales level and still get by. [31:52] Step 3 - Navigating Cash: The Cash Flow Forecast figures out how much cash can you touch now? There's a big difference between cash and free cash. [45:38] Opportunities for Growth: If your business doesn't cash flow, it will fail. Cash flow first, then focus on growth. Cash comes from different places. Tweetables Entrepreneurs confuse revenue, sales, top line, or top of the P&L statement with cash. There's actually a way to navigate the cash crunch, even if revenue is going down. Property management industry has a massive opportunity due to big shift in the market. Panic isn't productive. It's important to be urgent, not anxious. There's a big difference between cash and free cash. Resources Navigate the Cash Crunch with Jason Hull and Timothy Francis Tim Francis on LinkedIn Great Assistant Profit Factory Know Your Numbers Keith Cunningham Verne Harnish DoorGrow on YouTube DoorGrowClub DoorGrowLive DoorGrow Website Score Quiz DoorGrow Cold Leads Calculator Transcript Jason: Welcome, DoorGrow Hackers, to the DoorGrow Show. If you are a property management entrepreneur that wants to add doors, make a difference, increase revenue, help others, impact lives, and you are interested in growing your business and life, and you are open to doing things a bit differently, then you are a DoorGrow Hacker. DoorGrow Hackers love the opportunities, daily variety, unique challenges, and freedom that property management brings. Many in real estate think you’re crazy for doing it, you think they’re crazy for not because you realize that property management is the ultimate high-trust gateway to real estate deals, relationships, and residual income. At DoorGrow, we are on a mission to transform property management businesses and their owners. We want to transform the industry, eliminate the BS, build awareness, change perception, expand the market, and help the best property management entrepreneurs win. I’m your host, property management growth expert, Jason Hull, the founder and CEO of DoorGrow. Now, let's get into the show. I am hanging out here with Tim Francis. Tim, welcome to the show again. Tim: Good to see you Jason, again. Jason: Tim and I just started trying to do this on Crowdcast the normal platform. It didn't work out. The internet gods were not kind to us for some reason so we're starting it over. I wanted to introduce Tim to this audience again. Tim has been on the show before because he was talking about his company, Great Assistant, a fantastic company. I've hired assistants through it for US based assistants. His parent corporation, or company, or whatever you want to call it is Profit Factory. I recently went through training with him called Know Your Numbers. One of my goals for this year was to get really good at this learning financial decision making, maybe more business owner, CEO level accounting. Tim is the go to guy for this. He has a program on this that I went through. He had a really cool thing that he showed us how to deal with cash crunch and cash flow. He reached out to me and is putting this out to audiences trying to help businesses out right now. I'm excited to expose my audience to this idea of how they can navigate the cash crunch. Tim, welcome. Tim: Thank you so much for having me. Jason: We're going to do an event here in about a week. I'll just plug that now up front, just get that out of the way. It's for free and we're going to go into greater detail about these things. You're going to be sharing your screen, showing spreadsheets, helping them figure this out. But let's start with talking about the problem. What's going on with the market right now, the cash crunch, and why is this relevant? Tim: Yeah, you bet. If you think of Indiana Jones in Raiders of the Lost Ark, there's this amazing boulder scene. Jason, I have to give you credit for giving me this visual of this boulder rolling behind us as entrepreneurs. We're running as fast as we possibly can, and that boulder, that's expenses. Jason, full credit to you, every time I use this analogy now I'm giving you credit. A bit of the secret here is that there's actually a simple three step method that we can actually turn this into a different Indiana Jones scene. In the Last Crusade, Indiana Jones, there's this like leap of faith scene where he's standing on the very edge and he's looking at this massive chasm between him and where he needs to go. It looks impossible, it looks impossible that he’ll possibly be able to cross this chasm, but then he gets this idea. He takes some sand, and he throws it out and it covers, and there's this hidden balance beam, it's invisible, this invisible balance beam to walk across. That's exactly the three step method that I teach as a passion to entrepreneurs. I think a lot of entrepreneurs confuse revenue, sales, top line, or just that top of the P&L statement with cash. The thing is that they’re two extremely different ideas. Yes, one can lead to the other, however they're not necessary. There's actually a way to navigate the cash crunch, even if revenue is going down. I've helped many, many companies, I think I’ve had 139 board meetings now. I've helped over 70 companies, and at least 7 of them I've helped to escape bankruptcy, including that with them following the exact process that I'm going to teach today. Whether someone despises accounting and numbers, feels pretty good about them but maybe not a pro, or even if someone's an absolute pro at numbers, I think the perspectives that we share today are going to be really, really powerful. Also just in case anyone's afraid of like oh, my god, here we go, numbers and accounting. I hate that topic. I avoid my accountant like the plague. I'll tell you what, I was rejected from Business School three times. I couldn't finish calculus. I don't know my brain wasn't wired that way, and the good news is you don't need any of that to be able to navigate the cash crunch. If you know how to add and subtract, in fact Jason, you don't even need to be able to add, subtract. If you know how to use a calculator to add, subtract, we can make this happen. The tool that I'll go more in depth with you on our webinar coming in about a week from now, everyone will actually get access to a prebuilt spreadsheet. All you got to do, it takes maybe 20 to 30 minutes to put your own info in. Literally where you see a red box is a crisis line, and where you see a green box, you're good to go. That's it. It's adding and subtracting, and red boxes and green boxes, that help you to navigate. To build your very own—personalized to your business—path to navigate the cash crunch. Jason: Before we get into this, I want to touch on and create a little transparency in this. A lot of entrepreneurs are fearful. There's a lot of shame around admitting that something doesn't look perfectly successful. There's a lot of shame around finances and money. Like oh, no, I've got debt or I've got this. I'm going to share what we're experiencing at DoorGrow. Leading up to this, one of my goals for this year was to get control of finances, really understand and get into financials, which is why I did a training with you, Tim, and I'm working with you on different things, because that's a step beyond the Profit First. I've got my Profit First coach and accountant that I work with as well. I've been doing lots of calls with her getting all these different loans that are coming out, getting everything going. I'm glad that I was already working on this stuff prior. We started cutting expenses dramatically, we started doing shifts. As I was getting control of things, I was like why are we paying for that? If we weren't in momentum already—you used the analogy of the airplane flying over the trees—we probably would have hit some trees. We probably would have crashed. We were already in motion. Sales, March just stopped. Property managers stopped buying products and services from DoorGrow because they were holding their wallets tight, they were scared, and that's about half of our revenue. We had to tighten our belt really quickly. We weren't really ready for that, we haven’t budgeted the beginning of our month to do that, so we had to get really creative. Using some of these strategies helped us to keep that plane above the tree level, navigating the cash crunch, or in my Indiana Jones analogy, outpaced the boulder so that we were able to make it through the end of the month. I'm really excited to share this property management. I'll point out that I believe the property management industry has a massive opportunity right now. There are property management companies, especially in California, Florida, and Hawaii, that they are growing. March was one of their biggest growth months in adding new doors, in acquisitions, period, simply because there is a whole big shift in the market. A lot of people are going to be needing property managers. We won't get really into that now but there's a lot of opportunity right now. Property management is a really safe place to be hedging against the market right now. Most property managers will probably have pretty good cash flow. It's only the third and we're already seeing most people are paying rent on single family residential. They're not noticing much of a difference. They've had a few people reach out for payment arrangements, but all things, I'm saying is that it's basically normal. They're a little concerned about May, so this May become even more hyper relevant in the next month or beyond. I want everyone to pay attention to this. Property managers, you guys are blessed right now, while a lot of businesses are just done. They're failing, their revenue is cut to zero, especially luxury markets, vacation markets, restaurants in a lot of situations. Businesses are closing, failing. This also is the perfect excuse for entrepreneurs that are not really committed to their business to get out, perfect excuse. A lot of people are going to take it. If you are not one of those people, and you're committed to making this work and you want to grow, reach out to DoorGrow, I want to make sure we help you capitalize on all this. Tim, let's get into these three things that we need to pay attention to. Tim: There are three things to navigate, navigating mindset, navigating expenses, and navigating cash. I don't normally share this piece, but because of what you just so wisely shared just around the shame that sometimes entrepreneurs feel around money or like oh, I'm a failure or whatnot. I'll tell you what. I think that being a leader is a lot of responsibility. Even if you're a leader of 1 or 100, it doesn't matter. It's that classic man in the arena story. It's not the critic who counts. I think that there's actually something incredibly skilled when an entrepreneur sees that things have changed, and they're ready to change with it. I think that that's actually a sign of prescience is the word, when we can see things that are coming and to act accordingly. I also think that Verne Harnish has a great expression, he says, "Growth sucks cash." If you've been spending a lot of money to grow your company, and that's why you don't have a lot of cash to show for it, there's no shame in being ambitious either. There are mistakes of sloths, and there are mistakes of ambition. Mistakes of sloths are when we make mistakes because we're sitting on the couch not going for it and life passes us by. Mistake of ambition is when we were really going for it and things didn't work out. Mistakes of ambition, it's even arguable to say that it's even a mistake at all. I just think if you're in a position where you’re a little tight on cash, or maybe a lot tight on cash, I get that the shame narrative is available and I don't know that I'd go there. First of all, it's not accurate, and secondly, it's not productive. This leads us into our whole first of our three steps mindset, navigating mindset. Before anyone decides to tune out and say mindset is going to be the secret or some law of attraction, maybe more airy type topic. I assure you, it is not. I assure you that it is not. In 2008 I had a real estate portfolio of my own, not a big portfolio, just four houses, but I ended up losing around $100,000 mostly of other people's money. Around that time, I also had a mentor who ended up being one of the two leaders of a $12 million Ponzi scheme. Didn't start as a Ponzi scheme but it became a Ponzi scheme, that's typically the way they go. His business partner is convicted in court, barred folding securities for 25 years, and ended up actually leaving the country. This is in Canada, where I'm from. It was extremely exhausting and stressful to go through all that and to see everything that was happening around me. It led to me developing an illness called Erythema nodosum. Erythema nodosum is something there's no real cure for. You just have to wait it out. It's just bed rest. Your body really swells up and becomes so painful to walk that you can't, then it becomes so painful that you stand that you can't, and you end up just lying in bed every single day. 50% of cases are stress related. There's no way to know for sure, but I'm pretty sure mine was stress related. If you think an economic collapse like 2008 is bad, or an economic collapse like 2020 is bad... I'll tell you what's even worse is having economic collapse and also having a health collapse, where you actually can't do anything about your situation because you're in bed. Thankfully, at the time, I had very, very, very few dependents, I had no teammates and so the impact, the blast radius was small, it was just on me. Had my mom not paid my mortgage for me for three months, I would have gone double bankrupt, my personal finance, my business finance. Talk about an eye opener, and I was only 28. I was only 28 at the time. When I talk about the importance of managing mindset, this is absolutely crucial that we manage stress. I'll tell you, I've been not just through economic collapse, economic plus physical collapse, and it is not a pretty situation. You do not want to go through that. Along the lines of how do we go about managing mindset, I think that there are a few important perspectives in addition to some of the obvious practices. I'll just start the obvious because it's pretty straightforward. Make sure you're getting some exercise even if it's just a walk on a treadmill, or a peloton bike, or something like that in your living room, whatever the case may be. Get some sunshine if you can, even though we're all locked indoors, that sunshine is super important. Diet, take care of that. Make sure you’re getting lots of water, maybe ease off on the booze a little bit too if you're someone who enjoys to imbibe a little bit. Be good to your body. Probably the biggest of all, for most people, is actually sleep. Sleep is something that we can lose very quickly in times of turmoil and stress. You might need to turn to things like small meditation, reading, journaling, or something before bed to help take your mind off of some of the challenges of the day. I'm telling you that it's absolutely crucial. When I look back at my sleep habits and actually have been keeping track of my sleep for years and years and years. Jason, I'd sleep for four hours and lay on the floor next to my computer, sleep. I'd work till 5:00 in the morning, I'd sleep four hours on the floor next to the computer and I would stand up, go pee, and go back to the computer and start working again. Desperate times sometimes call for desperate measures, but there is such a thing as too high a price to pay. Remember that this too shall pass. September 11th came, the world changed, and we got back to business in a new normal way. The housing crisis came, the world changed, and we got back to business in a new normal way. Jason: Tim, I'm going to touch on what you just said real quick, interject. These are really basic things but they're showing some significant correlations between COVID-19 and melatonin, and nitric oxide in your blood, vitamin D. These are the basic principles of health. I have training for our clients called health secrets and it's these basics. We talk about getting sleep, that's when melatonin starts to get produced in your brain. It's much higher in children, it gets less. You may want to supplement with that but getting good sleep, getting some sunlight, finding a way to get sunshine and sunlight on your body is going to be a big deal that releases nitric oxide from your skin into your blood, if vitamin D gets produced, these are basic. Sleep, nutrition, some physical activity, exercise, some sunshine, water and hydrate. This and all of that lowers your stress levels and it lowers our pressure and noise significantly. I love that you're sharing that. Keep your stress levels as low as possible and start physiologically. Tim: I think along with stress is this idea of engagement. I don't know if I need to share this part, but I'll say it just to be responsible. If someone is not engaged enough right now, you're not paying attention to what's going on in the world. If you're only at about a 6 or 7 out of 10 engagements, goodness gracious, it might be time to pick it up a bit. If you're also to 9 or 10 engagements it's probably too high, you're over stimulated, you're over engaged. We need that 8 out of 10 where we're focused, pupils dilated just a little bit. Eye on the prize. I always say that panic isn't productive. It's important to be urgent, not anxious, to be urgent, not anxious. Jason: I'm too Agilent right now. I'm excited and that's where I'm at. I love chaos, let's be honest. Maybe there are other entrepreneurs like that but when chaos happens, that's opportunity. That's where we get to be a light and we get to stand out, so I'm enjoying this even though it's uncomfortable. Tim: Very nice, very nice. I think that two other mindset pieces, one is that it's important to actually protect relationships. Yes, I mean the personal relationships that we have in our life because they can be such a source of security, joy, and comfort. I also mean business relationships. We're going to get to the other side of this, and unlike other past catastrophes that were measured in years, I think, yes, our economic catastrophe is going to be measured in years on this one for sure. I think that in terms of months, I think this pandemic is going to be measured in months, not years and years and years. One of my questions at each point is what is the state of the relationships of suppliers, vendors in the case of property managers, tenants, if you're managing on behalf of other people like your clients, your investors, and owners. What's the state of those relationships going to look like in three months from now, or six months from now when we're on the other side of this. You might make it through, but do you still have people that respect you? I heard a story the other day of an entrepreneur that just cancelled all their credit cards and said well, everything's just going to fail in terms of expenses and I'm going to add back one by one the few things that make sense. It's a shortcut to just cutting expenses. That's a way to go about it, but are you going to just supremely piss off everyone in the process? I think that protecting relationships is important to keep in mind. That doesn't mean that you're always bringing good news to everyone along the way, especially in the cutting expenses part of our presentation today. I think to be respected for being accountable, navigating agreements that you have with people rather than just abandoning them. My other mindset piece is that early action is crucial. If you discover that you need to get alone, act now before more businesses are closing, and possibly soaking up some lending capacity, or even just work capacity that bankers have to fill out applications and whatnot. If you discover you need to reduce a teammate's hours, tell them as early as possible so they can start making plans of their own personal and family finances. So that if a dip comes for them income-wise, they're prepared for it. If you can help them find a new opportunity elsewhere, do what you can to manage those relationships. I got an interesting perspective from someone who used to have a business helping individuals, not businesses, but individuals navigate bankruptcy. He said one of the most common patterns he saw with people going through bankruptcy is they didn't cut expenses deep enough or soon enough, deep enough or soon enough. I think that that's a very interesting perspective and maybe a usable guideline would be to say anything that's not going to help increase the profitability, and specifically cash coming into your business in the coming six months, I'd probably delay it. If you're thinking of a new website, if that's not going to immediately give you a bump in cash in the next six months, then let's put that on pause. We'll see if we can renegotiate it, put it on hold, delay it, or even cancel it. I think that's a really powerful way and maybe for you, the number isn't six months, maybe it's three months or eight months, whatever. But if we can keep an eye on what's going to bring cash in, in that timeframe, that really makes decision making a lot easier around what expenses you can continue with and which do not. This leads us to our second of the three steps of what we need to navigate and that is expenses. I think that something I'd say in my path of learning accounting and I even went and took night classes at the University of Alberta. I finally did go and take University accounting classes. It was not for credit though, they wouldn't let me into the for credit version, but they'd let me still sit in the classes and study. You know what, Jason, I got 100% of my midterm. I wanted to throw up my middle fingers as I walked into the room. I can't complete calculus, I can't get into business school, but here I'm getting 100% of my midterm. How about that? How do you like them apples? One of the big ahas that I had is that in my brain, because we all grow up thinking about personal finance. I think in personal finance, we think if I make $1, I can spend $1, and $1 in is $1 out. If I want to go buy a car, a pair of jeans, or a pair of shoes, I just need to get that amount of income to be able to pay for the shoes, the jeans, or the car. When it comes to business finance though it's a little bit different. To be able to buy $1 of expenses, we can't just make $1. It's because there's other expenses in the business. That's why we always talk about profit margin. If I have $100,000 in revenue, and I've got $50,000 in expenses, then I have $50,000 in profit. My profit margin is 50%. What that means is at the end of that year, or quarter, that month, for me to have an extra dollar to go buy something the next month, quarter or year, I don't need to make $1, I actually need to make $2 because my profit margin is only 50%. I have to make the $2 at the top, 50% gets stripped away by expenses. I'm left with $1 to now go and spend in the next month, quarter, or year. There's this idea, I invented it, it's called bloat factor. How many dollars do I have to sell at the top line to have $1 at the bottom line to be able to use and go and spend and buy something else in the coming month, quarter, or year? It's very simple math. If you're at 50% profit margin, which very few businesses are—very, very, very, very, very few businesses are—then you'd have to earn $2 to have $1 at the bottom to be able to go and spend in the coming period. If I've got a 25% profit margin, I have to make $4 at the top to have $1 to go and spend. If I'm at a 10% profit margin, which a lot of businesses around that 10% margin mark, I have to go make $10 to be able to have one at the bottom. Jason: This is super important for people to realize. A lot of us entrepreneurs, we look at our bank accounts and we think well, I've got $1 that we made. Now I can go buy this thing for $1. They think it's a one to one relationship. That's a huge mistake. Tim: Whatever your business's profit margin is, you got to figure out the bloat factor. Let's just say for example, you're at a 10% profit margin, that means you have to make $10 to keep $1, your bloat factor is 10X. If you cut $1 of expense, you now don't have to sell 10X that in revenue to be in the exact same place. For example, this is actually an extraordinary story Jason, this going to blow your mind. I talked to one of my private consulting clients here. He and I had like uh-oh, the crisis is coming call like three weeks ago. He cut $9,000 a month in recurring revenue. Does that mean that he doesn't need to sell $9,000 in the coming year? Well, of course not, because it's recurring expenses. Jason: I was going to say he lost them? Tim: No, no, no. He cut $9,000 per month of expenses. At his profit margin, his bloat factor is 8.7. $9,000 times 12 months in a year times 8.7, he does not have to sell $944,882 in the coming year. He cut the need to sell a million dollars just by cutting $9,000 a month in expenses. That is mind expanding. Jason: We have pretty healthy profit margins at DoorGrow, we’re pretty tight. We're a virtual team but we cut a ton of expenses. Maybe if we have time, I could list some of the crazy actions that we took to help make sure that we cash flowed. It makes a ton of sense to me. Tim: Big time. I'll just take a super simple example. I actually set up a calculator which we'll play with in the free webinar you and I will do. We'll play with the bloat calculator a little bit. If I have a profit margin of 10%—not uncommon for businesses—my bloat factor would be 10. If all I removed was $250 a month, that's it, $250 a month of recurring expenses, canceling subscriptions, canceling unused services, access to different websites and whatnot, I would not have to sell $30,000 in the coming year. $250 a month does not sound like that much to cut, and yet a 10X bloat factor, that's $30,000 you do not have to sell anymore. You tell me what's easier, finding $250 a month and cutting it, or going out and generating $30,000 in new revenue in the coming year? Jason: Especially right now for us. My accountant was really impressed with me. We cut $10,000 in monthly expenses, depending on what our profit margin is. That can be pretty significant for us as well in terms of how much sales we don't have to do to make it each month. That's made it breathable for us significantly. Tim: When you talk about being able to survive and thrive even when sales go down, you just created a situation for yourself where you don't have to sell as much. Even if sales go down, you can still meet it at a lower sales level and still get by which is really incredible. Jason: I met with my accountant last night and we mapped out the month with all the recurring revenue that we have coming in. If we do no sales this month, we will make it. Tim: I love that. Jason: We’ve pivoted quickly and reduced the expenses, but right now it’s a great opportunity for property managers to grow and we're offering some crazy deals. Hopefully, we'll also be doing some sales this month and making a big difference. Tim: I love that. I think you were sharing offline about how all these Airbnbs are now switching to long term rental. They got smoked out of the market and now they just want to go back to traditional long term rentals. So there's all this flood towards property managers. For a property manager that knows how to convert an Airbnb into a standard long term rental, ready to rock, and knows how to find those deals, goodness gracious, this could be a really revolutionary time. Jason: There are several channels right now for growth and each one is going to get bigger. Property managers right now, they can capitalize on it. We're pushing our clients aggressively to start taking action on these things right now. Tim: That's so exciting. There's another way that we can navigate the cash crunch even if sales go down. It's not just by managing expenses but it's also by navigating cash. Let's get into the third and final step in navigating the cash crunch. The free webinar that we're gonna do in approximately a week from now, we're actually going to do live exercises. We're actually going to share screens and you're actually going to see this spreadsheet in action. It's super simple. Anyone can do it. It can be a game changer. Of the multi-million dollar companies that I've helped save, some of them I didn't even do private consulting with. They just came, they know your numbers, or they heard me talk about just this one tool, The Cash Flow Forecast. They use it religiously when they're in a tough spot and it helps them get through. It's very exciting. There's actually two parts to this. The very first is actually understanding how much cash can I actually touch right now? There's a big difference between cash and free cash. Cash is the amount of money that's in the bank if you add up your checking and savings accounts. That's cash. Free cash on the other hand, we have to deduct some money out of that total cash to get the free cash to know what we can actually work with. From our total cash amount, we need to set aside committed costs. Committed cost is any amount of money you've promised that you're going to pay. Let's say for example a website, I've signed a legal agreement to get a new website done. If I don't manage that agreement to delay the project, I'm on the hook for it. If that's a $10,000 cash outflow that's coming up in two weeks from now, that is a committed cost. I haven't received the service yet but I've committed to receiving the service or the product for that matter. Jason: It's money that's earmarked. It's money that is going to disappear. If you can't pay it, it could cause some serious problems. Tim: Big time, getting all the way back to that whole topic about managing relationships even through the tough times. The second category that we need to earmark some cash is payables. Let's say that you already had the website built. It was finished last week. You've enjoyed the service. You've received the service or the product for that matter. You're on net 30 terms or net 60 terms and now you got to pay that person. That's a payable. Now, one of the biggest payables that is unavoidable is death is taxes. Thankfully, the payment deadline in the United States has been extended, which allows for some cash flow breathing room for entrepreneurs, which is very important right now. I would do my best to get clear and make sure that I've got a separate account for tax. I actually have a separate bank account. It's a little profit first esque or Richest Man in Babylon esque that there's a separate account for income tax and that's where I would hold my income tax. Jason: I have that too. The idea is to have it at a bank that is difficult to get into. That's completely a normal thing. Tim: You don't know the pin. You give it to someone else. Two keys to authenticate and turn to open the vault. Jason: The worst online bank ever or something like that. Tim: Or the brick and mortar bank that has no online, something like that. After committed costs and payables including income tax, we also need to remove or set aside any deposits that we've got. This is huge in property management because we have deposits from tenants. You can't really spend that money, it's not money that you've earned. It's just money that you're holding as a deposit so we got to park that on the sidelines. Then from there, whatever amount that you've got to pay in credit card debt or any other very short term, high interest debt. Most credit cards are 10% more. If you've got all kinds of rewards on your card, you probably are facing 19.99% or 21.95% interest. We really want to make sure that we're getting that paid off at the end of each month or else we're facing colossal interest rates. I would earmark that money to hold to the side as well. Then from there, there's two more. The next one is ultra-short term debt that you need to pay. Short term debt in accounting refers to any debt that's due this year. A Tim Francisism ultra-short term is in the next 30 days. If there's any portion of debt that you need to pay down in the next 30 days, I would earmark that cash as well because if you don't pay it, a lot of small business loans have liens or guarantees against your house. You might lose your house if you don't pay it, or you don't renegotiate that payment because there are some circumstances now where banks and different lenders are allowing you to skip the payment right now because of what's going on. Our last category where we need to earmark and subtract cash, I actually have a whole separate account in my bank for this particular category, is what's called Unearned Revenue. I don't think that's as big in property management candidly. For example, for someone who's offering other services, unearned revenue can be the difference between life and death to know what is earned and what's not. For example, if someone hires me for a year of consulting and they pay in a block amount of money at the start of the year, they pay the whole year in advance, I can only touch 1/12th of that with each month that goes by because it's unearned revenue until I've delivered that guidance for the year. Understanding our starting point of actual free cash is the first part of managing cash, and then the second part is to build out what we call a cash flow forecast. It's very simple. It's 13 weeks which is 90 days, just three months. We simply plot into the cash flow forecast where we've got cash coming in and cash going out. Jason, would it be appropriate for me to just show a screenshot of a cash flow forecast or should we wait until the webinar? Jason: The podcast listeners won't see it so let's get that, we’ll show it on the webinar. They'll just be listeners but it's pretty cool. I'll give you a testimonial related to this. I met with my accountant. We're mapping out all the recurring revenue that we have at DoorGrow and figuring out what expenses. We basically went through this. She started doing this manually in a spreadsheet real time, basically doing exactly what your spreadsheet does. She was figuring out which things are going to hit, what are the due dates for these. We're figuring it all out. I was like that's so funny because Tim has a thing that does this. She took me through it manually to make sure that our cash flow situation is going to be good because it's not just hey, this month we're going to make X number of dollars. We're going to have X number of expenses and we're okay. It's maybe at the beginning of the month, you have a whole bunch of things that are running and you're making that revenue later in the month or however it might work. You need to make sure it's all going to be timed perfectly. That's the brilliance of your cash flow thing because if it ever dips below zero, you're dead. It goes into the red, that's death. You have to make sure that you always know when things are going to hit and this is what your spreadsheet does, which is pretty brilliant. Tim: I agree. I totally agree. I'll tell you, when people are calling you every single day to collect money, 29 days is an extremely long time. It is an eternity. Being clear about when money is arriving, not just by the month to your point, but to the week. To be very clear about when cash is leaving to the week, and making sure that not you or anyone in your team is sending cash out the door too soon especially without other people like a bookkeeper helping or an executive assistant helping to pay different bills, if you don't direct your team on when to pay bills, people in your office or on your team, they might just pay the bills when they come in. They just might pay it exactly the same day that they open the envelope or they get the statement online. They're like oh, well, I was just doing my job. I was just paying this because it came in. You got to give your teammates leadership, guidance, vision, and direction on items like this especially in a cash crunch. People oftentimes ask me Tim, this tool is brilliant. How often should I be looking at it? I say that you look at the tool as often as you need to, relative to two factors. Number one, how low is your plane flying relative to the treetops? This is just the analogy we talked about earlier. If your wheels are clipping the tree tops and those trees might take your plane down, then you're looking at that cash flow forecast possibly every single week to make absolutely damn sure that you're getting the money in that you're expecting on that week, and you're not sending money out any earlier than you're supposed to on that week. Jason: Even daily. Tim: A hundred percent. The clients that I have that weren't had multimillion dollar businesses which can have a lot of complexity, moving parts, people, teammates, products, clients, and all the rest, they would literally have it open every single day just to make sure things were coming and going, that all the trains are running on time because there was no margin for error. The other reason why you'd want to have your cash flow forecast updated in front of mine regularly is if there's a lot of turbulence in the air. Whether you're flying close to the trees or not close to trees. If you got a lot of altitude, that's great. But if there's a lot of turbulence, that can do a lot of damage to your plane as well. Maybe you're not looking at it every single day, maybe not even every single week, but at least once a month. I hate making absolute statements because there's always an exception to the rule, but more or less 100% of entrepreneurs are in turbulence right now because of the climate that we're operating in. This is not a situation, it's limited to a city, a state, or even a country. This is worldwide. The cash flow forecast is how you make sure that you've got oxygen in your tank and that you can keep moving. Without that oxygen in the tank, doesn't matter how big and fast your flippers are to generate revenue. You got to have the cash in the oxygen tank. If you do hit any spots where you've got red on your cash flow forecast and you need to manage that crisis line, there are a lot of different strategies. Some of the more obvious strategies would be applying for some of the SBA loans. The only downside to that is we don't know when they're going to arrive. Secondly, bank lines of credit or if you've got access to them already and they're just sitting unused, that becomes an option. There's raising money from family and friends or an investor. If you wanted to, this is maybe less attractive for most entrepreneurs, we can actually sell shares in your company to raise money. There's also just the simple renegotiating if you need to pay something. Let's say it's $5,000, it's in three weeks from now, and that's when your first red square hits on the cash flow forecast, that's your crisis line. If you're going to be short just $1,000 or something, maybe you could call that person that you owe the money and say can I make it in two payments? I'll pay you in three weeks half, and then one week after that the other half. Lo and behold, just by splitting to 2 payments over 14 days instead of once, all of a sudden you've made up the difference and now all your squares are green. Now you've got not three weeks of safety, but five weeks of safety. Jason: The plane can fly through all of those and knock at the trees. Tim: Hundred percent. The thing is there's a lot of conversation out there about how we have to pivot our businesses and how we have to change our sales and our marketing. I think that is all extremely important conversation to have, absolutely crucial conversation to have. Inevitably, if we're going to pivot our offerings in any way, shape, or form, it's going to take time to roll them out. If it's going to take, say, four weeks to come up with a new offering of some special for an Airbnb owners that want to convert into long term rental, if you need to create a marketing campaign to identify those people, if you need to train up your staff to call certain Airbnb to see if they're distressed. Whether it's people, projects, processes, offers that you're rolling out, it's going to take some time. Even if you do it really quickly, it will probably still take at least a month, if not a few months, to be able to make that pivot and to make that implementation. It doesn't matter if you've got the best idea. It takes four weeks to roll out, but you only have two weeks of cash. That's like building a brand new airplane that's the world's fastest, sexiest, coolest, most comfortable, smoothest plane in the world, but if you only give it 100 yards of runway, it's not going to take off. It's just not. Jason: To boil this down real simple for those listening, all these opportunities for growth, it does not matter if your business doesn't cash flow. It's going to fail. Cash flow first and then let's get you focused on growth. Tim: Cash can come from different places. It can come from loans and other places, not just from revenue. To your point, Jason, I just think there are so many opportunities on the other side of this. We just have to make sure we have enough runway. Surprisingly, amidst this entire thing, I'd say the thesis of all of this is that the most important factors in navigating a cash crunch is actually not cash itself. It's actually time. Time is what we're playing for and cash gets us time. By getting time, we can now get out of panic. We can get back to being calm, clear because we've got a cash flow forecast. You can see what's coming down the pipe. We're confident because you know the exact steps you need to take and because we're clear, confident, and calm, now we can be creative to take advantage of the opportunities that are coming down the pipe. That is the name of the game. Those three steps, navigating mindset, navigating expenses, and navigating cash are how we build the runway that we then can launch off whatever the new opportunities are to take us into the new economy. Jason: I had Michael McCalla on the show. I've worked with Al Sharpton as a coach. One of the things Al would say is if you lower the pressure noise for an entrepreneur, that's where their brilliance and genius comes out. One of the things Michael Mccalla talked about is that when we have constraints or limitations which this market is creating, it's going to create innovation. If you give somebody the Pareto principle, if you give somebody an endless amount of time to do whatever, they don't have to innovate. We're innovating crazy inside DoorGrow. My team members are getting new ideas. We release some contractors. Our salaried staff are figuring out new ways of doing things, ways to save money, ways that are more efficient, ways that are faster. These are big opportunities right now for you and your team to give them some constraints, have them work with you on lowering expenses, solving the cash crunch crisis that you may be experiencing, and allowing innovation creativity to happen. If you can keep your presence calm, your team will be there as well. This is a step towards that. Tim: Did you want to share with folks maybe a little bit about our presentation we're doing next week? We're actually walking people through building a cash flow forecast. Jason: Yeah. Let's just touch on the details. It's going to be on Thursday, what day is that? Tim: April the 9th. Jason: It's going to be on April 9th. It's going to be 11:00. Our time, we're both in Austin, Central, which is 9:00 AM Pacific noon Eastern. What are we going to be sharing during this? What are you going to be sharing with everyone? Tim: You bet. First of all, folks, go to navigatethecashcrunch.com/doorgrow. I know podcast listeners won't be able to see this, but Jason, I'll just share my screen so you can see it. We've got Navigate the Cash Crunch with Tim Francis and Jason Hull. It's happening Thursday, April 9th, 2020 at 11:00 AM Central, which is Chicago time just like Jason just shared. In it, we'll be sharing the three step process we've talked about today. We're not going to go into as much detail into mindset because we talked about it here today already. We'll cover a few tools around expense management. The real star of the show is building your very own cash flow forecast. You can register for that webinar at navigatethecashcrunch.com/doorgrow. What you'll get is access to the training. You also get the cash flow forecast template as well, which you can just drop into your very own computer and get to work with seeing where your crisis line is. Hopefully, it's not too close and from there, seeing the exact path to navigating safely. If you happen to be listening to this podcast episode of the DoorGrow Show after the webinars already happened, so after April the 9th, 2020, no problem. You can still go back to the exact same URL. You can see the resources and the replays there so that you are not left in the dark. Jason: navigatethecashcrunch.com/doorgrow. Tim: Yes, indeed. Absolutely. Maybe you guys can throw that in the show notes or something like that for anyone listening to the podcast. Jason: Absolutely. Tim: That's that. I think that somewhat as a final thought on my end over here. It's just that deep down inside, we as entrepreneurs, we take on a lot to be great leaders. I do view property managers as entrepreneurs. I hope they do too, because they are there. They're doing the courageous things of entrepreneurs every single day. Sometimes leadership isn't easy. Sometimes it has uncomfortable conversations. Sometimes it has uncomfortable moments. I think that there's something really beautiful about getting clear on where we are. Oftentimes we talk about our goals and what's the most important to us, but we also have to be very clear about where we are. Getting to Austin, Texas is very different if you're starting in Chicago versus Waikiki. Knowing where we are right now with free cash, and then from there being able to map the path with our cash flow forecast, it really creates calm, it really creates clarity. Therefore, it really creates confidence which then creates creativity that we can now take on this new economy. Something I am very sure about is not anyone including myself could have specific data around this. I just know my gut, Jason, that the economy that we had two months ago, it's over. It's gone. I don't just mean bull versus bear. What I mean is the way we did business once upon a time is forever changed. I'm very nervous for what kind of discomfort is coming for anyone who thinks that how we used to do things is coming back to what it used to be. As we chart into these new territories, I think being able to be calm, clear, confident, and creative is the path. It takes courage and just a couple simple tools to be able to have that. I think that if we're operating from clear facts and confidence, we become lighthouses that can attract what we need to attract into our worlds, and also fend away what we need to fend away. We're not left making super emotional decisions. One of my mentors, his name is Keith Cunningham, he talks about emotion and intelligence often working inverse of one another. The more emotional we are, which is really saying the more that we're in our amygdala, the less that we're in the frontal lobe of our brain, the less our executive functioning is there and the less that we're able to make intelligent, clear, confident decisions. On the flip side, the more that we can make calm, clear, confident decisions, the less that we become really emotional about what's going on. That's not to say we're not passionate. We are so passionate about our businesses. Yes, emotion has its right place. We just don't want to get stuck making decisions or taking action that we may regret down the road. Jason: Absolutely. Tim, thanks for coming on the show. Everybody else, make sure you tune in when we do our presentation. For those listening, watch the replay. Until next time to our mutual growth. Bye, everyone. 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Dr. Grumpypants joins us to discuss this group of disorders that have a very distinct appearance but very different causes and prognoses. We will cover erythema annulare centrifigum (EAC), erythema gyratum repens (EGR), erythema migrans (a/w Lyme disease), and erythema marginatum (a/w rheumatic fever) Connect with us: • Facebook: https://www.facebook.com/learndermpodcast/ • … Continue reading "Ep26 VASC – Figurate (Gyrate) Erythemas (EAC, EGR, Erythema migrans, Erythema marginatum)"
We kick off our 3rd reaction pattern, the vascular disorders, by discussing EM with the help of another new attending, Dr. DOOD. As always, we’ll share pearls in the H&P, workup, and management of EM patients Connect with us: • Facebook: https://www.facebook.com/learndermpodcast/ • IG: https://www.instagram.com/learndermpodcast/?hl=en • … Continue reading "Ep21 VASC (Vascular) – Erythema multiforme"
Costs associated with dermatology residency applications average $10,000 per applicant. Dr. Daniel Mazori talks to Dr. Aamir Hussain about ways to reduce costs for applicants, particularly during the interview process when frequent long-distance travel may be required. “Right now we’re in this lose-lose situation where applicants feel like they need to apply to every single program to maximize their chances and program directors are overwhelmed by hundreds of applications for one or two spots,” advises Dr. Hussain. * * * We bring you the latest in dermatology news and research: Dupilumab-induced head and neck erythema described in atopic dermatitis patients It’s a common side effect that’s underreported in clinical practice and clinical trials. Calif. woman poisoned by methylmercury-containing skin cream The patient has undergone extensive chelation therapy, but she remains unable to verbalize or care for herself. * * * Things you will learn in this episode: Many dermatology applicants apply to residency programs they are not genuinely interested in to maximize their chances of matching in a very competitive specialty. Program directors who are overwhelmed by hundreds of applications for one or two may use arbitrary metrics to weed out candidates because there currently is no way to evaluate who has a genuine interest in the program. A cap on the number of applications permitted per applicant would reduce application fees and help students focus on programs that are the best fit for them. According to Dr. Hussain, 50-60 applications generally is a reasonable number: “After that point, there seem to be diminishing returns in the number of interviews you’re getting for every application you send out in addition to that.” Dermatology applicants often choose to write separate personal statements or contact their programs of choice directly. An option to flag applications for the programs a candidate is most interested in may be an effective way to formalize this process. Regional interview coordination among all the dermatology programs in certain cities or areas of the country would allow applicants to interview with multiple programs at the same time and save on travel costs, in addition to providing neutral ground for home applicants; however, that would require coordination and buy-in from every dermatology program in the region. Video conferencing could reduce travel costs during the interview process but would need to be standardized for every applicant, as candidates who participate in video interviews are consistently rated lower than those who have in-person interviews. Hosts: Elizabeth Mechcatie, Terry Rudd Guests: Daniel R. Mazori, MD (State University of New York, Brooklyn); Aamir Naveed Hussain, MD, MAPP (Northwell Health, Manhasset, N.Y.) * * * Show notes by: Alicia Sonners, Melissa Sears, Elizabeth Mechcatie You can find more of our podcasts at http://www.mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgeDerm
A review for the emergency physician of this common tick-borne illness. Hosts: Audrey Bree Tse, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Lyme_Disease.mp3 Download Leave a Comment Tags: Infectious Diseases Show Notes Episode Produced by Audrey Bree Tse, MD Background Most common tick-born illness in North America Endemic in Northeast, Upper Midwest, northwest California 80% to 90% in summer months Pathophysiology Ixodes tick (deer tick) has a 3-stage life cycle (larvae, nymph, adult) & takes 1 blood meal per stage Deer tick feeds on an infected wild animal (infected with spirochete Borrelia burgodrferi) then bites humans On humans, they typically move until they encounter resistance (e.g. hairline, waistband, elastic, skin fold). It takes 24-48 hrs for B. Burgdorferi to move from the tick to the host Pathogenesis: organism induced local inflammation, cytokine release, autoimmunity No person to person transmission Clinical Presentation Stage 1: Early Symptom onset few days to a month after tick bite Erythema migrans rash: bulls eye rash seen in more than 90% of patients with Lyme disease (Irregular expanding annular lesion(s)) Regional adenopathy, intermittent fevers, headache, myalgias, arthralgia, fatigue, malaise Stage 2: disseminated/ secondary Days to weeks after tick bite Intermittent fluctuating sx that eventually resolve Triad of aseptic meningitis, cranial neuritis, and radiculoneuritis: bell palsy most common Cardiac symptoms: tachycardia, bradycardia, AV block, myopericarditis
A review for the emergency physician of this common tick-borne illness. Hosts: Audrey Bree Tse, MD Brian Gilberti, MD https://media.blubrry.com/coreem/content.blubrry.com/coreem/Lyme_Disease.mp3 Download Leave a Comment Tags: Infectious Diseases Show Notes Episode Produced by Audrey Bree Tse, MD Background Most common tick-born illness in North America Endemic in Northeast, Upper Midwest, northwest California 80% to 90% in summer months Pathophysiology Ixodes tick (deer tick) has a 3-stage life cycle (larvae, nymph, adult) & takes 1 blood meal per stage Deer tick feeds on an infected wild animal (infected with spirochete Borrelia burgodrferi) then bites humans On humans, they typically move until they encounter resistance (e.g. hairline, waistband, elastic, skin fold). It takes 24-48 hrs for B. Burgdorferi to move from the tick to the host Pathogenesis: organism induced local inflammation, cytokine release, autoimmunity No person to person transmission Clinical Presentation Stage 1: Early Symptom onset few days to a month after tick bite Erythema migrans rash: bulls eye rash seen in more than 90% of patients with Lyme disease (Irregular expanding annular lesion(s)) Regional adenopathy, intermittent fevers, headache, myalgias, arthralgia, fatigue, malaise Stage 2: disseminated/ secondary Days to weeks after tick bite Intermittent fluctuating sx that eventually resolve Triad of aseptic meningitis, cranial neuritis, and radiculoneuritis: bell palsy most common Cardiac symptoms: tachycardia, bradycardia, AV block, myopericarditis Stage 3: tertiary/ late
Heute geht es um die durch Zecken übertragene Frühsommer-Meningoenzephalitis (FSME) und Borreliose // ÜbertragungGemeiner Holzbock (bis 4,5 mm): FSME (Virus, 300 Fälle/Jahr in D, Risiko 1:10.000), auch viel häufiger Lyme-Borreliose (Bakterium, 60-100.000/Jahr in D, Risiko 1:100) Etwa in Höhe bis 25 cm, innerhalb weniger Sekunden Bein hoch, Kniekehle, Schritt, ritzt (beißt) dann sticht, saugt, dann fällt sie ab (50% wissen gar nichts vom Stich) Auwald-Zecke (größer, vollgesogen 16 mm!): schwierig, Wer aus der Haustür tritt, steht im Lebensraum der Zecken; bei niedrigeren Temperature, häufiger aber Tiere Rohmilch/käse, insb. Schafe und Ziege, pasteurisierter Milch keine Gefahr https://www.deutsche-apotheker-zeitung.de/news/artikel/2017/04/06/neue-uebertragungswege-fuer-fsme FSME-VirusNicht jede, nur 1-5% Zecke Nicht jeder Stich gefährlich, nicht jede infizierte Zecke infiziert FSME-Symptome1-2 Wochen nach dem Stich grippalen Krankheitsbild kurz beschwerdefreies Intervall Hirnhaut- oder Gehirn-Entzündung (Meningitis, Enzephalitis), starken Kopfschmerzen, Nackensteifigkeit, Verwirrtheit und möglicherweise Koma. https://www.crm.de/presse/pressemappe_fsme/5_Tab1_Zecken_uebertragene_Krankheiten.pdf BorrelioseHängt davon ab wie lange die Zecke im Körper verbleibt Symptomatik außerordentlich vielgestaltig, Inkubationszeit sehr variabel 3 Stadien: grippale Symptome und eine sich zunächst flächenhaft, später ringförmig ausbreitende rötliche Hautveränderung um die Stichstelle herum ("Erythema migrans" = Wanderröte). Heilt oft folgenlos ab. Nervenentzündung mit Lähmungen und brennenden Schmerzen. Kinder Hirnhautentzündung. Herzentzündungen und rötlich-blauen Knötchen auf der Haut (Borrelien-Lymphozytom). Monate bis Jahre nach der Infektion schubweise oder chronisch verlaufende Gelenkentzündungen. Bläuliche Pergamenthaut, Lähmungen. https://www.crm.de/presse/pressemappe_fsme/5_Tab1_Zecken_uebertragene_Krankheiten.pdf Wie entfernenZeckenbiss ist falsch, Zecken können nicht beißen, kratzen auf und stechen dann Nicht aus der Haut drehen, haben kein Gewinde Pinzette oder Zeckenzange nahe der Hautoberfläche gegriffen und langsam und gerade aus der Haut ziehen, ohne das Tier zu zerdrücken, Nicht Öl: erbricht Krankheitsrreger in Stich Wenn Teile verbleiben kein Problem Einstichstelle desinfizieren, noch eine Weile auf Rötungen beobachten. https://www.apotheken-umschau.de/Gehirn/FSME-stoppen-Zeckenforschung-554755.html Wie vorsorgen?körperbedeckende Kleidung und feste Schuhe. regelmäßigen Kontrolle des Körpers: Zeckenstich keiner Schmerzen, Jucken Zeckenspray Icaridin für nichttropische Gebiete empfohlen werden. gegenüber Kunstfasern und- stoffen (Sonnenbrillen) inert. Leicht Allergen, aber wirksam Auch gegen Mücken Oft 2 Sprays gleich zusammengesetzt, einmal Mücke, einmal Zecke (hält kürzer) Diethyltoluamid (DEET) liegen die längsten praktischen Erfahrungswerte vor. Es ist seit fast 70 Jahren im Einsatz und gilt als Mittel der Wahl zur dermalen Insektenabwehr bei Reisen in die Tropen, mehr Allergien, gegenüber Kunstfasern und- stoffen (Sonnenbrillen) nicht inert Para-Menthan-3,8-diol (PMD) wirk zu kurz und allergener https://www.deutsche-apotheker-zeitung.de/news/artikel/2017/04/28/was-ist-der-beste-mueckenschutz/chapter:2 Behandlung?FSME: keine Borreliose: bei Wanderröte (nicht geschwollen, tut nicht weh) Antibiotika: Tetracyclin-Tablette (Doxycyclin 200 mg/Tag, nicht in die Sonne) oder Infusionen (Cefotaxim, Ceftriaxon), 2-4 Wochen. ImpfungIn FSME Risikogebieten, v.a. Bayern und Baden-Württemberg, aber auch Thüroingen. Sachsen. Hessen, Rheinland-Pfalz, Saarland; Österreich, der Schweiz, Skandinavien und Osteuropa Forstarbeiter 3 mal, alle 3-5 Jahre auffrischen http://www.rki.de/DE/Content/InfAZ/F/FSME/Karte_FSME.pdf?__blob=publicationFile Borreliose, keine Impfung Zusammenfassung: // FSME nicht so häufig wie Borreliose, jetzt aber ...
People who live with Crohn’s disease and ulcerative colitis experience stigma because of their inflammatory bowel disease (IBD). The taboo topic of bowel disease can permeate all aspects of a person’s life, especially when there are cultural influences also at play.Tina Aswani Omprakash, who lives with Crohn's disease and a permanent ileostomy, shares her story of personal empowerment and how she is working to help other people with IBD live their lives with confidence. Tina describes how IBD has profoundly affected her family as well as why she decided to become an outspoken advocate for the IBD and ostomy communities and start her blog, Own Your Crohn’s. Concepts discussed on this episode: Pouchitis: https://www.verywellhealth.com/what-is-pouchitis-in-a-jpouch-1942974 Rectovaginal fistula: https://www.verywellhealth.com/rectovaginal-fistula-overview-4587356 Perianal disease: https://www.verywellhealth.com/what-is-the-perianal-area-1942412 J-pouch: https://www.verywellhealth.com/before-during-and-after-j-pouch-surgery-4137938 Ileostomy: https://www.verywellhealth.com/what-you-need-to-know-about-ileostomy-surgery-1942936 Step therapy: https://www.crohnscolitisfoundation.org/get-involved/be-an-advocate/steptherapy/ Abscess: https://www.verywellhealth.com/perirectal-abscess-2328821 Pyoderma gangrenosum: https://www.verywellhealth.com/pyoderma-gangrenosum-skin-disorder-1943016 Erythema nodosum: https://www.verywellhealth.com/erythema-nodosum-1943012 Find Tina Aswani Omprakash at: Blog:http://ownyourcrohns.com/ Facebook:https://www.facebook.com/ownyourcrohns/ Twitter:https://twitter.com/ownyourcrohns Instagram:https://www.instagram.com/ownyourcrohns/ Find Amber J Tresca at: Verywell:https://www.verywell.com/ibd-crohns-colitis-4014703 Blog:http://aboutibd.com/ Facebook:https://www.facebook.com/aboutibd Twitter:https://twitter.com/aboutIBD Pinterest:https://www.pinterest.com/aboutibd/ Instagram:https://www.instagram.com/about_IBD/ Additional sound engineering courtesy Mac Cooney, https://www.facebook.com/michaelandrewcooney/ "About IBD with Amber Tresca" © Cooney Studio http://cooneystudio.com/
Listen to the podcast for why each multiple choice answer is right or wrong!#1 A 2 year old boy presents with a 3 day history of rhinorrhea, conjunctivitis, barky cough, and a fever of 102 degrees. On physical examination you appreciate cervical lymphadenopathy, an erythematous throat most likely from the cough, and while you’re inspecting the mouth, you see a number of 1-3 mm white and gray elevations in the back of the cheek. Otherwise he has normal heart and breath sounds. This presentation is most consistent with:A. RoseolaB. RubeolaC. RubellaD. streptococcal pharyngitis#2 A 5 year old boy presents with a 2 day history of fever and runny nose. His father states that he woke up this morning with rosy cheeks, and sure enough he’s sitting on your exam table with rosy cheeks. Physical exam reveals a light reticular rash over the extensor surfaces. Which of the following is the most likely diagnosis?A. Scarlet feverB. Erythema infectiosumC. VaricellaD. Epstein-Barr virus#3 A 6-year-old boy presents with a fever for the past week. His mother states that over the course of the week, he has been getting worse. You take a look at the boy and doesn’t look very good. He has a 38.5C fever, bilateral conjunctival injection, a macular, erythematous rash on his abdomen and arms and a beefy red tongue. Which of the following is the most likely diagnosis?A Herpes simplex 1B Hand Foot and Mouth diseaseC Tinea capitisD Kawasaki diseaseAnswers#1 B. Rubeola#2 B. Erythema infectiosum#3 D. Kawasaki diseaseFeel free to reach out with questions and suggestions at leonardsee94@gmail.com. IG: @lenny_see
Topics: Introducing a New Innovation in the Treatment of Persistent Facial Erythema Faculty: Julie Harper, MD This Product Theater, sponsored by Allergan, Inc., is from the SDPA Annual Summer Dermatology Conference 2017.
Dr. Sunjya Schweig, M.D. is a board-certified physician who has been studying, teaching, and practicing integrative and Functional Medicine for over 20 years. In 2014 he joined forces with Chris Kresser to launch the California Center for Functional Medicine, offering patients an investigative approach to healthcare. He is also the founding Chair of the Integrative Medicine Committee for the International Lyme and Associated Disease Society (ILADS) and serves on the Scientific Advisory Board for the Bay Area Lyme Foundation. On this podcast, Dr. Schweig shares the personal journey that resulted in years of focused study and his current expertise in Lyme Disease. He discusses the factors that interfere with getting the right treatment, including political pressure and inadequate testing protocols. He also offers his best resources for keeping yourself and your loved ones safe from tick-borne illness. Here’s the outline of this interview with Sunjya Schweig: [00:00:05] Mission Heirloom. [00:03:40] California Center for Functional Medicine, Chris Kresser; Podcast: How to Become a Health Coach (And Why Health Coaching Will Transform Healthcare). [00:05:28] Cleveland Clinic Center for Functional Medicine; Mark Hyman, Patrick Hanaway, The Institute for Functional Medicine. [00:06:00] Article: Topol, Eric J. "Individualized medicine from prewomb to tomb." Cell 157.1 (2014): 241-253. [00:08:15] Kalish Institute of Functional Medicine; ADAPT Health Coach Training Program. [00:08:53] Ray Stricker, Richard Horowitz. [00:09:29] Clymb Health. [00:09:53] Oura Ring. [00:13:56] Hill Park Integrative Medical Center; Brian Bouch. [00:18:16] Erythema migrans (bullseye rash),
Join Dr Mike in the PediaCast Studio for more answers to listener questions. This week’s topics include erythema multiforme, acne and Accutane, baby yoga, infant development, sitting positions, double-jointedness, and the possible hazards of electromagnetic waves.
This podcast is on Mirvaso Gel for Rosacea, First and Only Erythema Treatment with A Product Theater with Firas Hougeir, M and was recorded at the 2013 SDPA Fall Conference in Atlanta.
Medizinische Fakultät - Digitale Hochschulschriften der LMU - Teil 16/19
Zusammenfassung Die enteropathogenen Yersinia-Arten Y. enterocolitica und Y. pseudotuberculosis verursachen neben Enteritiden und Enterokolitiden auch extraintestinale Erkrankungen wie reaktive Arthritis oder Erythema nodosum. In ihrem Infektionsverlauf zeigen sich allerdings zwischen diesen beiden Arten Unterschiede. So erfolgt eine Dissemination von Y. pseudotuberculosis meist in Form einer mesenterialen Lymphadenitis, im Falle von Y. enterocolitica hingegen kommt es zusätzlich zum Befall und zur Schädigung der weiter proximal und distal gelegenen Darmabschnitte im Sinne einer Enterokolitis. Bislang ist nicht geklärt, wodurch diese Unterschiede im Infektionsverlauf bedingt sind. Das Virulenzplasmid der enteropathogenen Yersinien kodiert für verschiedene Virulenzfaktoren, unter anderem für das Yersinia-Adhäsin YadA. Zwischen den YadA-Varianten der beiden Yersinia-Spezies und ihrer Serovare finden sich Unterschiede in der Aminosäuresequenz, die als Ursache für Unterschiede im Bindungsverhalten der Bakterien an EZM-Proteine diskutiert werden. Da die Bindung an Wirtsgewebe einen entscheidenden Schritt in der Pathogenese einer bakteriellen Infektion darstellt, könnten diese Unterschiede in YadA verantwortlich für die unterschiedlichen Infektionsmuster sein. Um dies zu klären, wurden yadA-Varianten und -Hybride aus beiden Arten in Y. enterocolitica Serotyp O:8, Stamm WA-314 als definiertem Expressionsprototyp eingebracht. Die verschiedenen Varianten wurden hinsichtlich ihres Bindungsverhaltens an immobilisierte EZM-Proteine und ihr Adhärenz- und Invasionsverhalten an HeLa-Zellen untersucht. Hierbei fand sich eine signifikant stärkere Bindung von Mutanten mit einem YadAent an Kollagen I und Fibronektin. In der Adhärenz an HeLa-Zellen konnte dieser Unterschied nicht dargestellt werden, aber alle yadA-positiven Stämme zeigten eine stärkere Adhärenz als die yadA-negativen Kontroll-Mutante. Allerdings ließ sich kein Unterschied der Zellinvasivität in HeLa-Zellen verglichen mit der Negativkontrolle nachweisen. Außerdem wurden zum Vergleich yadA-Knock-out-Mutanten von zwei Y. pseudotuberculosis-Stämmen erstellt. Diese wurden gemeinsam mit ihren Wildtyp-Stämmen mit den o. g. genannten Y. enterocolitica WA-314-Mutanten im oralen Mausinfektionsmodell verglichen. Hierbei fand sich kein Unterschied in der Virulenz zwischen den yadA-positiven und yadA-negativen Y. pseudotuberculosis-Stämmen. Hingegen war die yadA-Deletions-Mutante von Y. enterocolitica WA-314 nicht mausvirulent im Gegensatz zu den yadA-positiven Y. enterocolitica WA-314-Mutanten. Zusammenfassung ___________________________________________________________________________ 118 Die Ergebnisse der histologischen Auswertung von Milz und Peyerschen Plaques weisen auf einen unterschiedlichen Infektionsverlaufs von Y. enterocolitica im Vergleich zu Y. pseudotuberculosis hin. Allerdings zeigte sich auch hier, dass Unterschiede im Infektionserlauf für Y. enterocolitica WA-314 im Mausmodell nicht von der exprimierten YadA-Variante abhängig sind. Es zeigte sich, dass das yadA-Gen von verschiedenen Yersinia-Spezies, Serotypen und Stämmen nach Übertragung auf Y. enterocolitica WA-314 im vergleichenden Mausinfektionsmodell keinen Virulenzunterschied deutlich machte. Zudem konnte die Kopfregion, unter Nutzung der homologen Sequenzen im Konnektor-Bereich, ohne Virulenzminderung ausgetauscht werden. Zudem zeigte sich in dieser Arbeit, in Einklang mit Erkenntnissen, wonach die Kopfregion die EZM-Bindung vermittelt, dass nach einem solchen Austausch das Bindungsverhalten an Kollagen I und Fibronektin durch die Kopfregion bestimmt wurde. Die Analyse der Adhärenz an HeLa-Zellen zeigte allerdings, dass eine stärkere Kollagen I- und Fibronektin-Bindung nicht mit einer stärkeren Zellbindung einhergeht und somit kein ausreichender Prediktor für die Zellbindungsfähigkeit ist. Die Auswertung der Mausinfektionsversuche bestätigen, dass YadA für die Virulenz von Y. enterocolitica entscheidend ist, wohingegen Y. pseudotuberculosis auch ohne YadA seine volle Mausvirulenz behält. YadA, das für Y. enterocolitica ein wichtiger Virulenzfaktor ist, kann unter gewissen Voraussetzungen, wie für Y. pestis nachgewiesen, auch nachteilhaft für das Überleben im Wirt sein. Für Y. pseudotuberculosis könnten andere Virulenzfaktoren eine wichtigere Rolle spielen als YadA.
Wed, 09 May 2012 14:32:37 GMT http://saveyourskin.ch/podcast/EN/1.1.13.EEM.mp4 Prof. Dr. Dr. h. c. Günter Burg, MD Zürich & Prof. Dr. Walter Burgdorf, MD 2013-03-10T14:32:37Z Prof. Dr. Dr. h. c. Günter Burg, MD Zürich & Prof. Dr. Walter Burgdorf, MD no Ery
Wed, 09 May 2012 14:32:37 GMT http://saveyourskin.ch/podcast/DE/1.1.12.Erythema_nodos.mp4 Prof. Dr. Dr. h. c. Günter Burg, MD Zürich 2013-03-10T14:32:37Z Prof. Dr. Dr. h. c. Günter Burg, MD Zürich no
Wed, 09 May 2012 14:32:37 GMT http://saveyourskin.ch/podcast/DE/1.1.13.EEM.mp4 Prof. Dr. Dr. h. c. Günter Burg, MD Zürich 2013-03-10T14:32:37Z Prof. Dr. Dr. h. c. Günter Burg, MD Zürich no Erythema exsuda
Wed, 09 May 2012 14:32:40 GMT http://saveyourskin.ch/podcast/DE/2.2.8.Borrelioses_Eryth_chr_migr.mp4 Prof. Dr. Dr. h. c. Günter Burg, MD Zürich 2013-03-10T14:32:37Z Prof. Dr. Dr. h. c. Günter Burg, MD Zürich no
Wed, 09 May 2012 14:32:37 GMT http://saveyourskin.ch/podcast/EN/1.1.12.Erythema_nodos.mp4 Prof. Dr. Dr. h. c. Günter Burg, MD Zürich & Prof. Dr. Walter Burgdorf, MD 2013-03-10T14:32:37Z Prof. Dr. Dr. h. c. Günter Burg, MD Zürich & Prof. Dr. Walter Burgdorf, MD no
Wed, 09 May 2012 14:32:40 GMT http://saveyourskin.ch/podcast/EN/2.2.8.Borrelioses_Eryth_chr_migr.mp4 Prof. Dr. Dr. h. c. Günter Burg, MD Zürich & Prof. Dr. Walter Burgdorf, MD 2013-03-10T14:32:37Z Prof. Dr. Dr. h. c. Günter Burg, MD Zürich & Prof. Dr. Walter Burgdorf, MD no
Objective: We evaluated whether immunoblotting is capable of substantiating the posttreatment clinical assessment of patients with erythema migrans ( EM), the hallmark of early Lyme borreliosis. Methods: In 50 patients, seroreactivity to different antigens of Borrelia burgdorferi sensu lato was analyzed by a recombinant immunoblot test (IB) in consecutive serum samples from a minimum follow-up period of 1 year. Antigens in the IgG test were decorin- binding protein A, internal fragment of p41 (p41i), outer surface protein C (OspC), p39, variable major protein-like sequence expressed (VlsE), p58 and p100; those in the IgM test were p41i, OspC and p39. Immune responses were correlated with clinical and treatment-related parameters. Results: Positive IB results were found in 50% before, in 57% directly after therapy and in 44% by the end of the follow-up for the IgG class, and in 36, 43 and 12% for the IgM class. In acute and convalescence phase sera, VlsE was most immunogenic on IgG testing 60 and 70%), and p41i (46 and 57%) and OspC (40 and 57%) for the IgM class. By the end of the follow-up, only the anti-p41i lgM response was significantly decreased to 24%. Conclusions: No correlation was found between IB results and treatment-related parameters. Thus, immunoblotting does not add to the clinical assessment of EM patients after treatment. Copyright (c) 2008 S. Karger AG, Basel.
Background: An erythema migrans (EM) remaining smaller than 5 cm in diameter, called mini EM by us, has not been addressed in detail. Objective: To study the significance of the mini EM as a sign of Lyme borreliosis. Methods: Patients with suspected mini EM were retrospectively selected out of 257 consecutive patients with EM. The diagnosis of mini EM rested on the cultivation of Borrelia burgdorferi. Species and subtype analysis of culture isolates was performed using outer surface protein A (OspA) polymerase chain reaction followed by restriction fragment length polymorphism and sequencing of the OspA gene. Results: There was one patient with definite (0.4%) and another patient with a questionable mini EM. Borrelia garinii OspA type 6 was identified in the patient with the definite and B. burgdorferi sensu lato in the patient with the questionable mini EM. Conclusion: The mini EM represents an important and apparently uncommon sign of early Lyme borreliosis.
Meine Einstellung zum Thema Bareback: 10 Kondome: ? 2,99 Nebenwirkungen: Keine alternativ: Trizivir, 60 Tbl. ? 1.031,11 Nebenwirkungen: Lebensbedrohl. Überempfindlichkeitsreakt., Anzeichen u. Symptome einer Überempfindlichkeitsreakt. (kursiv wenn b. 10% d. Pat. berichtet): Magen-Darm-Trakt: Übelk., Erbrechen, Diarrhoe, Bauchschm., Geschwüre im Mund; Neurolog. System/Psyche: Kopfschm., Parästhesie; Blutbild: Lymphopenie; Leber/Pankreas: erhöhte Leberwerte; Muskel-/Skelettsyst.: Myalgie, Myolyse, Arthralgie, Erhöh. d. Kreatin-Phosphokinase; Respirationstrakt: Dyspnoe, Halsschm., Husten, akutes Atemnotsyndr. b. Erw., respirat. Insuff., grippeähnl. Sympt.; Haut: Hautausschlag (gewöhnl. makulopapulös od. urtikariell); Urogenitaltrakt: Erhöh. d. Kreatinins, Nierenversagen; Sonstige: Fieber, Lethargie, allg. Krankheitsgefühl, Ödeme, Lymphadenopathie, Blutdruckabfall, Konjunktivitis, Anaphylaxie. Überempfindlichkeitsreakt. auch ohne Fieber od. Hautausschlag mögl. Sympt. traten innerh. d. ersten 6 Wo. nach Beginn d. Behandl. auf, auch zu jeder Zeit d. Therapie mögl. Engmaschige medizin. Überwach. während d. ersten 2 Mon. erforderl., Untersuch. mind. alle 2 Wo. Hinweis d. Pat. auf d. Wichtigkeit d. regelm. Einnahme. Erneute Einnahme v. Trizivir od. and. Abacavir enthalt. AM nach Überempfindlichkeitsreakt. führt zu raschen Wiederauftreten d. Sympt. innerh. v. Std. u. schwererem Verlauf als b. d. ersten Verabreich., kann mögl. zu lebensbedrohl. Blutdruckabfall u. zum Tod führen. Wenn entschieden wurde, Trizivir b. solchen Pat. erneut einzusetzen, muss dies im Krankenhaus erfolgen. NW in Zusammenhang mit den einzelnen arzneil. wirksamen Bestandteilen v. Trizivir (kursiv von b. mind. 5% d. Pat. berichtet): Abacavir: Übelk., Erbrechen, Diarrhoe, Kopfschm., Pankreatitis, Laktatazidose, Fieber, Lethargie, Müdigk., Anorexie. Hautausschlag, sehr selt. Erythema multif., Stevens-Johnson-Syndr., tox. epidermale Nekrolyse. Lamivudin: Übelk., Erbrechen, Diarrhoe, Bauchschm. od. -krämpfe, Kopfschm., Schlaflosigk., periphere Neuropathie od. Parästhesie, Neutropenie u. Anämie (beide gelegentl. in schwerer Form´) b. Kombi. mit Zidovudin, Thrombozytopenie, sehr selt. isolierte Aplasie der Erythropoese, vorübergeh. Anstieg d. Leberenzyme (AST, ALT), Hepatitis, Anstieg d. Serumamylase, Pankreatitis, Muskelfunktionsstör., Arthralgie, Rhabdomyolyse, Husten, nasale Sympt., Hautausschlag, Alopezie, Laktatazidose, Fieber, allg. Krankheitsgefühl, Müdigk. Zidovudin: Übelk., Erbrechen, Anorexie, Diarrhoe, Bauchschm., Pigmentier. d. Mundschleimhaut, Dyspepsie, Flatulenz, Kopfschm., Schlaflosigk., Parästhesie, Schwindel, Schläfrigk., Konzentrationsschwäche, Krämpfe, Angst, Depress., Anämie, Neutro-, Leuko-, Thrombozyto-, Panzytopenie m. Knochenmarkhypoplasie, selt. isolierte Aplsie der Erythropoese, sehr selt. aplast. Anämie, Lebererkr. wie schwere Hepatomegalie mit Steatose, erhöhte Werte v. Leberenzymen, Bilirubin im Blut, Pankreatitis, Myalgie, Myopathie, Husten, Dyspnoe, Hautausschlag, Pigment. d. Nägel u. der Haut, Urtikaria, Juckreiz, Schwitzen, Laktatazidose, allg. Krankheitsgefühl, Fieber, Miktionsdrang, Geschmacksstör., allg. Schmerzgefühl, Schüttelfrost, Brustschm., grippeähnl. Syndr., Gynäkomastie, Schwäche. NW in Zus.hg. m. antiretroviraler Komb.-ther.: Laktatazidose, Lipodystrophie, Stoffwechselanomalien (Hypertriglyceridämie, Hypercholesterinämie, Insulinresistenz, Hyperglykämie, Hyperlaktatämie). ( Dies ist dem Original Beipackzettel entnommen) Wobei (danke an "André"), angesprochen sind vor allem folgende Chat-Vertreter: -Unterschätzer der Gefahr, -die, die an die Unverwundbarkeit durch das Gefühl der Liebe glauben, -Sensations-Seeker -Neueinsteiger(innen), die in der Teenager Skatersprache es einfach uncool finden -die die glauben, Risiko zu minimieren, indem sie abschätzen, ob einer krank aussieht oder promisk ist.. ...denn "Barebackern", die bereits positiv sind, kann man(n) i.d.R. nichts mehr (be)lehrendes vermitteln. Hier entstehen im schlimmsten falle Resisstenzen sowie die Übertragung weiterer Virenstämme sowie evt. Hep c usw.. Ein weiterer interessanter Einwand von FFMScorpio: "...nun der Grund für das Desinteresse für Kondome liegt in der Problematik, dass sich bei Deiner Berechnung ein kleiner Rechenfehler eingeschlichen hat: für 60 Tage Kosten Eigenanteil Kondome ? 30 ? 30 Trizivir ? 1.050 ? "0" Also ist "bare" günstiger... jedenfalls so lange, wie die Gesundheitskosten von der Allgemeinheit getragen werden..." Ja, ja, die zynische Wahrheit!
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