Friday Q&A: Ebola virus; skin cancer; gas & bloating; and plantar fasciitis

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The following questions have been lightly edited for length and clarity.

QUESTION #1: EBOLA VIRUS

I’m reading headlines about Ebola virus. I can’t bear to actually read the articles because it feels like one more thing to be terrified about! So can you give us your “upshot” about it? Thank you, Dr. M!

—Sami

Hello Sami,

I hear you. Hantavirus, Ebola, oh my.

The good news first: as of today, no cases have been reported in the US, and the CDC says the risk to the American public is low. The outbreak is real and serious where it’s happening, centered in the DRC and Uganda, and caused by the Bundibugyo strain of Ebola. Just this week, the WHO declared a public health emergency of international concern. There are 500+ suspected cases and 130+ suspected deaths, and there’s no licensed vaccine for this particular strain yet.

Here’s the part most headlines bury: Ebola isn’t airborne. It spreads through direct contact with the bodily fluids of someone who is symptomatic, not through casual contact, not through the air, not through your groceries. The reason the 2014 outbreak didn’t become a US crisis is that public health infrastructure caught it early and contained it. The same containment work is happening now, with the CDC implementing enhanced travel screening.

And here’s the harder question: How much bad news can I consume before it stops being information and starts being its own kind of health problem? The amount of news we take in is like anything else: the dose matters. So, just like you’re mindful of healthy eating, be mindful of what your eyeballs take in, too.

I hope that is helpful!

QUESTION #2: SKIN CANCER CHECKS

Hi Dr. McBride, I suddenly remembering that I haven’t had a skin check in awhile. I’m in my 50s and pretty healthy. What should I be checking for at home? How often do I need to see a dermatologist?

-Janelle

Hello Janelle,

Good timing, as summer is upon us! The standard rec for adults in their 50s is an annual full-body skin exam with a dermatologist. The frequency increases if you have fair skin, a history of heavy sun exposure or sunburns, a personal or family history of skin cancer, or a lot of moles. If any of that applies and it's been a few years, get that appointment on the calendar!

In between visits, a monthly self-exam is a good idea. The main thing to look for is change. The “ABCDE” framework is a useful shortcut: Asymmetry, Border irregularity, Color variation, Diameter larger than a pencil eraser, and Evolution over time. That last one (evolution) matters most. A spot that’s been the same for decades is far less concerning than one that’s appeared or shifted recently.

Pay attention to high sun-exposure areas, such as your face, neck, chest, forearms, tops of your ears, your scalp (esp if you’re losing hair up top), and the backs of your hands. But don’t skip the less obvious spots. Melanoma can show up between the toes, under nails, and on the back, which is where a mirror or a partner’s eyes come in handy.

And for this summer: SPF 30 or higher, broad spectrum, applied consistently and reapplied every few hours outdoors. It’s the most effective prevention tool we have, and it’s never too late to start using it more seriously. (Read all my thoughts on sun protection here!)

The upshot: book the appointment, and go before summer hits in full force. ☀️

QUESTION #3: GAS AND BLOATING

I have worried about bloating for many years. I have been receiving numerous instagram posts about these kits that you can send your saliva or something like that, and then they send you back a list of all the foods and things that are not good for you and that cause bloating. Maybe it’s a good question for your substack readers as I don’t think I’m the only one who’s concerned about it. Thanks for listening.

-Margie

Hi Margie-

The IgG blood tests sold by alternative and functional medicine practitioners look at antibodies your immune system makes to specific foods. The catch: making IgG antibodies to a food usually just means your immune system recognized something you ate, which is what a healthy immune system does. It's not a reliable signal that any one food is causing your symptoms. The American Academy of Allergy, Asthma & Immunology actively cautions against using these tests for this reason. They send a lot of people down expensive rabbit holes and into unnecessarily restrictive diets.

If you suspect food is driving your bloating, the most useful (and cheapest) tool is a food journal. I’ve watched patients have genuine “aha” moments just by writing down what they ate and when symptoms hit. A structured elimination diet, done with a dietitian, is a good next step. And if symptoms persist, a workup with a gastroenterologist can rule out things with real evidence behind them—such as lactose intolerance, celiac disease, irritable bowel syndrome.

True food allergies (the IgE kind, tested by an allergist) are real and worth diagnosing. They’re just far less common than the bloating most people are actually dealing with.

The upshot: don’t pay $300 for a test that doesn’t tell you what it claims to! Start with what you eat, when, and how you feel. (Read my article on what your gut might be telling you here.)

QUESTION #4: PLANTAR FASCIITIS

I've always been active and mobile, but over the last couple of years my feet/heels have started to hurt in ways they never did before, especially in the summer. I've heard plantar fasciitis mentioned a lot. Is that what this could be? Anything I can do about it? I am tired of googling it!

-Jackie

Hello Jackie,

Yep! Plantar fasciitis is one of the most common culprits for the kind of foot pain you’re describing, particularly in active people, and it does tend to flare in summer when sandals and flip-flops replace more supportive footwear.

The plantar fascia is a thick band of tissue that runs along the bottom of the foot, connecting the heel to the toes. When it becomes inflamed from overuse, inadequate support, or changes in activity, the result is typically a sharp, aching pain in the heel or arch, often worst with the first steps in the morning or after sitting for a while. If that pattern sounds familiar, plantar fasciitis is a reasonable place to start the conversation with your doctor.

The good news: for most people, this responds well to conservative treatment. Stretching the calf and plantar fascia consistently (especially before getting out of bed) makes a real difference. Supportive footwear is non-negotiable, which means ditching your flat sandals for a bit. Over-the-counter or custom orthotic inserts help redistribute pressure. Ice and a short course of anti-inflammatories help with acute pain, and targeted PT can help if symptoms aren’t resolving on their own.

One caveat: not all foot pain is plantar fasciitis. Achilles tendinitis, stress fractures, and arthritis are common in this age group too, which is why a proper evaluation matters. If the pain has been around for more than a few weeks or is interfering with how you want to move, see a podiatrist or orthopedist.

The bottom line: foot pain is not an inevitable part of aging, and it doesn’t have to ruin your summer!

Did I mention this already? 😆 I’m starting a book club!

Join me this summer for the official Beyond the Prescription Book Club. It’s open exclusively to Substack readers and gives you early access to the book. Sign-ups are open in May only.