Wednesday, October 12, 2016

Doc, I Need an Antibiotic!

We are nearing that time of year again where our phones ring off the hook and our waiting room overflows with sick patients. Our medical staff are fielding calls insisting for same day appointments or demanding antibiotics. So I just want to blog a little about what we see and treat this time of year. Let's start with sinusitis.


What are the common symptoms?
  • purulent nasal discharge ("gross yellow/green mucous")
  • nasal obstruction ("can't breathe")
  • facial pain, pressure, or fullness
  • can also get cough from the mucous and postnasal drip
What causes it?
  • viruses are most common (antibiotics don't help here)
  • bacteria 0.5-2% of cases
How do you know if you may need an antibiotic for treatment?  
See your doctor and let your doctor weigh your history and physical exam to determine. Usually these are the indicators:
  • symptoms are lasting for 7 or more days
  • symptoms are worsening, especially if after initial improvement
  • fever greater than 101
  • moderate to severe facial pain
Well, what happens if you take an antibiotic when really you did not need one?
  • you will get better no faster than if you did not take the antibiotic (you will never know)
  • you risk side effects of the antibiotics like diarrhea which may worsen your course
  • you are increasing the incidence of antibiotic resistant bacteria (like MRSA)
So what can you do if you don't need an antibiotic?
  • rest and drink lots of fluids
  • motrin or tylenol for pain
  • saline nasal spray to irrigate or use neti pot to irrigate
  • topical nasal steroids (like flonase) may help
  • topical atrovent (requires prescription)
  • guaifenesin (AKA Mucinex) can break up/thin out the mucous
What to avoid?
  • antihistamines (like benadryl, claritin, or zyrtec) may over dry and increase discomfort
  • zinc preparations show no benefit
How to prevent in the future?
So next time you get sick, you may want to try some of these remedies and give your body a fighting chance for a few days before you pick up the phone to call your doc. Now if you have been sick for 1 week and not improving, call your doc.

One more last pearl... coughs can linger and linger... according to one recent study the average duration of cough is 18 days!  However, if you are wheezing or short of breath with your cough... or it is just getting worse... go see your doctor.

Saturday, October 8, 2016

Probiotics and Colic

Few years back I blogged here about how probiotics can help reduce the severity of viral gastroenteritis (stomach flu) and even prevent antibiotic induced diarrhea in kids.  Well, now there is even a small but randomized, double-blind, placebo-controlled trial that showed how probiotics help colicky babies. You can read the full study here. For 21 days, breastfed Canadian babies who were given lactobacillus had significantly improved reduction in length of crying and fussing times based on recorded diaries and maternal questionnaires. Granted this investigation only involved 52 infants (very small sample). However, for tired parents looking for relief why not give this a whirl? Note that the study was only done with breastfed babies and not formula fed babies so it is unclear whether the same would hold true with the latter. But again, it wouldn’t hurt to try if parents are struggling for relief.

So the official definition of colic is uncontrolled crying for more than three hours per day, more than 3 days per week, and for longer than 3 weeks.... AND infant needs to have appropriate weight gain and a normal physical exam. This is very important! Therefore, if you are suspecting colic in your baby please do not just add yogurt to your infant's diet in hopes that the crying will stop. Consult your doctor first!  Other more significant medical causes need to be ruled out.  Some examples:

  • An infection
  • Acid reflux or stomach problems
  • Pressure or inflammation of the brain and nervous system
  • Eye trouble, like a scratch or increased pressure
  • Irregular heartbeat
  • Injury to bones, muscles, or fingers

If your doctor does confirm the diagnosis of colic in your infant then you can try giving lactobacillus via infant drops.  Here are some other tips that may help:

  • Eliminate all allergens (cow's milk, eggs, fish, peanuts, soy, tree nuts, wheat) from the diet of the breastfeeding mom
  • Switch formula-fed infants to hydrolyzed formula

Majority of infants outgrow colic by 6 months. That may seem like a long time so if you are feeling like you are at the end of your rope, please seek help. It is overwhelming and stressful enough to care for a brand new baby, let alone one that cries often. Having a good support system is critical and knowing when to seek help is just as important.

Tuesday, October 4, 2016


Hello folks! It’s back to school and routine. I actually love this time of year. I love making schedules… color coding all the different activities per kid… typing up excel sheets to figure out how best to maximize time… and yet… and yet… we are warned not to overbook… not too overstimulate… Kids still need to be kids and have down time and play time. Yes, it’s all a balancing act. Parents are encouraged to be involved but not hover like helicopters…

So this year we have 3 kids in the public school system and 1 who just started preschool. We are sliding into a totally different phase of life. Before it was all about diapers, sleep hygiene, food intake… Now we still do keep track of the kids’ input, output and sleep…  but we also have to figure out how to attend Back to School Night for 3 kids at the same time... know when library books are due (...and of course all three kids have different library days)... as well as whether to dress our youngest in orange or black or yellow for whatever color of the day it is at preschool. Helping with homework, driving to activities, talking about friends… our days are full…
How not to get overwhelmed and stressed? Stress is a good topic to chew on for a while. I believe a lot of medical illnesses likely stem and definitely is exacerbated by stress. In fact, a couple of years ago I blogged about it here, how lifestyle modification can prevent/alleviate disease and stress being one of those factors. So what is stress?  It seems like such an overused term. Google defines it as “a state of mental or emotional strain or tension resulting from adverse or very demanding circumstances” Well, “very demanding circumstances” may vary in meaning from person to person. Seems to me like a very broad and nonspecific description. Bottom line is your emotions and mental state is feeling strain and tension. So let’s look at this from two perspectives… prevention and treatment.

Easier said than done… but may start with knowing your limits and learning to say “no”. If possible, make choices that avoid those difficult circumstances. Too bad there is no vaccine for stress! But you know how if you are healthier to begin with, you have a better chance of fighting sickness? So you exercise, eat right and sleep right to make sure your immune system is strong to fight when sickness may fall and you may not be as sick. Similarly, I think if you exercise, eat right, sleep right, and have a good support system you will be more equipped to handle stress when it hits.

So the treatment for certain medical illnesses are supportive measures such as fluids, rest and time. Just as nutritious food, sleep, and even exercise help the body fight the bug, the same can help relieve stress. But you know what else? I think laughter is the best medicine for reducing tension. I think after having kids, I forgot how to laugh. Instead of laughing with them, I find myself often annoyed at the silly giggles and ridiculous cackling. O to discover my sense of humor again! Now there is also something called the Relaxation Response that I’ve blogged about before which also combats stress… but I’m telling ya… I’m going to be more intentional about laughing! Finally, just like with sickness, we need a prescription antibiotic to recover if the symptoms become severe and we become infected with a bacteria, we may need a prescription if the stress symptoms become severe and turn into something else. Do talk to your doctor if you are wondering if your stress level requires further intervention.

OK.. going to end with a video I found online that made me tear… Michael McIntyre and his stand up comedy about "people with no kids don't know"...