Fresh from The New York Times: An Article on Wrinkle Removers, Backed by Science. You can read the entire article by clicking on the blue type.
By NICHOLAS BAKALAR
Published: August 18, 2008
Nostrums that promise to smooth wrinkled skin are a staple of snake-oil salesmen everywhere, but now there is strong evidence that certain kinds of treatment are effective. Over the past decade, researchers have been learning which treatments work, and why.
The key is a growing understanding of the skin’s connective tissue, called the dermal collagen, and a recognition that damage to the mechanical properties of the collagen outside the skin cells, and not necessarily genetic damage to the cells themselves, causes wrinkled skin.
A recent review in The Archives of Dermatology concludes that three anti-aging treatments are proven clinically effective: the topical application of retinol; carbon dioxide laser resurfacing; and injection of hyaluronic acid, a moisture-retaining acid that occurs naturally in the skin. Each depends on the same mechanism, the interaction of skin cells called fibroblasts with the collagen they produce.
“This is an area where there’s a lot of hype and not much substance,” said David J. Leffell, a professor of dermatology and surgery at Yale who was not involved in the review. But, he said, this study is “good science.”
Theory and experiment back these treatments, the authors write. Fibroblasts — connective tissue cells — secrete a complex group of polysaccharides and proteins that creates collagen, which gives the skin shape and elasticity and supports the blood vessels that permeate it. The network of collagen tissue is maintained by its mechanical tension with these skin cells.
Skin deteriorates as it ages, but its exposure to sunlight inhibits the ability of fibroblasts to produce collagen. The hands, face, neck and upper chest all suffer more than unexposed skin, and light-pigmented people wrinkle more readily than others. This damage, the authors write, is essentially an accelerated version of chronological aging. Ultraviolet radiation induces production of the same enzymes that degrade collagen with age.
Collagen fibers last as long as 30 years. But with age and ultraviolet exposure, they deteriorate and fragment, and fragmented collagen impairs the collagen-producing function of the fibroblasts that created it. As the fragmented collagen accumulates, new collagen production declines, the connections between the fibroblasts and the collagen weaken, and the skin, now lacking support, begins to wrinkle.
But there are treatments that counter this process. Topical application of retinol, a form of vitamin A, was the first to be proved useful. Although the molecular pathways are not well understood, retinol causes new collagen to form in chronologically aged skin and in skin damaged by ultraviolet light.
I am printing this entire article because few of you will be reading the Military Officers Association of America newsletter, and this is one of the best articles I have seen on the subject. It is SO easy to dismiss a parent’s complaints as just being a normal part of aging – and it is important to catch these things early.
Role Reversal — How to Spot Infections
By Nanette Lavoie-Vaughan
The next time your parent complains of feeling “out of sorts” or gives you a vague list of minor problems, don’t dismiss it as normal grumpiness. There’s a good chance your parent could have an infection.
Diagnosing the elderly with an infection can be difficult. Seniors are less likely to have classic symptoms such as fever, chills, and vomiting. Instead they might have atypical symptoms such as subnormal temperature, confusion, fatigue, and decreased appetite. In many cases, these subtle signs can be attributed to the normal aging process — or ignored until the late stages of the infection.
Let’s take a brief look at how the infection process works. When the human body is under stress or exposed to bacteria and viruses, it triggers a healing chain of events that, in most cases, results in the prevention of infection or illness. However, when the amount of bacteria is too great an infection occurs. At that point, the immune system kicks in doubly hard, releasing a flood of chemicals to attack the infection and promote recovery.
Seniors are more susceptible to infection because multiple chronic illnesses that occur with age put extra stress on the body, and the medications for these conditions can block the immune system. In addition, the immune system naturally weakens as we grow older.
The most common sites for infections in older adults are the urinary tract, the respiratory tract, and the skin. It also is common for seniors to develop an infection prior to an acute deterioration of their chronic medical condition or in combination with other acute medical problems. A typical example is the person with congestive heart failure who develops pneumonia. The symptoms of cough, congestion, and shortness of breath are similar and might occur simultaneously, or the onset of pneumonia might precipitate an acute attack of congestive heart failure.
So how do you know if your parent is developing an infection? Look for:
an acute change in his or her ability to perform day to day activities;
increased pulse rate;
poor appetite; and
fatigue with increased aches and pains.
For specific infections you might want to look for the following signs:
Loss of appetite
New onset of incontinence
Pain with urination
More frequent urination
Blood in the urine
Pain or tenderness
If you note any of these symptoms, due diligence requires a complete medical evaluation to determine the source of the infection and any other acute medical problems.
Why is this so important? The risk of sepsis, an overwhelming infection that enters the bloodstream, is higher in the elderly. The longer these types of symptoms go untreated, the more likely the bacteria will find its way into the bloodstream.
Another concern is the prevalence of antibiotic-resistant infections. The overuse of antibiotics for viral illnesses and the common cold have caused bacteria to mutate and become resistant to antibiotics that once treated most infections. The three super infections that pose a threat are Methicillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile (C diff), and Vancomycin-resistant enterocolitis (VRE).
MRSA is diagnosed by obtaining a culture of the body fluid (sputum, urine, blood) where the infection is present. MRSA infections can occur anywhere in the body, and even though treatment with Vancomycin appears successful, a small amount of the bacteria can remain — a phenomenon medical professionals refer to as colonization. The remaining bacteria can cause infections to reoccur at any time.
C diff and VRE both cause diarrhea and are the result of antibiotics killing the normal, beneficial bacteria that reside in the intestinal tract and allowing infection-producing bacteria to proliferate. C diff can occur after the prolonged use of any antibiotic; VRE is specific to the use of Vancomycin. Treatment includes preventing dehydration associated with diarrhea, a bland diet, and bulking agents to decrease the amount of diarrhea, and administration of Flagyl to treat the condition and allow the normal bacteria to return to appropriate levels.
The good news is that most infections are isolated and can be treated with short-term antibiotics. Basic preventative measures — such as assuring that your parents have a pneumonia vaccination, receive the flu vaccine yearly, avoid others with acute infections, and stay well-hydrated — can decrease the likelihood of serious infections.
In addition, keeping the skin well moisturized can prevent skin infections. Dry skin is more likely to crack and tear, providing an opening for bacteria to enter. Urinary tract infections are prevented by good hygiene and adequate fluid intake.
Infection in the elderly is a serious concern, but a few simple measures and a diligent eye are all it takes to keep your parents healthy.
(For more information about infections in the elderly, super infections, and vaccinations go to http://www.health.nih.gov/topics. )
Nanette Lavoie-Vaughan is an adult nurse practitioner and professional consultant. She is a featured speaker at national professional conferences and writes about geriatrics for multiple publications. If you’d like to send Nanette a comment, question, or suggestion for a future column, please e-mail firstname.lastname@example.org.
Because it is a time to be considering holy things, and because I was sent this in the mail this morning, and because we have been talking about the prophet Job/Ayoub, I will share this morning devotion with you:
Job 22:24-25. Assign your nuggets to the dust, your gold of Ophir to the rocks in the ravines, then the Almighty will be your gold, the choicest silver for you.
A story tells about a rich man who pleaded with God to let him bring into eternity one suitcase full of his most valuable possessions. God finally conceded, and the man packed as much gold as he could into his biggest suitcase. When he arrived at heaven’s gates he was met by St. Peter, who opened the suitcase, curious to see what the man valued most.
“What!” St. Peter was incredulous; “You brought pavement?”
(For my Moslem readers: I don’t know why, it doesn’t say this anywhere in the Bible, except that Peter is given the responsibility for the building of the church and is often shown holding keys – like in the keys to the kingdom. Peter is often pictured in cartoons as the keeper of the gate into Paradise; he is portrayed as an old, bearded man with a long list in front of him, like who is naughty and who is allowed in. I know it might seem strange to you, but this is not considered offensive; it is an affectionate portrayal.)