A pet peeve of mine aggravated this time of year by the increase of upper respiratory illnesses (URIs) is inappropriate use of Antibiotics (Abx -medical shorthand). Yes we can get a sore throat or a bout of productive cough (acute bronchitis) but unless ‘immune suppressed’ (either from medication or immune disease) the body will win over the virus that cause over 90% of these infections. Many studies show bacteria cause only 10%. Have a read of the blog on ER testing for flu. Abxs do not kill viruses ONLY bacteria!
Why put a chemical – drug into your body unnecessarily? And please do not play the ‘out of a abundance of caution’ card. Over prescription of antibiotics remains a huge problem and I am ignoring the cost side but the real harm is the resulting emergence of ‘superbugs’. There are other complications, these Abx wipe out your ‘good’ gut bacteria (intestinal flora), hence whenever prescribed an Abx take a probiotic (diet or pill). Side effects abound commonly nausea or diarrhea. Some individuals especially but not exclusively in Diabetics, yeast infections commonly occur when taking an Abx. So do not ask for an Abx actually ask if one is really necessary.
Haloween is the time to stock up on tricks and treats. Most of us go for the latter, enjoying the memories (good and bad) as we stroll down the candy aisle. A caution though avoid black licorice.
The FDA reports “If you’re 40 or older, eating 2 ounces of black licorice a day for at least 2 weeks could land you in the hospital with irregular heart rhythm or arrhythmia.” The culprit is glycyrrhizin, which is the sweetening compound derived from licorice root. It results in potassium levels dropping to potentially dangerous levels causing the heart to skip around into abnormal rhythms (arrhythmias). Low potassium will also affect blood pressure. These adverse effects were noted in those over 40 and reversed by stopping the candy.
Historically in eastern medicine the root has been used as a natural remedy. It has been used as a treatment for heartburn, stomach ulcers, bronchitis, sore throat, cough and some infections caused by viruses, such as hepatitis; but no evidence for its merit is found by the National Institue Medicine (NIH).
The consensus among studies, doctors and the medical community is that 30% of all antibiotics (ABX) are given unnecessarily. Unwarranted ABXs are most commonly given for ear infections (otitis media), sinusitis, sore throats (pharyngitis), upper respiratory infections (URI) and bronchitis.
Sinusitis is a viral infection 90-98% of the time. It usually starts after 5-6 days of a running nose. So, wait 10 days before ABX, and then seek them only if it’s still as bad. However, if with symptoms of sinusitis you have facial pain, pus-like discharge, headache and a fever over 102°F (39°C), THEN ABX (commonly Am/Cl) will be needed.
Bronchitis (with no fever present) is also viral, and proper care is to treat the symptoms, for example, with decongestants. However, if your heart rate goes over 100 and your respiratory rate over 24, along with fever >100.4°F (38°C), you need to see a doctor for a thorough lung exam and probable chest X-ray. A good medical caregiver will listen with a stethoscope for abnormal sounds, including wheezing, and will also look at what you are coughing up – is it yellow or green? Smokers are especially susceptible to bronchitis that requires ABX.
Pharyngitis, commonly termed sore throat, along with a hoarse cough and nasal congestion, is most commonly caused by a virus. Only about 5-15% of adults get strep throat. It is most common in ages 5-15. Strep screening, a rapid antigen detection test (RADT), is not 100% accurate, but takes minutes; a 2- or 3-day throat culture is much more accurate.
PLEASE do not insist on ABX if your medical caregiver does not think you need them!
Doctors need to think twice before writing for antibiotics (Abx) I have blogged about the hazards of over prescribing these drugs for viral infections. But a second consideration is the exposure to life threatening heart arrhythmias (abnormal rhythm/beating pattern). A study (10 years) of US veterans who were prescribed amoxicillin, azithromycin (Z-pak™) and levofloxacin reveals more dangers. Investigators found increase of death risk and dangerous arrhythmias when taking azithromycin for 5 days. Same increased risk in those taking levofloxacin as directed for 10 days. No increase in cardiac arrythimias or deaths from taking amoxicillin. Important I believe is the study subjects were of an average age of 56.
Contrary last year in Denmark a study showed that azithromycin was not associated with a greater risk of cardiovascular death in younger and middle-age adults compared with penicillin.
The New England Journal of Medicine (2012) published data that showed the increased risk of cardiovascular death was higher with the macrolide Abxs (levofloxacin, azithromycin) compared with amoxicillin or no Abx treatment. Result FDA issued a warning last year for this class of Abx drugs.
Please realize that these Abx are still on the market because the absolute risks were relatively low. Listen to your body antibiotics can have all sorts of side effects and even cause death!
Note: These are all too common Abxs given for ear nose throat and respiratory (lung) infections. Overwhelming information shows most of these infections are caused by viruses- remember antibiotics do not kill viruses!
You may often thought do I really need all those tests – well finally medical professionals from 17 medical societies have addressed this issue.
They have identified tests and procedures that are likely unnecessary for the 26 medical specialties. Examples of unnecessary tests from the specific medical society include:
American Academy of Pediatrics (AAP): Antibiotics for apparent viral respiratory illnesses such as sinusitis or bronchitis
American Academy of Neurology (AAN): Electroencephalography (EEG) for headaches
American Academy of Ophthalmology (AAO): Antibiotics for pink eye
American Society for Clinical Pathology (ASCP): Population-based screening for vitamin D deficiency
American Urological Association (AUA): Routine bone scans in men with a low risk of prostate cancer
Society of Hospital Medicine, Society of Nuclear Medicine and Molecular Imaging (SNMMI): PET/CT scans for cancer screening in healthy individuals.
The American College of Obstetricians and Gynecologists (ACOG), which is new to the list, recommended against performing annual Pap tests in women ages 30 to 65, since doing so offers no advantage over screening at 3-year intervals
Asthma is a chronic inflammation of the airways, which carry air to and from your lungs. This inflammation makes airways sensitive and prone to overreact when exposed to certain allergens or environmental factors called triggers. When faced with a trigger, muscles around the airways contract. The airways narrow, become more swollen, and in doing so produce excess mucus. You can do the math –the result is less air flow to the lungs and some difficulty breathing, YES THIS is called an asthma attack.
Exercise-induced asthma is this difficulty breathing that is triggered by physical activity. It is also called exercise-induced bronchospasm (EIB). The muscles contracting so as air passes makes the sound of wheezing
Twenty million Americans have asthma AND experience symptoms during exercise. However, many people without asthma may also experience asthma symptoms during physical activity. Myself included!
How do you know you have exercise-induced asthma?
The main symptom is difficulty breathing during exercise, which may be experienced as any of the following:
Coughing
Wheezing
Chest tightness
Chest pain
Extreme fatigue
Shortness of breath can’t touch your breath
Any of these symptoms can begin within five to twenty minutes of starting exercise, reach their worst point about five to ten minutes after stopping exercise, and then gradually resolve. Take heart-Symptoms are often gone within 60 minutes, but can last longer.
In children, symptoms may be more subtle. For example, a child may complain of not being able to keep up with the others in sports activities or he or she may avoid participation in physical activity.
Causes of exercise-induced asthma?
It is unknown why people with EIA have overly sensitive airways. Having parents or siblings with asthma may increase your risk, as asthma tends to run in families. In addition, early-life exposure to irritants such as tobacco smoke, infections, and allergens may make airways more vulnerable.
Once your airways are vulnerable, an asthma attack is caused by a trigger. In the case of EIA, mouth breathing during exercise is the trigger. With EIA, your airways are sensitive to rapid changes in the temperature and humidity (wetness) of air. When you’re at rest, most breathing is done through the nose. Air is warmed and moistened in the nasal passages before it reaches the lungs. During exercise, though, most breathing is done through the mouth, which allows air to pass more quickly to the lungs without being warmed or moistened. When the colder, drier air coming through the mouth mixes with the warm, moist air in the lungs, it can be a shock to your airways resulting in asthma symptoms.
Sports that require continuous aerobic activity or are played in cold weather are most likely to trigger an EIA attack. EXAMPLES:
• Distance running
• Basketball
• Soccer
• Hockey (ice and field)
• Cross-country skiing
• Competitive cycling
Sports that are least likely to trigger an EIA attack are those that are less vigorous, require short bursts of activity alternating with breaks, or are done in a warm environment. These include:
• Walking
• Recreational biking
• Hiking • Swimming
• Short-distance running
• Track and field events
• Baseball or softball
• Golfing
• Football
• Volleyball
• Wrestling
• Gymnastics
• Downhill skiing or snowboarding
• Surfing
Diagnosis of Exercise-Induced Asthma
The doctor will ask about your medical history, give him or her a careful description of your symptoms. It is likely that a breathing test will be preformed.
The breathing test is usually done in your doctor’s office. You’ll exercise for at least six minutes on a treadmill or stationary bicycle. Before you begin and at several instances from two to 30 minutes after you stop, you will be asked to breathe into a meter device- a spirometer. The spirometer measures how much air you can exhale in one second—the forced expiratory value in one second or FEV1. A drop in the FEV1 of 12-15% from YOUR normal hints that you have EIA.
Your FEV1 can also be measured “out on the field” with the use of a hand held device called a peak flow meter. Here you will be perform the activity that triggers your symptoms for at least six minutes. Your breathing will be measured once before and several times after this exercise. A drop of 15-20% from YOUR normal in the FEV1 indicates EIA.
For added information, your doctor may attach a pulse oximeter to your fingertip. This is a painless, clothes-pin-like device that measures percentage of oxygen saturation in your blood. A chest x-ray may be warranted in certain cases.
Treatment of Exercise-Induced Asthma
EIA cannot be cured. But, with training and proper treatment, most people with EIA can control their symptoms and continue to be as physically active as they want.
Medications
Drugs that dilate –open up the bronchus (bronchodilators) are used to treat EIA
For 80-90% of persons, the use of an inhaled medication 15 minutes prior to exercise can prevent symptoms. The most commonly used medication is a short-acting ‘beta-2 agonist bronchodilator’, such as:
• albuterol
• pirbuterol
• terbutaline
These medications work quickly and last up to four to six hours. Bronchodilators make it easier to breathe by relaxing the muscles of the airways and allowing them to open wider, thereby allowing more air to pass through. As with any other medication there are side effects. Most common are rapid heartbeat and shakiness.
It is important to know the correct techniques for using your inhaler-OTHERWISE you will not get the correct dose! Keep it clean per instructions.
Short-acting bronchodilators can also be used to treat EIA symptoms once they begin. Your doctor should design an action plan for you-that is what to take and under what circumstances to prevent/treat an EIA attack. BE sure you are clear on the amount of medication to use and how often.
Cautions
Be sure to tell your doctor about any other medicines you are taking for asthma or any other conditions- including over the counter and herbal preparations. NEVER – use non-prescription inhalers. Such inhalers contain a very short-acting drug that may not last long enough to relieve an EIA attack and may cause side effects.
Lifestyle management
Other tips for preventing or minimizing EIA:
1. If you smoke, QUIT.
2. Include a warm-up and cool-down with each exercise session.
3. Avoid exercise when you have a respiratory tract infection-cold, flu, or bronchitis.
4. In cold weather, wear a scarf over your mouth and nose to warm the air that you breathe in.
5. Avoid exercise in extremely cold temperatures.
6. If you have known allergies, avoid exercise when the pollen counts and air pollution levels are high.
Excerpt from “Your ER Survival Guide” written by Doc Handal (available estore)
Like any other area of work, the ER has its own language, often comprised of abbreviations used to save time and space—something like texting. For example, saying someone is “SOB” does not mean the same as it does in the street: “SOB” in the medical world stands for short of breath. As part of your inside view of the ER, I’ve put together a list of common terms you might hear around the ER.
ABG (Arterial Blood Gas)- a blood test to measure your exact blood oxygen and other critical values
AMA (Against Medical Advice)- leaving the hospital against the advice of your physician and without a discharge order.
Angina Pectoris -chest pain from heart disease
AOB (Alcohol on Breath)
Block – refers to injecting a nerve to stop it from transmitting impulses, most commonly pain
BP – blood pressure
CABG – (Coronary Artery Bypass Graft)- open heart surgery- An operation in which a piece of vein or artery is used to bypass a blockage in a coronary artery; performed to prevent myocardial infarction and relieve angina pectoris.
CAD (Coronary Artery Disease) – Atherosclerosis (hardening) of the arteries to the heart
CATH (Catheterization )-passing a catheter into arteries to see if there is narrowing, commonly used to study the heart
CHF (Congestive Heart Failure)-condition where the heart is unable to pump efficiently, resulting in fluid retention in the tissues and shortness of breath
Cocktail – multiple medications given together to have an improved effect
CODE – refers to resuscitation attempts to restore breathing and blood circulation
COPD (Chronic Obstructive Pulmonary Disease) – emphysema or chronic bronchitis
CT– pronounced “cat”, referring to an x-ray study that looks inside the body as cross-sectional images
CVA (Cerebral Vascular Accident)- a blockage or rupture of a blood vessel in around your brain, also referred to as “stroke”
DOA (Dead on Arrival) used when no resuscitative effort is made due to state of the body
DNAR (Do Not Attempt Resuscitation) –advance written directive regarding wishes should your heart stop. A form that varies from state to state.
ECG/EKG (electrocardiogram) – a test that measures and shows the electrical activity of the heart muscle
EMS (Emergency Medical Services) – collectively refers to ambulance response system, including paramedics and EMTs
ETOH – usually used to refer to alcohol use or intoxication
FOS (Full of Stool) – arrived at as a finding when exam or X-ray reveals presence of a large amount of stool in colon
HBP (High Blood Pressure) – elevated reading for age or your ‘normal’
Hook up – attach equipment devices to patient to monitor BP, oxygen and heart
ICD (Implantable Cardioverter Defibrillator) – a device under the skin with a wire in the heart that can sense and deliver electrical energy as needed to keep the heart in normal rhythm
ICU (Intensive Care Unit – floor in the hospital for critical patients with very close monitoring
I&D (incision & drainage) – procedure to open and clean a collection of pus
IM (intramuscular)-refers to an injection given into the muscle
IV (intravenous,) –a way to give you medication, fluid or blood through your vein ”.
KVO (Keep Vein Open) – refers to a flow rate to ‘run’ IV fluids into your vein, usually a very slow rate
MI (Myocardial Infarction or heart attack), meaning the heart muscle is dying
MRI (Magnetic Resonance Imaging) – using a magnetic device to provide a detailed view of a particular area inside the body
NG Tube(Nasogastric Tube) – tube passed inserted through your nose into your stomach
MVA – motor vehicle accident
NPO – nothing by mouth, means you can’t eat or drink anything
O2 (oxygen) – given through plastic tubing in your nostrils or through a face mask, dialed to percentage concentration
OD (Oculus Dexter) – right eye
OS (Oculus Sinister) – left eye
OU (Oculi Unitio) – both eyes
PA (Physician’s Assistant)
PATCH – EMS personnel communicating with the hospital while en route
PCP – (Personal Care Physician)
PET scan (Positron Emission Tomography) – shows how organs and tissues are functioning—ex. blood flow, oxygen use, and sugar (glucose) metabolism
PO – by mouth
PUSH – refers to injecting a medication rapidly into a vein
ROM (Range of Motion) – refers to joint movement in degrees
RN (Registered Nurse)
RN-P (Registered Nurse Practitioner)
SCAN – imaging studies, most commonly an MRI, CT or PET
SOB – short(ness) of breath
SQ (subcutaneous) – injection given just under the skin
SVN (breathing volume nebulizer) – a ‘machine’ to inhale medication and deliver it to your lungs, sometimes called a breathing treatment
Strip – an ECG tracing of your heart activity off a monitor
T-boned-a motor vehicle collision involving the sides of the motor vehicle
TIA (Transient Ischemic Attack) – temporary loss of speech or limb function, often referred to as a “mini stroke” that may herald a stroke
UA (Urine Analysis) – a lab test to exam urine for infection or chemical abnormalities
UDS (Ultrasound Doppler Sonogram) – a study that uses differences in sound wave transmission to visualize internal structures.
FACT: Antibiotics do not cure viral infections
You may often thought do I really need all those tests – well finally medical professionals from 17 medical societies have addressed this issue.
Recent Comments