Next Avenue – Appalbarry.com

It’s Only Earwax — Should You Worry?

By Barry Rueger
Published: Next Avenue
August 1, 2025
1318 words
Read on-line.

Earwax is one of those things that everyone encounters, but nobody discusses. If you’re like me though, it blocks up your ears time after time, and you go looking for answers. The good news is that earwax — technically known as cerumen — is really not a significant health risk. The bad news is that because it’s a minor problem, you’ll find all manner of folktales and remedies, many of which are nonsense.

Many doctors recommend starting with over-the-counter ear drops.

An excess of wax in the ear canal is seen in around 10% of children, 5% of adults and increases to around 60% in older populations. Wax obstruction is more common in men than in women. Wax problems may be commonplace, but unless that yellow or brown stuff actually blocks your ear, you tend to ignore it, or maybe get annoyed when you find a little blob of it on your pillow in the morning.

I spoke to Desmond A. Nunez, M.D., a specialist in ear, nose and throat surgery (or otolaryngology) at the University of British Columbia.

“Earwax” is not really wax, like you find in a candle. Earwax is a combination of the cells of the skin of the outer ear, which are always being shed, and oils from sebum glands and other skin glands that produce substances for perspiration and temperature control purposes. All of that is incorporated into the earwax that we produce. The specific composition of earwax varies from one person to the next.

Earwax does have a purpose. Nunez explains, “It’s partly protective, so the presence of the wax in the ear canal will prevent things from getting into the ear, and also the amount of lubrication from sebum secreting glands gives you an oil base, a protection against water ingress.” Your earwax keeps your ears from getting infected while swimming.

Causes of Excess Earwax

For most people, the accumulation of earwax is self-regulating. But what about people like me who routinely find our ears plugged and hearing impaired? What is the cause of this excess earwax?

In health forums and on Facebook you’ll find many theories from people with earwax buildup, and you’ll be offered many possible causes. One favorite with people in the live music business is that loud sound levels cause wax to become impacted. The claim is that “If you are in a noisy environment, the body creates wax to protect the ears.” Other people say that regular use of over-the-ear headphones somehow causes more wax to be created. Some posters claim that “non-smelly underarm sweat” can indicate that you’ll have more wax problems, or that different allergies can cause wax buildup.

Another factor that impacts people over 50 is the use of hearing aids. Because they block the ear canal, they also tend to impair the ear’s ability to self-clear wax buildups.

Another claim is that people with Asian heritage more commonly suffer earwax problems. Nunez explains that while some genetic factors can influence what happens in your ears, it’s likely that it’s more a matter of luck. “I have a very diverse patient population base, but even within individuals of one particular demographic, there’s a huge amount of variation.”

“Other things you have to be aware of is that if you have skin disorders like psoriasis or eczema affecting your ears, that reduces the efficacy of self-clearing mechanisms. If one examines those people’s ears, you will see more wax. But I don’t think it’s because they’re producing more wax. I think it’s because the clearance mechanisms are broken down,” Nunez says.

Another factor that impacts people over 50 is the use of hearing aids. Because they block the ear canal, they also tend to impair the ear’s ability to self-clear wax buildups. (Ordinary ear buds can have the same effect.) And the wax itself will sometimes plug up the holes in the hearing aid, making them less effective at assisting hearing.

Beyond simple hearing loss, if wax is in contact with the tympanic membrane (the ear drum) it can cause discomfort and occasionally vertigo.

Removal Tips

Regardless of how your earwax might have been created, if it’s blocking your ear you’ll need to remove some of it. Once again the internet will offer a near endless array of suggestions, as well as videos, disgusting photos and people bragging about how plugged up their ears were and about the sheer volume of earwax they removed.

A much better choice for advice is your family doctor.

If you see your doctor and he or she sees excess earwax, they will likely start by telling you to use over-the-counter ear drops. The drops you’ll be looking for will be specifically for earwax removal. Other drops target infections, or swimmer’s ear. Some doctors will suggest using ordinary olive oil, almond oil or similar substances to soften impacted wax, but commercial earwax drops (which can be oil based, water based or non-water based) will include active ingredients that may include hydrogen peroxide, glycerin, sodium bicarbonate or carbamide peroxide (a combination of hydrogen peroxide and urea that’s also used in teeth-whitening products). There are also homeopathic ear drops with different herbal ingredients.

The usual advice is to administer your drops for four or five days.

Any of these options aim to soften or loosen impacted wax to make removal easier, either naturally on its own or by the doctor using a syringe. Separating facts from internet opinions on earwax removal choices can be difficult, but this is one area where there has been actual research. A 2018 review out of the NIH in the United Kingdom concluded that “using ear drops when you have a partially or completely blocked ear canal may help to remove the earwax in your ear. It is not clear whether one type of drop is any better than another, or whether drops containing active ingredients are any better than plain or salty water.” But in 2020, another study in the Journal of Clinical Otolaryngology found that drops containing glycerol, hydrogen peroxide and urea do make a difference.

The usual advice is to administer your drops for four or five days. Lie down with your head tipped to one side, carefully drop a few drops into your ear canal, then sit for a few minutes to let them work. When you sit back up you can rinse your ear with warm water and wipe away the excess.

Your doctor may also offer to syringe your ears, shooting in warm water to loosen and remove wax buildup. There is some suggestion that too much water pressure may actually damage your ears. And some places, notably Britain, have largely stopped the syringe method.

Removal Risks

Once when traveling in China, I found my ears totally blocked with wax. Our host directed me to a fellow with a market stall. With a bike-headlamp attached to his forehead he carefully scraped the wax out of my ears using a bamboo stick. It worked, and no harm was done, but my North American doctors all have been horrified by the idea.

If you remove all of the earwax or if your tool causes a break to the skin of the inner ear — the eardrum — your ear can easily become infected. Most minor ear injuries will heal themselves, but they can be painful and may need antibiotics. The other concern is that your ear wax protects against swimmer’s ear, a bacterial infection that can have serious consequences.

Vendors will sell you cheap kits with a tiny bluetooth camera, and various kinds of scrapers and tweezers for cleaning out your earwax. Despite the many videos on YouTube showing how to use them, experts all agree that you should never be sticking anything — even a Q-tip — inside your ears.

Your ears are delicate and essential. The risk of injury is just too great to go poking around in them. Instead, see your doctor.

Understanding the Different Types and Causes of Seizures

By Barry Rueger
Published: Next Avenue
Aoril 9, 2025
1313 words
Read on-line.

One sunny day in mid-October I realized that I was in the hospital. I didn’t know why, and I didn’t know how long I had been there, but I was definitely in the emergency ward at Vancouver General Hospital.

By the end of the day I had learned that my wife, Susan, had found me on the dining room floor in my dressing gown, that she had called the paramedics and that through the examinations and the ambulance journey, my eyes had been open and I was answering questions.

A week later, my new neurologist, Oscar Benavente, M.D., told me that I had probably suffered a seizure. The “probably” was because the event had happened days earlier, and he hadn’t been there to see it.

According to the Cleveland Clinic, there’s a one in 10 chance you will have a seizure at some point in your life. The likelihood increases depending on underlying medical conditions, a family history of seizures or if you are over 50. Children can also experience seizures.

A seizure is, at its simplest, a surge of electrical activity in your brain that causes affected brain cells to quick-fire random signals to other surrounding cells. Your seizure can be a one-off event, or if it is caused by epilepsy, may be one in a continuing series. Your doctor might be able to say why your seizure happened, or it may remain a mystery. And those electrical signals can cause all kinds of symptoms.

Types of Seizures

In the broadest of terms, you’ll want to know if you are suffering from epileptic seizures, meaning you’re prone to having repetitive attacks, or if your seizure is likely an isolated episode. How your doctor will determine this is through observation over a long period of time. In my case this meant that for the following six months I was prohibited from driving, and was monitored for further seizures.

Seizures are first categorized by type of onset. Your doctor will ask whether your seizure began on one side of your brain (a focal-onset seizure) or on both sides (a generalized-onset seizure). If you can’t tell, it may initially be classed as an unknown-onset seizure. The neurologist will try to answer this and other questions by booking a variety of tests including a CT brain scan (computed tomography, using X-rays to scan the brain), an MRI (magnetic resonance imaging, using magnets), and possibly an EEG (electroencephalogram), a test that measures electrical activity in the brain.

Those three broad categorizations are useful, but seizures fall into dozens of different categories and combinations depending on your specific symptoms — and whether anyone was on hand to note what was happening. Most seizures last only a minute or two, so there’s every chance that it will be over before anyone else could notice how you behaved, or what parts of your body were moving in which fashion.

No Longer Called Grand-Mal

Most people associate a seizure with (what used to be called ) a grand-mal seizure, where an unconscious person’s limbs shake and jerk. These seizures — now termed “tonic-clonic seizures” —are just one of a variety of generalized-onset motor seizures. These seizures include both clonic behaviors — rhythmic jerking — and tonic stiffening, where parts of your body become rigid. Generalized-onset seizures can also include spasms, or loss of muscle tone or combinations of behaviors.

There are also generalized-onset non-motor seizures, (formerly petit-mal seizures) which still originate on both sides of the brain, but include absence seizures, where a patient “blanks out” for a few seconds but without any lasting symptoms.

Focal-onset seizures begin in only one area of the brain and can be categorized by the patient’s level of awareness. If awareness is impaired during any part of the seizure, the seizure is classified as a focal impaired-awareness seizure. As with generalized-onset seizures, jerking and stiffening of parts of the body are common events although often only one limb or one side of the body will be involved. It is common for an initially focal seizure to spread to other parts of the brain, creating a focal to bilateral tonic-clonic seizure.

If clinicians are unsure about a seizure, they may choose to describe it as an unknown-onset seizure. After further testing and scans they may be able to reclassify it as either general- or focal-onset seizure. This is important for choosing the correct approach to treatment.

Possible Causes

Just as there is a long list of seizure types, the possible causes of a seizure can vary widely, and it’s not always possible to be certain of the cause. Merck & Company’s MSD Manual lists risk factors such as head trauma, neurological disorders, family history, alcohol or drug use (or withdrawal) or not following prescribed anti-seizure drug schedules. More factors can include a high fever or heat stroke; brain infections from malaria, HIV, rabies or a variety of other bacterial or viral conditions. High or low levels of glucose or sodium can be a cause, as can kidney or liver failure.

Various cardiac problems may cause inadequate oxygen supply to the brain, as can near-drowning or carbon monoxide poisoning. Damages to the structure of the brain, such as strokes or tumors, can trigger a seizure, as can fluid accumulation, and poisoning from lead or strychnine also will cause a seizure.

In other words, just as a doctor may not ever determine exactly what type of seizure a person had, the patient also may never know what caused it.

The Problem With Low Potassium

By Barry Rueger
Published: Next Avenue
October 3, 2024
1526 words
Read on-line.

It was unexpected when my family doctor announced that I had very low potassium levels, or hypokalemia. Aside from prescribing some of the largest pills that I’ve ever seen, and directing me to an endocrinologist, he had little to say to me. I quickly realized that I knew nothing about this essential element, either inside my body, or in the world around me.

Potassium, known as its chemical symbol K, is the 17th most common element on Earth, a silvery white metal that you can cut with a knife, but which reacts rapidly with oxygen in the air to form flaky, white potassium peroxide. Potassium is actually incredibly important in farming as potash, and 95% of potassium is used in fertilizers for agriculture. It also has dozens of different uses in things like inks, dyes, wood stains, explosives, fireworks, fly paper and matches.

‘ll admit that I can’t recall ever thinking about the potassium in my body. Potassium is one of five “major minerals” found in nearly every part of the body and is one of the most abundant minerals inside humans to help regulate fluids, send nerve signals, and help with muscle contractions. A healthy potassium level is essential to good health. Roughly 80% of potassium is inside muscle cells, and the rest is in bones, the liver and red blood cells.

Inside the water in these cells, potassium acts as an electrolyte, meaning when dissolved in the water inside cells it produces positively charged ions. This allows it to conduct electricity and carry electrical signals to other cells. This messaging is critical to the proper functioning of nerve and muscle cells, particularly heart muscle cells.

What Causes Low Potassium?

Most health authorities agree that getting 3,500 to 4,700 milligrams of potassium daily appears to be the optimal amount, but there is a wide variation in recommendations depending on age, sex and physical attributes. According to the UK National Institute of Health, adult men for instance are said to need 3,400 mg daily, while adult women need only 2,600 mg.

Fortunately potassium is abundant in many whole foods, especially fruits, vegetables and fish. Topping the list for potassium are yams, pinto beans, white potatoes, portobello mushrooms, avocados, sweet potatoes, spinach, kale, salmon, bananas and my favorite: brewed coffee.

Still, experts say that most adults don’t meet their daily needs. This is likely due to the Western-style diet, which favors processed foods over whole plant foods that are high in potassium. Fortunately, a lack of potassium in the diet will not usually cause a problem and deficiencies usually happen because the body is losing too much potassium.

Low potassium is often the result of things that cause a person to lose water: diuretic drugs can lead to low potassium, as can intense physical workouts that cause heavy sweating. Heavy drinking can also lead to low potassium.

Digestive disorders like inflammatory bowel disease can influence fluid and salt balance, which can drop electrolyte levels. Specific conditions such as diabetic ketoacidosis and metabolic alkalosis can also lower potassium levels. Eating disorders, such as anorexia nervosa, purging, or laxative abuse as well as undereating and malnutrition also can lead to lowered potassium levels.

Warning Signs

My diagnosis of low potassium came from a blood test. Symptoms of low potassium are quite general, and really a blood test is the only reliable way of measuring potassium levels. I’m not sure that I had reported any of the common symptoms of low potassium, aside from a general feeling of being tired, and finding myself getting up to pee several times each night, but even if I had, I’m not sure that potassium would have been my doctor’s first guess.

Other symptoms include:

General weakness and fatigue: When blood potassium levels are low, the deficiency may affect how the body uses nutrients, and that can result in fatigue. Because the flow of potassium is central to healthy nerve function, low potassium can lead to numbness or tingling in the hands, arms, legs and feet.

Muscle weakness and cramps: When blood potassium levels are low, the brain cannot relay signals to stimulate contractions or to end them. If the brain can’t tell muscles to move, people will feel weak.

Irregular heartbeat: The flow of potassium in and out of heart cells helps regulate the heartbeat. Low potassium can lead to an irregular heartbeat or “heart arrhythmia.”

Digestive problems: Potassium helps send signals from the brain to the muscles in the digestive system. These “smooth muscles” are what the digestive system uses to churn and propel food through the body so it can be digested. If those muscles don’t work properly, it can cause digestive problems like bloating and constipation.

Frequent urination: Just as it may affect the digestive system, low potassium levels may impair the kidneys’ ability to concentrate urine and balance the blood’s electrolyte levels, leading to increased urination. And excessive urination may lead to even lower levels of potassium.

Watch for these symptoms, but the truth is that low potassium won’t have any obvious symptoms for most people.

I was told by my family doctor that I had very low levels of potassium. Instead of the expected 3.6 to 5.2 millimoles of potassium per liter (mmol/L) my blood had only 1.5 mmol/L. That is a level which is considered dangerous.

My doctor ordered a visit with an endocrinologist for more specialized assessment and advice, but because the waiting time would be quite long, I was also prescribed fairly large amounts of potassium chloride — four 1,500 mg tablets each day — to bring my potassium levels back to normal, and weekly blood tests to measure those levels.

Conn’s Syndrome

Slowly, but consistently, my potassium levels increased. This was important because I needed to have fairly normal levels of potassium for my endocrinologist to test me for levels of aldosterone, which would indicate whether I was suffering from primary aldosteronism, or Conn’s Syndrome.

Aldosterone is a hormone that helps regulate blood pressure by managing the levels of sodium (salt) and potassium in the blood. Having too much or too little aldosterone can cause health issues.

Individuals with Conn’s Syndrome have higher-than-normal aldosterone levels. This condition is usually caused by a benign (noncancerous) tumor on one of the adrenal glands, which causes the gland to overproduce aldosterone. High aldosterone levels cause elevated sodium levels and low potassium levels.

The primary test for Conn’s Syndrome is the aldosterone to renin ratio (ARR). Aldosterone regulates the levels of sodium and potassium, in part by causing kidneys to excrete potassium through urine. Levels of aldosterone are controlled by renin, an enzyme released by kidneys that triggers the adrenal glands to release aldosterone.

Laboratories measure the ratio of aldosterone to renin. The test shows the level of each hormone, and the relative balance of aldosterone to renin present in the blood. In healthy individuals, these levels rise and fall together. In those who have primary aldosteronism, aldosterone is high while renin is low — renin is said to be “suppressed.” The higher the ARR result, the more likely a person has Conn’s syndrome.

Back to the Beginning

After several weeks, my potassium levels had crawled back to the normal range, and I was able to be tested for aldosterone. After another anxious two weeks I was finally told that my aldosterone levels were within normal levels, so I wasn’t suffering from Conn’s syndrome.

I passed this test, but the Primary Aldosteronism Foundation warns that, “up to 50% of elevated ARRs may be false-positives. To remediate this risk, patients must undergo confirmatory testing to validate or rule out false positive ARR results.”

That places me and my doctors back at the beginning. I’ll be pushing for a second set of aldosterone measurements, and I’ll be back asking specific questions such as what caused my potassium to be so low? And what is my longer-term outlook?

Happily, if I’m not suffering from Conn’s syndrome, the symptoms of hypokalemia might go away after adequate treatment with potassium. Once my potassium levels are back to normal, they might just stay there. And a single instance of hypokalemia doesn’t usually cause long-term problems.

It’s also possible that if my potassium levels are back to normal, my high blood pressure will improve. A number of studies have found that people who increase their potassium intake see their blood pressure go down.

What Is a Small Stroke?

By Barry Rueger
Published: Next Avenue
January 26, 2024
1526 words
Read on-line.

In mid-summer, my partner Susan was concerned. She was sure my behavior had changed in recent weeks and wanted me to get it looked into. I wasn’t convinced and consequently was shocked when our doctor told me that my MRI scan showed that I had suffered “a small stroke.”

When he said “stroke,” I imagined what I had seen on TV or heard from friends whose parents had suffered strokes: half-paralyzed faces, an inability to talk and perhaps the loss of the use of hands or legs. My doctor was upbeat, but I was stunned. And as I left his office, I had many questions.

Read the full article on-line at Next Avenue.