Archive for December, 2011

There are many misperceptions about the appropriate use of antibiotics for the treatment of upper-respiratory infections.

As we come to the end of another year and find ourselves in the midst of the cold and flu season, I want to talk about the diagnosis and treatment of the common upper-respiratory infections. These infections include sinus infections (sinusitis), sore throats (pharyngitis), ear infections (otitis) and coughs (bronchitis).

These are the most common illnesses seen in my practice in urgent care, as well as in most acute-care practices. We physicians are constantly receiving information from current medical literature indicating that almost all of these infections are caused by viruses, which are completely unaffected by the use of antibiotics. These viral infections will usually improve with time. The big question here is how much time.

At what point does the simple viral infection become a secondary bacterial infection that can be cured with an antibiotic? That is the critical issue, and one that I’m sorry to say is difficult to determine.

We physicians have various means to confidently diagnosis such problems as appendicitis, heart attacks, ulcer disease, diabetes and others. But we have no easy, fast, or accurate method of determining at what point in time the upper-respiratory infection changes from a viral infection to a bacterial infection.

I want to say emphatically that antibiotics will not shorten the duration of an upper-respiratory infection.

Why not just give an antibiotic and hope for the best?

Simply put, antibiotics can cause problems from annoying to life-threatening allergic reactions, diarrhea and yeast infections. Just recently, overuse of antibiotics has been linked to obesity by Dr. Martin Blaser, a professor of microbiology at New York University Langone Medical Center. Antibiotics are also very costly and drive up the cost of health care when prescribed needlessly.

The most important issue is that the inappropriate use of antibiotics causes the development of “super germs” that resist treatment by almost all antibiotics. Unfortunately, unlike in past years, very few new antibiotics are being developed. The situation worries me.

What I would ask of patients with symptoms of the abovementioned respiratory illnesses is to give as much time as possible for the illness to run its course. If you have a fever or increasing pain, if you feel so sick that you can’t perform your usual routine or if you develop any other symptom that worries you, an immediate trip to your physician is justified.

Once you decide to see your doctor, you should expect the doctor to listen to your explanation of symptoms, examine you, give you a diagnosis and offer an estimate as to when you should feel better. Then let him or her advise you of the proper treatment to help you feel better.

When it comes to the common upper-respiratory infection, let us do for you what will ultimately help you, in the safest and best way, feel better.

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Diabetes, Part 2

In my November column on diabetes, I discussed the definition, symptoms, causes, risks and complications of this common disease (“Diabetes a common peril,” Page 20, Nov. 23). Today, I would like to discuss the diagnostic tests and treatments for diabetes, prevention and the impact of the disease on our society.

Before I do so, though, a reader who has a child with Type 1 diabetes has asked me to clarify a few points. Type 1 (childhood) diabetes is not caused by eating too much sugar; it is caused by the body not having enough insulin, which causes increased blood sugar. Also, a child will not “grow out of it.” Type 1 diabetes is a lifetime health issue.

Now, on to today’s topics:

Blood tests are used to diagnose diabetes. The fasting blood sugar test is the one most commonly used. It tests the amount of sugar in the bloodstream after a period of fasting. A more reliable blood test is called the A1C test and measures a person’s average blood sugar over several months.

Specific treatment for Type 1 diabetes involves the use of insulin, frequent monitoring of one’s blood sugar level and counting carbohydrates. Treatment of Type 2 diabetes involves oral diabetes medications, possible use of insulin, blood sugar monitoring, maintaining a proper diet and routine exercise.

Type 1 diabetes can’t be prevented and can only be treated with insulin. However, Type 2 diabetes can be prevented by the same lifestyle choices that also treat the condition, including:

– Eating healthy foods.

– Getting plenty of physical activity.

– Losing extra pounds, if overweight.

About 26 million Americans have diabetes, and the numbers are growing yearly. About 2 million of these diabetics have Type 1 diabetes, and the remaining 24 million have the more preventable Type 2 diabetes. Twenty-six percent of all hospital costs are related to the treatment of diabetes and its complications, costing $175 billion to $200 billion per year.

In summary, we know that Type 1 diabetes usually begins in childhood, is most often caused by genetic or other unknown factors, is not caused by a poor diet and can be treated with insulin injections. It is incurable.

Type 2 diabetes affects mostly adults and is treated and often cured by diet, exercise and preventing obesity.

About 25 million Americans have prediabetes, a precursor to Type 2 diabetes. I would advise patients to talk with their physicians at their next routine visit about being screened for this common disease.

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