Friday, October 30, 2015

#RingWorm skin infection common in #BJJ, #wrestlers and other contact sports.

Ringworm is not really a worm infection at all, it is a form of tinea or fungal infection of the skin.
The infection looks like a ring in nature hence the name, can be raised at the borders.   I have heard of athletes using cigarettes the burn the ringworm out.   Old folkstale cure in the BJJ world possibly but the cigarette burn damages the layer of skin where this fungus lives. In essence killing the fungus as well as its food supply.   Analogy of bulldozing  a house for a roach infestation.     There are safer, less damaging  though less macho ways to treat this infection.

Warm, moist environment such as wet shoes, wet uniforms, wet gym floors / mats from some hard core training can be the culprit, some quick facts

  1. can be passed from person to person
  2. can be easily treated, usually with topical , over the counter antifungals used for athlete's feet
    1. same organism
  3. rotate uniforms , shoes, socks so that they have enough time to dry between workouts
  4. if over the counter topical care does not resolve the issue, then call your doctor to be assessed and possible oral antifungals may be required or just a stronger cream that is only available via prescription from your doctor

How to avoid
  1. rotate shoes , socks and uniforms
  2. fully dry your socks, shoes and uniforms prior to wearing.
  3. Use a rashguard, my favorite is 

Monday, October 26, 2015

#MRSA aka Methicillin resistant staph aureus infection in #BJJ, #Wrestling + other contact sports, what you want to know

MRSA aka methicillin resistant staph aureus infections are more common nowadays due to previous over use of antibiotics and nature of bacterias to quickly mutate their genes to resist certain antibiotics.    Staph is all over our skin and a natural part of our skin flora or home bacteria, but if there is a cut / rash, the bacteria can enter the body and cause an infection.    If an abscess forms a surgeon would have to perform surgery to drain the abscess and take a culture to assess the bacteria and sensitivity to antibiotics.   Majority of skin infections are still regular staph or MSSA methicillin sensitive, but if high suspicion or history of MRSA then the patient is usually started on one of the anti MRSA drugs vs normal antibiotics.

  • Risk factors:
    • Previous history of MRSA infection
    • Immunocompromised patients such as: HIV, Rheumatoid pts on immunosuppressants
    • Increase number of people on the mats over time vs interval of cleaning of the mats with antiMRSA agents.   
    • Rolling / training that results in skin abrasions often = more probability for catching and spreading infection. 
    • Healthcare workers, corrections officers etc can be carriers of MRSA on their skin and in their nose due to hazards of the job. 
      • often we, the doctor, assume MRSA until proven otherwise in this group. 
  • Signs of MRSA infection:
    • Redness, pain at the site
    • Regular antibiotics does not work
    • increase in size of redness and swelling
    • increase drainage from the site despite antibiotics
  • What to DO:
    • Go to urgent care or physician ASAP 
    • If initial antibiotics are not working please return to the urgent care or physician ASAP
    • Must have history of previous antibiotics taken for this particular infection as well as other skin infections in the past
    • If after hours , report to nearest emergency room, some of these MRSA can spread fast causing significant tissue injury.   Injured tissue area  great source of food supply for the MRSA  bacteria. 
  • Oral antibiotics vs IV antibiotics
    • There are some oral antibiotics that works well for MRSA infections. 
    • If usual antibiotics don't work a quick workup with a culture or sample of the wound is required to help identify which antibiotic your infection is more sensitive to. Every bug is different in the way it responds to antibiotics
  • How to lower your chances
    • Clean gym on a regular basis
    • Clean uniform required for classes
    • Rash Guard with Silver as a part of fabric such the Hyabusa silver rash guards which are my favorites. 
      • Silver is a nature antimicrobial and rashguards and prevent rashes and cuts.

Monday, October 12, 2015

Giants player, Daniel Fells infected with MRSA stemming from a a foot & ankle injury

Giants player, Daniel Fells infected with MRSA stemming from a a foot & ankle injury. What is MRSA? 

MRSA stands for Methicillin Resistant Staph Aureus, this is a form of staph aureus that is resistant to most common antibiotics such as penicillins, etc.   In general, bacterias become resistant from exposure to antibiotics in the past or they can obtain a gene through a virus or another bacteria that renders them untouchable by an antibiotic class.  MRSA used to be an uncommon strain during my medical and surgical training with vancomycin IV being the drug of choice.     

Two common subgroups: Hospital acquired or community acquired. 

Treatments for such:

  • IV antibiotics like vancomcyin
  • Orals such as tetracycline class, bactrim, zyvox, etc. 
  • Surgical debridement
  • removal of infected tissue and flushing out of infected tissue. 
  • Done through a culture of the bone, tissue, wound, drainage by your physician
Ways to avoid and treat
  • contact sports
    • wear rashguards with silver such as hyabusa silver lined rash guards
    • wash all wounds with warm water and antibacteria soap
    • redness or swelling, see a doctor ASAP
      • if on antibiotics and still redness and pain persists see your doctor again or go to urgent care or emergency room
Results if left untreated
  • Deep space infections requiring significant surgery
  • removal of significant tissue, even amputation by a surgeon
  • death in cases whereby the bacteria enters the blood stream

Dr. Kevin Lam

Thursday, October 1, 2015

Foot and ankle #fractures hard to find at times after accident

#Injuries such as #slipandfalls #motorvehicle #mva  may not result in the typical mechanism of injury that we study in school in trauma classes.  The pattern of injury can be just plain crushed or twisted or retwisted (if there is such a term) in various ways vs a typical mechanism or trajectory.    The foot contains 28 bones and a good portion of them are flat bones which means they will be hard to examine via a plain film which is 2 dimensional in nature.   CT or MRI is often requested after a severe injury with unknown or difficult mechanism of injury.     At our center in #Naples, FL when encountering such trauma, an xray is initially taken, if the pain level of the patient does not correlate with the xray findings an MRI, CT would get ordered to exam the bones and ligaments in more detail.  Often injuries are missed or delayed in care without the proper imaging and suspicions. CT's are better for bone injuries while MRI's are more comprehensive and used more for soft tissue , tendon, ligament injuries.   

When injured in #MVA, #workerscompensation injuries, always tell your doctor everything that you remember.  Detail is important in figuring out the injuries that may affect you for life.    This history will also help when multiple specialists are required to be involved in your care. 

Seek immediate medical attention.