Monday, October 7, 2013

Antibiotics: Can I Have More Please? Part 3

Looking back at past meetings which I've attended over the years, there's been a dramatic reduction in the push by Big Pharma for antibiotics aimed at upper respiratory infections.  Most recently, the American Academy of Family Physicians has added to the growing list of what not to do (no antibiotics early on in the course of an acute sinus infection) as summed up by the American Board of Internal Medicine Foundation's Choosing Wisely campaign.  This conservative approach is supported by a study published in January concluding that a typical cough illness lasts an average of 18 days.

Well, we've long used the color of phlegm as a gauge to determine whether to prescribe antibiotics or not: clear implied viral origin while discolored phlegm suggested bacterial origin requiring antibiotics.  WRONG!  It turns out that phlegm color has nothing to do with infectious etiology.  It just sounded good.  In fact, in a randomized double-blind, placebo-controlled trial published three days ago in the British Medical Journal, the authors concluded that neither ibuprofen nor amoxicillin-clavulanate shortened the duration of cough or production of discolored phlegm due to an acute bronchitic infection compared to placebo.

Granted those 136 randomized to ibuprofen coughed an average of 9 days (range 8-10) compared to those 137 randomized to amoxicillin-clavulanate or 143 to placebo who coughed an average of 11 days (range 10-12 vs 8-14) but this was not considered statistically significant.  More important, those who received an antibiotic had 2 to 4 times the risk of side effects compared to those randomized to the anti-inflammatory or placebo.

Bottom line, antibiotics aren't useful in treating most upper respiratory infections.  Your doc is actually doing you a favor by trying to talk you out of your request for antibiotics while the next doc you see is doing you a disservice by quickly acquiescing to your request just to get you out of his/her office that much more quickly.  In other words, be careful what you ask.  




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Sunday, October 6, 2013

Q&A Session at HealthTap.com

I am just 20 years old and I have a problem of low blood pressure feeling pain in head,sholders and feeling sleepy all time? Is there any serious prob



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Is it ok to take benefiber with Paxil and klonopin? Thank you Dr.



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Am I pregnant? Haven't had my period in a month. Last time was in August. I only get browning but have had that for years. Been really stressed a lot.



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Are there any ways to lighten the skin on my penis? Creams? Lemons? Soap? Etc?



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Are detoxing diets ok for you...? If so what kind is best for you...to lose weight?



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Saturday, October 5, 2013

Q&A Session at HealthTap.com

DX turbinate hypertrophy. Obstructed . Is that the cause of my shortness of breath ?



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I am 5'4" at 99lbs is this a healthy weight?



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I have a bad UTI & taking a strong antibiotic. My blood test (sugar/lipids/hemoglobin) is in 2 days. Would it affect results? Should I reschedule?



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Boyfriend and I not sexually active.we are intimate. Inserted tip of penis but didn't penetrate. Late period, brown discharge 5 days,a blob came out.



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Can i use erythromycin and eye drops to get rid of pink eye faster?



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MRI Monday morning possible disc herniation. Doc wants me to take a Valium before hand, never called it in. I have Xanax for my dog. (.5mg). Same?



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63yoDad ischemic stroke 2wks ago. Before had a DVT & asymptomatic brain aneurysm. @risk for falls from motor control issues. Should he start coumadin?



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What happens if an object was to enter the anus and not exit the anus later?



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Started taking levofloxacin 5 days ago. By day 3, my lip broke out in cold sores, by day 5 starting to feel ear joint pressure & sore glands. ???



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Vaginal irritation (itching, burning, tenderness) with progesterone suppositories 2x day. No yeast like discharge. How do I cope? I have 6 more weeks!



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Nasal congestion. Cold sensation when I inhale& occasional palpitations. I do have GAD. Can this be GAD or asthma? I have never wheezed nor do I cough



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Are spring valley brand vitamins and supplements of decent quality?



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Friday, October 4, 2013

Q&A Session at HealthTap.com

Should I not drink beer when taking testosterone replacement?



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Is it safe to drink on testosterone and hgh?



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What drugs raise natural testosterone production?



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Mediterranean Diet vs Depression

Everywhere you look, someone's trying to sell you this diet or that diet, most w/preposterous claims of miraculous weight loss and dramatic cures of a multitude of conditions.  In truth, very few of these diets have any peer-reviewed published evidence supporting their claims.  Of these, I would daresay that the Mediterranean diet has the most data behind it, having been linked to lower risk for dementia, diabetes & heart disease.

So perhaps it shouldn't surprise you that a multicenter, randomized, primary prevention trial of community dwelling participants published 2 weeks ago in BioMedCentral found that the Mediterranean diet supplemented w/nuts was linked to a lower risk of depression in diabetics. No, we can't explain the physiology behind this finding but given that there's been no harm found as a result of this manner of eating, it's certainly reasonable to consider the reverse, that perhaps eating this way may be useful in treating depression.  

Yes, I realize this is a major leap of faith since we haven't established cause & effect in the forward direction.  But for the multitude suffering from depression who aren't responding to medications, suffering from side effects, or who want a more natural means of treating their depression, we should consider adding the Mediterranean diet to counseling, exercise & sleep.



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Thursday, October 3, 2013

Q&A Session at HealthTap.com

I have enlarged prostate and erectile disfunction problem.Any solutions?



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Can we buy armor thyroid without prescription?Need to shift to a higher dose.Doctor's visit net month!Current medication almost over.



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I usually go to urinate 3times at my sleeping.Have i overactive bladder?At day , i usually go 8 times to urinate? What can be reason?



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Is any drug better and newest than viagra or tadalafil?



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Menopausal Hormone Therapy: Clear as Mud (Part 2)

So what did you think of yesterday's post regarding the latest analysis of the Women's Health Initiative?  Confusing, right?  Some benefit, but definitely some risk, too.  Of course, it appears that starting earlier is better than taking it later on.  Well, coincidentally, a population-based case-control study was published at the beginning of this week in JAMA Internal Medicine in which the authors concluded that oral conjugated equine estrogen (CEE) use was linked to greater risk for clotting & heart attack compared to plain estradiol (E2).

If you compare the above findings to the Global Consensus Statement on Menopausal Hormone Therapy published in March as well as the American College of Obstetricians and Gynecologists' Committee Opinion #556 published in April, you'll find that transdermal estradiol has an even lower risk of clots compared to any oral estrogen, but especially when mixed w/medroxyprogesterone acetate (MPA) as compared to plain progesterone.

For now, if you need MHT for unbearable menopausal symptoms, and not just for disease prevention, it would appear that you should try some form of transdermal E2 first.  And only if that doesn't work should you try an oral E2, leaving oral CEE as your hormone of last resort.  And if you have your female parts still in place (in other words, you haven't had a hysterectomy), ask for progesterone while avoiding medroxyprogesterone acetate.  I'm sure there'll be more updates to come in the future.  The final nail hasn't been hammered in yet!



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Wednesday, October 2, 2013

Q&A Session at HealthTap.com

Hi I am like 5ft 4inches and weigh about 140. Could losing 20 pounds be great for me?



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Where is the weakest spot on someone who is big and solid with nothing but muscles? Like pro wrestling where one guy is bigger than the other guy.



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I'm on testosterone therapy, is 50mg of zinc supplement safe to take?



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Menopausal Hormone Therapy: Clear as Mud (Part 1)

Well, that cleared things up! The latest analysis of the Women's Health Initiative was published in today's JAMA in which the authors concluded that risks & benefits are not so clear cut. Recall that WHI was a randomized double-blind, placebo-controlled trial involving 27,347 post-menopausal participants 50-79yo at time of enrollment. There wertwo different arms to the study, one involving conjugated equine estrogen (CEE) alone vs placebo and the other involving CEE + progestin, medroxyprogesterone acetate (MPA), which many will tell you is nothing like human progesterone. Of course, these same people will also tell you that equine estrogen is for horses, not humans.

And as you'll no doubt recall, when the CEE+MPA study was originally released over a decade ago, there was a loud outcry as the baby was thrown out with the bath water.  However, others pointed out that the danger was not quite so apparent when CEE alone was analyzed two years later.  So here we are 11 years later.  While the authors still don't recommend CEE either alone or in combination w/MPA for prevention of chronic disease, both are now deemed acceptable options for those women suffering from unbearable menopausal symptoms.  

Use of CEE+MPA remains linked to greater adverse outcomes eg heart disease, breast cancer, stroke, thromboembolism, etc while CEE alone actually continues to be linked to lower risk of breast cancer.  And while neither CEE+MPA nor CEE alone made a dent in all-cause mortality, there appears to be a glimmer of hope when CEE alone is linked to lower all-cause mortality when used by younger menopausal women 50-59yo compared to those 70-79yo.

So where does this leave us?  Stick around for Part 2!



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Tuesday, October 1, 2013

Q&A Session at HealthTap.com

What are the chances of getting pregnant when husband takes testosterone?



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Husband is on testosterone and we are trying to conceive what will he have to do?



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Husband on testosterone injections for low t.. can I still get pregnant?



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Exercise vs Knees: It's Not Just For Your Heart

If you've been anywhere near any media over the last several years, surely you've heard repeated exhortations to exercise. Get off your a-- and get moving! We've linked exercise to lower mortality, lower risk for diabetes heart disease & obesity, as well as less dementia, depression, disability & falls. 

But for most of us, those conditions are way out there in the future. We still live with a teenager's sense of invincibility. That won't happen to me! That only happens to those other people. Which might help explain why so few of us exercise regularly as so strongly suggested. But what if exercise could bring about a more immediate benefit? 

For instance, do any of you (or your patients) suffer from osteoarthritic pain, especially of the knee(s)? Enough to take non-steroidal anti-inflammatory drugs (NSAIDs) that might lead (or have led) to gastric distress in the form of gastritis or even a bleeding peptic ulcer? Or perhaps an elevation in blood pressure due to chronic kidney disease? Or perhaps having failed NSAIDs, are now dependent upon opioids & their derivatives?

The good news is that in a meta-analysis published last month in the British Medical Journal, the authors concluded that a combination of resistance training, flexibility & aerobics was best at dealing with pain & loss of function due to osteoarthritis of the knee. The authors filtered the literature down to 60 randomized controlled trials involving 8,218 participants over an average of 15 weeks (ranging from 4 up to 79). The participants were mostly from the States, United Kingdom & Australia. 

Granted, we may have some difficulty weaning someone off his/her narcotic, but that fact remains that we should make exercise the foundation to our treatment of knee arthritis, even before we pick up a pen to write a prescription.



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