WARTS: AN INTRODUCTION

Did you know that there are only 2 kinds of warts? This is a good thing, because it makes self-diagnosis and treatment of warts quite simple. You can treat your own warts at home, but you should not be shy about going to your doctor to have warts treated. You see, doctors like warts. Warts give a doctor an opportunity to cut, shave, and freeze- satisfying procedures that make us feel like we're "doing something." I always get excited when a patient is coming in to have some warts treated, because I know it's going to be fun.
THE TWO KINDS OF WARTS:

1. Genital warts: these are caused by a strain of the human papilloma virus, or HPV. They generally occur in the genital area, but can occur on the anus as well. While they don't always cause cancer, they do have the ability to transform skin cells into cancer cells in some cases. For that reason, it's not a great idea to leave genital warts around, hoping that they will go away. It's also pretty hard to treat these at home; over-the-counter wart medications don't usually work on genital warts, and most of them will require a prescription cream or some freezing.

2. Common warts: these are the raised, rough warts that occur on the hands, elbows, and the feet, usually on the bottoms of the feet. These warts are also caused by a virus, in this case a strain of virus called human herpes virus 8, or HHV. The terminology is confusing because HHV is not a true herpes virus, and it does not cause herpes. It just causes these benign, painless, but annoying warts on hands and feet. Unlike genital warts, common warts do not ever cause cancer and they can be treated at home.

HOW DO WARTS SPREAD?
1. Genital warts: unfortunately, genital warts are very contagious. Brief skin contact with a genital wart can transmit the HPV virus from person to person. What's worse is that skin and mucus membrane contact with someone who has HPV can transmit genital warts EVEN IF the infected person does not have any warts, and EVEN IF they have never had any manifestations of HPV. For this reason, genital warts are scary, and they are common. Only condoms can prevent you from getting genital warts.
2. Common warts: the amazing truth is that we don't really know how common warts on the hands and feet are spread from person to person. You can touch someone's hand wart every day for years, and you probably won't get a wart. There are theories, none of them remotely proven, that the HHV virus that causes common warts lives in soil, bathroom floors, etc- but the truth is that we don't know. If you have a common wart, and chances are that you will sometime in your life, we just don't know where it came from.
HOW WARTS ARE TREATED: GENITAL WARTS
Most commonly, genital warts are given a freezing treatment with liquid nitrogen in your doctor's office. There is a cream called Aldara that has revolutionized genital wart treatment- this is applied at home and can completely eliminate warts, though it does cause skin irrititation. You need a prescription for this from your doctor. In my office, I usually freeze genital warts first, then have my patients use Aldara at home; in combination, the 2 treatments can eliminate the vast majority of genital warts. There are other topical medications that your doctor can prescribe as well. If all else fails, dermatologists can remove the most stubborn genital warts surgically or with laser treatment.
HOW WARTS ARE TREATED: COMMON WARTS
Freezing works great for common warts, but there are effective treatments you can use at home. You may have heard of patients treating warts by covering them with duct tape- this may work, but only about 30% of the time. Duct tape is actually a pretty crappy wart treatment when used alone. But salicylic acid is a great treatment, and it's available in drug stores without a prescription. As a liquid it is sold as "Compound W" which is dropped on the wart; it also comes in little patches, most notably Mediplast (by Dr. Scholl's). For home treatment I recommed that patients apply a Mediplast patch over warts, then cover the patch with duct tape. Any time the patch and tape falls off, it needs to be replaced with a fresh patch. This is important because it takes about 2 weeks of continuous coverage with salicylic acid to remove a wart. I'm not sure the duct tape does much, but it does help keep the salicylic acid patch in place. Using this method, all but the largest warts will usually completely fall off in 2 weeks.
You can also speed up the removal of a wart by filing down the dead skin. Periodically take a nail file or pumice stone, and rub off the top part of the wart. Don't do this if the wart starts bleeding.
Finally, some new products available in drug stores allow you to freeze your own warts. These products are not as cold as the liquid nitrogen doctors use, but they still can work. If you use one of these sprays or applicators, make sure to freeze the wart until it's completely white, then allow it to thaw out, and freeze it again 2-3 times. If it does not hurt at least a bit, you are probably not freezing the wart enough. The skin under the wart may blister after freezing- if so, leave it alone. Eventually it should dry out and the wart should fall off.
If home treatment does not work, you should see your doctor. Your doctor may cut some of the dead tissue off the top of the wart (this is painless), then freeze the wart underneath. For large warts, it can take 3-4 treatments (usually once a month) to finally get rid of a wart. But all warts can be conquered eventually!

THE SIMPLE TRUTH ABOUT VITAMINS

    "Should I take any vitamins?"   That's a question I get all the time in clinic.   Not that patients listen to me; many have a laundry list of vitamins they take, regardless of what I tell them.   I just can't seem to get people to stop taking vitamins- perhaps because people think they are "natural," which they are not, they must be good for you.   In fact, ALL vitamins you buy in the store are synthesized in a chemistry laboratory.   There is nothing the least bit natural about them.

     The worst thing about vitamins is that, for the most part, they don't work.   Enormous studies have tried, optimistically, to find some health benefit of supplemental B vitamins, vitamin C, vitamin A, and vitamin E; to no avail.    In fact, vitamin A seems to increase cancer risk, though only very slightly.   These other vitamins, when taken as a supplement, probably do little or nothing.

     Are there any vitamins worth taking?   I'd have to say yes, in some circumstances.   Vitamin D is looking pretty good these days, for a number of reasons:

1. As our awareness of skin cancer grows, our exposure to sun goes down, and sun produces vitamin D in the skin, a major source for humans.   As a result, vitamin D deficiency is extremely common.

2. Vitamin D is essential for calcium absorption, and therefore to bone health.   To maintain strong bones, you need vitamin D as much as you need calcium.

3. Studies have shown that vitamin D seems to have properties essential to the nervous system as well.   Seniors, for example, had better balance and fewer falls when they took vitamin D in a recent study.

WHAT ABOUT MULTIVITAMINS?

      "Multivitamins" are usually "multivitamin/multimineral supplements." That is to say, they have most essential vitamins in them AND most of the essential minerals in various amounts.   There is little scientific evidence that multivitamins have a major benefit on health.   This is probably because a reasonably balanced diet has all the vitamins and minerals we need, in appropriate amounts.  However, unlike individual vitamin supplements which usually have huge quantities of a single vitamin, most "one-a-day" multivitamins have a modest amount of all the main vitamins.   For this reason, I have less of a problem with these- overall, my opinion is that a daily multivitamin can't hurt.   I take one myself (regular Centrum one-a-day).   I know it contains a modest amount of a good vitamin, namely vitamin D.   It also has a few minerals I might not get enough of, such as iron, calcium, and zinc.   As for the rest, I probably don't need it- but at least nothing is present in large amounts.

VITAMINS: SUMMARY

1. Take a multivitamin once a day if you want to and can afford to; but if your diet is fairly diverse, you probably don't need it.   If your diet sucks, and especially if you don't eat lots of vegetables, you might actually benefit from taking a multivitamin.

2. Don't spend a ton of money on a multivitamin.   Good old Centrum, and drug-store generic equivalents of Centrum, have an excellent and broad formulation of all essential vitamins and minerals, coming from a reputable lab.   Health-food-store multivitamins are more expensive and of questionable quality in some cases.

3. If you are thin, elderly, don't eat dairy products, or have ever had a fracture, you might want to take a mixed calcium/vitamin D supplement.   This is often NOT a good idea if you have had kidney stones.    A total daily dose of 1200 mg of calcium and 800 IU of vitamin D is a good bet, but talk to your doctor if you're a senior citizen- you might benefit from a higher or lower dose. Overall, few vitamins or minerals have the proven benefits of calcium and vitamin D!

4. Keep your diet varied and variable.   The more different things you eat, the more you are offering your body all the vitamins and minerals it needs, in a variety of forms.   No tablet is ever going to do for you what a good diet can.  

THE NUMBERS DON'T LIE: THE FRENCH ARE HEALTHIER

    Well, I finally got some hard data and the truth hurts: despite smoking more, drinking more alcohol, and eating fattier food than Americans, the French actually do live longer than we do.   Life expectancy in France is a full 3 years more than it is in America.  That may not sound like much, but when you look at the full spectrum of countries, it turns out that France has a longer life expectancy than the vast majority of European countries; moreover, the U.S. has a shorter life expectancy than ANY European country, with the exception of Ireland and Denmark.  Even (gasp) Bosnians live longer than Americans do.  So rather than asking, "why do the French live longer than we do?" you might ask "why do Europeans live longer than we do?"

      I have no frickin idea, to tell you the truth.   I have only been to the Netherlands, Ireland, England, Greece, and now France.   I can understand why Greeks live longer than we do- I have never seen so much salad and fresh seafood consumed as I did when I hung out in Greece.   Moreover, Greeks seemed to be chronically happy and relaxed most of the time.   But the French are an enigma.   They seem to suck down cigarettes the way Greeks suck down salad.   They eat meat in more varieties than I thought possible.  They seem to start consuming alcohol with gusto around noon.   Is it the carbs?   No.  Consuming a baguette a day (made with white, processed flour) is the norm among the French, and that's after they have enjoyed croissants and various pastries all morning.  

       So why, in fact, do French people live longer than Americans?  Here are my leading theories:

1. The French are not as fat as Americans.   

2. They walk more.   At least in Paris, if you can't walk well you are fairly hosed, because driving a car is supremely difficult and parking a car is impossible.

3. They work less.   This assumes, of course, that work is not healthy, which I'm not sure has really been proven.  But French people seem to take very long lunches and go home early.  Sounds at least mentally healthy.

4. French people clearly eat more fruit than Americans.   Fruit is everywhere.   The crappiest theatre or museum snack bar or coffee-cart in France sells little fruit salads, and all over Paris people are eating their fruit.   I can't remember the last time I saw an American pay to eat fruit in a restaurant.   

5. Flies must carry some essential nutrient.   I say this because in Paris, much food is sold in open-air markets and all the food has flies landing on it.  In all seriousness, the cheese shops all have open doors and the cheese has flies just relaxing on it.     In fact, the more expensive the cheese in Paris, the more flies there are walking around on that cheese.   It would be impossible to get a good piece of meat, fish, or cheese in Paris without flies being on it at the time of purchase.   One can only conclude that flies somehow improve the quality, or health value, of the food in France.

      Obviously, none of these theories are very satisfactory.   If you have your own theory, feel free to let me know.   In the meantime, I'm going to start eating moldier cheese and trying to encourage more flies to land on in.