Infectious mononucleosis, or "mono," is an infection caused by a virus similar to herpes. It is well-known for the rather severe symptoms it causes in teenagers and young adults.
It often starts out much like strep throat with a sore throat, swollen glands and a fever. Excessive tiredness usually becomes the predominant symptom and the person may be bed-ridden for days or even weeks.
About half the time the spleen enlarges along with the lymph glands of the neck. The enlarged spleen can rupture and bleed internally, especially if there is any trauma such as in football or from falls skiing. An enlarged spleen needs to be followed by your doctor until it resolves. Occasionally the liver is involved with hepatitis-like symptoms.
The skin may develop a rash. If antibiotics, such as amoxicillin, are used, this rash is much more likely to develop. Antibiotics should not be used for mono unless there is a definite bacterial infection.
Mono is spread through body fluids, especially oral secretions. Thus, the virus is usually spread through kissing or communal use of eating utensils, but mono is not particularly contagious. We are all exposed to mono numerous times in our lives, but do not develop the infection unless the conditions are right. People who have had the illness will frequently continue to excrete the virus for years and can expose others for years.
There is no specific treatment for mono. Antibiotics do not help, but in more serious cases steroids may be used to alleviate the symptoms. Other helpful steps are to get plenty of rest, use pain pills and throat lozenges, and treat the symptoms until they resolve.
Constipation is a common problem affecting millions of Americans. There are also medical reasons for preventing constipation. Many doctors believe that a person can decrease the risk of colon cancer by having regular bowel movements using fiber or bulk-forming laxatives, probably by more quickly eliminating any cancer-causing chemicals.
There are numerous methods of preventing and treating constipation. The first is by developing good bowel habits and a routine time to use the bathroom each day. Another simple measure is to increase the amount of water you drink. Physical activity is also helpful. Walking routinely or participating in other sports can help promote good bowel habits.
Good dietary habits are especially important. By eating foods high in fiber, a person will help keep his body healthy in many ways. First, fiber makes the stool larger and softer and bowel movements will be more frequent. Bulkier stools will also decrease the chance of developing diverticulitis which is a common problem as a person grows older. Other advantages of fiber include a lower cholesterol level, a decrease in the risk of colon cancer, and a more steady rate of absorption of nutrients from the bowel. This is especially important in diabetes.
If other measures are needed, there are a variety to choose from. Some medicines, such as polyethylene glycol or milk of magnesia, help draw extra water into the gut to keep the stool softer. There are also "stool-softeners" and lubricants, to make bowel movements easier. Laxatives work by stimulating the colon to empty but they can harm the colon if used on a long term basis.
If constipation is a new symptom, you must also consider bowel cancer or other illnesses and consult your doctor for an evaluation.
Breastfeeding Helps Prevent Ear Infections
Some simple things can be very important. Breastfeeding is one of the simple things a woman can do to help her child in many ways. For example, it is one way of preventing ear infections in her child.
The exact mechanisms of how breastfeeding helps prevent ear infections are not known, but may relate to antibodies in the milk. Breastfeeding also averts one of the common causes of ear infections—putting a child to bed with a bottle. Falling asleep with milk pooling over the Eustachian tubes is a common cause of infections.
How long does a woman need to breastfeed? Studies show that as little as two weeks can make a difference. This can cut the risk of infections in half, and breastfeeding longer may reduce the number of cases by 65-70% according to studies.
Breastfeeding mothers are also less likely to smoke, especially near the infant. Exposure to cigarette smoke is a huge factor for many children. Many children who have frequent ear infections or need tubes placed in their ears live in homes where someone smokes. If you have children, you should never allow anyone to smoke in the house.
Infants who are breastfed are also less likely to be in a day care center and less likely to be exposed to viral infections. Day care centers are a necessary part of life for many families, but they can expose your child to every infection that comes to your town. Children in day care centers have triple the frequency of upper respiratory infections, which is one of the major reasons why infants and young children get ear infections.
Fad Diets Can Be Harmful
Best-sellers are not always the best buys. New diet books are constantly on the shelves and millions of people buy them. But for each million copies sold, only a few people lose weight. Often, more people are harmed than helped by the gimmicks used in these fad diets.
There is no easy way to lose weight--you simply must burn up more calories than you eat. And even this must be done within reason. Some diets recommend 500 or 700 calories a day, but at these starvation levels the body lowers the thyroid activity, and the weight loss will slow down or stop. Then when a person resumes eating normally again, which always happens, the weight rebounds and usually goes higher than before.
Many diets rely on getting their quick weight loss by eliminating water from the body. These diets can result in dehydration within the cells and metabolic changes that can be harmful to you. One of the changes is a low potassium which can cause fatigue, muscle damage, and even dangerous heart rhythms. Many people died from the liquid protein diets which were promoted a few years ago.
Diet books are usually poor places to learn about basic nutrition. Many books mislead you about the roles of vitamins, talk about enzymes fighting in the stomach, food allergies and even quote studies done over 80 years ago.
Perhaps the most harmful effect of fad diets is the disappointment they cause when they are ineffective after promising an easy cure. There is no easy cure. A person must stay physically active and follow a balanced diet on a life-long basis. His calorie intake must consistently meet or fall slightly short of his daily caloric needs, not exceed it.
What Causes Cataracts?
Cataracts are opacities in the lenses of the eyes that prevent light from passing through. This results in a loss of visual acuity, the brilliancy of colors, a generalized darkening of one’s vision and eventually loss of vision.
Cataracts are so common they can almost be considered a normal sign of aging. Virtually anyone who lives long enough will develop them. But just what causes cataracts, or brings them on at an earlier age, is not entirely known. Presently, ophthalmologists believe that lifelong exposure to ultraviolet light outdoors or from man-made sources is the most significant factor.
There are numerous other factors which may play a role for certain people. Injuries to the eye are a cause in some people and can result in cataracts at an early age.
Cortisones and cancer drugs may contribute to formation of cataracts. Use of these and a few other uncommon medicines may necessitate regular exams by your ophthalmologist.
Cataracts are also more common in people who have diabetes or a family history of cataracts. Infants can be born with cataracts caused by rubella and other viral infections which had occurred before birth.
Whatever the cause, the result is basically the same. The crystal clear cells of the lens become cloudy and opaque and vision is lost. The visual impairment may vary from minor difficulty with needlework and reading to complete loss of useful vision.
Cataracts are treated by outpatient surgery which takes less than an hour. Only the eye is anesthetized and unless there are other eye problems, good vision is restored in 98-99% of people.
Written by Dr. Rick Jackson
A steward is a person or organization trusted with the management of a property or commodity. We in medicine are constantly reminded of our responsibility to practice good antibiotic stewardship. The ability to prescribe or administer antibiotics is a powerful tool and we must not abuse it, or it will become useless in the future. Our patients can help us practice good stewardship by becoming informed about the use and misuse of antibiotics. Please take this test to see how much you know about antibiotics.
1) When you have a cold and your mucus turns from clear to green, it is proof that you have a secondary bacterial infection, not a virus. True or false?
2) If a child is given amoxicillin for a cold with a fever, then develops a rash, it must be due to a penicillin allergy, and that child should never be given penicillin or related drugs in the future. True or false?
3) If you have an artificial heart valve, and need to have a boil lanced, you should take a large dose of an antibiotic 30 minutes before the procedure. True or false?
4) Antibiotic eye drops will treat pinkeye and keep it from spreading. True or false?
5) If you have chronic obstructive pulmonary disease and get a bad cough, fever, wheezing, and shortness of breath associated with a cold, you should get an antibiotic. True or false?
6) If your have an ingrown toenail with redness, swelling and tenderness, an antibiotic may prevent the need for surgery. True or false?
7) Some farmers give antibiotics to their cattle, hogs, and poultry to keep them healthy, and there’s nothing wrong with that, since the meat, eggs, and dairy products are still safe to consume. True or false?
8) Grandma has dementia and is living in a nursing home. She has become agitated, more confused, and the nurses requested that her urine be checked for infection. The urinalysis showed a small amount of bacteria. Treating with the proper antibiotic, based on the culture and sensitivity results, is good medicine, even though she has no burning
on urination, fever, or other signs of infection. True or false?
9) Antibiotics may treat acute appendicitis without surgery. True or false?
10) My 2 year old has a sore throat and I was able to look down her throat, and it was red. I need to get her treated for strep throat to prevent rheumatic fever. True or false?
11) I have fever, a headache, and my jaws ache when I chew .I really can’t afford to take time off. I’ll get my provider to call in some penicillin and make an appointment to be seen in a couple of days if I’m not better. This is OK, isn’t it? True or false?
1) False. Viruses, as well as bacteria, can cause green mucus. Signs of a sinus infection include facial pain and tenderness, pain radiating to your teeth, fever, especially if it is 7 to 10 days after the onset of a cold, after other cold symptoms were getting better. (“second sickness”.)
2) False. Many viral illnesses are associated with a rash. One must consider proper allergy testing by a specialist to see if it is a true penicillin allergy. Up to 90% of self-reported penicillin-allergic patients, (after careful testing) were able to tolerate penicillin.
3) True. Most heart valve patients know to receive antibiotics before dental work, but incision of infected tissue anywhere in the body can result in bacteria entering the bloodstream, so prophylactic antibiotics are indicated.
4) False. Pinkeye is caused by a virus, and is highly contagious, but antibiotic drops are useless. If there is a large amount of pus, or swelling and redness of the lids, it might be worthwhile to see your provider for further evaluation, possibly including a culture.
5) True. COPD exacerbations can be caused or aggravated by a bacterial infection, particularly if there is fever, purulent sputum, and shortness of breath.
6) False. The redness, swelling, pain and pus are usually the result of a foreign body reaction. Your own toenail may not be considered “foreign,” but when it has burrowed under the skin, the body “rejects” it. Sometimes prescription cortisone ointments can help, but surgery is usually required and in my experience, systemic antibiotics are a waste of time and money.
7) False. The practice of giving antibiotics to farm animals is common (in 2009, 9.3 million Kg of antibiotics were sold for agricultural use, compared to 3.3 million Kg for use in humans). This has contributed to the emergence of resistant strains of bacteria which can contaminate soil and water and infect humans.
8) False. Low levels of bacteria are common in urine specimens obtained at nursing homes. It doesn’t contribute to decline unless there is a fever, or symptoms such as burning, frequency, or worsening incontinence. Trying to eliminate all bacteria can lead to the development of resistant organisms, yeast infections, diarrhea, and other side effects.
9) True. In selected cases, when the diagnosis can be made, usually by a CT scan, antibiotics can treat the appendicitis without surgery.
10) False. Strep throat is extremely rare under age 3. The child should be evaluated, but don’t be surprised if your provider doesn’t do a throat swab.
11) False!!!! These are symptoms of temporal arteritis, an inflammation of the blood vessels that can result in permanent blindness if not immediately diagnosed and treated with large doses of cortisone-type medications.
Risks of Antibiotics
Some antibiotics can cause side effects that have nothing to do with their antibacterial action. Quinolones (Cipro, Levaquin) can cause tendon rupture. Macrolides (erythromycin,clarithromycin, azithromycin) can affect the heart rhythm when combined with certain other medications. Tetracyclines, especially doxycycline, can cause a skin rash if the patient is exposed to sunlight. Long term use of macrodantin can cause lung fibrosis. Broad spectrum antibiotics can cause C diff infections of the colon , which can be very serious and hard to get rid of.
Many ear infections will heal without antibiotics. I frequently will give the parents a prescription to be filled only if the child runs a high fever or has worsening pain.
Here are some tips for managing colds and coughs without antibiotics:
1) Avoid getting sick by using good hand sanitation. Use a hand sanitizer immediately after fueling your vehicle. I keep a pump bottle of Purelle in the map pockets of all my vehicles. Use your own pen or stylus when signing after you use your credit card. Sanitize the handle of a grocery cart before using it. Be careful about shaking hands; consider a “fist bump” instead. Get a flu shot!
2) At the first sign of a cold start using zinc lozenges—Zicam or Cold-Eeze. Keep using them for 2 or 3 days .Zicam nasal swabs don’t work.
3) Use honey for cough suppression (not for infants).
4) Use a sinus rinse twice a day.
5) There is weak evidence that Vitamin C and Echinacea can reduce the incidence of colds. Thera-flu, Mucinex and similar OTC medications can help with symptoms, but they won’t help you get over colds and flu. Breathe –Right nasal strips can help, especially at night.
In conclusion, it is definitely worthwhile to see your provider when you have a fever, respiratory symptoms, or any signs of an infection. A careful examination will help determine if there is a need for antibiotics. We can usually help with your symptoms, run tests to look for serious underlying conditions, and make sure that anything we prescribe has benefits that outweigh the risks.
How To Read Food Labels
Food producers can give their products any name they like. Putting "Lite" or "Low-fat" in the brand name is legal, but putting misleading statements in the ingredient list is not.
To get the best nutrition for your money, it pays to learn how to read the ingredient list on the food label. Here, producers must follow approved definitions and include the ingredients in order of the quantity present in the food.
If sugar is first on the list, sugar is the main ingredient. You must also beware of other forms of sugar such as corn syrup, honey, and other sweeteners which are essentially the same as table sugar. A food that is "naturally sweetened" may be no better than if sweetened by sugar. Natural sugars found in foods are still sugars.
The fat content must also be studied. The more healthful fats are the polyunsaturates and monounsaturates (mainly vegetable oils), while saturated fats contribute to a higher cholesterol. Some vegetable oils—mainly coconut and palm oil—contain no cholesterol but are so high in saturated fats that they are no better than lard. Avoid them.
The word "lean" means that there is less than 10% fat, compared to regular beef which contains about 30% fat by calories. You can now buy hamburger that are very low in fats.
Salt is another important ingredient. "No salt added" foods can still contain plenty of sodium as a preservative. "Sodium free" foods truly contain a low amount of salt.
Finally, it can be wise to read the food labels to see where the product was produced. You may want to think twice about foods made in some foreign countries.
We give our children vaccines before they have an infection to prevent viruses such as measles and mumps. The results have been remarkable. But can we give vaccines after a person has already had the infection? Surprisingly, there is just such a case where giving the vaccine years after having an infection can give you protection.
Shingles develops as an eruption of the skin from a virus that has been living dormantly for decades in certain nerve cells near the spine. When the virus travels down the nerve, it will cause a neuritis pain in the distribution of the nerve and a skin rash where the nerve endings reach the skin. It is most common in older people, usually someone over 60, but it can occur at any age.
Any person who gets shingles had chicken pox when he was young, perhaps as an infant. The person’s immune system has provided immunity to chicken pox for many decades. But over time, the immune system forgets about this infection of long ago the body’s defenses against it wanes. That is just when the virus makes a break for it, escapes from its hideout in the nerve cells, and rushes to the skin where it causes its severest symptoms.
The vaccine works by renewing the body’s “memory” of the chicken pox virus and rebuilding its defenses against the virus, holding it in check for another 10 or 20 years.
If you can prevent the shingles from breaking out, you will also prevent the painful neuritis that may develop in the involved nerve. And in the long run, the chronic pain is much more troublesome than the skin rash.
If you are over sixty or have chronic illnesses such as diabetes or cancer, consider this vaccine and discuss it with your doctor. It could save you a lot of pain.
Don't Overuse Cortisones
Doctors prescribe cortisone creams for many different rashes. Patients like them too—they usually work wonders. But many people think if a little is good, a lot is even better. There are, however, many rashes that cortisones should not be used for, especially in the stronger doses. The newer synthetic cortisones have become incredibly potent and should be used only when prescribed by a physician and only for a limited period of time.
Cortisones are absorbed through the skin and can cause serious medical side effects. The amount absorbed is affected by a variety of factors, but steroids are most easily absorbed from the head, groin, and areas of skin folds. The absorption is also increased if the cortisone is in an ointment, occluded with dressings, or is put on moist or thin skin.
When enough cortisone is absorbed from the skin, it can cause hypertension, glaucoma, and suppression of the adrenal glands (which makes a person more vulnerable to serious medical and surgical stresses). In children, cortisones can also cause stunted growth, cataracts, skin damage, and thin bones.
One of the main misuses of cortisone is in treating dry skin. Cortisone does not moisturize the dry skin, nor does it do as much for the itching caused by dry skin as antihistamines do. Moisturizers are better for both of these symptoms.
Cortisones should be avoided on the face because they can actually cause a dermatitis, acne, atrophy of the skin, and changes in the skin's pigment.
Another error is to use them too often or apply too much. Use only a thin coat and rub it in well. Twice a day is effective. Many of the potent cortisones should be used only once a day.
Never use prescription strengths of cortisone unless your doctor prescribes them and not for longer than advised.
Are You An Organ Donor?
A 17-year-old athlete weakens and becomes short of breath with minimal exertion. He has a viral infection of the heart which weakens it to the point that it has become life-threatening.
A full evaluation is carried out, matching studies are done, and he is given a pager—he will need to get to the transplant center in an hour or two when an organ becomes available. He waits for the call—day and night—when his life-saving heart becomes available and his pager goes off. For some, the call never comes.
Other patients are on waiting lists for kidneys and must face dialysis every two or three days. There are also waiting lists for livers, corneas and other organs. Yet, the sad statistic remains that two thirds of possible donors are not utilized because people had not considered this life-giving opportunity.
A kidney can be donated from a relative without harming the donor, but organs such as eyes and hearts obviously cannot be. These must be obtained from victims of accidental deaths where these organs are still healthy. Then careful matching of the organs to the appropriate recipient must be done to lessen the chance of rejection.
Since time is crucial in obtaining and processing donor organs, the decision to donate is best made by you beforehand—not by your family at a time of great sadness and turmoil.
You should make the decision today to donate organs in case of an accidental death and let your relatives know. Also sign the "Anatomical Gift Statement" on the back of your driver's license.
You could give someone the gift of life or sight.
Time For Flu Shots
It is time for flu shots again. Each fall and early winter, people at high risk of complications if they catch this serious influenza virus should receive the shot. Unfortunately, only about 20-40% of people who should get the immunization do so. This low immunization rate allows the virus to spread through a community very easily. The virus normally spreads through the United States during the winter months, so it is important to get the shot by mid-November.
A person should get the shot if he is over 65 or if he has any severe or chronic illness, such as heart disease, lung disease or diabetes. Residents of nursing homes or other long-term care facilities should routinely get the shot. Younger people should be immunized if they have any chronic illnesses, such as kidney failure or immune deficiencies.
A person can receive the vaccine even if he is allergic to eggs unless there has been a severe reaction. The shot should not be given during an acute respiratory infection or other active infection. For people over 65, a high dose formulation is available which gives a stronger immunity in older people.
The shots are very safe and if any reaction occurs it is usually a mild fever, aching and fatigue. This may last one to two days. Rarely, a person will get hives or a more severe reaction.
The more serious paralysis of Guillain-Barre syndrome is very rare and is only known to be associated with the "swine flu" component which was last used in 1976.
The immunity against the virus wanes, and the viral strains change each year which is why the shot is needed each year.
Ringing in the ears is a common symptom that can be very bothersome. It is usually due to hearing loss from aging or exposure to loud noises. Occasionally it can be due to more serious diseases, such as nerve tumors, so a person should see his doctor, especially if the ringing is new or mainly one-sided. Some causes can be easily treated, such as high blood pressure, anemia, and side effects of medications. Other causes can be difficult to treat.
The benign forms of hearing loss from aging and noise exposure cause a hearing loss of the higher frequencies. The ringing is often made worse by anxiety, depression, illnesses or fatigue and it commonly is most noticeable at night when the room is quiet and a person is trying to sleep.
There are a number of things that can be done to decrease the ringing. The underlying problem cannot always be cured, but hearing aids can improve hearing and reduce the sensation of ringing.
When the room is quiet, "maskers" can produce the right amount of background sound to hide the ringing. The masker is matched to the frequency and intensity of the ringing. These work quite well for the people who use them and many people find that the ringing is gone for several hours after using the device.
One of the newer treatments is biofeedback. By learning biofeedback maneuvers to relax the facial muscles, some people can effectively control the ringing.
While most cases are mild and do not require treatment, it is wise to have your doctor evaluate the symptoms for any correctable causes of ringing, and to determine if hearing is decreased to a point where a hearing aid would help.
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