In my practice, I have a fair number of young men who are feeling stressed because of hair loss.  Some have a family history of baldness, while a few are setting new trends on their own.  Many have been taking finasteride for a few years, to help them retain the hair on their heads, and ask my advice when it is time to renew their old prescriptions. 

Widely advertised as "Propecia", this drug for baldness is identical to the prostate drug "Proscar", made by the same company.  The former is in 1 mg tablets, the latter in 5 mg size tablets.  Just to make things annoying to the customer, both are priced the same.  So you can save five times the money by simply cutting each triangular Proscar tablet across the equator.  The smaller (top) half can be cut in two, while the larger bottom half can be cut into three.  If done on a kitchen cutting board with a chef's knife, the savings can be truly substantial.

However, that's assuming you even want the drug.  While some dermatologists still follow the old-school program of using the drug as a first line of defense against hair loss for men (and to a lesser extent in women), more specialists are now suggesting caution. 

For one thing, baldness is not a disease, it is an (obvious) cosmetic issue.  However the side effects of the "cure" can be cause for concern.  For one thing, researchers are now finding some cases of Erectile Dysfunction while men are on the drug, and, even more alarmingly, for years after they stop it.  Other studies are showing an increased incedence of the rare male version of breast cancer.  Still other studies are showing an increase of anxiety and depression for propecia users. For more details: http://www.businessweek.com/ap/2012-04/D9U3HR3G0.htm

Hair transplant specialists are now telling more of their patients to discontinue the finesteride, and focus mainly on the topical treatment of Rogaine, or minoxidyl , in either spray or foam versions.  While it may seem the transplant doctors are biased against the pills for baldness, they actually are concerned about retention of hair follicles in the donor areas.  In addition, they naturally want any transplanted follicles to continue to thrive.  So if anything, they would espiecially want a pill to help their patients retain hair. 

In balance, I remind my patients that hair loss is not a disease, but the side effects of finesteride can indeed be a big health concern.  If my patients weigh the choices and still want to continue the drug, I give it to them with the above caveats. 

For those who elect not to take it, I remind them to take Minoxidil in the 5% format, not the popularly available 2%.  Many will find the spray version less messy, but it can cause scalp dryness and flaking.  The foam is a little easier to deal with; just follow directions and apply twice daily to your scalp.  To purchase, go online to http://www.minoxidildirect.com/Minoxidil.htm . Even in the group that elect to take the oral drug, these topical options can add to the retention. 

Another product that dermatologists suggest is Chronostim, which can also help retain and treat thinning hair.  It is not a prescription, but can be found at  http://well.ca/products/ducray-chronostim-lotion-for_3462.html. These topical treatments are not magic, but they at least offer some retention of existing hair. 

If you prefer, many patients get benefits from using simple oils, like coconut or aloe, applied directly after application of the topical treatments.  (These elements are also found in shampoos and conditioners).  An even more important tip is to not overwash one's scalp, twice a week is usually enough.  Daily rinses are fine, just don't overdo the shampoo, or the hair dries out.  Also, for men and women, be carefull of damage done by hot hair driers, or by excessive tugging with brushes (or rollers).  In general, finger-drying with a cool blast of air is the easiest on the scalp.

 If you are wishing for more definitive results, your doctor can recommend a good hair transplant specialist (an MD) who will examine your donor scalp areas, and let you know the realistic expectations you could gain from transplants of existing follicles.  This surgery can now be done in a way that does not leave obvious circles of new hair clumps; they use just one or two follicles at a time along the front hairline, so the results are virtually undetectable.  The costs are considerable, but at least the results are dramatic and lasting. 

In any event, don't forget that many of the most admired leading role models are thin on top.  From Sean Connery in his seventies to Jason Statham in his forties, to Prince William in his thirties, bald can still be beautiful! 

So keep your eyes open when you are considering baldness pills, as the side effects could be hair-raising.  For more specific advice, please consult your own physician.

Dry eyes are more than a modest problem.  They can be the cause of great stress.

Sufferers wake up with scratchy eyes, and have to take drops frequently just to avoid discomfort.  

When untreated, dry eyes are more likely to get infections or redness, and their owners are more likely to be irritable. 

Let's take a look at the problem, and consider solutions.

1. What are tears?

Tears are really a mixture of three layers over the surface of the eye; water, oil, and mucous.  The water layer is closest to the cornea, while the oil or lipid layer is secreted by the mebomian glands of the lids.  The lipid layer keeps the water from evaporating.  The mucous layer on the top is there to protect the other two layers from blasts of air and particles that might prove irritating.  The final protective layer of the eyeball is the lids, which blink to renew the spread of the three layers, and to refresh the eyeball surface.  Tears are produced inside and along the edges of the lids, and drain out through the punctum or hole in the inner margin of each of our upper and lower lids, close to the nose.  The tear ducts then carry them away into the nose.  This is why crying is also associated with blowing your nose!

2. What makes eyes go dry?

There are many factors that lead towards dry eyes.  These include staring too long at computers, tablets or cell phones, where the eyes are trying to stay open for focus and concentration.  The same can happen with prolonged study of books, or staring at the road while driving on a long trip.   LASIK surgery (to restore normal vision to people who need glasses) can also be drying in later years.  People with certain skin diseases like acne rosacea and Sjogren's syndrome may suffer from dry eyes.  Even birthdays can cause dry eyes, starting at about the age of 50.  In younger people, makeup and facial soaps can add to the problem, as can wearing contact lenses for excessive periods of time (even if the manufaturer promises you can leave contacts in overnight).  Ambient dust or other small particles can also bedevil the dryness problem.  Certain medications can also cause dryness as a side effect; be wary of drops that "remove redness" as these too can make the problem worse.

3.  What can I do about it?

Try to establish root causes.  If your room air is dusty, try to control it with air filtration or other measures.  If you wake up with dry eyes, make sure your pillow is not a bag of dust by washing or dry-cleaning it.   If makeup is a problem, use hypoallergenic products, and learn how to apply them properly.   If you stare for hours at computers, then try to take your breaks outside, and focus on distant objects to give your eyes a break from the short distance stare.  If non-prescription drops are not sufficient, please see your doctor.  While your family doctor can initiate investigations, including for general health issues, you will need to see a specialist to further examine the eye, including to measure the production of tears with a strip of litmus paper and stained eye drops.  As you will see on our post on the subject, it is important to have the full array of modern tools to examine the eye, not just a hand-held light with an eye chart at the end of the room.  Once the doctor assesses the problem, then a menu of options apply. 

 Punctal plugs can be inserted into the drain holes of each lid, commonly the lower ones.   If you have tried non-prescription drops, make sure you use them often and correctly. (see our article on Eye Drops Made Easy)   

 If the problem is with dry wax in the meibomian glands of the edges of each lid, then try to use warm compresses such as a face-cloth. 

Press firmly over each eye for a minute or so, and the dry balls of wax in each gland opening will melt away.  Shampoo in the eyes, (almost!) can also be effective in dissolving the waxy gland material; use a gentle shampoo like Baby Shampoo, and rub it into each eye, almost opening the lids.  After leaving it for a minute, then rinse under the shower. 

Use regular drops like Refresh or Systane, just for lubrication and moistening. 

Above all, make sure you have your eyes examined regularly, and protect them with sunglasses, or appropriate goggles for handywork or sports. 

Joint inflammation,  or “arthritis”, is very common with today’s active public.  As opposed to a disease that travels through various joints in the body, osteo-arthritis is one condition that is physical in nature.  In other words, “osteo” form of arthritis is a “wear and tear” or “rusty hinge” phenomenon, usually caused by repetitive trauma in any joint, which can vary depending on the activity in question. 

For example, runners often get this in their great toe joint, where the toe meets its metacarpal.  This form of repetitive motion is certainly aggravated by poorly fitted shoes, or by running on concrete (instead of grass or soft ground).   When this joint is inflamed by gout (a systemic condition where millions of crystals of uric acid deposit in joints and kidneys), we call it “podagara”.  Coincidentally, Sports Medicine researchers are now finding that an old-fashioned natural remedy for gout can also work wonders for any “osteo” joints in the body. 

Tart cherries have long been suggested as an anti-inflammatory aid to gout patients, as part of their treatment protocol.  But recently researchers at the Oregon Health and Science University studied twenty women between the ages of 40-70, all of whom had osteoarthritis.  Each was asked to drink tart cherry juice twice a day for three weeks.  They were tested for markers of inflammation in the blood stream.  It turns out that excellent results were seen, especially with those who had the worst inflammation to begin the study. 

Principal investigator Kerry Kuehl  M.D. of the Oregon Health and Science Universtiy, was delighted to confirm that a natural food could offer such anti-inflammatory help without any of the side effects associated with drugs.  Since most people who exercise are also health conscious, this is particularly good news for athletes, including the weekend “warriors”. 

Leslie Bonci, Director of Sports Nutrition athe University of Pennsylvania Medical Center for Sports Medicine, has incorporated tart cherries into the training menu for all of her athletes. 

The active ingredient in the cherry is the antocyanins; antioxidant compounds that reduce pain and inflammation at levels comparable to many well-known pain pills.   Available in dried, frozen and juice forms, tart cherries are versatile, and easy to find.

So if you are aching in any joint, don’t be intimidated by all the pills at the drug store.   Sometimes the best treatment can be “cherry-picked” right from your local grocery store. 

For more reading: Reduce Chronic Inflammation in People with Osteoarthritis 

And for another good way to treat pain without drugs: Acupuncture: An old treatment gets to the point!

Not very long ago, society people were pale, and outdoor workers had suntans.   For whatever reason, society reversed the trend, and now it is fashionable to have a dark tan.  

Movie stars led the way.  George Hamilton was so addicted to tanning that it was written into his contracts that he could escape for weekend tanning breaks.  This led to some humorous continuity problems on set, like one movie where he jumped out of an airplane tanned, and was then seen untanned in his parachute a few seconds later!  Today, icons like Paris Hilton continue the trend.

A generation ago teens would lie out in the sun for hours, and use no protective sun lotions.  Worse, they would use baby oil, sometimes tinged with iodine to enhance absorption, in order to get a faster tan.  Lotions and oils were sold for tanning, but not for screening.

When Christmas/New Year's holidays came, students who went south for the sun would actually try to stay a couple of extra days, in order for their tans to last further into the new term back at school.

Then dermatologists started reporting the obvious.  Sun exposure/tanning was horrible for the skin. 

 Not just for reasons of skin cancers like melanoma, but for cosmetic reasons. The price of burned skin is premature aging.

 We are now seeing signs of permanent damage in younger adults.  Hence the rise of procedures such as chemical or laser peels, dermabrasion, injections into the face and lips, and face-lift surgeries. 

Here are a few facts that might help change your mind before sunbathing or using a suntan bed.

1. The tanning-bed suntan before a beach holiday does not protect you from sun damage.  Even with a great tan, you are fully exposed to risk when bare skin is in the sun or UV lamp light.  

2. The suntan from a bottle or spray lasts about as long as a real tan, and doesn't flake during the second week. And of course it can be reapplied at regular intervals, unlike having to take a trip to the tropics every couple of weeks. Also, the fake tan is indistinguishable from the tan gained under the sun or lamps.

3. Skin cancer (basal cell cancer, and melanoma being salient) risks are increased over 75% in those who tan before the age of 30. 

4. Tanning beds (and of course tanning in real rays) has been ranked with asbestos and cigarettes as a huge cancer risk. 

5.  In addition to dangers of cancer (to which most young tanners will feel imune), consider the cosmetic consequences.  Like splotches of discoloured skin, increased moles, permanent wrinkles on the lips and face, and even thinning and sagging of the skin.

6. If you must be out in the sun, cover up with a hat, and use a high SPF sunscreen.  Reapply as needed.  Also avoid the brightest part of the day if you have a choice; stay in the shade during the midday sun.

For additional information: Tanning Beds: what you need to know

 For an interesting message to teens, read this link: Tannning Bed Risks

Updates:

April 9, 2013: Wear your sunscreen, seek the shade, wear protective clothing and never, ever go to a tanning salon. Despite decades of repetition, many of us fail to follow that skin-saving advice — and a new study shows that's true even for people who have had the most serious form of skin cancer. Read more...