Antibiotics and the Looming Disaster

April 7th, 2019

The New York Times reported in an article titled, “A Mysterious Infection, Spanning the Globe in a Climate of Secrecy” on the front page today that a new fungus called Candida auris is causing several deaths worldwide.  This could be what the medical profession has been dreading for the past 50 years, an antibiotic resistant microorganism for which we have no arsenal of weapons to fight.  How did we know this was inevitable?  Right now, antibiotics are overprescribed with approximately one in three prescriptions considered unnecessary.  In addition, much of our food supply has been tainted with antibiotics.  Animals raised for food are often susceptible to infections, so they will often be given antibiotics even if they aren’t sick.  How does this translate into antibiotic resistance?  It’s all a matter of numbers.  When you kill 99% of the bacteria with antibiotics a small number will develop resistance to that medicine and multiply.  Magnify this by the number of people taking antibiotics and how much we can easily travel from continent to continent and we have a recipe for disaster.

Even worse, there have been no new antibiotics developed in the past 10 years and there doesn’t seem to be any new development to fight the resistant microorganisms.  What can we do about this looming crisis?  Here are some things you can do.

  • Don’t take unnecessary antibiotics.  Cold and flus are caused by viruses and antibiotics do NOT work on them.  Some people think that because they took a friend’s Z-pack last time they had a cold and “miraculously got better really fast” that the antibiotics had anything to do with it.  If they had been given placebo (or candy), they may have recovered just as quickly.  The perception that if a pill is a prescription, it is automatically “stronger” is a fallacy.  Do not pressure your healthcare provider into prescribing antibiotics.  If you health care provider prescribes an antibiotic, ask him/her if it is really necessary.  In some healthcare settings such as urgent care settings, some providers have gotten so used to prescribing unnecessary antibiotics for colds because they have become tired of arguing with patients and would rather just prescribe it.  This is a sad situation that many hope will be changing.  I have seen in my own practice, patients who become very irate when they don’t get their “Z-pack”.  Instead, ask the provider what other things you can take to feel better.  Maybe ask the provider if you could check back in 3 days and be reevaluated if things aren’t better.  As a rule, most sinus infections, coughs, and sore throats do not require antibiotics.
  • Eat certified organic, antibiotic-free foods.  It’s shocking how much antibiotics are being given to livestock and farmed fish.  These antibiotics ABSOLUTELY get introduced into our bodies when we eat them.
  • If you are prescribed antibiotics, take the entire course as directed by your healthcare provider.  Do not stop because you feel suddenly better.  Resistance is more likely to occur when you don’t eradicate enough of the bacteria.  Also, do not save the antibiotic pills for a future infection. I have had many patients who said they did this.  Antibiotics can not be taken without proper medical supervision.
  • Discard antibiotics appropriately.  Unused pills should never be thrown in the garbage or flushed down the toilet.  Many studies have found antibiotic resistant bacteria in fish living in waters contaminated by sewage likely because of the introduction of these chemicals.  Instead, bring the leftover meds to your local pharmacy or healthcare provider office.  Both of these places will have proper medication disposal systems that won’t pollute the environment.
  • Increase the “good” bacteria in your body.  Here is blog on probiotic foods.
  • Stay out of the hospital.  Many resistant bacteria start off in hospitals.  They can spread easily via surfaces such as doorknobs.  No matter how clean a hospital is, there is always a potential for coming in contact with resistant bacteria each time you enter a hospital.  Try to limit unnecessary visits to hospitals (social visits).  Does someone really need 20+ family members visiting their loved one?  It can also be stressful for person who is sick as they feel obligated to thank each of their guests.  Save the visits for after the person goes home.  If you are on an immunosuppressant medication for an autoimmune disorder (IBD, psoriasis, rheumatoid arthritis, MS, lupus, etc.) you absolutely should not go to hospitals if you do not need to.  As an alternative, set up a “virtual visit” with your loved one via video chat, or maybe create a video card they can see on their phone.
  • If you do go to visit someone in the hospital, check in with the staff on duty first.  If there has been a resistant bacteria detected on your loved ones body, you may need to wear gown, gloves, and possibly a mask.  I would also recommend washing the clothes you wear immediately after you get home.   Use hot water and high heat dryer setting.
  • Avoid bringing home items from the hospital.  Some people bring home the flowers and balloons they get from visitors.  Please avoid doing so, as they may have been contaminated.  I recommend leaving those items at the hospital with the nurses who have provided you with care.  If you brought clothing to the hospital, make sure you wash them thoroughly after you get home.

Measles Outbreak in New York

March 30th, 2019

Just this past week, Rockland County in New York enacted a ban on people under 18 years old who are unvaccinated from entering public areas.  While this may sound draconian, this is an aggressive move to prevent the spread of measles.   This potentially deadly disease has not been seen in the US for decades until the recent few years, however due to many people refusing to vaccinate their children we have seen a resurgence.  Some people are quick to blame specific religions as the cause for the refusal to vaccinate, but in fact most faiths have no objections to vaccines.  It turns out the recent movement to not vaccinate was begun in small pockets of people who were particularly vocal and persuasive.

I strongly recommend that if you have not had your required childhood vaccinations, you should get them.  It’s never too late.  If you are not sure if you had all your childhood vaccinations or are potentially in a group that could be exposed (healthcare worker, daycare worker, etc.) you should get a titer, which is a blood test that provides evidence whether you have the measles antibodies (protection in your immune system).  There have been several outbreaks also reported in Japan and the Philippines recently as well, so if you are planning travel to Asia, you may want to get an MMR booster.  Vaccines prevent deadly disease effectively, make sure to protect yourself and your family.


The Flu season is underway! Get your flu shot now!

January 12th, 2019

The CDC has just announced that the dreaded flu season is upon us.  This usually occurs after Christmas and New Year’s holidays when we gather together and change our routines (not as much sleep, too much alcohol, too much fatty foods, and a break from our usual exercise regimen).  In my own practice, I am seeing many cases of the flu and mainly among people who have not gotten the flu vaccine.  I strongly recommend that if you haven’t gotten the flu vaccine, you should get it now.  Currently, there is no flu vaccine shortage, so you can definitely get it from your primary care provider’s office, local urgent care, or many pharmacies.

Need more reasons to get the flu shot?  Here are a few of them:

  1. Getting the flu means 2 or more weeks of feeling miserable and usually happens at the worst possible time (your long awaited vacation, wedding, Christmas holiday, etc.)
  2. It is covered under all insurances and medicare.  If you don’t have insurance, some community health centers can provide it for free.  Check with your local public hospital.
  3. It’s quick!  A typical flu shot takes 30 seconds.  Make sure you wear clothing where you can roll up your sleeves to the deltoid muscle.
  4. It hurts for only 1-2 days.  Yes, most flu shots can cause some local pain, but that’s temporary and pales in comparison to the body aches when you are getting the actual flu.
  5. The flu shot takes 2 weeks to become effective.  Getting a flu shot now will ensure that you are protected before the holiday season.
  6. By getting the flu shot, you are not only protecting yourself but also your family.  If you got the flu you could spread it to your children or elderly relatives.  Anyone with a newborn less than 12 months old absolutely needs to get a flu shot, even if the newborn already got the flu shot.  Because their immune systems aren’t fully developed, they can get infected by the flu virus very easily.
  7. The flu shot can prevent you from losing weight.  This sounds like a stretch, but imagine you are sick with the flu, you will not likely be hitting the gym, and instead you’ll be drinking plenty of fat-laden chicken soups, possibly ice cream to soothe your sore throat, not to mention sugary lozenges and honey.  Inflammation in the body often releases a hormone called cortisol which can lead to weight gain by increasing the sugar levels in your blood as well as hunger.  Don’t let the flu ruin your new year’s resolution to shed those pounds.
  8. The flu is not “just a bad cold”.  The flu virus generally causes an illness with fevers, chills, sore throat, and body aches, but it can also cause a serious condition called encephalitis which is a brain disease and can cause death.  The flu can also lower your immune system and put you at risk for getting pneumonia or bronchitis which can result in hospitalization.
  9. You never want to be THAT person that gets everyone else sick in the office or family.  Be considerate of your fellow human beings.  Make sure the flu stops with you!


New Year, New You!

January 5th, 2019

A new year has just begun!  Many people have a tradition of setting new year’s resolutions for themselves.  Unfortunately, many of us don’t keep them up for more than a month or so.  I recommend that instead of these resolutions, we find ways to make gradual changes.  One way is to set S.M.A.R.T. goals.  For example, rather than saying “I want to lose weight this year” you would set a goal to exercise at least 15 minutes 3 days a week.  This is one small step, but by making it easy and being able to accomplish it, you will fuel motivation for more changes.  Think about how someone achieves a long term goal such as finishing a college degree or learning how to play piano.  Are either of those achievable in a month or two?  I doubt it, unless you are a genius!  Losing weight, changing your eating habits, or getting into a regular exercise routine is similar in that they all need time and dedication, and incorporated gradually into your lifestyle.

Aside from setting S.M.A.R.T. goals, you can also start tracking your progress and reward yourself along the way.  Maybe you could take a calendar and mark a red X on the days when you accomplished your task.  For example, if you went to the gym, you would mark that day.  Another way is to put a large jar on your kitchen counter, each day you meet your goal, you put a $1 or $5 bill inside.  At the end of 3 or 6 months, use that money towards something that will bring you pleasure (but also healthy), such as a massage treatment/facial, or perhaps a weekend getaway.  I understand that this is not likely feasible to continue for many years, but by as a few months go by, you will have incorporated this habit into your life and you will likely be able to continue it.

Assess how you feel after adopting a healthier lifestyle.  Do you have more energy?  Are your moods turning more positive?  Do you feel motivated at work?  If so, keep going and continue on this path throughout the year.


December 14th, 2018

A large proportion of people suffer from the occasional headache.  In fact, it’s one of the most common reasons for visits to primary care providers.  There are a multitude of causes of headaches ranging from stress to brain tumors.  Fortunately, only a very small are due to the latter.

Most everyday headaches are classified as “tension” headaches.  The most common reason for this type of headache is a change in our usual routine.  If you find yourself having headaches, start keeping a journal or “headache diary”.  By keeping a log of your activities, you may start noticing trends and possible triggers/causes for your pain. I have listed some common foods and lifestyle changes in the table below.  The main issue is sudden changes in your lifestyle (whether they have a positive impact or not).

  • Lack of sleep/too much sleep
  • Stress
  • Alcohol (especially red wine)
  • Too much caffeine or sudden decrease in your usual dose of caffeine, aka “caffeine withdrawal”
  • Relaxation.  No, this is not a mistake!  some people can actually get headaches on their vacations since this is a change in their usual routine of a stressful workday
  • Irregular eating habits/skipping meals.  The body likes to have a steady source of energy.  Like your car, it does not like to run on empty.  Be sure to carry a snack with you if you think you may have to skip a meal.
  • Too much phone/tablet/computer use.  Eyestrain associated with headaches indicate an underlying vision problem.  Schedule an appointment with your eye doctor if this is occurring.  You may need your vision checked and may need to have a glaucoma screening.
  • Medications such as antibiotics, blood pressure medication, nasal decongestants, cough/cold medications, ad many more prescription and over the counter medications can cause headaches.
  • High blood pressure.  Anyone with a headache should have their blood pressure checked.  Fortunately, headaches caused by high blood pressure usually get better when the blood pressure returns to normal.
  • Carbon monoxide is a colorless, odorless gas which can accumulate inside your home from heat sources or car exhaust.  It is most dangerous during the winter, when we keep our windows closed and light our fireplace.  Make sure you have carbon monoxide detectors in the home.  If you keep having headaches in your home but not anywhere else, you may need to check your carbon monoxide levels.  If the levels are high, you will need to find the source and open the windows to vent out your home immediately.

Disclaimer:  If your headache is severe or the “worst headache of your life” associated with other symptoms such as fever, neck stiffness, weakness, loss of vision, or gets worse with bowel movements/straining during exercise or sex, you should see your medical provider immediately.  These are considered red flags and indicate a need for more thorough workup which may include a neurological exam and possibly imaging of the brain.