‘less is more’

All Articles tagged ‘less is more’

If It Were My Child: A Turkey Without Antibiotics

turkey photoMy coffee arrived in a red cup today so I know the holidays are officially upon us; Thanksgiving will be here before you know it.  If you’re ordering a turkey (and/or you’re incredibly organized) you’ll likely be picking out your bird in the next few days. Who are you people? For you prepared and pre-paid types and even those of us who wait until the Thanksgiving week, we have some decisions to make and a great opportunity. What turkey we buy matters.

This year I’ll be making the choice to purchase a turkey raised without antibiotics –when you choose this type of turkey it doesn’t mean “organic” (even some organic meats come from animals fed antibiotics). Antibiotic resistance is a growing problem and I’m taking a new step to keep my kids away from excess antibiotics, like those found in many Thanksgiving turkeys. This is new for me and hasn’t been a priority until the last few years as I’ve tuned into information about the human microbiome and ways that antibiotics in our land, food, water and pharmacies really change our own habitat and potentially our family’s health.

The Problem With Unnecessary Antibiotics

I’ve written several posts on avoiding antibiotics when unnecessary, but here’s the cliff notes version: When you (or your child) take an antibiotic, most of the susceptible bacteria exposed to the drug will die. “Good bacteria” (naturally living on our skin or in your throat or GI tract) and “bad bacteria” (the ones causing the infection) will fail to survive. However, some bacteria will possess genes that allow survival amid the presence of antibiotics. Over time and without competition from other organisms, these bacteria can even thrive. This set-up creates different colonies of bacteria where some will be resistant ‘superbugs’ and changing the bacteria in our environment and our own bodies. Some of these colonies will eventually cause infections that are hard to treat. The more antibiotics are used anywhere, the more possibilities for these ‘superbugs’ to replicate with resistance over time. In fact 97% of doctors are extremely or fairly concerned about the growing problem of antibiotic resistant infections. Most parents are worried, too.

The Case For Antibiotic-Free Turkeys

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Is It Really An Ear Infection?

Screen Shot 2013-02-26 at 9.46.22 AMEar infections cause significant and sometimes serious ear pain, overnight awakening, missed school, missed work, and lots of parental heartache. For some children, infections in the ear can be a chronic problem and lead to repeated clinic visits, multiple courses of antibiotics, and rarely a need for tube placement by surgery. For most children, ear infections occur more sporadically,  just bad luck after a cold. Fortunately the majority of children recover from ear infections without any intervention. But about 20-30% of the time, they need help fighting the infection.

Ear infections can be caused by viruses or bacteria when excess fluid gets trapped in the middle portion of the ear, behind the eardrum. When that space fills with mucus or pus it is put under pressure and it gets inflamed causing pain. Symptoms of ear infections include pain, fever, difficulty hearing, difficultly sleeping, crankiness, or tugging and pulling at the ear. This typically happens at the time or soon after a cold—therefore the fluid in the ear can either be filled with a virus or bacteria.

The most important medicine you give your child when you first suspect an ear infection is one for pain.

Antibiotics only help if bacteria is the cause. When a true infection is present causing pain and fever, antibiotics are never the wrong choice. Often you’ll need a clinician’s help in diagnosing a true ear infection.

Three’s been a lot of work (and research) over the last 15 years to reduce unnecessary antibiotics prescribed for ear infections. There has been great progress. Less children see the doctor when they have an ear infection (only 634/1000 in 2005 versus 950/1000 back in the 1990’s) and they’re prescribed antibiotics less frequently. Recent data finds that less than half of children with ear infections receive antibiotics (only 434 of every 1000 children with ear infections). However, the far majority who go in to see a doctor do still receive a prescription for antibiotic (76%).

The American Academy of Pediatrics(AAP) just released new guidelines to help physicians do a better job treating ear infections. Sometimes children really benefit from using antibiotics and new research has led to an update on the 2004 previously published recommendations. Over-use of antibiotics can lead to more resistant and aggressive bacteria so we want to use them at the right time. These recommendations may help improve care for children.

In my opinion, NPR published the best article I’ve read covering the new recommendations. I especially liked the balance provided: Read full post »

Antibiotic Use May Increase Risk For IBD

We’re surrounded by bacteria– literally. They live on the surface our skin and set up camp in our intestines immediately after birth. The complexity of the colonies that live there diversifies throughout our lives–many sticking around for the duration. And we’re dependent on the ka-billions of bacteria that co-exist with us to maintain our health. Without them, things can go off-kilter as bacteria really are a part of our wellness–supporting digestion and maintaining harmony on our skin. Of course, some bacteria come in that we’d really rather not have. That’s when we use antibiotics.

As cough and cold season returns, a study published today serves up a needed reminder. Antibiotics can cause significant changes to our body. Because many infections are caused by viruses (not bacteria) antibiotics are often unnecessary. When we take antibiotics by mouth (or IV/injection) they may kill the bacteria causing a troubling or painful infection yes, but they can also kill the desired “good bacteria,” too. This is a side effect all antibiotics carry. Often we witness this in our children by changes in their poop—after a course of antibiotics they get really runny poop or diarrhea or it will smell entirely different. You really are witnessing the change of colonies in their intestines when you see this.

Sometimes antibiotics are absolutely necessary and life-saving. But recent research has found that antibiotics are prescribed in 1 out of 5 pediatric acute-care visits. And of the 49 million prescriptions for antibiotics given annually, some researchers estimate that 10 million of those are unnecessary. Avoiding those unnecessary courses is up to all of us–parents and clinicians.

I really do think the tide is changing in this regard. It’s rare that a family requests or urges for antibiotics in clinic.

New research is looking at how altering bacteria in our bodies may change our life-long health. It’s not just the alteration in our poop immediately after antibiotics that changes. A new study shows antibiotic use may set us up for chronic disease. And this may be especially true when antibiotics are used in infants and young children.

Research Finds Antibiotics May Be Associated With IBD Diagnosis

  • Dr Matthew Kronman and colleagues studied over 1 million patient records in the UK. They evaluated the infant and childhood exposures to certain antibiotics and the later development of Inflammatory Bowel Disease (IBD). The causes of IBD are incompletely understood; Dr Kronman wanted to understand if bacterial changes in the intestines at young ages affected inflammation that could potentially increase the likelihood of being diagnosed with IBD (Crohn’s disease or Ulcerative Colitis). They studied medical charts of a huge group of patients to determine if children prescribed common oral antibiotics in outpatient clinics (penicillin, amoxicillin, Augmentin, clindamycin, metronidazole, for example) had increased rates of IBD later in life. Read full post »

Avoiding Antibiotics Whenever Possible: Less Is More

I work hard (as do most doctors) to avoid prescribing antibiotics when unnecessary. The reason? I’m concerned about both the short term effects (diarrhea, rash, allergies) and long term effects (drug resistance, altered normal bacteria and microbes on our bodies) of antibiotic use in children. As we learn more about health and about the role of “good” bacteria in wellness preservation, I suspect we will feel more and more compelled to avoid antibiotics in children. Less is often more.

There are certain medical conditions that benefit greatly from antibiotics (Strep throat, pneumonia from bacteria, kidney infections, some severe skin infections, for example). Hands down, antibiotics save lives and prevent terrible infections when bacteria are to blame. But antibiotics are not without risk. And, we know that antibiotics do no good for children when viruses are the cause of the infection. The use of antibiotics when unnecessary, contributes to “unnecessary [health care] costs, avoidable adverse events, and the development of antibiotic-resistant infections” a study published today reminds.

The hard part for parents (and pediatricians) is knowing when bacteria are to blame and when they are not. Read full post »

5 Things We Shouldn’t Do

I really want you to trust your child’s doctor. I really want them to trust you, too. Partnership is key to any relationship. Recently an article was published in the Archives of Internal Medicine entitled The “Top 5″ Lists in Primary Care. It sounded more like a blog post than an article. In media summaries, reporters wrote about less being more. Not surprisingly, it was right up my alley. Like I’ve said many times before, in medicine, less is often more. Partnering with your child’s doctor is essential in assuring that when nothing needs to happen, nothing does.

This list is a reminder for us all.

The group authoring the article is part of the “The Good Stewardship Working Group” and represents 22,000 physicians for the National Physicians Alliance. Their intentions: to find 5 things “not-to-do” in primary care. For pediatrics, the committee used evidence (Cochrane reviews, AAP/AAFP Guidelines, The FDA, NAEPP), experience in the office, and field testers (pediatricians) to generate a list of what to avoid/what not to do, to avoid harm. The goal is to improve health, reduce burdens both financially and physically, and ultimately to empower patients, parents, and pediatricians to avoid unnecessary testing and intervention. I’m sharing them here because good care is partnered care. Being a strong, informed parent is likely the best asset your child will ever have in a health system. Parents need to know this list. If I could tattoo it on your arm, I would. You’re the strongest and most motivated person to advocate for your child. You’re also the most likely to help avoid unnecessary and dangerous intervention alongside the doctor or nurse caring for your child. The “don’t” list according to this group: Read full post »

Less Is More: 4 Ways To Know

I keep saying less is more. So often, with children, the less we do, the better. Pediatricians often pride themselves on being smart enough to know when to do…..nothing.

Take pink eye, for example. You know, the gnarly ooey-gooey, eyes-sealed-shut-yellow-crusty-“sleep”- in-the-eye that never goes away? The highly contagious infection where your child looks uber-crummy and straight-up, infectious? When it happens, you create a self-imposed lock-down-blinds-drawn-cancel-all-plans-covert-stay-home and watch a movie to hole-up the contagion. You or your child may want to hide from the world until it improves.

In my practice, pinkeye is one of the those infections that inspires me to wash my hands over and over and over again.  It is really contagious. And the best thing you can do when you see a glimpse of it, anywhere, is wash.your.hands.

So you haul in to see your pediatrician. Question is, what does your doc do for your child? School is asking for a note to come back and you’re there for a quick-fix thinking, “Just give me something to make this go away. And fast.” And like always, it depends on a number of things. Read full post »