Doc, I've got a question

This is a great question! It can be difficult to know exactly how serious an issue is to warrant going to either the clinic vs. an urgent care vs. the emergency room. What I usually tell me patients is that if you’re not sure, just ask! Most clinics and emergency rooms have someone available 24/7 to answer phone calls from patients. If you belong as a patient to a particular clinic, call there first. If the clinic is closed, most will have voicemail instructions on how to reach the on-call provider for that given time. If you don’t belong to a clinic, you can also call an urgent care or emergency room and someone will be available to answer your medical question(s) and help determine when you should be seen. There are some other systems in place as well to help you get the care you need in the most appropriate setting. For instance, if you present to the clinic or an urgent care for chest pain suspicious of a heart attack, you would be transferred over to the emergency room. If you require more specialized care than a particular location can offer, you will be informed and the appropriate arrangements can be made. Again, I always suggest calling your clinic, urgent care, or emergency room first if you are unsure as to where you should go because this also helps prevent you from going to an emergency room or urgent care when maybe waiting until your clinic is open to be seen is more appropriate for your medical issue(s).

My skin is shedding like a snake. Does this mean I need more water? Lotion? Or is it just a winter thing and it’ll disappear in spring?

Having dry skin is fairly common in the winter months in places that experience cold and dry winters, such as here in the Siouxland area. Dry skin can be a sign of dehydration and other medical problems, but is more often a symptom resulting from dry environmental conditions. However, if your skin is actually “shedding like a snake,” that might be something more than just dry skin. Dry skin usually flakes off and doesn’t typically shed off in layers. Moisturizing lotions and creams usually help with dry skin, so I would suggest trying a moisturizer and if no response or you have a change in signs or symptoms, you should go see your doctor. Shedding skin can be a sign of something more than just dry skin and having a doctor actually look at the skin and sometimes taking a sample for testing, called a biopsy, can be helpful in making an accurate diagnosis. Your doctor can also ask more questions such as “Does this only happen in the winter?” and “How old were you when this all started?” Skin problems and rashes are difficult to diagnosis without seeing the actual problem, and still then sometimes we often scratch our heads about what the diagnosis might be just based on looking at the skin. This is why sometimes we also need to do other testing, such as a biopsy and bloodwork, to come to a precise diagnosis.

Is there such a thing as the 24-hour flu? I’ve had friends who have been fairly sick for a day with vomiting and diarrhea and then they’re better the next day. Could it have been food poisoning? What’s the difference?

Ah, good, so this is one of my pet peeves, and I’d love to make some clarifications. So, when many people use the term “flu” and describe their symptoms as vomiting and diarrhea, this is actually a misleading term because true influenza (flu) viral infections do not typically cause vomiting and diarrhea in adults. However, I will say that in children, about 10-20 percent who test positive for influenza can in addition to the symptoms I’ll describe below have vomiting and diarrhea, but again this is less common and not the general presentation. Influenza characteristically begins with an abrupt onset of fever, headache, muscle aches, and malaise (a general feeling of discomfort and illness). These symptoms are then accompanied by indicators of a respiratory tract illness, such as a dry cough, sore throat, and runny nose. You may have heard the term “stomach flu,” which involves vomiting and diarrhea, but this illness is usually a viral, bacterial, or parasitic infection known as gastroenteritis and not actually influenza. This gastroenteritis infection is what most people then think of as the “24-hour flu.” Gastroenteritis can also be caused by bacteria from food poisoning. In a sense, gastroenteritis is a broad term used to describe a lot of different infections of the gastrointestinal (GI) tract. Less severe gastroenteritis from food poisoning typically is shorter lived but more severe forms of this type of infection from food poisoning or other causes can last several days. Sometimes a way to distinguish between gastroenteritis from food poisoning vs. other infectious causes is to see if other people who ate the same food as you are also sick. Food poisoning typically affects a group of people who ate the “bad” food, whereas gastroenteritis from other causes is typically more isolated, affecting people more “randomly.”

Why do my hands and feet take so long to warm up? The rest of my body warms but they’re always cold. Is this the sign of something else?

If you are prone to cold hands and cold feet, this phenomenon is often worse with cold temperatures. The body’s natural response to a cold environment is to maintain a normal body temperature. So, when your body detects a drop in outside temperature, it responds by increasing blood flow to the central areas of your body to maintain core body temperature. Therefore, blood flow to the extremities, the hands and feet, decreases and they start to feel cold. Some people have exaggerated responses to these temperature changes, and thus they have overly cold hands and feet that don’t warm up well. Sometimes this is a normal variant and occasionally this is due to something else such as a phenomenon known as Raynaud’s syndrome, or even poor circulation due to disease of the arteries. In order to differentiate between whether this is a normal variant or something else, I would suggest seeing your doctor to be able to gather more information about you: your past medical history, how these symptoms presented, when they presented, etc.