Trucker MD
Two ‘Dear John’ letters: itchy feet and heart attacks

By John McElligot, MD

For this issue, I am sharing two Dear John letters I got from two different women with some very good questions.

My husband is a trucker and has the unhealthiest feet of anyone I know. He wears sandals when he takes showers at truck stops but if there’s any foot crud he can get, he will get it. What more can he do?

Itchy feet are a very common problem in the labor force. Trucking with itching, burning feet makes for a miserable trip. Let’s fix this.

First of all, are there any medical issues? If so – and I always have to ask – is one of them diabetes? If so, then you may have a fungal infection that requires an antifungal pill or cream. Diabetes must be controlled or the fungal elements will never be able to be cured.

I know this sounds elementary, but there are many causes of itchy feet. Here’s my short list:

  • Sweaty feet that get no air due to poor foot wear;
  • Allergy to leather called shoe contact dermatitis. Get good footwear that breathes. If you can smell your shoes, something is wrong!
  • Dyshidrotic eczema of the feet that causes small blisters;
  • Exfoliativa dermatitis; and
  • Athlete’s foot.

Remedies are many, but good No. 1 is just good old soap and water daily. Use products like over-the-counter foot powder to keep the feet dry and never go barefooted. Those are two steps I recommend for keeping your feet healthy.

Next is to always wear clean socks every day. If you wear sandals, clean them with a Clorox wipe every day. If your nails are fungal, you will need special treatment like Lamisil or Lotrimin. Let your feet breathe the open air and, if sweaty, clean them and let them air dry.

Three things you need to know when you are on the road and required to be your own skin doctor is “if it’s wet, dry it. If it’s dry, wet it,” and of course, “if it itches don’t scratch it.” Remember when you scratch your feet the fungus gets under your fingernails and can contaminate your face, hands and private parts! So hygiene is paramount.

I understand that symptoms for women having heart attacks are different for men. What are those symptoms and is there a reason they are different from heart attacks in men?

First, let’s look at the accepted list of classic symptoms from the American Heart Association.

1.  Uncomfortable pressure, squeezing, fullness or pain in the center of your chest. It lasts more than a few minutes, or goes away and comes back.
2.  Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
3.  Shortness of breath with or without chest discomfort.
4.  Other signs such as breaking out in a cold sweat, nausea or lightheadedness.
5.  As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting and back or jaw pain.

These five do not reflect that women often have no symptoms and often have only fatigue. If they are diabetic, asymptomatic heart attacks are common.

The experts agree women are special and different. Noel Bairey Merz, MD, is director of the Barbra Streisand Women’s Heart Center at the Cedars-Sinai Heart Institute.

“Men might complain about tingling in the arm, which is widely recognized as a sign of a heart attack,” says Dr. Bairey Merz, “whereas a woman might present with symptoms such as exhaustion or overwhelming fatigue. A physician who knows how men and women manifest heart disease differently would recognize that symptom as an indication to look further.”

I advise – in fact, I preach – the importance of early diagnosis. Don’t wait until it’s so obvious that the cashier at the truck stop can diagnosis the problem. LL

 

John McElligott is an MD, Fellow of the American College of Physicians, and medical director of the St. Christopher Truckers Development and Relief Fund. This column is the opinion of the writer and does not necessarily reflect the opinions of Land Line Magazine or its publisher.