The Medical News Report

May, 2021

#112

Samuel J. LaMonte, M.D., FACS

samlamonte@gmail.com

www.themedicalnewsreport.com

 

Subjects for May, 2021

1. COVID-19 updates

Shorter subjects below:

2. Grandparents raising grandchildren

3. Acute appendicitis-surgery vs. antibiotics

4. Cochlear implants for profound deafness

5. Deadly germs—lost cures!

6. FDA recommends mercury containing amalgam dental fillings should be avoided in high risk groups

IMPORTANT REMINDER!!!! PLEASE READ!!!

  I remind you that any medical information provided in these reports is just that…information only!! Not medical advice!! I am not your doctor, and decisions about your health require consultation with your trusted personal physicians and consultants.

  The information I provide you is to empower you with knowledge, and I have repeatedly asked you to be the team leader for your OWN healthcare concerns.  You should never act on anything you read in these reports. I have encouraged you to seek the advice of your physicians regarding health issues. Feel free to share this information with family and friends, but remind them about this being informational only. You must be proactive in our current medical environment.

  Don’t settle for a visit to your doctor without them giving you complete information about your illness, the options for treatment, care instructions, possible side effects to look for, and plans for follow up. Be sure the prescriptions you take are accurate (pharmacies make mistakes) and always take your meds as prescribed. The more you know, the better your care will be, because your doctor will sense you are informed and expect more out of them. Always write down your questions before going for a visit.

  Thank you, Dr. Sam

 

1. COVID-19 update

   General comments

   As of April 5, 2021, 33 states are now offering vaccines to all ages. Please do not think that the vaccines alone will get this pandemic in complete control. It requires people to continue to be smart when they are with people unvaccinated, in crowds, traveling, or in bars and restaurants.

  We all must honor businesses’ rules for masks, distancing, etc., but respect other people’s behavior about this. The media continues to peddle fear as does some of the information provided by certain experts. A very recent MIT study casts doubt on distancing with or without masks, because this virus is airborne, and hard to catch from casual contact with positive people.

  With herd immunity (those who have been infected and those vaccinated), we can continue to get back to normal with certain restrictions in higher incidence areas.

  And yet another reason to get vaccinated is that according to JAMA, 15% of the COVID-19 cases who have mild disease, have persistent symptoms 8 months later. JAMA, April 7, 2021

  While 5800 breakthrough COVID cases out of 68 million vaccinated in America have been reported by the CDC. However statistics without any reassurance that a vaccination is the best defense we have is not the proper approach. Some people just don’t create enough antibodies and there are variants that may have a small impact. The breakthrough rate has been cited at 0.008%. The CDC can’t expect those hesitant to get the vaccine to follow through, when they insist we continue to wear double masks in public.

  Public Health officials are always in a narrow lane and do not take into consideration the effects of their fear mongering and unintended consequences of isolation and lockdowns. It requires a level head that takes into all factors when determining public policy to combat any crisis. This is why it is impossible to keep politics out of medicine in our current environment. Too bad!! The virus has been so politicized and still is.

  Everyone 12 and older eligible should get vaccinated, and the good news is the U.S. has enough to vaccinate everyone. The FDA just gave emergency approval for ages 12-15. Some vaccines are still recommend 16 and older, but will change.

  J&J Pharmaceuticals has just been taken off the pause with no restrictions, somewhat surprisingly. In the U.S. because of 15 cases (out of 8 million vaccinated) of blood clots in the veins of the brain (central venous thrombosis) occurring within 2 weeks in women 18-34. Those who already got the J&J vaccine have not reported this side effect that is still not proven it is vaccine caused.

  Not surprising, but all the vaccine companies are stating that a booster shot within 12 months of the last shot, and could need an annual shot similar to the influenza vaccine. There are ongoing studies to prove the length of immunity. So far, 6 months or better seems to be what is quoted in the medical literature…90% effective.

  With near 40% of the U.S. population having received at least 1 dose of vaccine, and all those who have been infected (32 million confirmed cases reported by the CDC, but many estimate double that number), we are not that far from herd immunity. A significant number are getting their second shot…..sad! It would be nice to hear some encouraging words from the CDC, would it not! Medscape, April 16, 2021

 

A. Vaccine effectiveness--Pfizer effective against South African variant

  Recent clinical trials found that the Pfizer vaccine was 100% effective (moderate to severe illness) against a variant that has found its way around the world from south Africa—B.1.351

  Pfizer vaccines have already been shown to be effective against the UK variant and both Pfizer and Moderna have been declared the vaccine safe for pregnant women to obtain in the thirs trimester, according to the NEJM, April 24, 2021 There was no increase incidence of pregnancy related issues or postpartum, including the infants.

  The vaccine stimulates the body to produce neutralizing antibodies quite effectively against the recent variants.

  Also Pfizer has 6 months of data to prove safety, which is required to obtain full licensure from the FDA. These vaccines have been approved so far under the emergency use rule started by the previous administration, but will soon be approved through the normal channels.

  Great news for America!

  Now that Pfizer has been given emergency use approval for adolescents 12-15, children are being studied currently from 6 months to 11 years of age, and the results will be forth coming.

  The J&J vaccine is 67% capable of preventing moderate to severe viral disease in their phase 3 trials, according the researchists at J&J; 83% for severe illness. NEJM, April 21, 2021

Medpage, April 1, 2021

  And we now have solid evidence that in the real world, these vaccines are showing to be as effective as they were in clinical trials, according to a huge study by the CDC* on healthcare workers over the past few months as they were able to get both doses of the vaccine (Pfizer).

  Pfizer is 91% effective against symptomatic COVID-19 up to 6 months.

*The new CDC study included my daughter (Dr. Ashley Fowlkes, Sc.D.), who works in the virology department of the CDC and was one of the authors. Sorry, but I have to brag on her!!

Reference: Research data in the CDC Morbidity and Mortality weekly Report, April 2, 2021

  Also a smaller study in California also came up with essentially same results.

  This is encouraging news for those hesitant to get vaccinated. Unfortunately younger healthcare workers and minority groups are still reluctant to get vaccinated (30%) are a significant percent of military younger in age.

  The effectiveness in people who are immunosuppressed, have kidney, heart, and diabetic disease drops to the 80s, which should not be too surprising. Obese and overweight people do not have lower effectiveness if healthy otherwise. World Pharma News, April 21, 2021

  There are studies to cite increased liklihood of contracting more symptomatic disease in these individuals based on waist size, age, and sex, but it is encouraging that they achieve great results from the vaccine.

  A nice comparison of vaccines can be found in the Mayo Clinic Housecall internet service.

 

B. Travel recommendations from the CDC for those fully vaccinated:

  Domestic travel

  1- Those 2 weeks past their second shot, are free to travel domestically, however, there are greater risks for international travel. These people do not need to be tested before or after travel inside our country. They do not need to quarantine.

  2- During travel, the CDC still recommends masks, 6 foot distances, and wash their hands frequently.

  The CDC still recommends those not fully vaccinated should delay their travel. These recommendations could change based on rates of infection.

  If immune compromised people travel, they should discuss this with their treating doctor. 10 million Americans are immunocompromised. However, many of these patients are receiving medications that may combat the virus.  

  If not fully vaccinated, they need to be tested 1-3 days before the trip. Post-travel, they need to be tested in 3-5 days, go home, and stay quarantined for a full 7 days even if tested negative. If positive, isolate for 10 days and monitor for symptoms. Do not travel if exposed.

  All travelers using public transportation should check for restrictions.  CDC, April 2, 2021

 

  International travel (fully vaccinated)

  The CDC has specific recommendations for international travel different from domestic travel for those fully vaccinated.

1- Pre-travel does not require testing if fully vaccinated according to the CDC unless the destination requires it. The exception is air travel, which requires pre and post travel testing. 

2- Post-travel, get tested in 3-5 days.

3- Post-travel after arrival in the U.S., quarantining is not required.

4- Be fully aware of the pandemic extent in individual countries visited and know their rules.

5- Before returning to the U.S. from international travel, each individual must be tested 3-5 days before entering the U.S.

  If a person has been infected, they must recover for 3 months and have medical proof they are completely well before flying internationally.

  Consult the CDC website for people unvaccinated and must travel internationally.

  Cruise lines are still on hold in most cases.

C. Oral pill to treat COVID-19 could be ready by the end of the year! NIH*announces new guidelines for treating COVID-19

*NIH=National Institutes of Health

  An experimental oral drug taken as a pill is being studied to treat COVID-19—molnupiravir designed to do what Tamiflu for Flu sufferers, to shorten the course of the illness. After taking this pill, none of the participants grew any virus compared to 24% of the placebo participants still grew virus.

  There are 2 other oral drugs being tested as well for hospitalized patients. There is great anticipation for an oral drug to be approved. Medscape, March 12, 2021

 

NIH provide new guidelines for treating COVId-19

  This report is exhaustive and probably more than most readers want to know, however, if interested, log on to

 https://www.covid19treatmentguidelines.nih.gov

  The monoclonal antibodies in combination with corticosteroids for select hospitalized patients is still recommended, including remdesivir, convalescent plasma, and a new addition--interleukin-6-inhibitors (tocilizumab). There are many other drugs, vitamins, supplements, etc. that are not recommended.

  These were updated on April 21, 2021

 

D. Popular over the counter meds (NSAIDS) not as bad for kidneys as thought in older patients-read why it is important in COVID-19

  Non-steroidal anti-inflammatory drugs have been touted as dangerous for the kidneys especially in older people. In fact, they are, if taken regularly without monitoring the kidney function. Those with kidney disease should avoid these medications.  

  However, a recent study found no difference in the kidney function, even in older people who took NSAIDs regularly and did not have higher rates of kidney malfunction. This is not to understate the potential for damage in certain people with normal kidney function. That is why these blood studies must be followed especially when these stronger NSAIDs are taken daily.

  NSAIDs have been routinely used for osteo-muscular disorders, even COVID-19, for years, but when physicians were forced to reduce the number of prescribed opioids, the use of NSAIDs increased and even acetaminophen. 

  NSAIDs include aspirin, ibuprofen (Motrin, Advil), naproxen (Aleve), naprosin, Voltaren, indomethacin, Celebrex, etc.  Acetaminophen is not an NSAID.

  Because of certain effects on the body, (stomach trouble, blood thinners,, or those with impaired kidney function), should be very careful about taking these NSAIDs.

 

Use in COVID-19

  Because NSAIDs are often taken to treat the symptoms, there has been some poor documentation that they might diminish the antibody response from the vaccine. A significant number of people have muscle aches and fever with vaccines and often individuals reach for these mostly over the counter medications to combat these side effects.

  I bring this up because I saw a small article in the Sarasota-Bradenton newspaper in late March, warning people not to take them around the time of their receiving the COVID vaccine. Tylenol was recommended.

  Tylenol is preferred for many reasons, but in searching for scientific data to support such a statement about avoiding one or two days of NSAIDs regarding depression of the immune system, I was unable to find it.

  I suggest as always to talk to your doctor about taking these over the counter medications when getting the COVID-vaccine to prevent fever and muscular ache. Also, just because a medication is OTC (over the counter), does not mean it is without side effects and must be respected. 

J. American Geriatric Society, March, 2021

 

E. Who is getting vaccinated? Differences in diversity; vaccine hesitancy

There are some reasons why some people are hesitant to get the vaccine..negative and positive

  These vaccines have only been approved for emergency use, and none of them are actually FDA approved. Astra Zenica is not approved in the U.S. because of clotting issues, and now J&J has a handful of cases and is on pause.

  It takes 2 years of followup for a vaccine and many drugs to be sure there are no long term side effects. We are only into the second year. Yet, unless you don’t believe scientists that the vaccine is extremely safe, then there is no excuse unless your doctor says no for medical reasons. However, many healthcare workers are still “wait and see”.

  There are also those who have had anaphylactic reactions, or are very allergic to components in the vaccine. Those probably should not receive the vaccine, however, circumstances are very different for individuals and it always rests on the treating doctor to decide whether a patient should receive the vaccine.

On the positive side

  Think of the lives that would be spared of the virus from the vaccine compared to 6 women of childbearing age who got clots from 2 non-approved vaccine. There are far more clotting problems from birth control pills.

  The fact that certain diverse populations do not trust the medical field as much as others is a problem. Black people have not had enough black leaders to come forward and encourage them to be vaccinated. Yet, building better communication and trust in these communities has been a challenge for decades, and is a necessity to get acceptance in diverse communities.

  Most states have gone out of their way to reach out the black and poor communities with some success.

  People of color have 9 times the liklihood of dying from COVID-19. Has anyone stated that to them? This is a very good reason to get vaccinated, since their rate of underlying disease far surpasses that of other races and greatly complicates the viral infection.  Those who have been vaccinated are not reaching out to their friends sufficiently encouraging the vaccine. Fear reins!

  Those who fear the mild symptoms of a vaccine or have had these mild symptoms from a flu shot, rationalize they might have a more serious side effect.

  40% of U.S. Marines have refused the vaccine and a third of healthcare workers have delayed or refused the vaccine. Many are in the “wait and see” mode.

  All people 12 and over can get the vaccine and many of the sites are accepting walk-ins. More than 100 members of Congress have yet to be vaccinated. What kind of a message is that?

  There is an enormous group of antivaxxers with sophisticated websites lying about the vaccine. These advocates are not going to bend.

  When it comes to being a team player medical experts state the vaccine is safe, it comes down to trust and faith. It is also is important to decide if a person wants to run the risk of contracting a potentially deadly virus and transmitting it to our friends and loved ones.

 

F. Early administration of inhaled cortisone reduces the length of COVID-19 infections for outpatients

  I have reported in previous updates that cortisone containing inhalers might benefit outpatients early in their bout of COVID-19. Clearly, these drugs (in IV form) are an integral part of the medication regimen in many hospitalized patients.

  It was found over time there were fewer people with chronic lung conditions being admitted to the hospital if they were taking inhaled cortisone medications such as budesonide, etc.

  Lancet Journal just reported a study on people early in their illness being prescribed budesonide inhalers and had 1 day earlier recovery from the virus.

  Talk to your doctor about the use of these inhalers, which are well tolerated and may be worth a try, especially if there are any respiratory symptoms when contracting COVID-19.

Lancet, April 09, 2021

 

G. Physicians pay from Medicare reduced in $1.9 trillion relief package

  Relief from COVID-19 in the way of a $1.9 trillion bailout will certainly not provide relief for physicians, after a year when many doctor’s practices failed, first responding physicians worked even harder than normal, many of them burning out, and a significant number of them citing psychological problems from the stress of caring for such sick individuals in major numbers.

  This is in the face of relief packages of $8.5 billion to rural providers. The rest went toward supporting the vaccine issue and support for Medicaid expansion, while a significant percentage of the bill wasn’t even for COVID related trouble.

  This relief package triggers a spending cuts at a deficit cut of $32 billion reduction in paying physicians to cae for Medicare patients. Physicans have faced hundreds of billion of dollars in deficit over the past year combating the pandemic and complying very restrictive rules, and not being able to perform elective surgery for months.

  It is hard to imagine that Congress would cut physician’s pay as they have been patting them on the back for working extraordinary hours.

  The relief bill also does not include an extension of the Medicare sequester bill that hangs over the head of physicians every year to cut 2% of their Medicare pay. Previously Congress extended that deadline saving the doctor from a 2% cut every year, but should have extended it in this package.

  Why punish the very physicians that have bent over backwards during the pandemic. No one is spared!

 Reference--Xtelligent Healthcare Media, march, 2021 with information from the AMA and American Hospital Association on Health Policy and News

 

2. Grandparents raising grandchildren

 

         

Raising children is difficult enough for all the obvious reasons, especially now when entitlement seems to be the order of the day and parenting has been made more challenging with virtual schooling and children exposed to the constant bombardment of the internet and all that happens with it.

  A timely article in the Journal of Pediatrics, August 3, 2020 cited their findings from a survey of grandparents.  They describe the added stresses becoming the primary caregivers. The information was taken from the National Survey of Children’s Health. The researchists compare the responses from grandparents vs parent’s attitude about caretaking challenges with children 3-17.

  Here are some of the highlights of the results:

1. Grandparents were of lower income and higher numbers were non-Hispanic whites and blacks. Often the grandparents are uneducated and living on a fixed income. The pandemic has magnified this issue greatly with massive unemployment.

2. Children living with grandparents had higher rates of 7 adverse childhood experiences (divorce, death, incarceration, mental illness, addiction, or domestic violence among parents, and exposure too neighborhood violence).

3. Circumstances regarding the need for grandparents to become the primary caregiver influence the behavior of the children greatly. Parents may have died, are addicted to drugs, have overdosed, are in prison, have serious health and or mental issues, were child abusers, or they abandoned their children.

4. Drug abuse of parents continues to be an increasing reason for grandparents stepping in. 20,000+ parents died of overdose in 2015. Many times Child Protective Services have removed the children. 2/3 of the child abuse or neglect are linked to substance abuse

5. Confusion, anger, fear of the unknown, grief, etc. are often experienced initially by these children regarding the circumstances of transfer and the loss of being with their parents, even if they were unfit.

6. 2.7 million children were primarily raised by their grandparents as of 2012 (CDC). Often, one parent is living with the grandparents and their children. Frequently this is an unmarried or divorced parent.

7. Boys have more externalized behavior issues than girls.

8. There is a higher incidence of ADHD (especially ages 3-5), emotional issues, and learning disabilities, however, a loving caregiver can reduce the incidence of future bouts of depression and anxiety in the children.

9. For every child in foster care, there are 25 children living with their grandparents.The adult children can hamper the progress their children are making with their grandaprents, therefore, rules must be strict to prevent conflict.

10. Grandparents need to seek legal assistance to seek qualification for government assistance.

11. Grandparents reported a higher frequency of quality interactions with children, and lived in somewhat more supportive neighborhoods.

12. Grandparents reported no greater problems with caregiver coping compared with parents.

  Thankfully, there are dedicated grandparents that can save these children from foster homes, giving them the love and support needed to potentially prosper. However, grandparents need to know the risks and challenges of becoming the primary caregivers. Often they can share the responsibility and take considerable stress off the parents, making for a more loving, wholesome environment. God bless grandparents.

  In the future, I will report on the effects of being in a foster home.

 

3. Appendicitis—surgery or antibiotics

    

Inflammation of the appendix is a common ailment, and for decades was considered a surgical disease, and it still is. The main complication that must be prevented is appendix rupture and abscess.

  A study from the JAMA Network, July 27, 2020 reported 67% of patients ages 7-17 who were evaluated early in the disease progression and treated with antibiotics had fewer disability days (6.6 days) than those who had emergency laparoscopic surgery (10.9 days). The 67% of patients were still well at 1 year, saving a little over 2/3 of these patients needing surgery. About 25% within a year will have a second bout, and all of them have operated on, according to WebMD.

  180,000 adults and 70,000 children undergo appendectomy each year. It can be performed as an open or laparoscopic procedure. 5-15% of operative cases have some type of complication with 1-7% serious complications from anesthesia, wound infections, postoperative pneumonia, etc.

  Indications for appendectomy usually include localized pain in the right lower quadrant of the abdomen, fever, or evidence of localized or diffuse peritonitis especially with an elevated white count (usually greater than 5000 but less than 18,000 count).

  If it is not clear about the diagnosis, a watchful wait of 4-6 hours may be indicated. CT scan may help clarify the situation. If symptoms improve and the patient is discharged, they must return quickly if symptoms recur. Delaying surgery for 12-24 hours is usually safe if a ruptured appendix is not a great concern.

  If a ruptured appendix is a great concern, antibiotics may be an alternative to try with drainage of a localized abscess through the skin.

  Laparoscopic removal is the favored approach today. It has fewer complications in adults but the final results are the same for children.

  Complications of surgery include a ruptured appendix, persistent dilated intestine (ileus), fistula (leakage from  the intestine), or abscess.  

  Surgical removal of the appendix usually occurred within 12 hours of admission to the hospital. A decision for surgery was met with higher parental approval than medication only management. But the bias of surgical removal being the norm is not surprising. Doctors would have to provide more time in education and decision making for parents to buy in to a non-surgical approach.

  Non-operative management has been proven to be a viable alternative to surgery with multiple studies showing 65-80% success. This study only included children and teenagers. I have not seen a study on adults.

  There is no follow up in this study after a year, and possibly patients developed another case of appendicitis after a year.

  Obviously, when seeing a surgeon in the emergency room, there will be a bias toward surgery, so parents must play a role in the decision making and be given an alternative of antibiotics as a trial.

  If antibiotics are chosen, careful observation in a hospital is absolutely necessary, because if the white blood cell count rises, or symptoms progress, a change in approach  may be necessary.

  19% of patients were eligible for a non-operative approach. Of those patients (370) chose antibiotics whereas 700 chose surgery. There was a systematic protocol to follow the continued conservative approach or switch to a surgical one.

  Convincing parents, pediatricians, primary care doctors and even surgeons that non-medical management in younger people is a viable alternative if antibiotics can be instituted early.

Medicine.net

 

4. Hearing aid technology study—cochlear implants

Hearing loss has become an epidemic in even younger people thanks to louder music, ear buds for i-phones, and lack of hearing protection for millions of workers exposed to higher frequency noise (above 85 decibels).

  Cochlear implants, over the past few decades has been a big success in providing hearing to those with severe to profound hearing loss.

  The JAMA-Otolaryngology-Head and Neck Surgery announced in an article several key points:

1. Pure tone audiometric evaluation is the most effective method for screening people for nerve deafness (sensorineural). Example of severe loss across the hearing specrum. Those lines should be at the top in a normal hearing ear. Where the lines are placed is severe hearing loss across all frequencies. People would have difficult understanding words, hearing in crowds, and have actual inability to carry on a conversation very well without reading lips and watching expressions. The two lines would be superimposed if strictly nerve deafness, but the lines are separated indicating a loss of transmitting sound through the middle ear bones too. Even if surgery were performed on those middle ear bones, the improvement would be negligible. Strong hearing aids would be necessary. This would be the first thing to consider. People needing cochlear implants fail using standard hearing aids.

2. Age alone should not be a factor in considering cochlear implants, in that both young and old who have cochlear implants improve speech recognition and improved quality of life.

3. Speech improvement occurs in both quiet and noisy environments.

4. Cochlear implants can still improve those who have gone for long periods of time without hearing aids. Electrodes are surgically placed in the inner ear (cochlea). They are attached permanently to the hearing aid via an implant in the skull as shown in these photos. Amplification occurs through the hearing aid portion of the hearing apparatus.

    

It is an option for those who have failure with standard hearing aids because the hearing loss is too profound. Rush Limbaugh, recently deceased, had a very successful cochlear implant.

Consultation with an ear specialist who performs cochlear implants, and there are not an abundance, so seeing an ENT specialist is a good start and then if a good candidate, can be referred to a ear surgeon who performs this procedure frequently.

 

5. Deadly germs-lost cures

  There are many medical blogs on the web. One is

“The Long White Coat”, which reports on timely medical issues just as I do. One of the articles reported on medical ongoing crisis regarding antibiotic-resistant bacteria and fungal resistance (Candida auris).

  The fungus just mentioned is killing people in nursing homes, hospitals, the elderly, chronically ill, and those immunocompromised.

  Below is a drawing showing the step by step process that occurs with antibiotic resistance.

 

Certain bacteria have become resistant to most antibiotics because the antibiotics used kill off the normal strains of bacteria in the gut leaving the resistant bacteria to flourish and take over.

  Most people are aware of MRSA—Methacillin-resistant Staphylococcus aureus. But there are many other bacteria that have become resistant to most frontline antibiotics.

  One of the important reasons why these bacteria mutate to fight antibiotics is overuse and abuse of antibiotics for unnecessary often viral infections!

  Also the animal industry administers antibiotics to herds of animals to prevent infections because of overcrowding of these animals. Our government allows this! As these animals are consumed, it increases resistance in humans by altering the bacterial flora in the gut.

  Even though physicians are trying to resist overprescribing antibiotics for cold and flu symptoms, the public is often insistent on doctors prescribing these antibiotics. Belive me, it is more difficult to talk patients out of antibiotics rather than just prescribe them.

  “Doc just go ahead and give me a Z-pack. It always works”. Most doctors have heard that too many times. Paying lip service to this issue does not get the job done. Patients must understand their responsibilities when going to the doctor and not ask for antibiotics when it may not be clear that they are indicated.

  With short doctor visits comes the tendency to grab the prescription pad rather than explaining why they are not indicated.

  As an ENT surgeon, I saw plenty of these patients with upper respiratory infections, but unless there were clear indications of a bacterial infection in the throat, ear, nose and sinuses, I would not prescribe them. Rather I required them to perform certain techniques including salt water sniffs, gargles, allergy medications, and mucus splitting drugs.

  The color of the mucus was important. Thick whitish to yellow mucus is rarely bacterial in origin. Cultures can be taken to determine if a bacteria was present. If the patient worsens, developing thick green mucus, a fever, and other significant symptoms, I would certainly prescribe antibiotics. Usually, the course of the “cold” will improve in a week, and if not, I always recommended they return for a more thorough evaluation.

  Patients rationalize that if those antibiotics were given very early, they would prevent an infection. Not true!  

  Rest is also a critical factor in allowing the patient’s own immune system to combat the illness.

Common bacteria

The ten most resistant bacteria are:

1. Staphylococcus aureus is known for causing MRSA, this bacteria used to be easily treated with the penicillins, but now require extremely strong antibiotics. Of course, not all staph infections are resistant, these infections usually occur in the hospital or those who contracted it while in the hospital.

  Strict hygiene rules in medical facilities is a must, but patients coming and going in the hospital as well as the staff are the main culprits, as staph germs easily grow in the nose without infection in a significant number (carriers). Infection control committees in these facilities are a must to constantly monitor the appearance and source of any resistant bacteria. COVID-19 safety measures has not only curtailed the flu this year, but has helped in resistant infections too.

 

2. Bulkholderia cepecia actually is the bacteria that cause onions to rot. It is most dangerous to those with chronic lung disease including cystic fibrosis, COPD, and asthma. Although still not highly resistant, it can be difficult to treat in these patients requiring combinations of antibiotics.

3. Pseudomonas aeruginosa can occur in wounds, the urinary tract, and can be extremely resistant to antibiotics. It is especially worrisome for the weakened patient for any reason in or out of the hospital.

4. Clostridium difficule, better known as C.diff. occurs in the gut of patients who are treated with multiple rounds of antibiotics, which kill innocent bacteria in the gastrointestinal tract, thus permitting the overgrowth of C.diff. causing serious life threatening nausea, vomiting, and diarrhea. This is a difficult infection to cure.

5. Klebsiella pneumonia is a common infection in resistant pneumonias. Identifying the resistant strains is imperative with cultures and sensitivities to certain antibiotics.

6. E. coli. (Escherichia coli) is well known to cause food contamination causing severe food poisoning but also meningitis. 

7. Acinetobacter baumannii causes pneumonia, meningitis, and urinary tract infections and has high resistance. It became very prominent in the Iraqi war amongst injured soldiers from medical facility to another. High resistance makes this a real threat.

8. Mycobacterium tuberculosis has become more resistant to the standard TB drugs. TB has been around for 9,000 years having been culture out of the remains of human bodies that old. With the influx of immigrants, TB is once again a great concern.

9. Neisseria gonorrhea is the most common serious venereal infection, and are becoming resistant to penicillin, now requiring stronger antibiotics.

10. Streptococcus pyogenes causes 700 million throat (strept throat), lung, and skin infections globally annually—usually sensitive to penicillin, now resistance is growing. Throat cultures for strept are easily performed with a swab in the office or urgent care.

  Another sad note is that antibiotics are in short supply. The U.S. has been dependent on foreign countries (especially China) for medical supplies and production of the basic ingredients for medications including antibiotics far too long.

 

6. FDA recommends mercury containing amalgam dental fillings should be avoided in high risk groups www.fda.gov

Amalgam fillings

  There has been great controversy over the years about mercury containing dental fillings being harmful to health. A trace amount of mercury vapor has been detected from these fillings, but no evidence has been proven between them and medical or psychological disorders.

  Many unnecessarily have had their amalgam fillings removed, because false reports about the link of mercury vapors being hazardous to an individual’s health including links to neurobehavioral disorders, kidney, and other medical issues.

  Since 1998, the American Dental Association, the American Medical Association, and other national organizations have reviewed the medical literature and found no compelling evidence of a link to amalgam dental fillings and medical or psychological disorders.

  On September 24, 2020, the FDA came out with a recommendation for high risk groups not to use mercury-containing amalgam dental fillings.

  The high risk groups listed included pregnant women or those planning on becoming pregnant, nursing mothers, children (especially under 6), people with pre-existing neurological disorders, those with kidney disease, and those allergic to mercury or other components of amalgam.

  Without any scientific evidence, the FDA cited concerns for these groups, which has muddied the water. I would like to know the underlying reason the FDA came out with this recommendation at this time, which will certainly create unnecessary fear and confusion in the public, when year after year, the medical and dental literature does not support removing amalgam fillings due to the lack of clinical trials showing little evidence of harm. In fact, currently, the FDA does not recommend having these fillings removed to prevent any medical condition (unless medically indicated). Medically indicated must mean a specific doctor or patient has concern and wants to remove them without proof of value. Whatever happened to following the science?

  What are the medical indications when the medical literature does not support this concern?

This pamphlet put out by the FDA states there might be concern in these groups, stating these higher risk groups might be more susceptible to the effects of minor vapor exposure from these dental fillings.

  Most dentists no longer use amalgam anyway, because of the dark silver cosmetic appearance. Rather they have been using composite filling material.

  The alternative medical websites (the conspiracy folks) have long condemned mercury containing fillings with no scientific proof. But people believe what they read.

  Look at the number of antivaxxers refusing to take vaccines without any scientific proof of harm. 

  The FDA further states that certain signs in a person indicating true mercury poisoning include fatigue, sleep difficulty, mood disorders, memory, tremors, coordination, visual or hearing disorders. Therefore, one might conclude that certain fearful individuals connect the signs of mercury poisoning to these signs and symptoms, and the federal government concluded that the FDA should make recommendations on the side of caution as does the CDC.

  The FDA provides (below) how to reach them if there is a suspected incident.  I suggest anyone concerned with this subject discuss it with their dentist and doctors to make informed decisions about removing fillings.

For those with the above named disorders, follow the FDA’s recommendations. Mercury containing amalgam fillings are unnecessary today when better composite fillings that are the same color as the tooth can be used as restorations as a wise alternative.

 

 

This completes the May, 2021 report. As always, I appreciate your interest in reading the best and latest information on medical issues.

The June, 2021 Medical News Report will include:

1. COVID-19 update

2. Meds that can cause heart arrhythmias

3. Liquid biopsy for cancer diagnosis

4. New innovations in knee cartilage surgery vs physical therapy

5. New surgical treatment for Obstructive Sleep Apnea

6. Probiotics

 

Stay healthy, well, and enjoy your life!! Dr. Sam