Vitamin D basics

Maddy Draper, APRN, a health care provider at OSF OnCall, says vitamin D is a nutrient our body needs to produce calcium. Calcium helps create strong teeth and bones. So logically, not having enough vitamin D leads to brittle bones (a risk for greater injury after a fall), plus muscle aches and pains. Others with a vitamin D deficiency may not show symptoms. Either way, a provider may order a blood test to confirm the issue and then may advise you to take a supplement. This is usually in pill form and can be prescribed or bought over the counter by itself or as part of a multivitamin.

“Or the provider may just talk about vitamin D-rich foods first before starting a supplement,” Draper says. “High fat fishes, egg yolks, some cheeses and mushrooms.”

Draper adds that pregnant women, babies (especially babies who are breastfed), the elderly and people with darker skin often lack vitamin D.

On the flip side, Draper says it’s rare, but a person can get too much vitamin D. Symptoms include nausea, vomiting and heart palpitations (feeling like your heartbeat is fast, pounding or otherwise irregular). You may also suffer kidney damage.

Summer sun

Here’s advice to commit to memory: Draper says research shows 10 to 15 minutes of sun exposure three times a day can get you a healthy amount of vitamin D.

“You want to protect your skin while doing that,” Draper adds. “Sunscreen and protective clothing like a hat and sunglasses. There’s not any research showing that sunscreen or clothes will prevent you from getting the vitamin D you need.”

Experts say your sunscreen should have a sun protection factor (SPF) of 30 or higher, and you should reapply every two hours. Clothing should be lightweight and light colored (Dark colors absorb more sunlight, leading to quicker heat illness.) Stay hydrated, and watch for redness and blisters from sunburns and suspicious moles that may be skin cancer. See a provider right away if you have issues from getting too much sun.

Another thing to note: Experts say a specialized lamp can help with seasonal affective disorder, a mental health condition often seen in the winter due to decreased daylight. The same logic does not apply for vitamin D. You need natural, not artificial light to get the vitamin D you need.

The bottom line

Draper says most people don’t have to worry about getting too much or too little vitamin D.

“The average person will get it through the sun,” Draper says. “If you live in a cold and dark environment, you’re at higher risk for vitamin D deficiency. People farther away from the equator are higher risk.”

If you have symptoms of too much or too little vitamin D or just have a concern, talk to your primary care provider.

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Consequences

Some people may see skin care as purely cosmetic. If I’m not a model or television news anchor, I’ll just do the bare minimum.

That’s not the right approach, Oberheim says. Poor skin care, especially in older adults, can lead to persistent bruises and skin tears leading to wounds.

“Sometimes it doesn’t take much. I’ll see patients who have small dogs that jump on them. Even just the clawing from the dog will put a tear in the skin because the skin is so thin and fragile,” Oberheim recalls. “When that happens, we have to make sure to keep the skin clean and dry. If we end up with an infection, that can lead to cellulitis. Cellulitis can lead to other things, including sepsis [a possibly deadly condition where your body responds improperly to an infection]. So we’d need to take precautions and fix the infection with maybe some antibiotics.”

The bottom line, Oberheim says, is if your skin problem isn’t responding to at-home treatment after a few days, see your primary care provider or a dermatologist.

Other conditions

Other skin conditions to be aware of:

• Eczema (also called atopic dermatitis): This causes dry, itchy scaly skin patches. Experts don’t know exactly what causes it. But Oberheim says allergies, asthma and even stress can play a role, and it’s often worse in the winter. She says eczema can affect all ages and appear anywhere on your body.
   
• Rosacea: This causes redness, pimples, broken blood vessels and, in severe cases, a misshapen nose. It most often affects the face and eyes.
   
• Age spots (also called liver spots): Oberheim says these look like “big freckles.” They’re often flat and dark-colored. They’re associated with sun exposure, and so they’re often seen on the head and face.
  
  “They’re usually not super problematic, but they’re not cosmetically appealing,” Oberheim says.
   
• Psoriasis: This causes inflamed, red raised areas of skin that can itch and be painful. This is often seen on the scalp, elbows, knees and lower back.
   
• Poison ivy and oak: Oberheim says she sees these issues often in her clinic. When someone rubs up against the plant or an object that’s touched the plant, they can get a red, bumpy itchy rash with fluid-filled blisters.

Prevention

So, what should your daily skin care routine be? Should you be getting facials at the spa regularly? That’s probably not necessary, Oberheim says. But daily washing and moisturizing is. Look from certain things on skin care product labels: retinol (helps with skin firmness and reducing wrinkles), vitamin C (helps brighten age spots), hyaluronic acid (helps with moisturizing), niacinamide (helps reduce redness), collagen and peptides.

Other things to consider:

• Wear sunscreen of 30 SPF [sun protection factor] or higher when outside, and reapply it every few hours.
   
• Wear protective clothing like a wide brimmed hat, long sleeves and long pants when outside. Wash clothes right away when you get home. Also, know which plants are in your area to avoid the pesky ones.
   
• Don’t smoke.
   
• Drink plenty of water all the time, not just during outdoor activities.
   
• Don’t bathe or shower in very hot water. This can dry the skin.
   
• Try not to itch any skin lesion. You don’t want a wound to open and risk an infection.
   
• Know your body. Watch for suspicious moles or lesions that might be a sign of skin cancer. Experts say you can remember the ABCDEs: if the mole is asymmetric, has an irregular border, has an odd color, has a big diameter or is evolving, see a provider.

Learn more

Read more about how to keep your skin healthy on the OSF HealthCare website.

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Author's note: this is part one of a two part story on staying healthy during summer vacations. Click here for part two.


Summer means getaways to de-stress and make memories. But the last thing you want is to catch a cold or worse, especially if you’re halfway across the world where health care resources might be different or scarce.

It's not too late to make some quick preparations, says Jennifer Whitfill, APRN, a family nurse practitioner at OSF HealthCare.

• Stop by the doctor’s office: Whitfill says if you haven’t seen your primary care provider for a physical exam in a while, make an appointment before vacation to address any lingering health issues. This could include getting vaccines depending on your health and where you’re going. Whitfill says typhoid fever (seen in southern Africa, Asia, Central America and South America), yellow fever (Africa), hepatitis A (remote or underdeveloped areas) and rabies are ailments to protect yourself against.
   
• Stock up on over-the-counter medication.
  
  “It’s important to be prepared,” for when these medications are needed, Whitfill says. “Consider packing Tylenol or ibuprofen, anti-allergy medicines like Claritin, Zyrtec and Benadryl. Dramamine is a good one for motion sickness or nausea. Some people reach out to their provider if they’re going on a cruise. There’s a prescription called a scopolamine patch that you can put behind your ear. It’s good for three days and helps offset motion sickness.

“Eyedrops are good if you have seasonal allergies. Over-the-counter saline or Pataday drops,” Whitfill adds. “Creams like hydrocortisone and triple antibiotic ointment are good to have.”

For outdoor trips like camping, essentials including a first aid kit, sunscreen and bug spray are must-haves, too. Know if you’re on a medication, such as certain acne creams and menstrual cycle medications, that makes you more prone to sunburn.

And regardless of what you pack, Whitfill says flyers should check the Transportation Security Administration guidelines about what can come on a plane. She says to leave medicines in their original packaging when preparing airport luggage.

• Medicine, part two – before you go: You might hear travel bloggers say to boost your immune health before traveling to reduce your risk of catching something. Is the advice overblown?
  
  Whitfill says no. She says elderberry, vitamin C and D and zinc are all good supplements to take before a trip. Start three to four weeks before departure, if you can. And if you have concerns about supplements interacting with prescription medication, talk to your provider.
   
• Check the U.S. Centers for Disease Control and Prevention website for travel advisories about disease outbreaks, civil unrest and more.

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• YES: moles, blisters, bumps, acne, boils, peeling skin from a sunburn, rashes, poison ivy or similar skin reactions, warts, skin tags and bug bites
   
• YES, BUT: Dr. Kumar says freckles and birthmarks are lesions, but they are not harmful.

In other words: “A skin lesion is any type of abnormal growth. It can happen anywhere on the body. If it doesn’t look like normal skin, it’s considered a growth,” Dr. Kumar says.

Causes for each of these lesions vary. We know acne is due to bacteria, and warts are from a virus, for example. Medications, lifestyle choices (like eating certain food that doesn’t agree with you) and medical conditions (such as diabetes and liver failure) are other culprits. But when the cause is unexplained, health care providers might need to investigate.

“We look at the lesion. The majority of the time, we can tell if something is benign or malignant. If we have questions, we err on the side of caution and do a biopsy,” Dr. Kumar explains. That involves cutting out part of the lesion and sending it off to a lab for analysis. “Biopsies can be done in the office. If it’s a bigger procedure, we have to go to the operating room.”

If the biopsy confirms evidence of a problem, such as cancer, the doctor will remove the rest of the bad tissue. Or, Dr. Kumar says some people come to him with a cosmetic or practical reason. They have a large birthmark or cyst on their face, are self-conscious about their appearance and would like it removed, for example. Or, they wear a hard hat for work, and the hat rubs against a lesion on their forehead, causing discomfort.

Dr. Kumar outlines how he would remove a lesion: “Let’s say it’s on your arm. We clean up the arm. We inject some lidocaine, which is a numbing agent. Then with a knife or other instrument, I’m able to cut it all out. Depending on how deep it is and the size of the lesion, we can glue it back together or put stitches in.” Regardless of the method, Dr. Kumar says most of these procedures are routine for providers with minimal aftereffects for the patient. In complex cases, like if the lesion goes down into a muscle, a plastic surgeon might be consulted.

Prevention

We can’t control if we have things like freckles or moles. But there are plenty of things you can do to help prevent problematic lesions.

• Limit your exposure to ultraviolet rays from the sun or by tanning. In fact, Dr. Kumar would not recommend tanning at all. For outdoor activities, use waterproof sunscreen of 50 sun protection factor (SPF) or higher, and reapply every few hours. Wear long sleeves and a wide brimmed hat.
   
• Wear bug spray when doing outdoor activities, such as hiking, where insects are present.
   
• Wash your body regularly.
  
  “Don’t overclean,” Dr. Kumar warns. “If you scratch your skin, that allows bacteria and other things to get into your skin and cause infections.”
   
• Don’t smoke. Dr. Kumar says smoking changes your skin for the worse, such as developing wrinkles and lesions.
   
• Find the right skincare products. If you use a lotion and it causes a rash, for example, don’t use that product again. Dr. Kumar adds that Vaselines and petroleum jellies are good for moisturizing your skin. But they’re thick and can clog pores.
  
  “Keep it simple. The $100 face cream is going to work the same as the $10 one,” Dr. Kumar says.
   
• Know the ABCDEs of suspicious moles.

o    A is for asymmetry. One half of the spot is not like the other half.

o    B is for border. The mole has an irregular, scalloped or poorly defined border.

o    C is for color. The spot has varying colors, like tan, brown, black, white, red or blue.

o    D is for diameter. Dermatologists say melanoma skin cancers are usually greater than six millimeters, or about the width of a pencil eraser. But they can be smaller, so don’t consider diameter alone.

o    E is for evolving. The mole looks different from the rest or is changing in size, shape or color. Dr. Kumar says you can take pictures to show your provider how the mole has changed.

                           If your lesion has any of the ABCDE red flags or you just have a concern, see a provider.

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A federal panel recently advised women get a mammogram every other year starting at age 40, rather than 50.

And the American Cancer Society estimates that in 2023, nearly 300,000 women in the United States will learn they have breast cancer. About 43,700 women will lose their life due to the disease.

The headlines are reminders to know your breast cancer risks. While many risks are out of your control, there’s just as much you can control, says Heather Thompson, a breast health navigator at OSF HealthCare.

Major risks you can control

• Active lifestyle and healthy eating: Thompson puts it plainly. If you eat junk, you’ll feel like junk. And any exercise will give you more energy and burn fat. Fat produces estrogen, which feeds cancer cells.

“You want to make sure you’re well-maintained with your weight, even after menopause,” Thompson says.

• Taking hormones: This impacts your ovaries, reducing or adding estrogen. Whether you’re at a routine appointment or you have been diagnosed with breast cancer, talk to your provider about what hormones you’re taking.

“We don’t encourage people who are having menopause symptoms [like hot flashes] to take hormones,” Thompson lists as an example. “We encourage other things to help treat those. It eliminates those estrogen cells increasing.”

• Alcohol and smoking: They are a risk for any type of cancer. But Thompson says one drink per day can increase a woman’s breast cancer risk by 12%. Alcohol is sugary, and that’s a fuel for estrogen.
   
• Night shift work: Thompson says our body expects to sleep when the sun goes down. Night work throws that off.

                “You’re getting artificial light all night. That changes the melatonin that the body naturally makes,” Thompson explains. “When your melatonin is off, it increases estrogen.”

                If you don’t work the traditional day job, see if you can work different shifts so you are not up all night all the time.

Risks you can’t control

• Age: Thompson says women generally develop breast cancer at age 50 and above. 
   
• Family history and genetic mutations: A family history of breast cancer puts you at a higher risk. Thompson says the higher risk is often seen on the person’s mother’s side of the family. For example, your mother and her sister (your aunt) may have breast cancer, and so you’d need to talk to your provider about your risk.

              Some women diagnosed with breast cancer and who have a family history may undergo a genetic test.

“Those tests can tell us if this is something being passed down from generation to generation,” Thompson says.

• Reproductive history: Young women who develop menstruation before age 12 and women who go through menopause after age 55 have an increased risk.

“That gives them a longer time with their ovaries working. They’re producing estrogen,” Thompson says.

• Dense breast: More tissue and less fat mean a dense breast and an increased cancer risk, Thompson says. Usually, the younger you are, the denser your breast is. The density of your breast is something that will be noted on every mammogram result. Thompson says mammogram technology is getting better at finding cancer in dense tissue. An early diagnosis may mean a better outcome.

Takeaways

Make sure your health care provider knows about your circumstances so they can decide on the best preventive care, like a different schedule for mammograms. Some of the information to have handy: a family history of cancer and any physical change you noticed during your monthly breast self-check.

Learn more about breast health and breast cancer care on the OSF HealthCare website.

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Prevention of breast cancer starts with awareness

Author's note: this is part two of a story on outdoor water safety. Click here for part one.


More sun and rising mercury mean people will head outdoors to lakes and forests. But something as simple as drinking river water can lead to an illness that derails your spring.

Bethany Huelskoetter, APRN, a family medicine provider at OSF HealthCare, hits the major safety points about leisure time on the water.

• Bug bites: Coat yourself with bug spray to start the day, and avoid hanging out in tall grass where pests can hide. If your bug bite comes with skin tissue damage, chest pain, muscle cramps, sweating or nausea, see a provider right away. Also, watch for a rash in the shape of a bullseye, which is common with tick bites. To remove a tick, use tweezers to get close to the skin, and gently pull the insect out. Avoid twisting and yanking.
   
• Life jackets: Illinois and Michigan outline their life jacket laws. And some additional suggestions from Huelskoetter: for young kids, use a life jacket that straps on like a diaper. Life jackets that go over the chest could come up over the child’s head, and they could slip out or have trouble breathing. And read the life jacket label to make sure it’s right for you based on your chest size and weight.
  
  Huelskoetter also says a life jacket or any wet object has a risk of mold. So, dry the life jackets by hanging them in the sun.
   
• Fire extinguishers: Like life jackets, Illinois and Michigan laws require a United States Coast Guard-approved fire extinguisher on board most watercraft. Boat fires do happen, Huelskoetter says, and a fire extinguisher can mean the difference between a small fire and an explosion.
   
• Dirty water: It’s tough for kids who want to explore, but Huelskoetter says you should keep lake water out of your eyes and mouth. For kids, that could mean wearing goggles.
  
  “There are bacteria, parasites and other microorganisms that can get in your eyes. Also, don’t open your mouth underwater. You don’t want to drink that water,” Huelskoetter says. “If you swim in a lake and your eyes get red or itchy, that’s a sign you might have an infection from an organism in the water. So we want to put you on the proper antibiotic or whatever medication we feel is best.
  
  If you drink the water, gastrointestinal upset can occur. If you have nausea, vomiting or diarrhea, you definitely want to be seen by a provider. We’ll do testing to determine what bacteria or parasite you came in contact with so we can treat appropriately,” Huelskoetter adds.
   
• Alcohol: Drinking responsibly can be a part of your day on the water. But Huelskoetter says the rules are just like on land: A blood alcohol concentration (BAC) of .08% is the legal limit, so be aware if you’re the boat captain.
   
• Fumes: My group is in the open air. How much should we worry about boat exhaust?
  
  Huelskoetter says you should be fine, but make sure your watercraft has good ventilation. You can also buy carbon monoxide detectors made to clip on boats or life jackets. This can be extra helpful if your boat has an enclosed cabin, Huelskoetter points out.
   
• Spoiled food: Of course, you’ll want to eat on your boating or fishing trip. That could include perishable items like a sandwich.
  
  Putting the food and drink in an ice-filled cooler isn’t enough, Huelskoetter says.
  
  “Keeping your cooler covered and out of the sun is going to do wonders. It’ll keep that ice nice and cool,” she says.
  
  “Never eat anything that’s been sitting out, and now it’s hot,” Huelskoetter adds. “Once food reaches room temperature, you want to be careful. You can go by smell, too. If it doesn’t smell right, don’t eat it.”

Getting help

Have a first aid kit for minor injuries. For major injuries like a head or limb wound, gently move the person to land and call 9-1-1. The word “gently” is important to avoid further injury like paralysis.

Experts also point out that cell phone service can be spotty in the wilderness. So you should also have a global positioning system (GPS) device.

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These are probably a few things you’ve heard once, or a thousand times, over the years by a parent, teacher or coach.

However, roughly 5.4 million basal and squamous cell skin cancers are diagnosed each year, affecting more than three million people (some individuals have more than one skin cancer). Skin cancers are by far the most common type of cancer in the United States. The American Cancer Society says this is probably due to better skin cancer detection, people getting more exposure to the sun, and people living longer.

But what are we forgetting? Tim Smile, MD, is a radiation oncologist with OSF HealthCare. He breaks down key tips for people to remember before heading outside.

"A lot of people wear a nice baseball hat that covers their faces really well, but the tops of your ears, neck, and even the front of the top of your sternum area can get exposure to the sun without you realizing it,” Dr. Smile says. “Keep an eye on those areas and make sure you're applying sunscreen there." 

Just because it's overcast, doesn't mean the UV rays aren't there.  Dr. Smile says you can still get burnt.

And, don't forget your lips! Use lip balms with SPF protection.  Dr. Smile adds your lips can get sunburned and lead to skin cancers due to UV exposure.

Video Version With Chyrons

Video Version Without Chyrons

While it might be tempting to ignore those warnings, don't. 

The light from an eclipse can do some serious damage.

“There is a concern if you get direct sunlight for too long of a period of time to the back of your eye, you can essentially burn your retina and have permanent vision loss, sometimes complete vision loss if that exposure is long enough and intense enough," says Ben Kemp, MD, an emergency physician with OSF HealthCare. 

NASA has some safe eclipse viewing tips: 

- Wear specially made eclipse glasses or welder's goggles rated 14 or higher. 

- Use specially designed solar telescopes or solar binoculars. 

- Supervise children closely when they're using solar filters and eclipse glasses

While autism in adults has improved, the ability to recognize what it looks like in everyday life is still a challenge, according to Theresa Regan, PhD, the lead neuropsychologist at OSF Saint Francis Medical Center in Peoria, Illinois. 

Dr. Regan says misconceptions remain, and that many cases don't get diagnosed until adulthood.

“The great majority of adults who are autistic are either undiagnosed or misdiagnosed with other mental health conditions," Dr. Regan says. "So we want to rectify that and have the right diagnosis for every person every time.”

Dr. Regan says autism characteristics have to be present in childhood. 

But in many cases, it's not recognized until more complex situations arise like navigating relationships. 

She adds that self awareness is key, and to speak with a medical provider if you have any questions or concerns.

Health Highlights Video Version With Chyrons

Health Highlights Video Version Without Chyrons

El mes de septiembre comenzó con una noticia triste: el fallecimiento de Jimmy Buffett, superestrella de la música country. El creador de Margaritaville murió de una forma agresiva de cáncer de piel llamada carcinoma de células de Merkel (CCM), una enfermedad con la que luchó los últimos cuatro años.

Según la Skin Cancer Foundation, el carcinoma de células de Merkel es una forma mucho menos frecuente de cáncer de piel, y se da un caso por cada 130,000 personas en los Estados Unidos. Se diagnostican unos 3,000 casos nuevos al año y, según la fundación, se espera que esta cifra aumente a 3,250 casos anuales en 2025.

Banesa Chavez, enfermera registrada de práctica avanzada de OSF HealthCare, advierte a las personas que no subestimen las señales del cáncer de piel.

"Las personas piensan 'Ah, esta lesión no es nada', pero no saben lo que hay debajo de esa lesión que ven", dice Chavez. "Pueden tenerla ahí durante años y podría haberse propagado ya a otras partes".

Chavez afirma que la agresividad del CCM de Buffett debió ser motivo de preocupación para las personas, y un recordatorio para cuidar bien la piel.

"Lo detectaron (el cáncer) hace un par de años, por lo que avanzó rápidamente. O ya había hecho metástasis cuando lo encontraron".

Chavez asegura que el cáncer de piel no discrimina por edad o estado de salud general. Sin embargo, señala que es más difícil luchar contra el cáncer de piel a una edad avanzada.

"Todo el mundo está más sano cuando es más joven. Cuando envejecemos, los órganos no funcionan como lo harían en una persona de 20 o 30 años", dice Chavez. "Así que sus opciones de tratamiento pueden variar en función de su salud".

Consejos para proteger la piel:

"Si nota algún cambio en la piel (una lesión que crece o algo nuevo), asegúrese de tratarlo. No lo ignore. Además, aplíquese protector solar. Cuando se aplique protector solar, fíjese en las recomendaciones sobre la frecuencia con la que debe aplicárselo porque desaparece".

Chavez añade que hay que usar sombrero cuando se esté al aire libre para evitar también los daños causados por el sol. Además, si observa algún cambio en la piel, acuda al médico lo antes posible para que lo derive a un dermatólogo.

El cáncer de piel es, hasta ahora, el más frecuente. Alrededor de uno de cada cinco estadounidenses será diagnosticado de cáncer de piel a lo largo de su vida. Cuando se diagnostica a tiempo, la tasa de supervivencia de cinco años para las personas con cáncer de piel es del 99%.

Para evaluar la salud de su piel, puede someterse a un examen básico con un dermatólogo.

Puede visitar el sitio web de OSF HealthCare aquí para encontrar un lugar cerca de usted donde reciba atención.

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