Diabetes management is More than A Notion.... WHEW !!

We're talking time . . .  from 9:40 am testing....

Its now 10:20 to consume health breakfast.... food fix-up time, chew slowly....inject Humalog w/least pain....

 

Something New..... Always Monitoring the Diabetes Monstor ~ Deep Within !

A New Free Meter.....     Touch screen + download data....
A Bowl of Oatmeal w/milk....

and slice of Raisin/Cinnamon Toast w/Smart Balance Butter!  No other sugars or jelly!

My drink of the day.....

lemon, lime and orange slices in water!!!

Wells' Syndrome.... it's a flare up via 4 yrs!!!

Itching, itching, and mild swelling... annoying deep skin pain!!

Definition

Wells syndrome is a rare condition of unknown cause. It is also called ‘eosinophilic cellulitis’. What does Wells syndrome look like? Typically the rash is preceded by itching or burning skin and consists of markedly swollen nodules and plaques (lumps) with prominent borders. The patches are usually bright red at first, frequently looking like cellulitis, then fade over four to eight weeks, leaving green, grey or brown patches. They can blister. The rash most commonly occurs on the limbs, but may also affect the trunk. The patient often feels very tired and has a fever in approximately 25% of cases. Recurrent cellulitis followed by an eruption of skin lesions that are usually brawny, filled with fluid, and heavily infiltrated by eosinophils and histiocytes. Also called eosinophilic cellulitis. A blood count may reveal increased numbers of white blood cells called eosinophils – these are often associated with allergy or insect bites. The diagnosis of Wells syndrome can be established by a skin biopsy finding of typical histopathological features with many eosinophils and characteristic ‘flame figures’. However, flame figures are not diagnostic of Wells syndrome and can be seen in other conditions that have increased numbers of eosinophils. An important part of the management of patients with Wells syndrome is to exclude underlying causes such as parasitic disoders (e.g. a worm infestation) or an allergic contact dermatitis with the help of the appropriate tests. Treatment Oral corticosteroid treatment with prednisone can lead to a dramatic improvement within days and the course is typically tapered over one month. Other treatments include minocycline, dapsone, griseofulvin, ciclosporin and oral antihistamines. Mild cases may respond to topical steroid therapy alone.

Approach Considerations

There are numerous treatment options for Wells Syndrome (eosinophilic cellulitis), including the use of topical corticosteroids, calcineurin inhibitors, griseofulvin, H1 antihistamines, cyclosporine, dapsone, and systemic corticosteroids.^[38]
Systemic corticosteroids are the most effective treatment, but they may lead to corticosteroid dependence.

I'm a Rare Disease Person....in addition to diabetes huh?

Wells Syndrome:  Background

In 1971, George Wells first described this syndrome as a recurrent granulomatous dermatitis with eosinophilia.^[1] Wells and Smith renamed it eosinophilic cellulitis in 1979.^[2]
Wells syndrome (eosinophilic cellulitis) is an uncommon condition of unknown etiology. The presentation usually involves a mildly pruritic or tender cellulitis-like eruption with typical histologic features characterized by edema, flame figures, and a marked infiltrate of eosinophils in the dermis.^[3] Papular and nodular eruptions at the clinical presentation have also been reported.^{[4, 5]} The condition can recur and may be preceded by a pruritic papular eruption. Although Wells syndrome is usually sporadic, some familial cases have been reported.
One study showed the successive occurrence of vasculitis, Wells syndrome, and Sweet syndrome in a patient. This finding suggests that there is an overlap between these diseases.^[6] Another report describes a dominant syndrome consisting of eosinophilic cellulitis, mental retardation, and abnormal body habitus in one family.^[7]

Next Section: Etiology

Pathophysiology

At least some cases of Wells syndrome (eosinophilic cellulitis) may represent hypersensitivity to an arthropod bite or sting. An impressive response of peripheral lymphocytes to mosquito salivary gland extracts has been documented in some patients with Wells syndrome.^[8] A dermal infiltrate of histiocytes, eosinophils, and eosinophilic granules occurs between collagen bundles, which forms the classic flame figures. The eosinophilic infiltrate is almost always restricted to the epidermis and the dermis, but it has also been found in the subcutaneous tissue and the underlying muscle. The location of the infiltrate is correlated with the different clinical features.
In one study, immunophenotyping of peripheral T cells revealed an increased proportion of CD3⁺ and CD4⁺ T cells.^[9] These lymphocytes spontaneously release significant amounts of interleukin 5 (IL-5); this finding suggests that activated T cells may be involved in the pathogenesis of blood and tissue eosinophilia. The eosinophils then degranulate in the dermis, causing edema and inflammation.^[10]
With immunofluorescent stains, eosinophil major basic protein is identified in the granules of the flame figures. On electron microscopy, the collagen fibers are intact; this finding suggests that an initial degeneration of collagen is not a factor in initiating the formation of flame figures.

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Next Section: Etiology

Etiology

The etiology of Wells syndrome (eosinophilic cellulitis) is unknown. Wells syndrome may be due to drugs, various infections, and, possibly, nonhematologic malignancies as trigger events.^{[11, 12]}
Wells syndrome is usually sporadic, but some familial cases have been described. Suggested precipitating factors include the following:

• Arthropod bites and stings, including those of the honeybee^[13]
• Cutaneous viral infections; there is a possible link between parvoviral infection and Wells syndrome^[14]
• Cutaneous parasitic infestations, including toxocariasis,^{[15, 16]} ascariasis,^[17] and onchocerciasis^[18]
• Leukemia
• Myeloproliferative disorders
• Atopic dermatitis
• Fungal infections
• Hypersensitivity reactions to medications or metals, including metallic alloy implants^[19]
• Churg-Strauss syndrome: This syndrome has been associated in a few patients^[20] ; these reports are noteworthy for the presence of bullae and of antineutrophil cytoplasmic antibodies^[21] ; only a few other autoimmune diseases have been associated, including a case report of systemic lupus erythematosus^[22] ; sometimes, differentiating between these disorders can be challenging^[23]

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Next Section: Etiology

Epidemiology

Wells syndrome (eosinophilic cellulitis) is rare. Only about 80 cases have been reported worldwide.
Wells syndrome usually affects adults, but it has been known to occur in children.^{[24, 25, 26, 27]} In one case series of 19 patients, the classic plaque-type presentation was the most common variant found in children, whereas the annular granuloma–like variant was the most common variant in adults.^[28]

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Next Section: Etiology

Prognosis

The prognosis for patients with Wells syndrome (eosinophilic cellulitis) is excellent. It tends to resolve in weeks or months, usually without scarring. It occasionally recurs. In these recurrent cases, it can take years to ultimately resolve.

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 Contributor Information and Disclosures

Author  Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School 

Additional Contributors   David F Butler, MD Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.
Rosalie Elenitsas, MD Herman Beerman Associate Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System
Rosalie Elenitsas, MD is a member of the following medical societies: American Academy of Dermatology and American Society of Dermatopathology
Disclosure: Lippincott Williams Wilkins Royalty Textbook editor; DLA Piper Consulting fee Consulting
Takeji Nishikawa, MD Emeritus Professor, Department of Dermatology, Keio University School of Medicine; Director, Samoncho Dermatology Clinic; Managing Director, The Waksman Foundation of Japan Inc
Disclosure: Nothing to disclose.

References

1. Wells GC. Recurrent granulomatous dermatitis with eosinophilia. Trans St Johns Hosp Dermatol Soc. 1971;57(1):46-56. [Medline].
2. Wells GC, Smith NP. Eosinophilic cellulitis. Br J Dermatol. Jan 1979;100(1):101-9. [Medline].
3. Brehmer-Andersson E, Kaaman T, Skog E, Frithz A. The histopathogenesis of the flame figure in Wells' syndrome based on five cases. Acta Derm Venereol. 1986;66(3):213-9. [Medline].
4. Ghislain PD, Van Eeckhout P. Eosinophilic cellulitis of papulonodular presentation (Wells' syndrome). J Eur Acad Dermatol Venereol. Mar 2005;19(2):226-7. [Medline].
5. Holme SA, McHenry P. Nodular presentation of eosinophilic cellulitis (Wells' syndrome). Clin Exp Dermatol. Nov 2001;26(8):677-9. [Medline].
6. Consigny S, Courville P, Young P, et al. [Histological and clinical forms of the eosinophilic cellulitis]. Ann Dermatol Venereol. Mar 2001;128(3 Pt 1):213-6. [Medline].
7. Davis MD, Brown AC, Blackston RD, et al. Familial eosinophilic cellulitis, dysmorphic habitus, and mental retardation. J Am Acad Dermatol. Jun 1998;38(6 Pt 1):919-28. [Medline].
8. Koga C, Sugita K, Kabashima K, Matsuoka H, Nakamura M, Tokura Y. High responses of peripheral lymphocytes to mosquito salivary gland extracts in patients with Wells syndrome. J Am Acad Dermatol. Jul 2010;63(1):160-1. [Medline].
9. Plotz SG, Abeck D, Behrendt H, Simon HU, Ring J. [Eosinophilic cellulitis (Wells syndrome)]. Hautarzt. Mar 2000;51(3):182-6. [Medline].
10. Espana A, Sanz ML, Sola J, Gil P. Wells' syndrome (eosinophilic cellulitis): correlation between clinical activity, eosinophil levels, eosinophil cation protein and interleukin-5. Br J Dermatol. Jan 1999;140(1):127-30. [Medline].
11. Kaufmann D, Pichler W, Beer JH. Severe episode of high fever with rash, lymphadenopathy, neutropenia, and eosinophilia after minocycline therapy for acne. Arch Intern Med. Sep 12 1994;154(17):1983-4. [Medline].
12. Hirsch K, Ludwig RJ, Wolter M, et al. Eosinophilic cellulitis (Wells' syndrome) associated with colon carcinoma. J Dtsch Dermatol Ges. Jul 2005;3(7):530-1. [Medline].
13. Lin HL, Lin JN, Chen CW, Kuo LC, Lee WC. Eosinophilic cellulitis after honeybee sting. J Formos Med Assoc. Dec 2009;108(12):964-6. [Medline].
14. Cherng E, McClung AA, Rosenthal HM, Hicks J, Levy ML. Wells' Syndrome Associated with Parvovirus in a 5-Year Old Boy. Pediatr Dermatol. Dec 9 2011;[Medline].
15. Hurni MA, Gerbig AW, Braathen LR, Hunziker T. Toxocariasis and Wells' syndrome: a causal relationship?. Dermatology. 1997;195(4):325-8. [Medline].
16. Bassukas ID, Gaitanis G, Zioga A, Boboyianni C, Stergiopoulou C. Febrile "migrating" eosinophilic cellulitis with hepatosplenomegaly: adult toxocariasis - a case report. Cases J. Nov 28 2008;1(1):356. [Medline].
17. Tsuda S, Tanaka K, Miyasato M, Nakama T, Sasai Y. Eosinophilic cellulitis (Wells' syndrome) associated with ascariasis. Acta Derm Venereol. Jul 1994;74(4):292-4. [Medline].
18. van den Hoogenband HM. Eosinophilic cellulitis as a result of onchocerciasis. Clin Exp Dermatol. Jul 1983;8(4):405-8. [Medline].
19. Zhu L, Hu D, Wang Q, Hou J, Li M. Diffuse polymorphic eosinophilic cellulitis in a patient with metallic alloy implants: a possible association?. Int J Dermatol. Dec 2011;50(12):1535-7. [Medline].
20. Lee SH, Roh MR, Jee H, Chung KY, Jung JY. Wells' syndrome associated with churg-strauss syndrome. Ann Dermatol. Nov 2011;23(4):497-500. [Medline]. [Full Text].
21. Fujimoto N, Wakabayashi M, Kato T, Nishio C, Tanaka T. Wells syndrome associated with Churg–Strauss syndrome. Clin Exp Dermatol. Jan 2011;36(1):46-8. [Medline].
22. Yin G, Xie Q. Systemic lupus erythematosus associated with Wells' syndrome. Rheumatol Int. Feb 22 2011;[Medline].
23. Omiya W, Fujita Y, Baba K, Shibaki A, Odani T, Shimizu H. Unusual cutaneous manifestations of Churg-Strauss syndrome mimicking Wells' syndrome. Eur J Dermatol. Jun 15 2012;[Medline].
24. Anderson CR, Jenkins D, Tron V, Prendiville JS. Wells' syndrome in childhood: case report and review of the literature. J Am Acad Dermatol. Nov 1995;33(5 Pt 2):857-64. [Medline].
25. Nielsen T, Schmidt H, Sogaard H. Eosinophilic cellulitis. (Well's syndrome) in a child. Arch Dermatol. Jul 1981;117(7):427-9. [Medline].
26. Shams M, Hudgens J, Lesher JL Jr, Florentino F. Wells' syndrome presenting as a noninfectious bullous cellulitis in a child. Pediatr Dermatol. Mar 2012;29(2):224-6. [Medline].
27. Powell JG, Ramsdell A, Rothman IL. Eosinophilic cellulitis (Wells syndrome) in a pediatric patient: a case report and review of the literature. Cutis. Apr 2012;89(4):191-4. [Medline].
28. Caputo R, Marzano AV, Vezzoli P, Lunardon L. Wells syndrome in adults and children: a report of 19 cases. Arch Dermatol. Sep 2006;142(9):1157-61. [Medline].
29. Spinelli M, Frigerio E, Cozzi A, Garutti C, Garavaglia MC, Altomare G. Bullous Wells' syndrome associated with non-Hodgkin's lymphocytic lymphoma. Acta Derm Venereol. 2008;88(5):530-1. [Medline].
30. Odia SG, Purschel W, Worret WI, Rakoski J. Hypereosinophilic cellulitis(Wells' syndrome) resembling urticaria. Acta Derm Venerol (Ljubljana). 1994;6:193-195.
31. Mutasim DF, Cooper CH. A case of Wells' syndrome in a patient with lymphocytic lymphoma. Geriatr Dermatol. 1996;4(1):11-14.
32. Falagas ME, Vergidis PI. Narrative review: diseases that masquerade as infectious cellulitis. Ann Intern Med. Jan 4 2005;142(1):47-55. [Medline].
33. Leiferman KM, Peters MS. Reflections on eosinophils and flame figures: where there's smoke there's not necessarily Wells syndrome. Arch Dermatol. Sep 2006;142(9):1215-8. [Medline].
34. Moossavi M, Mehregan DR. Wells' syndrome: a clinical and histopathologic review of seven cases. Int J Dermatol. Jan 2003;42(1):62-7. [Medline].
35. Stern JB, Sobel HJ, Rotchford JP. Wells' syndrome: is there collagen damage in the flame figures?. J Cutan Pathol. Dec 1984;11(6):501-5. [Medline].
36. Peters MS, Schroeter AL, Gleich GJ. Immunofluorescence identification of eosinophil granule major basic protein in the flame figures of Wells' syndrome. Br J Dermatol. Aug 1983;109(2):141-8. [Medline].
37. Aberer W, Konrad K, Wolff K. Wells' syndrome is a distinctive disease entity and not a histologic diagnosis. J Am Acad Dermatol. Jan 1988;18(1 Pt 1):105-14. [Medline].
38. Herr H, Koh JK. Eosinophilic cellulitis (Wells' syndrome) successfully treated with low-dose cyclosporine. J Korean Med Sci. Oct 2001;16(5):664-8. [Medline].
39. Church MK, Maurer M, Simons FE, et al. Risk of first-generation H(1)-antihistamines: a GA(2)LEN position paper. Allergy. Apr 2010;65(4):459-66. [Medline].
40. Brown J, Schwartz RA. Wells' syndrome (eosinophilic cellulitis). Cesko-Slovenska Dermatol. 2002;77:261-263.

 

 

 

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Happy Wednesday !

Rejoicing over Diabetes....

Hurray.... for a being a GOOD DIABETIC  !! live long, live well!

Black Folk eating good ol' Greens (aka Kale)

Yippee! My Vitamin D ~ Guide sheet

The Aretha Franklin Snicker Commercial

Habits form when you associate pleasure to an action, whether that action is going to serve you in reaching your goals or not is another story. However, you can use this information to your advantage and practice creating new, positive associations to habits you want to form - like eating a salad instead of having fries, or drinking a glass of water before anything in the morning....


CRAP vs. FOOD   Wellness Blogger/site

I've found a blog friend named Annie's Ruby Slipperz

Annie's Ruby Slipperz

Luvin my Healthy Life Choices

. . . .you probably already knew about all the bad things

 that can happen to you if you are in a

 "STRESS MESS" 

Thought processes go awry, not thinking clearly, inability to remember.
 Stress affects emotions, (feeling extra sad, frustrated, irritable)

It's dangerous to the heart, (high blood pressure, blood clots, strokes)
Stress can reek havoc on stomach and intestines (ulcers, acid reflux
irritable bowls, vomiting, and diarrhea).  And, skin suffers too,
(eczema, acne, cold sores and fever blisters), and...
with stress the immune system is in a weakened state.   

Some things that can help...

1)

Music...Playing calm music has a positive effect on

the brain and body, can lower blood pressure, and reduce cortisol,

 a hormone linked to stress.

2) 

Call a Friend...when stress hits, take a minute and

call a friend to discuss your problems.  A kind, reassuring voice,

even for a minute can bring things into perspective.

3)

 Eat right (and take vitamins)...stress levels and diet are closely related

When we are stressed we tend to want sugar and fatty foods.

These can make stress worse.  Fruits and Vegetables are

And, fish with high levels of omega-3 fatty acids,

which have been shown to reduce the symptoms of stress.

A tuna sandwich really is brain food.

4) 

 Laughter is good medicine...yep, it's true!  It releases

endorphins that improve mood and decrease levels of the

stress-causing hormones cortisol and adrenaline.

 5)

 Exercise (Even For a Minute)...you don't have to power lift

or train for a marathon.  Even a short walk around the office

or taking a short break to stand and stretch can relieve stress.

Getting your blood moving releases endorphins and can improve

mood almost immediately.  I need to go for a walk instead
of walking to the pantry!

 6)

 Sleep...stress causes many to lose sleep. And, lack of

sleep causes stress...Yikes! a vicious circle.  Make every effort

to get enough sleep (at least 7-8hrs).  It may be the best stress buster

HEALTH wisdom

Today's Lunch hour was serene

and  beautiful..... The OU Medical center outside eating area was so calming.  After I've have blood work done to check my Vit D levels...

 Above picture of an ORANGE SHERBERT (color and tasty) cupcake was not to be resisted.   It's OK... since I truly turn down breakfast donuts and other sugary foods..... THIS was my heavenly moment to indulge!

A little nostalgia.... I'm planning my 5960 Birthday party for the 1st Saturday in January 2013!!!  I'm remembering that my favorite color really is this peachy - orange sherbert!...   I was married in this color.... with a light blue coordinate... and I think I'll find me a casket and clothing to match warm-hearted peachy color!!!  

Wednesday Words for T2D (type2diabetes)

".......Unwilling to let the debilitating disease take his life, he began micro-managing every move he made and took control, one bite of food, one insulin injection, and one step at a time.
Mandell learned to live differently and, in doing so, realized that the restorative journey he'd embarked upon was one that could help others live better as well. "If everybody lived as if they were diabetic, you'd see all kinds of diseases going out the window," he said.

online magazine reading....  Type 2 Trudges Across America to Defeat Diabetes  Andy Mandell

Aug 17, 2012 

Diabetes and Muscle Cramps last night....

Potassium (K), 

A problem with muscle cramps can sometimes be a problem with the muscle not being able to function properly due to a lack of proper electrolite balance. Potassium (K),

Calcium (Ca), 

and Magnesium (Mg) are absolutely essential for a muscle to be able to properly fire....and to properly relax. 

If there is a lack of these minerals in the body, the muscle can temporarily lose the ability to relax and, therefore, cramps. 

Try taking K, Ca, and Mg suppliments regularly and see if that doesn't make a huge difference.

This could also be the effect of insulin resistance. I'm not sure of your weight or sugar intake, but if you have too much sugar or processed crap in your diet for a prolonged period of time, the body goes into what is called insulin resistance. Insulin is an anabolic hormone that also serves to store calcium and magnesium. Insulin resistance, by these means, can be a cause of not only muscle cramps

Read more: http://wiki.answers.com/Q/Why_do_you_get_leg_cramps_at_night#ixzz24koTLFQw

Water for T-2 Diabetics

It has been a theory . . . . .that a rapid drop in blood sugars can cause muscle cramping. I would suggest testing your blood glucose to see if this is the case with you.

Also dehydration sometimes causes muscle cramps, and patients with diabetes can potentially dehydrate faster. Make sure you drink enough water during the day.

What's a 'nonreactive' pot

NONREACTIVE  aka Lemon Meringue Pie

When a recipe calls  a 'nonreactive' pot for using or pan to cook something in, it is calling for a pan made of a material that will not react with acids or brines (tomatoes, pickles, etc). Glass, stainless steel and enameled are the most common nonreactive pans.  Undamaged nonstick pans may also be used, but be sure there are no scratches or other damage to the non-stick coating. Acid foods may react by discoloring food, forming toxic substances, and may effect both flavor and texture.  Salty mixtures may also pit aluminum pans if they are left standing in the pan.

Reasons to Eat Fruit !!

Living well,,, Total Wellness.... Loving Life....!!!