3 eclectic holiday gift ideas from Examined

Something for your feet, heart, and armpits.

I’m working on the next monthly installment of the Covidlandia series, curating studies of interest to primary care. It’s been a busy week with Thanksgiving and back to work! I hope you had a great little holiday, lots of food and gratitude for that food, and now might be thinking about the next great big holiday. I thought I’d present three eclectic gift ideas from the vault of vintage quick boost posts.

Who wouldn’t love to receive armpit anti-odorant spray in their stocking?

Imagine the joy of receiving bouncy thick sandals for sore feet?

Or the absolute rapture of tearing up wrapping paper, opening a box, and finding a shiny new home blood pressure machine replete with expert instructions on how to ace your next blood pressure reading!

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Curious gift idea #1

With the proliferation of “natural” and greenwashed deodorants showing up on the shelves of pharmacies and social media feeds, I think it’s important to do a quick post on why we don’t need to fear regular deodorants and antiperspirants… but why I actually like a new kind of “natural” deodorant better anyway!

~ Antiperspirants use a kind of aluminum salt to block the sweat ducts. There is some concern that long-term exposure to aluminum in the armpits might be associated with increased risk of breast cancer, and maybe even dementia. But fortunately these risks have been mostly disproven. The American Cancer Society has a summary sheet on how breast cancer lacks any credible association, and The New York Times has a good article debunking the fears of increased risk of Alzheimers Disease/dementia.

An interesting graphic below shows what’s happening on a microscopic level with antiperspirants. The aluminum salts form little plugs in the sweat ducts, thereby keeping armpits less sweaty. Less sweat means less substrate for bacteria in armpits to metabolize (which creates those unpleasant, smelly byproducts).

~ Deodorants aim to acidify the armpit and add a bunch of other fragrances to neutralize or overpower bacterial odors. They don’t significantly reduce the amount of sweat. Personally I have found these don’t work that well, or for very long. The “natural” ones often contain botanicals, plant extracts and essential oils which can actually be irritating to the skin for some people.

Both antiperspirants and deodorants can leave a residue on the skin and in the fabric of clothing. The fabric of tshirts can turn a yellowish color, or develop a starchy/crunchy feeling. This residue can also leave funky smells behind in clothing, presumably because it acts as a matrix that traps some bacteria.

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If you have an antiperspirant or deodorant that works well for you, natural or otherwise, most expert consensus and data show it’s fine to keep using. It should not increase your risk of breast cancer or dementia or other health problems. But if the little aluminum plugs creep you out, or the deodorants you’ve tried just don’t work that well, then you might want to try something different.

I did a little research a while back and found a product called Surface Deep. It’s a spray on “natural deodorant” that is formulated with glycolic acid. Glycolic acid is “a fruit-based substance that has natural sebum-control and exfoliation properties to neutralize and inhibit bacteria-causing odor.”

The glycolic acid and other ingredients make the armpit a very unfriendly micro-environment for odor-causing bacteria. Lowering the pH is key. As a spray on, there is no detectable residue. I find that it really works well for preventing odor. It does nothing to slow down sweat… but sweat itself does not smell. Recall it’s the bacteria feeding on moisture and other parts of sweat that release smelly byproducts.

While I wouldn’t eat these ingredients, they certainly seem safe enough for armpit application:

Water, Glycolic Acid, Lactobacillus Ferment, Saccharomyces Ferment Filtrate, Sodium Hydroxide, Salicylic Acid, Rosmarinus Officinalis (Rosemary) Extract, Vaccinium Myrtillus Fruit Extract, Saccharum Officinarum (Sugarcane) Extract, Acer Saccharum (Sugar Maple) Extract, Citrus Aurantium Dulcis (Orange) Fruit Extract, Citrus Limon (Lemon) Fruit Extract, Hamamelis Virginiana (Witch Hazel) Bark/Leaf/Twig Extract, Cocos Nucifera (Coconut) Fruit Extract, Eucalyptus Globulus Leaf Oil, Aloe Barbadensis Leaf Juice, Lactobacillus, Glycerin, Sodium Lauryl Glucose Carboxylate, Lauryl Glucoside, Allantoin, Dipotassium Glycyrrhizate, PPG-5 Ceteth-20, Polysorbate 20, Lactic Acid, Tetrasodium Glutamate Diacetate, Citric Acid, Sodium Benzoate

I will say that this product does not provide any dryness, so if that is a priority during a presentation or other stressful event, I would stick with an antiperspirant. But as far as odor goes, it works better than any other deodorant I’ve tried for up to 24 hours.

I have no affiliation with this company and receive no commissions from anything written here :)

Take care, and no pressure. Original post here. Favorite reader comment:

I gave it a try, and I'm so pleased with this product. Thank you for bringing it up!

I've used it for a week, and I've had amazing results with a single daily application. I had ok-ish results with other 'natural' deodorants, but Surface Deep, so far, is much better.

The next test will be to check clothes after washing. Fabric can hold onto funk, probably in residue from oil ingredients. I think that may be less of a problem with this product. Thanks for the info!

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Interesting gift idea #2

Case study

A very young and still athletic appearing 48-year-old man is on vacation. Among other things he fails to pack good footwear for walking. The subject walks all day in very old sandals, and by the end of the evening he is limping with pain in the ball of his left foot. Recurrent metatarsalgia. He makes it through the rest of the trip hobbling around. Upon returning home he ditches the old sandals. Upon closer inspection they actually had holes in the soles. The subject puts his feet into OOFOS brand sandals that his wife bought him and feels an instant relief of pain while walking. He continues to walk squeakily around at home, outside, and even in the office with these hyper-cushioned foam sandals. As subject is typing a week later, he reports that his foot pain has resolved by 95%.

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Discussion

Technically the above amounts to a testimonial and not much of a formal case report or scientific study, but I do present it with sincerity. OOFOS is a brand of sandal that claims its products reduce the load on the feet and ankles, absorb “37% more impact,” and conform to the arches of the feet with ergonomic design. In so doing the manufacturer asserts that the sandals and shoes:

• cradle the arches

• reduce stress on sore feet, knees, and back

• enable a more natural walking motion

• reduce energy requirements at primary joints for walking

OOFOS references a 2018 study out of the University of Virginia School of Medicine Speed Clinic that showed their unique footbed and foam material “reduces energy exertion in the ankles by up to 47% compared to competitors’ footwear.” Alas I couldn’t find the actual study, so unlike my deep dives recently I’ll let this assertion stand unexamined.

But it follows that with less pain and energy spent during exertion, a kind of relative rest and recovery can take place even with some activity during the daytime.

Here is what my sandals look like:

I am not a shill for this company, and I have no affiliate links or even contact with OOFOS. I can say that in my experience this week I have to admit that the improvement in pain was dramatic and instantaneous while wearing the sandals, and that my foot is mostly back to normal in other shoes 10 days out from the original injury.

It is possible that such a design would be helpful for people with general foot pain, hardwood floors, and chronic discomfort. Once examined by a doctor or podiatrist and proper work up discussed, perhaps these shoes, sandals, and even clogs might be a merciful addition to one’s closet. I have read that sizing can be little tricky, extra-wide models are not available, and they do cost money. More information can be found on the brand website.

I am even considering asking Santa to please bring me a pair of these dark shoes to wear with my scrubs in the office. For any older individuals who might be losing an inch or two of height with age, the 1-2” boost gained with these foam soles also feels significant.

Original post here. Favorite reader comment:

I have developed arthritis in my first metatarsophalangeal (aka base of big toe aka hallux rigidus) joint. Apparently this is very common. I switched to a tennis shoe with wider toe box with improvement and I'm putting voltaren gel. Maybe I'll try out your OOFOS. My wife swears by Birkenstocks, however, for all manner of foot pain including her issues with hallux rigidus.

Perhaps a randomized trial of Birkenstocks versus OOFOS is called for!

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Inspiring gift idea #3

Home blood pressure monitors are great. I like the ones that go around the arm instead of the wrist for better accuracy. ~$40-50 Omron ones seems like a good balance of value and accuracy. We all have thermometers. Why not BP monitors?

Nine of the most common problems adversely affecting a good blood pressure measurement were cited in an article published by the American College of Cardiology. The degree by which each factor can overestimate our actual blood pressure ranges from a little to a lot. If we add them all up in a worst case scenario, we might panic that our blood pressure readings are actually up to 100 points too high! This is obviously not the case except in very rare circumstances. But it’s still important to know these, and to do our best chipping away at sloppy techniques. Those nine:

☑️ Use a proper cuff size. Cuffs that are too small for a person’s arm can give artificially high readings. With very large arms and small cuffs, up to 20 extra points of inaccuracy was recently demonstrated in a study published in JAMA.

☑️ Rest for 5 minutes before measurement. This is logistically difficult in primary care settings where we have about 20 minutes per patient visit, loaded as each can be with 20 unique problems at times. I often try to double check a high blood pressure when I first walk into the room.

☑️ Chill quietly during the measurement. If you’re going to measure, measure. Don’t talk. Or text.

☑️ Avoid coffee and caffeine for 30 minutes. Everyone can experience a quick jolt in blood pressure right after drinking coffee. This effect is mild in people used to drinking coffee. It is more pronounced in people who don’t usually drink coffee. Overall drinking coffee is safe, unless you have very high blood pressure.

☑️ Empty your bladder. We have all experienced a full bladder and the discomfort that goes along with it. It turns out that this bladder distention activates the sympathetic nervous system and can lead to quite a significant rise in our blood pressures.

☑️ Avoid alcohol consumption. After holidays and weekends I note blood pressures that are worse than usual for many reasons. Much to my chagrin, the less booze we drink the better. I wrote previously about the pleasure and poison of alcohol.

☑️ Sit with your back supported. Core muscles firing and bad posture can mess up a good reading. Most examining tables can be converted so that our backs are supported, or we should sit back in our chairs. The arm should also be supported at the level of the right atrium (mid-chest).

☑️ Keep both feet flat on the floor. This can be difficult when legs are dangling from the high altitude examining tables found in most offices. For many people it takes constant focus not to habitually cross one’s legs. In general this impedes good venous blood flow, too, and can accelerate varicose veins and worsen edema.

☑️ Place the BP cuff on a bare arm. Several sources I read quoted this same wild range of variation, with up to 50 points systolic overestimation occurring! I doubt such a massive increase is common. But one of my sage 95 year old patients tells me each time she visits that she “is wearing her doctor blouse today.” Said blouse allows for easy and expert exposure of the bare upper arm, and I credit her with prioritizing this better than I do.

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A quick reminder that ideal blood pressures are lower than we might know or hope!

Let’s try to work together as clinicians and patients to check as many of these boxes as possible during blood pressure readings in clinical situations and while doing home blood pressure monitoring.

Increasingly I value the measurements people get at home more than the performative, stressful acts we read like tea leaves in the office. Telemedicine for monitoring hypertension might sound like a bad idea at first, but once the accuracy of someone’s monitor has been assured against a reading performed in the office, and they master the techniques above, checking off all these boxes is certainly easier from home in some ways.

Original post here. Favorite reader comment:

I used to teach taking blood pressure to first year medical students and it taught me how much I didn't know. Thank you for this--as always! I bought a decent home cuff and retake it after sitting quietly, with my arm supported--vs running in to an exam room and holding out my arm.

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PS - I receive no commissions from these products and have no financial relationship with the companies. Are they better than a pair of socks? Maybe not if those socks are made from alpaca.

Happy bargain hunting!

Up next: A chilly November in Covidlandia.

Take good care out there.