The Pharmacist Answers Podcast

Meningitis [Show Notes]

 in Brain / Podcasts  tagged bacteria / fungus / inflammation / meningitis / parasites / surgery / vaccines / viruses by

Basics

Meningitis = inflammation of meninges

Generalized symptoms:  fever, headache, stiff neck, light sensitivity, confusion, lethargy, 

4 types of infectious meningitis

  1. Bacterial – we have a vaccine for that! 3-7 days; spreads in close communities (like college dorms).  Spreads through prolonged contact.  Confirmed through spinal tap and cerebrospinal fluid culture
  2. Viral – most common type; can be caused by lots of viruses: enterovirus, mumps, measles, flu, west nile.  7-10 days.  This is why I believe in vaccines!
  3. Fungal – not contagious; most common in patient with suppressed immune systems or secondary from surgery.
  4. Parasitic – Rare yet fatal.  Amoeba enters through nose from warm contaminated fresh water sources or pool, even hot springs (warm up to 115* F).  Only 31 cases in the 10 years between 2002 and 2012.  Destroys brain tissue ~ 5 days. 

Non-infectious causes:  Surgery, injury, lupus, cancer

The most important thing is that all of this be monitored by a doctor – ALWAYS!!

2 quick tests for meningitis

Kernig’s sign 

Brudzinski’s sign

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Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

Special Episode #4: Life & Blood Sugar [Show Notes]

 in Diabetes / Podcasts / Special Edition  tagged allergies / blood sugar / Diabetes / exercise / glucose / glycogen / hormones / insulin / sickness / Sleep / smoking / stress / T1D by

For someone with diabetes, everything they do in life affects their blood sugar.  They could be eating 100% right and taking their medicine 100% right, and something would cause the blood sugar to be off.

Exercise

It is well-accepted that exercise is good for you.  Your body will store extra sugar as a large molecule called Glycogen.  Imagine a line of kindergarteners hold hands trying to make it through the museum, Glycogen is just a bunch of glucoses holding hands.  When you’re not eating, your body will snip off a glucose at a time as it needs it.  The liver stores and directs the glycogen most of the time.  Your skeletal muscles also store some glycogen, because when they do work (i.e. exercise), it takes too long for the liver to snip off glucose from glycogen and send it to them.  

After exercise, the body replenishes the muscles’ glycogen stores.  This can cause the blood sugar level to drop, for someone with diabetes, this can be dangerous because they can’t “untake” medicine.  When protein and carbohydrates are eaten together, before or after exercise, the blood sugar changes can happen more slowly – the nutrient absorption in the gut causes a “traffic jam” of sorts.

Sleep

Certain metabolism processes happen only when you sleep.    Some people with diabetes wake up with really high blood sugar, others wake up with really low blood sugar.  Sleep is not restful and restorative if the blood sugar is out of balance, but also if sleep is not restful, then blood sugar levels can be jacked up – not just in the morning, but for the rest of the day.

Stress

The hormones that are triggered by stress – even something as basic as adrenaline, can cause the body to respond to insulin and glucose differently.  

Sickness

Your body is going to responds things differently when the immune system is in high gear – that includes insulin, glucose, the food you eat.  An infection requires an antibiotic because you are infected with a bacteria.  Bacteria are living organisms.  Living organisms consume energy sources and produce waste.  This can affect the sugar levels in your bloodstream.  You’re immune system doing work also burns sugar.

Allergies

Works about the same as sickness.  Your immune system is actively trying to protect you from something (allergens) and so it responds differently.

Smoking

If you smoke, STOP!  The nicotine and other chemicals make you more resistant to insulin.  This is most troublesome in Type 2 Diabetes.

Hormones

Especially for women, hormone cycles can affect sensitivity to insulin differently during different times of the month.  Adrenaline can override almost any response to any previous hormone response.

Life is hard

Life with diabetes is super hard.  Diabetes and other chronic diseases are silent and it doesn’t show on the outside at first sight.  Extend grace, extend compassion.

The Nashville chapter of JDRF is having their annual One Walk on September 24th. Friend of the show and previous guest, Rachel Mayo has been #T1D for over 10 years and she is passionate about the cutting edge research and support JDRF provides for people and their families. Her goal is for her team to raise $5000, you can contribute!

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Music Credits:  “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0  http://creativecommons.org/licenses/by/3.0/

Brain Bleeds [Show Notes]

 in Brain / Podcasts  tagged brain bleed / epidural / extracranial / intracerebral / intracranial / intraventricular / meninges / subarachnoid / subdural / thunderclap headache by

Review

Your brain is held inside your skull by a tri-layer membrane called the meninges.  These membranes and all the other structures in your brain are nourished by blood vessels, and different circumstances will make these vessels at risk of rupturing.

*ALL BRAIN BLEEDS REQUIRE MEDICAL ATTENTION!* 

Brain bleeds are classified based on the membrane they are closest to.  They can be caused by physiological malformations, stroke or aneurism from age or disease, or trauma.

From the outside in

  • Extracranial bleed: (extra = external; cranial = cranium = skull bones), between your skin and your skull.  Doesn’t affect your brain, there is more room for it to stretch.
  • Intracranial bleed: (intra = internal); bleeds inside the skull increase the intracranial pressure and requires medical intervention.  Main goal is to reduce intracranial pressure so brain cells aren’t pressed on and damaged.
    • Epidural (yep, that place they put the anesthesia for women having babies, except it’s in the spinal cord): Epi = above, Dural = Dura mater, that topmost, durable layer of the meninges.  Between the skull and the dura mater.
    • Subdural: Sub = under; blood leaks in between the dura mater and the arachnoid mater, which are normally in close contact, so the separation causes pain.
    • Subarachnoid: under the arachnoid mater. Normally, under the arachnoid layer is the subarachnoid space which contain cerebral spinal fluid (CSF).  People who have had a subarachnoid bleed and survived, describe hearing a “thunderclap”.  Officially called a “thunderclap headache”.  It’s like they can hear the blood vessel pop and experience extreme pain all over their head all at once.  Described as “the worst headache of my entire life”.  Because the pia mater under the subarachnoid space lays directly on top of the brain cells and follows all the grooves and wrinkles of the brain, this type of bleed will require emergent attention and possible surgery.
  • Intracerebral: cerebral = cerebrum, the main part of your brain
  • Intraparenchymal: Parenchyma = organ tissue, means it’s right up against the brain cells
  • Intraventricular: Ventricles = pockets inside the brain that make, hold, and reabsorb CSF.  The deepest part of the brain.

*ALL BRAIN BLEEDS REQUIRE MEDICAL ATTENTION!* 

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Special Episode #3: Meds & Blood Sugar

 in Diabetes / Podcasts / Special Edition  tagged blood sugar / Diabetes / dose / food / Hypoglycemia / interactions / JDRF / medication / T1D / timing by

People with chronic diseases don’t get holidays or vacations from their medication.

4 ways medication can affect blood sugar

Type of medication

The goal of the medication that people with diabetes take is to lower blood sugar – either by increasing insulin sensitivity, encouraging the pancreas to make more insulin, or to replace insulin that’s not naturally made anymore.  Metformin is like insulin’s wingman; it helps make the cells ready for insulin when it comes by.  So usually these medications (including insulin) will lower blood glucose no matter if you eat or not.

Timing of medication

Most of the medications should not be taken if a meal is going to be skipped.

Dose of medication

The more sugar you eat, the more insulin you need.  The higher the blood sugar level, the higher the dose is needed.  It needs to stay proportional.  Any form of sugar you eat gets turns into glucose, the complexity of the sugar determines how fast it raises your blood sugar.  Even diabetics are at risk for hypoglycemia.  If one little thing gets out of whack, it can cause a drop in blood sugar and require a “rescue”.  Favorite hypoglycemia rescue “go to” is orange juice (lots of simple sugars).  Regular soda can be used, as well as hard candy or glucose tablets.  NO DIET SODA – artificial sweeteners do not affect sugar enough.  High blood sugar can cause coma, lower blood sugar can cause coma.  Bottom line: Coma is bad.

Interaction with medication

Fluoroquinolones can causes changes in blood sugar control and require a person to check their levels and adjust their medicines more often.  Steroids can also cause blood sugar to be more uncontrolled – this is true for acute (short term) use or chronic (long term – like autoimmune diseases) use.  Beta blockers used for blood pressure control can mask the symptoms of low blood sugar because the symptoms are very similar.  Symptoms of low blood pressure:  tiredness, weakness, dizziness, shakiness, inability to focus.  The only way to know which one you’re experiencing is to check your blood sugar and your blood pressure.

The Nashville chapter of JDRF is having their annual One Walk on September 24th. Friend of the show and previous guest, Rachel Mayo has been #T1D for over 10 years and she is passionate about the cutting edge research and support JDRF provides for people and their families. Her goal is for her team to raise $5000, you can contribute!

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Membranes [Show Notes]

 in Brain / Podcasts  tagged arachnoid / brain / dura mater / membranes / meninges / pia mater by

Membranes Basics

Meninges are a triple-layer membrane that helps hold your brain in place.

The inside of your skull bones have many boney processes protruding out.  The meninges surround the brain and provide a cushioning layer around it, and anchor to these processes.  This allows the brain to be suspended inside the skull and not touch the top, sides, or bottom.

This setup is partly contributes to concussions.  When the head experiences a large enough impact, the suspended brain crashes into the bone of the skull.

Meninges encase your brain and spinal cord to protect them.

Three layers

  • Dura mater (mah-ter, not may-ter): durable and thick, contains large blood vessels.  This is the layer that anchors directly to the skull bones.  Membrane that divides hemispheres, separates a few lobes, and coats glands near the brain.
  • Arachnoid mater (yes, like spiders): wispy like spider webs – thin & transparent. Directly in contact with Dura mater, but has cellular pillars that connect it to the Pia mater.  The cerebrospinal fluid flows around these pillars. Also overs the outside of the part of the brain as a whole.
  • Pia mater – delicate, contains the capillaries that nourish the brain.  Is in direct contact with brain cells – following all the contours and wrinkles of the brain.

Subarachnoid space – hold cerebrospinal fluid (a closed fluid system that insulates and cushions the brain and spinal cord).  Doesn’t mix with blood or lymph system.

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Special Episode #2: Food & Blood Sugar

 in Diabetes / Podcasts / Special Edition  tagged alocohol / blood sugar / Caffeine / carbohydrates / Diabetes / fat / Hypoglycemia / JDRF / protein / T1D by

Blood Sugar Basics

Your blood sugar affects how tired you are, your productivity, and your moods.  This is 1000x more true for those with diabetes.

Hypoglycemia = Low blood sugar

3 main energy sources in your food

Carbohydrates are some complex form of sugar that your body can turn into glucose very quickly.  Glucose is the main form of sugar that your body uses for energy.  Because your liver is very efficient in this process, you can get a blood sugar spike (sugar high) and then you crash after it’s over.  Insulin is the key to the door to let the glucose in your cells.

Fats can be turned into sugar by your liver is your glucose stores are depleted.  So, this can affect your blood sugar levels, although it’s less of an impact that carbohydrates.  Insulin has another job – fat storage.  If there’s a lot of fat, the insulin is being used up storing fat rather than allowing glucose into cells.

Proteins are promoted as a counterbalance to the carbs.  It causes a traffic jam in the absorption and metabolism processes that allows the sugars into the blood stream much slower.  The liver does have a process called gluconeogenesis (the creation of new sugar) where it can make sugar out of protein, but it’s a last resort.

Other things in your food

There is some evidence that shows caffeine causes temporary insulin resistance while it’s in the body.  You still get an “energized” feeling b/c caffeine increases the heart rate but the energy usage is not very efficient because the glucose is not being used well.

Alcohol can drop your blood sugar initially, especially if it’s consumed on an empty stomach.  When the liver is steadily detoxing the alcohol out of your bloodstream, the replenishment of the glucose supply slows down.  This contributes to what make you feel sleepy after drinking alcohol.  On the flip side, it will increase your blood sugar because 1) alcohol is usually mixed in a sugary drink (i.e. cocktails) and 2) alcohol is distilled from “high carb” sources (grapes, wheat, barley, rye, corn, etc).

Any changes to eating habits need to be exactly that – new habits.  It can’t just be a program that you do once without permanent change.  If you’re cutting out all or most of one of the 3 main energy sources, you have to make sure you keep up with your caloric needs.

Calorie Math

1 g of Fat = 9 calories

1 g of Carb = 4 calories

1 g of Protein = 3 calories

Calories are calories when it comes it energy, so the other nutrients from your foods are a more important to consider when choosing what to eat.

There are lots of things your body would have to adjust to when changing eating habits (digestion adjustments, for one) and 30 days may not be enough to get it “normalized”.

JDRF

The Nashville chapter of JDRF is having their annual One Walk on September 24th. Friend of the show and previous guest, Rachel Mayo has been #T1D for over 10 years and she is passionate about the cutting edge research and support JDRF provides for people and their families. Her goal is for her team to raise $5000, you can contribute!

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Music Credit: “Radio Martini” Kevin MacLeod (incompetech.com)  Licensed under Creative Commons: By Attribution 3.0 http://creativecommons.org/licenses/by/3.0/

Headache [Show Notes]

 in Podcasts  tagged auroa / cluster headaches / headache / migraine / OTC / pain relievers / rebound headache / sinus headache / tension headache by

5 Types of Headaches

Tension Headache

They come on if you’re stressed or having to hold your body in an uncomfortable or unnatural position.  Neck and shoulder tension can cause the headache to hurt in the back of your head (and can radiate to your eyes due to the location of the optic area of the brain).  Intense facial expressions (including crying) can hurt in the front or sides of your head.  Obsessive personality types are more prone to tension headaches.  OTC pain meds help turn off pain receptors.  Using a warm compress to loosen and soften muscles and then doing stretches can relax the muscles and relieve tension.  Some people find that ice packs can help because the cold decreases the inflammation in the area that is tense and painful.

Cluster Headaches

They happen in groups or cycles. Mild to moderate pain.  One-sided headache accompanied by watery eyes, sinus pressure, and runny nose on that same side.  Don’t be fooled into thinking that it’s a sinus headache.  The pain from cluster headaches will make you restless – “If I can just stay busy, I won’t think about the pain and will be ok”.  This type of headache can be treated with OTC medications.

Sinus Headache

Your sinuses (tunnels in your head and face bones) are lined with mucous membranes.  They can become inflamed if they are fighting off a virus (cold), infected by bacteria (sinus infection), or from overproduction due to a severe allergy attack.  The inflammation, in itself, can cause pain.  But if they swell shut and the air inside can’t even out pressure with the outside (just like your ears when you change altitude), it can cause pain. Antihistamines and decongestants can help, and again, OTC pain relievers.

Rebound Headache

If you use a medication for a prolonged period of time, your body chemistry will adjust to it always being there.  So, if you stop taking it, your body notices the gap and responds by sending pain signals.  This happens with headache medications as well as other pain medications.  Can be an indication of medication overuse. 

Migraine

These must meet a specific set of criteria to be diagnosed.  And because they are most affected by brain chemistry, OTC medications rarely work, thus require prescription medications. 

Diagnosis criteria

  • 5 or more debilitating episodes
  • An episode lasts 4-72 hrs
  • At least 2 of the following:
    • one-sided
    • throbbing (feel the pulse or heartbeat)
    • Moderate to severe
    • Interferes or prohibits daily activity
    • Daily activity makes it worse
    • Sensitivity to light and/or sound
  • With or without aura (visual disturbances – halo, floaters; hand numbness)

A deeper look

If your brain knows something is going on, it may preemptively redirect blood and nutrients to the vital organs and thus your extremities get neglected.

Still not 100% sure what causes migraines, Neurologists can do brain scans to look for patterns in electrical signals and misfirings. So far, we know it has something to do with neurotransmitters.

Hormones can affect the brain chemistry so strongly, that each menstrual cycle can come with migraine.  Pregnancy hormones can cause migraines – either temporarily or permanently.  

Serotonin, which is your “happy” chemical, is produced when your eyes are stimulated by sunlight.  If it gets out of balance, the brain responds.  

Treatment Options

  • Triptans (a class of medications used to treat migraines) affect serotonin levels to try and rebalance it.
  • OTC and home remedies don’t work for true migraines.
  • Some people do get relief with ice packs.  Ice reduces any inflammation, and also numbs the nerves so they don’t feel as much pain.  **Ice must be used conservatively because too much ice contact can damage the skin**
  • Other people find that warm compresses hurts because the muscles around the painful area get tense and the warmth can help them relax.

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Pre-Pharmacy Existential Crisis

 in Blog  tagged biology / chemistry / ethics / evolution / health / pre-pharmacy / relationships by

Day 1

When I got accepted into college and declared my major as Pre-Pharmacy, the next step was to meet with an advisor and register for my classes. The typical advice for Pre-Pharmacy was to be assigned to the Biology department. It was also recommended to register for 18 credit hours per semester to complete the Pre-Pharmacy requirements in the coveted 2 years. So, there I was, a Pre-Pharmacy Biology student with 18 credit hours on her schedule. This included Bio 1101 plus lab, Chem 1101 plus lab, English Composition 1101, some freshman intro orientation course, World History, and Philosophy & Ethics. Awesome!
The year started off with a bang!  Chem 1101 was a little review from the high school chemistry I took, and then much more. Bio 1101 was a review of the Hierarchy of Life and then dove straight into evolutionary taxonomic Latin.  Literally, I was learning Latin!  The only other stunner was Philosophy & Ethics. Here I was, brought up in the Christian faith, and the best advice I got regarding my spiritual survival of university-level Evolution and Philosophy & Ethics was “learn just what you need for the test and ignore the rest”. Oh great!

Crisis Ensues

So, at 18 years old, I have my first major existential crisis.  A 2-pronged crisis regarding the battle between humans’ philosophy of life and my belief in spirituality, as well as the evolution of life and my belief in Creation. This results in several C’s on my transcript (which caused another, albeit slightly less severe crisis).
When I knew there was no recovering of my grades, I sat in my advisor’s office, distraught and holding my head in my hands. I remember saying “all of this taxonomy means nothing to me on the path to becoming a Pharmacist”. In the Biology department, this path was leading me to classes like Botany and Evolutionary Biology. He simply nodded, and said, “what if you moved to the chemistry department?” “What?! Change departments? Pre-Pharmacy Chemistry? That’s a thing?!?! Why did nobody tell me that was a thing?!?! Where do I have to sign????”. We filled out the “Change of Major” form to get me to the Chemistry department and he happily signed off as my former advisor.

A Clear Path

When 2nd-semester registration opened, I met with my new advisor – a Chemistry professor. I still had 16 hours of credit hours.  Bio 1102 plus lab, Chem 1102 plus lab, English Composition 1102, PE, and Spanish were ahead of me. The weight was lifted because I could finally finish Biology and “learn just what I needed for the test”. This semester’s transcript has many more A’s and B’s on it and my path to Pharmacy was much more clear.  I knew the future held stops by Organic Chemistry, Biochemistry, Physics, and Physiology on the map.
Why did this change from Biology to Chemistry make such a big difference? Part of it was because my original plan was to graduate with a Bachelor’s degree before I went to Pharmacy School. (That plan changed, but that’s a story for a different day.) Another part of it was because Chemistry was the first science that allowed me to reconcile science with my faith on a scale that I was comfortable without another soap opera-worthy existential crisis.

So what’s the point of this story?

You have to find what works. What fits with your natural bent and the values and beliefs that are planted so deep inside of you that nothing that you can perceive could remove them from you. If you approach your health and your healthcare relationships and decisions in this way, you will find what works for you.

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Headbone [Show Notes]

 in Podcasts  tagged bones / brain bleeds / cranium / crazy stories / fractures / skull / soft spots / sutures by

Headbones Basics

Your skull is made up of 22 bones.  2/3 of it consists of cranial bones, even though there are only 8 of them.  The other 1/3 is your face.

Two main goals of the cranial bones:  protects your brain, acts as an anchor for neck and face muscles.

The 8 bones are connected together by sutures (because they look like they’ve been sewn together) – and it is a tight fuse that doesn’t allow anything through.

The frontal bone – at your forehead, it’s on the FRONT.  When babies are born, this bone is actually in 2 pieces to allow baby’s head to smush during delivery.  It fuses together so tightly, that it becomes one bone by eight years old.

Fontanels = soft spots that babies have that allows for rapid brain and head growth.  Babies have 6 total soft spots.  All of them close up by 3 months old except the big one in the front.

Steve’s Story

His daughter’s soft spot would sink in and she would cry.  His mother-in-law would fill her mouth with water and then suck the baby’s soft spot out.  *DO NOT TRY THIS AT HOME!!*

Sunken in soft spots can be a sign of dehydration because there is lots of blood vessels in that area.

The bones in your face and head have cavities and tunnels (called sinuses) that allow nerves and blood vessels to travel through, as well as keep air pressure stable.

Questions

Question 1: Skull fracture? Can possibly happen on a suture where two bones separate, but more often an actual crack in one bone.

Question 2: Is brain bleeding always dangerous? Always potentially fatal?  Yes, because your brain is closed in. Brain bleeds are classified into levels, and part of it has to do with how deep in the brain it happens, and how much pressure it puts on the things around it.  Blood vessels are found all throughout your brain, and the blood that flows through them has its designated space.  If the blood comes out of the blood vessels, then it starts crowding out the things around it (which can be important parts of your brain).  Sometimes people may have a brain bleed and they will remove part of the skull bone to relieve the pressure.

Another Story

Orbital hemorrhage caused vision loss and feeling loss in lower extremities.  If the nerve signal is interrupted temporarily, then the functions of those parts will return.  If the nerves are damaged permanently, then those functions will be lost permanently.  This was caused by blunt force trauma. As long as the rest of you is healthy, and the injury is fully healed, I would not expect it to happen again out of the blue.

Party Trick

Where does the bottom of your brain sit?  Your cranium has a floor.  One of the bones that make up the floor is called the Sphenoid bone (my favorite bone).

You can reach it and wiggle it and help with sinus pressure and drainage (it’s a neat trick!)  It works by creating tiny pressure differences in your sinuses.

The outside of your skull bones are rather smooth.  The inside of those bones are bumpy and jagged because it gives places for the membranes to anchor and keep the brain buoyant and centered.

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Skin Cancer ABCDE [Show Notes]

 in Podcasts  tagged ABCDE / carcinoma / early detection / fair skin / melanoma / pre-cancer / skin cancer / sun exposure by

Review

Epidermis = top layer of skin.  Living cells divide and then add in proteins that causes cells to harden as they die and become and protective layer to keep out water and dirt and critters.  Some of those proteins give your skin its color (melanin) and they help block and reflect UV light from the sun to keep the living cells from being damaged.

Mutations = if UV light damages the cells’ DNA, then when the cells divide and replicate, they copy the “error” and reproduce an abnormal cell.  If certain mutations cause the cells to die, others cause the cells to be weak, but others cause the cells to become cancer.

3 types of skin cancer

  • Basal cell carcinoma – most common of these 3, more common in people with fair skin.  Skin growth is flesh colored, can look like skin tags.  Caused when a basal cell gets mutated and starts to grow.
    Squamous cell carcinoma – more common in people with fair skin. Scaly patches or sores that open, start to heal but reopen and never heal.  Caused when a keratinocyte (living, dividing skin cell) gets mutated in the middle of replicating.
    Melanoma – Moles are just a place where a lot of melanocytes gather in one place, but sudden moles or dark spots can be the tip of a bad iceberg.  This is the deadliest type of skin cancer.  Caused by mutations in the melanocytes.

Some benign (harmless) skin characteristics can resemble skin cancer, thus it’s easy to overlook them in the early stages.

A tool for early detection of melanoma

A – Asymmetry – you can’t fold it in half and all the edges match
B – Boarder – jaggedy, sharp boarders
C – Color – uneven color
D – Diameter – > 6mm (bigger than the eraser of a #2 pencil)
E – Evolving – changes shape, size, or color in a short amount of time (< 1 month)

This is why the National Skin Cancer Foundation recommends you do a monthly skin scan to check skin characteristics for changes or new ones.

Early detection is the number one step to improve survival of all cancers.

Precancer = Actinic Keratosis – dry and flakey places in the skin, can be the precursor of Squamous Cell Carcinoma.  Usually shows up after 40 years old.

Cancer is not just a disease that happens to the aged, but as you age, the probability of you being exposed to something that could mutate your cells goes up.

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