Alcohol And Sports: A Losing Team

When you mix beer drinking with swinging bats and flying balls, the risk of injury skyrockets, according to Roger Willcox, M.D., director of emergency services at Columbia Paradise Valley Hospital in Phoenix. He estimates that half of emergency room sports injuries are alcohol-related. From broken ribs to severed limbs, alcohol and sports do not make a good team.

How common is it to find a sports injury as a consequence of drinking alcohol during the game?

Dr. Willcox: It's amazing how many times people over eighteen, especially males, how much alcohol is involved with sports injuries. The more alcohol that's involved the worse the injuries generally. I've seen over the years a tremendous correlation between alcohol ingestion and the sports injuries and it doesn't seem to be getting any better. It's still a problem. I'm not sure people are aware of the problems. Most people think they are playing this game of softball here, there's not much risk but you know they catch their foot on a base and break their ankle real bad. There was one patient that I saw that was going after a softball in center field and ran right into the Cyclone fence and he ended up with a waffle pattern on his face. So you get sort of all kinds of different problems that you see. I would say the more common are ankle sprains, ankle fractures, and sometimes they can go from a mild sprain, of course the mild sprains are extremely common, just tremendously common. We see bad trimalleolar fractures, very unstable ankle fractures in that situation. We see a lot of wrist fractures, hand injuries, thumb injuries, etc. You can also, without breaking a bone, injure your thumb pretty bad by tearing a ligament and we see that sometimes.

Is it in golf or is it other injuries?

Dr. Willcox: I've seen, in fact rather recently, I saw a big divot out of a guys head from a golf club. He had been drinking a little bit. Also saw a pretty bad, actually a fracture from a golf ball, a skull fracture from the same thing. So as you might guess in Phoenix we see quite a few golf related injuries, even though you don't think of that as a common sport to cause injuries. Golf is ubiquitous here in this area.

What is it about the alcohol that leads to these injuries?

Dr. Willcox: Judgment is probably number one. Secondly equilibrium is off, your sense of balance and your sense of judgment. It's easy not to know that cyclone fence is coming at you at a rapid speed. The most serious problem is just judgment. People do things that they might not ordinarily do. They try things they wouldn't ordinarily do and of course this is what makes drinking and driving dangerous too. Also the coordination is a problem with driving. It's really analogous to motor vehicle accidents in that you have to be reasonably coordinated and alert to drive a vehicle. The same with most sports and people get by with it for a long time and then suddenly they have a major injury. It goes from the very mild to the very severe, including broken necks and serious injury to limb, and even death. Disfiguring injuries, amputations, just about any degree. The problem again is that people are having fun. They don't really think of all the consequences of what could go wrong. Their judgment as far as the risk of a certain activity or whatever is just not there. For the same reason somebody that's been drinking might saw off their finger with a skill saw or wreck their car. The same thing happens on the softball field, or out playing golf, or playing tennis. It's fairly easy. You've had a few beers or Martini's or something, play tennis and you can get serious knee injuries, eye injuries. Handball/racquetball eye injuries are very common. With just about any sport, I'm sure badminton could be dangerous. But sports that you don't think about as being dangerous with a little alcohol on board that whole picture can change.

You said with athletes over eighteen. What percentage of the sports injuries do you see that are also alcohol related?

Dr. Willcox: I would say with twenty one and over certainly that it's, you know, there are some other demographics involved obviously, you see more injuries with males than females. Of course more males are playing sports too, so I'm not sure what the percentage would be but I'd say fifty percent. I'd say probably fifty percent are alcohol related in twenty one and over. The sport makes a difference too. For example, it's more common in softball. But obviously certain things like Rugby, it's asking for trouble right there and plus there is sort of this tradition of drinking beer and playing Rugby, the whole Australian and English thing, and the Genesis and whatever. So it's, unfortunately the same way with softball. There's sort of a tradition of drinking beer and playing softball. It's sort of a tradition and it's a dangerous tradition. Wait until afterwards I say, and then let somebody sober drive home.

A lot of people when they are very physically active, lose fluids in the body and they assume that drinking alcoholic beverages like beer or what have you is going to replenish those and it really doesn't, right?

Dr. Willcox: Absolutely right. That is a misconception a lot of people have that if drinking Gatorade is good to prevent dehydration then drinking beer is good and it's actually just the opposite. You know beer tends to have sort of a diuretic, well most people are aware of that, but it does tend to take lots of fluids out. So that's just a common thing that happens. Not only is one not getting enough of the right fluids, but there's actually probably some diuretic effect also which actually means more fluids are lost. If you throw that with our heat especially-actually obviously people get overheated all over the country and in Phoenix we have a lot of heat. The humidity isn't a problem though, but it's still a lot. You throw in alcohol and heat and there's a real tendency to have a lot of heat related illnesses. Sometimes rather severe. Usually in that group it's a lot of the bicyclist and runners and so on. As far as alcohol you know we've seen it some, it doesn't seem like it's quite as big of thing with running and cycling and stuff. I think people are pretty careful about that.

It seems like it's group sports where there's a lot of socialization going on.

Dr. Willcox: Right, you know there is a tendency though, runners often think that beer is good for them. You know for running, that it's a good beverage to take and there's a lot of talk about that back and forth. There a quite a few runners that do drink beer. It's usually not a big problem though that you see with say softball especially.

Is it because it's high in carbohydrates, they think that will give them better performance?

Dr. Willcox: Yes, it's almost legendary, some of the famous runners that believe in drinking beer. I'm not sold on the concept myself. I don't think it's a good idea. I would prefer they drink fruit juice, or Gatorade, or sports drinks. I can't recall where I read it but I know there is starting to be some talk the other way, you know this really is bad for you, why are we doing this, and there is that kind of talk among runners. So I would favor that approach.

Those other fifty percent of sports injuries that come in to you that are not alcohol related, what kind of things do you think could be done to prevent them? Any tips that you can offer individuals that they can do as far as stretching, warming up, things like that?

Dr. Willcox: Prophylactically, have a good understanding of what your limits are and be sensible. I think stretching. Some people, like myself, I'm the opposite of limber, so I really have to stretch and so on. Some people don't need it quite as much but everybody benefits from some stretching before they do physical activity and some of the stretching exercises that we've done for years can even cause problems. So you know my general philosophy is if it hurts don't do that. I think in general, both with when you're playing the sport but even if you are limbering up before, if you are stretching and so on pain is usually nature's way of telling you to slow down. Stretching is excellent if it's done conservatively and done right and usually you need to get all the major muscle groups that you're going to be using in that sport, especially in ball.

Can you talk about things like bandaging, a particular joint that you know tends to be vulnerable to injury?

Dr. Willcox: Well, I think that's more afterwards. Let's say you have an ACL tear or something, then you should be in a special knee brace. As far as other equipment, there are certain orthotics that some people need for their feet and if you need those, if you know you need those things don't go off and do the sport without them. In general, I don't recommend Ace-ing your knee before you play a sport or something because you might hurt your knee, but in certain cases like in certain sports injuries where a lot of people are walking around with an ACL tear that don't have surgery, they don't necessarily need surgery but they need a little extra protection say when they are skiing. That's another sport that there's a lot of drinking and skiing and horrendous injuries there.

Sounds like poor judgment before the alcohol ever hits their lips.

Dr. Willcox: Right, exactly. As far as protection, people that have an ACL tear that it hasn't been operated they generally should wear protection if they are going to be skiing or doing some activity like that. Their orthopedist has probably already told them to. If that's been recommended then you should definitely use it. The problem with all of us and of course I've had sports injuries myself, orthopedic injuries and the orthopedists and the emergency physician for that matter will tell you to do one thing and you've got to do it. It's hard to do sometimes but if someone has recommended something to prevent an injury, for example the ACL tear, you should wear that equipment. As far as just prophylactically using equipment and so on willie nillie, I don't necessarily recommend that. Because for example, there are certain knee braces and so on if they are not really indicated where you tend not to use that knee as much and you actually getting weaker in that knee so you have a detraining effect. So you've got to be careful in that regard.

Once the damage is done, let's talk about some of the myths out there, some of the confusion over how to treat sports injuries. Number one problem, heat versus cold, how do you follow that?

Dr. Willcox: There's a little bit of controversy on that, but I generally like to keep things very simple in that regard. I can't tell you how many times I see an ankle sprain that really wasn't that bad and they've been putting it in hot water or whatever for two days and its all bruised and swollen and it didn't have to be that bad because basically they went with the wrong decision. They went with heat initially. It really makes sense when you think about the logic of it. You go cold initially, you use ice packs initially the first two days. Some people say a day and a half and some people say three days. But I say two days and then heat later. The logic of this is that when you have a fresh injury you've got tissues torn, you've got fluid and blood in some cases, leaking into the extra vascular space and, meaning around the blood vessels, just leaking into the tissue out of the vessels and so on and out of the tissue itself from the injury. You don't want to promote more of that. In other words you want to keep that leakage of fluid because the more of that there is the more of an inflammatory response. Their body is trying to get rid of all this and fight all this off, it just becomes a bigger deal at that point. So you want to minimize that. If you think about it if you use heat that tends to promote more fluid moving into the tissue, more bleeding and so on and so forth.

It could cause more damage, couldn't it?

Dr. Willcox: More damage, right. So I recommend ice initially because that basically has the opposite effect, it kind of restricts to some extent and it calms things down. There's less fluid leakage, there's less bleeding. So ice initially and then heat later. Now later you want all this stuff that's leaked out into the tissue, you want it all absorbed and you want it all to go away and you want your ankle or whatever it is to heal. So heat then actually kind of promotes the whole metabolic process that's going on or the breaking down of protein fluids, the protein substance that's where it shouldn't be, breaking that down, taking that away. All the little white cells so on and so forth working. You've probably seen films and whatever in high school or whatever where you see all the little white cells at work and so on. You want your body to be doing its best to take care of these problems so heat at that point kind of just makes that happen a little fast and it of course feels soothing, it kind of tends to relax muscles that are kind of tight and it's also pleasant at that point in time. But it's not pleasant initially because it promotes more bleeding, more swelling and so on. So you've just got to use cold and heat in the right spot but both really help an amazing amount. Like I said, I've seen people here in the emergency department that didn't even need to be here if they would have known that. I don't know how many times I've heard, "Oh, gosh, I couldn't remember if it was heat or cold so I went with heat." I think that's why I always try to explain what's happening there and then it's more logical than just a guess. Well is it hot or cold, it makes sense that way.

Should we bandage or not bandage?

Dr. Willcox: Well, I would say in general yes if you're talking sprains. Again we'll use a sprained ankle as an example again. Compression is also a useful thing again initially. Sort of in the same time period that you're talking about ice. For the same reason to some extent, it might give some support but the main thing it does is by compression by not being as dispensable, the ankle fluid doesn't tend to just easily move into the extra vascular space and it just keeps the ankle in this case, from swelling as much and thus there are less problems later on. I think an Ace wrap initially is very useful. You see people wearing Ace wraps for weeks and I don't really recommend that. There are problems sometimes, people sometimes put them on too tight and then you get a lot of swelling above or distal to it. Sometimes I've seen people actually put a wrap around the ankle and then the foot swelled because it didn't extend on down into the foot. So you've got to do that right too but it does help. The other thing initially that really helps a lot and again for the same reason really is elevation. If you can stay off, we'll use the ankle again as an example. If you stay off your foot, if you're not putting pressure on it, obviously you're not re-injuring it. So that's another reason. Just elevating it, and again we usually say above your heart in those especially initially and the more severe cases, then that again tends to keep the fluid build up in the ankle in this case, from being as much. So those kind of elevation, compression, ice and the other thing is a question of anti inflammatories and Tylenol and pain relievers.

Is a prescription drug like a narcotic better than taking some regular aspirin?

Dr. Willcox: Yes that's true because the pain relievers for the most part don't have anti-inflammatory with them. Most of the narcotic type pain medicines usually have Tylenol in them, or acetaminophen. Acetaminophen is the generic name. There's a balancing act here and here's the balancing act. Acetaminophen is good in that it doesn't promote bleeding o.k., but it has no anti inflammatory effect. Ibuprofen, aspirin, naproxen, the anti inflammatories unfortunately have a tendency to promote bleeding a little bit. But they have an anti inflammatory effect and so actually, especially later on are very, very helpful in encouraging healing. So they actually not only have an analgesic or anti-pain effect, they actually have a beneficial effect because of the anti-inflammatory nature of those drugs.

So they really do promote the healing?

Dr. Willcox: Right, but then there is the other side of it, they do promote bleeding just a little bit. The platelets are important for your blood clotting and to be not as sticky when you take an anti-inflammatory, so they don't stick as well, they don't function quite as well, you can affect the clotting process just a little bit. So usually if I'm concerned about much bleeding, especially if something is getting black and blue right away, usually I'll hold off on aspirin or non steroidals initially just because I don't want to promote bleeding. As soon as I feel like that's not a problem usually in a day or so, then anti-inflammatories actually are better.

If that's not a problem and they are in pain and the prescribed amount on the bottle just isn't doing it for them, is there ever a time when they can take more than what the prescribed amount is?

Dr. Willcox: Well, yes and no. Here's the thing. Because it's over the counter most people think that the two hundred milligram ibuprofen, the little tablet that's over the counter, that that's the dose, one table every six hours or whatever. The fact is when we prescribe ibuprofen by prescription we prescribe six hundred milligrams or eight hundred milligrams. So I don't recommend going over a prescribed amount, what the amount should be but it tends to be under dosed over the counter and again it's because of the safety concerns and the fact that they are not seeing a doctor they are just buying the drug and taking it. But in general it's not a bad idea to check with the doctor or whatever to see if they are taking the appropriate dose in general. For an adult, three two hundred milligram ibuprofen rather than one would be the sensible dose.

A lot of it has to do with body weight and size?

Dr. Willcox: Absolutely. I usually try to go more by what their ideal weight would be. So if I see a person weighs three hundred pounds, but they are only three feet tall or something then I wouldn't prescribe by the weight probably. I'm of course exaggerating. But you're right, absolutely weight. But in general, an adult would be like six hundred milligrams. There are tiny people around. There are people that don't weigh very much, are not very big and they shouldn't tend to go on the high side. Certainly pediatrics is a whole different situation. As the pediatricians say, kids aren't just little adults, so you do have to be careful with medications with children. But some of the same principles apply.

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New Heart Attack Victims

Doctors say all of the medical education of risk factors and warning signs for heart attacks in men are working. Research shows over the last decade heart attacks have decreased 8 percent in this group. However, they are on the rise for women and the elderly. Now, doctors will have to shift gears for education.

A study by the Mayo Clinic examined more than 5,000 patients who were hospitalized for a heart attack between 1979 and 1994. They report while heart attack rates have dropped in 40-year-old men, they have increased in women, over 80 years of age, by almost 50 percent. Also, younger patients are surviving more heart attacks, but the effects are not true for people over 75.

The researchers write, "These findings indicate that the burden of coronary disease is shifting toward elderly persons and suggest that preventive and therapeutic gains have not been experienced equally throughout the population." They recommend more education be done to the female population, as well as the elderly population.

There are no definitive conclusions to explain the increase, however, the researchers do have some theories. They speculate more women may be smoking than in the past or more women have given up healthy lifestyles because they are working full-time. They also believe more of the medical education has been targeted at men and women have been excluded. The researchers are optimistic with focus on the elderly and women, the same positive effect will result as it has in men.

SOURCE: Archives of Internal Medicine, 2002;136:341-348

The Worry Trap

Worrying about little things usually isn't harmful and may even help people accomplish certain things and avoid hazards. Yet for some women, constant fretting can cause physical illness and interfere with relationships and the activities of their daily lives.

Dr. Edward Hallowell in his book, Worry: Hope and Help for a Common Condition, says that excessive worry is an exhausting and dangerous problem for millions of Americans. Everyone worries to a certain extent, but the difference is between those who can pull themselves out of this destructive pattern, and those who think about it so much that it becomes overwhelming and incapacitating.

How do you know when anxiety becomes an obsession and how much is too much worry? Experts say if worry is a habit that is out of control, makes people feel uncomfortable, interferes with sleeping patterns, and causes physical symptoms such as pacing, muscle tension or perspiration, then it is probably time to face the symptoms and take action.

Dr. Hallowell says the key to dealing with worry is to acquire the knowledge that will allow an approach to worry as a manageable problem instead of suffering through it as though there were nothing to be done about it.

Although everyone worries from time to time about family members, work, money, health and many other issues, research indicates that women may worry more than men do.

Worry expert, psychologist Susan Nolen-Hoeksema from the University of Michigan, has conducted research on gender differences in worrying. In a recently published article, she indicates that women tend to worry in response to distress more than men do. Women also have more difficulty in controlling negative emotions, which in turn, cause more worry. She has found that women also feel more responsible than men do for the emotional tone of relationships, and feel that they must maintain positive relationships with others at all costs. Nolen-Hoeksema also found that women feel less in control over important events in their lives than men do.

"Women know that worrying is not a good idea, but this apparently does not help some women avoid worrying," Nolen-Hoeksema says. "People know they would feel better if they avoided worrying, but worry anyway, perhaps because the emotions and thoughts they are focusing on are very compelling."

She believes that the key to decreasing worry is for women to achieve a balance and control of and attention to negative emotions.

Dr. Hallowell also advises that to stop worrying people should first get the facts about what they are worrying about. For example, are they worrying about aches and pains they've been experiencing lately and already jumping to the worst-case scenario that it could mean a fatal disease? Knowing the facts can help avoid jumping to incorrect conclusions.

Another way to stop worrying, according to psychologist Reid Wilson of the University of North Carolina, is to set aside time each day -- say 10 minutes-- to worry. By thinking only negative thoughts for a certain period of time each day, you eventually begin to shift your emotions. Worry time becomes boring and repetitive and you begin thinking positive thoughts about the situation you are worrying about. At the end of 10 minutes, you let your worries go and begin to relax. The theory behind this treatment approach is that if you stop fighting the worries by giving them space and support, their intensity diminishes. The worries just can't sustain themselves and soon you don't think about them anymore.

Experts also advise connecting -- with a family member or friend. Sharing fears can help get reassurance about those fears from those close to you. Experts agree that expending the energy thinking of ways to solve problems is more productive than spending the time worrying about things that may never happen. If people analyze their fears and take corrective action, soon the worry trap will set them free.

The Imposter Syndrome

Many people, at some time or another, have felt that they just aren't as expertly qualified in a certain area as they'd like to be in order to do a particular job. Somehow they find themselves doing it hoping no one finds out how little actual experience they have with the task at hand. Eventually, they learn as they go along. Psychologists say these feelings are normal and usually temporary. They are common in situations such as starting a new job where there's a learning curve involved. However, it's when these "imposter" feelings crowd out all others, particularly in women who have achieved credible successes that action should be taken to reverse the phenomenon.

In her book, If I'm So Successful, Why Do I Feel Like a Fake? Psychologist Joan Harvey says women plagued by the Imposter Syndrome cannot achieve enough success or recognition to ease the psychological pain and release them from the fear of being exposed as a fake.

"Victims of the Imposter Phenomenon are caught up in a cycle of emotions, thoughts, and actions that can virtually control their lives," Dr. Harvey says.

Gail Evans, an executive vice president at CNN, has written a book, Play Like a Man, Win Like a Woman, and devotes a chapter to the Imposter Syndrome. "The Imposter Syndrome causes us to live in constant fear that we will be discovered, that our inadequacies will be exposed, and that we will be humiliated, demoted and dismissed," Evans says.

She points out that women frequently spend as much energy trying to survive the impending "unmasking" of their inadequacies than they spend working at their jobs. "They also become very good at convincing themselves not to take risks because moving into new territory makes them even more vulnerable to exposure," Evans says.

How do you know if you exhibit signs of the Imposter Syndrome? Dr. Harvey points to three scenarios:

The sense of having fooled other people into overestimating your ability. There is a discrepancy between the way you see yourself and the way others see you.

Attributing your success to some factor other than intelligence or ability in your role.

The fear of being exposed as a fraud and suffering from anxiety.
Dr. Harvey believes these "imposter" feelings may originally come from family dynamics and labels attributed to children early on -- i.e. the smart one, the responsible one, etc. In order to fight these feelings, experts agree that women should be honest with themselves. Women should admit what they don't know and realize that no one knows everything about every subject. Instead, women should focus on learning more as they go and revise the standard by which they measure themselves. Dr. Harvey advises women to teach themselves to accept compliments, anticipate situations that bring on "imposter" feelings, and break the worry ritual.

Valerie Young, a self-described overcoming imposter, is a workshop leader and public speaker who tries to help women reach their full potential. She earned her doctoral degree in education from the University of Massachusetts in Amherst, and now helps other women eliminate psychological barriers.

In her seminars, Young instructs women to become more aware of imposter thinking by looking for stereotyping and self-defeating attitudes. She says that women often preface sentences with disclaimers such as, "this may not be right, but..." and they discount accomplishments with "anyone could have done it" or "it wasn't much."

Gail Evans says that confidence is half the game and advises replacing the imposter scenario with a self-confident one.

"Whenever you can convince yourself you'll score, your chances improve. When you convince yourself you'll fail, your chances diminish."

Acne in Adult Women

Acne is usually seen as a teenager's problem and is associated with french fries, burgers and chocolate. However, experts say that's not the case. Even adults, especially women, battle the problem.

Thirty-year-old Amy is a makeup artist. She knows if she doesn't clean her face properly, these products could impact her skin. However, she was surprised to find acne can show up later in life, regardless of how well you care for your skin.

Amy says, "As a teenager, I never had any acne, and as I got older, I started breaking out a little more. The last couple of years, I've really been breaking out."

Amy's not alone. According to a report in the New England Journal of Medicine, one out of five adult women battle acne.

Dermatologist says adult acne is primarily triggered by hormonal changes such as stress, pregnancy and some medications. The acne is caused by their hormone receptors. Anything that stimulates hormone production will worsen their acne.

A lot of women don't seek help, sometimes because they're too busy, and also, they're embarrassed. Kids have acne, women don't have acne.

There's another problem. Many of the treatments don't work. Sixty percent of women either don't respond to standard acne treatments or build up a tolerance to frequently used medications.

You can fight back. One way is with Aldactone, a drug that dries up oils. The most noticeable side effects to the person taking it are severe dry lips, dry eyes, things like that. It dries up the oil, but it dries up everything.

Aldactone works for Amy. Now she hopes other women won't be ashamed to get treatment. There are many treatments available. Some doctors prescribe birth control pills to control acne.

Bone Bank

You can't be too thin or too rich, right? Wrong. Very young dancers and other athletes are discovering that being too thin can mean thin bones too.
At 22, Helen's dreams seemed close to reality. "I'd spent my whole life believing I was going to be a professional ballet dancer with all the indications I had what it took to make it."

But then came a series of stress fractures and other dance-related injuries. This latest -- a broken kneecap -- is from a bicycle accident. Her periods had stopped, and, like so many dancers, she was extremely thin. So with 43 other young women like her, Helen enrolled in a study at Medical Center.

Doctor from the Center for Menopause, Hormonal Disorders and Women's Health, Medical Center, "We found very significant changes in their bones. Some of them had bones that were comparable to women in their 60's, 70's and 80's even."

Forty to 60 percent of normal bone develops during adolescence when sex hormones become active. When a young woman doesn't menstruate, her bones don't strengthen either -- even with vigorous exercise. So doctors tried the same hormone replacement therapy that prevents brittle bones in menopausal women. It didn't work. The study showed that for young women, the bone loss is apparently permanent.

Basically the bank closes at a certain age. That age is somewhere in the late 20's. And you draw on those deposits for the rest of your life.

Helen still dances, though not professionally. She's getting a doctorate in neuro-science and hopes her story will help other young dancers.

Skin Problems

Acne

This distressing and disfiguring complaint is mainly a teenager problem but can occur in older people as well. Teenage acne usually starts at puberty. There are many hormonal changes happening within the body at this time. As with most skin problems, acne treatment begins within the body. Following are some choices you can make for yourself for a healthy body and a healthy skin.

• Make sure that your bowels are regular.
• Eat lots of raw and cooked vegetables and fruit daily.
• Cut out, or certainly cut down on, eating junk foods.
• Think about taking the following daily supplements – multi vitamins/minerals, extra vitamin B6, vitamin E (d-alpha-tocopherol), vitamin C plus 15mg zinc, evening primrose capsules.
• Exercise every day as this increases circulation, which brings healing nutrients and oxygen to the skin.
• Drink six glasses of purified water daily.
• Treat your face to 10 minutes of sunlight a day, preferably early in the morning or late afternoon.
• Reduce salt intake.
• Talk to a doctor about Retin A therapy.
• Before breakfast, drink a glass of water containing the juice of one lemon, with no sweetener.
• Learn to relax. Join a stress management or meditation group; spend time peacefully alone; make sure you budget time for fun.
• Wash the face two times a day using very mild soap which contains glycerine, when rinse well with lukewarm water, and pat dry using a fresh towel each time if there are any weeping spots.
• Try to avoid using makeup. I know that this is hard but you stand a better chance of healing if you do this. Use only the Herbal Healing Day Oil and Herbal Healing Night Oil on your skin.
• Have a facial steam once or twice a week.
• Never, but never, be tempted to squeeze a pimple. The result of this type of interference will be scarring and a spread of infection.
Skin problems during adolescence can be greatly helped by the use of natural astringents.

Blackheads

When the sebaceous glands oversecrete and the excess sebum doesn’t move out of the duct, a blackhead results. This can become a problem if not properly dealt with, as the pore can become infected if the blackhead is carefully removed, but the area isn’t disinfected.

Facial scrubs are useful in the prevention of the formation of blackheads. The safest way to remove blackheads is to stem the skin, using boiling water and antiseptic oil to prevent infection. This loosens the sebum and relaxes the pores. Basic steam procedure for blackheads is as follows:

• Three-quarters fill a large bowl with boiling water.
• Place one drop tea tree essential oil and two drops geranium essential oil on the water, and cover your head with a towel, forming a tent around the bowl and your head.
• Steam for about 10 minutes, keeping your face about 12 in (30 cm) away from the bowl of water.
• Pat your skin dry.
• With absorbent cotton (cottonwool) wrapped around your nails, gently press the skin on either side of the blackhead until it pops out, or use a little tool for extracting blackheads, available from cosmetic counters and pharmacies.

Blackhead Remover

Never attempt to squeeze blackheads until the skin is soft, moist, and warm – as after one of the following treatments. Use a special tool for extracting blackheads or cover your nails with absorbent cotton (cottonwool) before squeezing.

• Steam the face using a blend of bay leaves, fennel seeds, lemon grass, and nasturtium leaves.
• Make and use a scrub using oatmeal.


Broken Veins Compress

Make a triple-strength tea of borage leaves and flowers, calendula petals, and chamomile flowers. Strain through coffee filter paper and apply daily as a cool compress.

Dermatitis

Dermatitis is inflammation and/or irritation of the skin. It is usually caused by sensitivity to a substance or substances with which the skin has come in contact. Bar workers and hairdressers often suffer from dermatitis due to daily skin contact with beer and the chemical used in hairdressing. Obviously, the condition won’t clear until the irritant is removed and in extreme circumstances this can mean giving up work. Stress is another factor that can aggravate the condition. The following eczema treatment is appropriate for dermatitis.

Eczema

This is an inflammatory condition of the skin that manifests variously as itching, skin inflammation, dry, thickened skin, and tiny blisters that burst, weep, and can become infected. It is a very difficult problem to treat – particularly if the cause isn’t found. Look for the cause among allergies, low stomach acid, stress, poor or inadequate diet, dysfunctional immune system, or build up of toxins.

Initially the aims of aromatherapy treatment are to lower stress, ease the itching, and so prevent scratching, and to promote healthy new skin tissue. Various oils should be tried until suitable ones are found.

Psoriasis

Psoriasis is a skin condition characterized by thick, scaly, pink patches of cells with overlapping, slivery scales. It usually appears on the scalp, back of the wrists, elbows, knees, and ankles. The condition is difficult to treat and patience may be needed. Stress or an underfunctioning liver may be the cause, and until the cause is found and addressed there will be no permanent cure.