Your doctor is, in addition to being guilty of unethical business practices, also apparently a quack. Or maybe this is a different doctor. Regardless, the state of medical care in heebieland seems unusually craptacular.
This is total nonsense, isn't it?
Yes. Antibiotic resistance develops from patients who are medicated but who end up (often from not completing their course of drugs) still having some that weren't zapped, and then spreading those to other people.
Her kids will have no more and no less resistance to any super-bug than someone who has been living on antibiotics.
I guess your more charitable reading is also possible. But seriously, a doctor saying something like that is almost ridiculously stupid and irresponsible. I would draw an illustrative analogy -- to Hitler -- but I know the rules.
Yes, nonsense. Hospitals and farm animals basically saturated with antibiotics are behind antibiotic resistant infections.
Many practicing MDs have unusual personal beliefs, probably a consequence of competence and overconfidence.
My instinctive reaction would be along the lines of 'run-don't-walk', but I guess it depends on the other available options. She certainly sounds like the kind of doctor where it's best to do your own research and show up more or less decided on what the reasonable treatment options are, though. (I totally get why doctors hate that, but seriously it's because patients end up saying roughly what she did there.)
Protected against superbugs is wrong, but isn't there something to trying to maintain a population of bacteria that isn't drug resistant? That is, if you've got a kid who hasn't had much antibiotic exposure, the bacteria colonizing that kid are less likely to be resistant. At which point if the kid gets some kind of clinically important infection, it's likely to be an overgrowth of the bacteria that were colonizing the kid to begin with, right? So if you need to knock them back with an antibiotic, they'll still be naive, and it'll work.
Dr. Oops told me once about a strategy for managing MRSA in particular hospitals, declaring specific antibiotics off-limits for a period of years, and then switching. So, e.g., you don't use vancomycin at all for anything for ten years, meaning that the bacteria hanging around in that hospital have no advantage from vancomycin resistance. Ten years later, you bring vancomycin back into play, and retire a different drug, and it's as if vancomycin is a whole exciting new antibiotic from the point of view of the hospital's local bacteria population. (I cannot remember if this was something hospitals actually do, or a bluesky fantasy plan. But it sounded smart.)
(That is,what the doctor said still sounds wrong -- her kids could still pick up resistant bacteria from someplace else. But not totally insane, because IIRC, lots of bacterial illness is overgrowth of the bacterial you were carrying around harmlessly to begin with.)
6.1 is basically what my wife just said when I asked her.
6.1 was my (absorbed from half understood newspaper articles and the general zeitgeist) understanding. Could be totally wrong.
use of antibiotics is a dark horse candidate for cause of the obesity epidemic:
Holy shit guys Ogged's wife is a quack.
10: But probiotics will save us!
10: AAAAAUGH. That story should be retired. Now. I'd hate to think that parents would be dissuaded to use antibiotics when needed in order to keep their children from becoming obese based on that article. This area is one that should be regarded with extreme skepticism until someone starts showing a mechanism and expanding into more human-relevant species. It's getting all kinds of media play, and it's truly scary to me that this might cost kids' lives.
Maybe she just meant that not overprescribing antibiotics makes superbugs less likely? (Granted, one doctor can't make much of a difference.)
It does seem like a lot of people take antibiotics much more often than they have any real need to.
6.2: Also, there are drugs of last resort, which are not prescribed unless everything else fails. There are several which are not in routine use anywhere, mostly because they had nasty side effects.
As to the theory, it really depends on how the kid gets the infection. Viral infections can lead to overgrowth of existing bacteria (this is where limited previous exposure would be helpful). You can catch drug-resistant bacteria from someone else or a contaminated surface (hi, MRSA), and I doubt that your regular microbiome makes much difference, although it might make some, since often resistance has a fitness cost, meaning that drug-resistant bacteria might be crowded out by regularly growing susceptible bacteria. I don't think there's data on that, though. Studying microbiomes is new enough that there's little consensus about what bacterial populations are "normal" and which aren't.
I've had vancomycin. That's nasty enough for me.
Viral infections can lead to overgrowth of existing bacteria (this is where limited previous exposure would be helpful).
This and 6.1 is basically what a yeast infection is, right? That's the only kind I've ever heard of, and those are super easy to treat.
Now, I can see the argument for minimizing exposure to antibiotics - welcome to the BIODOME! and who knows really what happens to it from excessive use. If she'd spouted a rationale along those lines, I probably wouldn't have batted an eye.
This and 6.1 is basically what a yeast infection is, right?
No, not really, or at least I don't understand what you mean. Yeast is a fungus, which can overgrow when antibiotics have damaged your normal bacterial flora, but it's not what I was talking about in 6.1.
17: Eye infections can be like that (which is why I think they still give antibiotic drops right away for conjunctivitis even though half the cases are viral, but that might have changed recently). I had a lymph node infection following a cold. The docs I saw thought I'd somehow contracted mumps until I mentioned I'd recently had a titre done. They said it just happens sometimes.
The PCAST report on AMR is conveniently coming out soon (maybe tomorrow I think?) and it's light enough that you can use it to smack her in the head, as opposed to dropping it on her foot.
I hope a couple of the lines I contributed made it through the hundreds of rounds of revision.
At which point if the kid gets some kind of clinically important infection, it's likely to be an overgrowth of the bacteria that were colonizing the kid to begin with, right?
What does this mean, then, if not yeast infections or eye infections per Ydnew? That if you have a cut gets infected, it's most likely being colonized by something you introduced from inside your mouth or body?
That if you have a cut gets infected, it's most likely being colonized by something you introduced from inside your mouth or body?
Sure. When I was on the vancomycin, that was because they accidentally pierced my trachea during a thyroidectomy. A tiny hole, but enough to let air in [surgical emphysema] and then [probably] bacteria. Which led to the nasty post-operative infection, and days in a hospital bed attached to a syringe driver.
The bacteria was almost certainly already in my mouth, or on my skin.
Makes sense. I guess post-surgical infections would often be because little buggies are getting across the surgical site from one part of you to another.
(Forgot a common one - UTIs.)
We don't usually track down where an infection comes from, but like I said, could be self, could be another person, could be a surface. I think when everything's going OK, it's unusual to have an overgrowth that bacteria are there anyway. Situations like ttaM's or a UTI mean that normal bacteria have ended up somewhere they shouldn't be.
which is why I think they still give antibiotic drops right away for conjunctivitis even though half the cases are viral, but that might have changed recently
Zardoz had viral conjunctivitis several months ago, and the treatment was... nothing! No drops.
What does this mean, then, if not yeast infections or eye infections per Ydnew?
With the case of a yeast infection, it's that we're not talking about bacteria any more. I think it's also more of a balance problem when you have a yeast infection: there are always both bacteria and yeast there, but the environment has allowed the yeast to take over more than it should.
Yeah, the doctors around here are often loathe to give you anything for pinkeye. It's a mini-war between daycare rules-makers and doctors, where they're not actually talking to each other but going solely through parents. The doctors hate that the kids are getting sent home from daycare for pinkeye, and the parents (me included) desperately want drops, because it's a fig leaf that enables you to send your kid back even though they still have visible symptoms.
So I've had conversations like this:
"I don't want to prescribe you drops, but I'll write you a note that you were here."
"It needs to be a note that indicates that the kid is safe to be around other kids."
"The kid is safe to be around other kids. For all intents and purposes, this is just like catching a cold."
"But daycare thinks it's a really big deal. Can you write the note indicating that the kid is being treated?"
"We aren't treating the kid."
"Would you feel comfortable writing 'the kid is being treated appropriately for this condition'?"
"Sure, I'd sign that."
"GREAT!"
22: Fun. The DE got a nasty kidney infection when the docs went looking for a stone that turned out to have vanished. She got Vancomycin for a week at Cedars in one of their fancier suites. Fancy doesn't make up for it.
I've had vancomycin. That's nasty enough for me.
The vancomycin today isn't like the mellow stuff you did in high school, man. It's, like, a hundred times more potent and people get all dosed up and lose their shit.
26/27: Huh, that's interesting that they finally switched. For a pretty long time, I thought the logic was to prevent secondary bacterial infection. Last eye infection I had was 5 years ago, though, and I think docs are getting much better about not prescribing antibiotics when not needed.
27: "The child has been seen by a doctor and has been prescribed a placebo, which should cause the condition to resolve within days."
28 is awful.
29: and dude do not just eat those Vancomycin gummies like they're regular gummy bears.
This is all quite comforting. I have contracted hat I assume is conjunctivitis (god knows how!), and have done nothing about it, supposing that a doctor would do nothing if I bothered her. I feel I made the right call.
Oooh, 27 hits home. We had almost an identical thing happen maybe 3 years ago. Figuring out what to do with a somewhat but not actually sick toddler/preschooler who really should be in school but they won't let in school is hard.
My mom totally thought antibiotic resistance was something that happens to kids who took too many antibiotics.
antibiotic resistance was something that happens to kids who took too many antibiotics
But if 6.1 is right (and Ogged's marriage is on the line here, people) I think this is indeed kinda true, or true enough for practical purposes.
I mean it's not really true, you can of course get an antibiotic resistant superbug no matter how few antibiotics you eat, but it is true that you may be less likely to get fucked over in some nasty way by antibiotic resistant bacteria if you don't take a lot of antibiotics (because your own stock of bacteria in your body, which can cause problems, is less likely to be antibiotic resistant). So as practical folk medical knowledge it's not way off, good enough for the vague half-knowledge on the basis of which most of us make medical decisions.
I had an eye infection (not conjunctivitis; I forgot the name but a mild infection in the corner of my eye) this spring and the eye doctor was adamant that the best treatment was nothing but rest/glasses instead of contacts.
"But doctor, I can't get the glasses under my eyelids."
With respect to potentially overused antibiotics: I'm hearing about a lot of people being put on doxycycline for actual or potential Lyme Disease. I'm one, and two friends have been on it in the last year; it appears that Lyme Disease is more rampant lately, at least on the east coast. A local CSA reports, anecdotally, that something like 1 in 10 people they run across have been affected.
I'm put in mind of this as ogged mentioned that he was bitten by a tick recently. Of course not all tick bites are a problem (most aren't), and one should not be freaked out by them. Yet all three people I personally know who've been on doxycycline were not proven to actually have Lyme Disease before they were put on the drug. hrm.
Not totally unrelated. I read an article recently (I think it was in Health Affairs) on research into how to convince people to get their kids vaccinated. Emphasizing that it will protect your child is the argument that works. This is probably obvious, but it appears that the public health argument about herd immunity and protecting other people's kids had no effect whatsoever. That makes me kind of sad.
38: I really wish that they would get a vaccine for Lyme disease out. West Nile virus too.
I had a UTI (sorry if that's TMI) recently and even before the culture the doctor was pretty insistent that I take an antibiotic. She said that if it was one (and it was) it would probably get to my kidneys by the time the culture was back.
Yeah, there are a bunch of things where antibiotics are really important: UTIs, Strep throat, etc.
Strep can now be cultured very quickly. I think you can wait for the test on that.
Right, that one's not a hurry, but antibiotics are still important for avoiding Rheumatic Fever?
I assume. It hasn't come up for us.
My doctor wouldn't even do a culture for me after telling her that my son just had a negative culture the week before. She basically told me to go deal.
46: I went out to a suburban hospital which is affiliated with the hospital I go to in Boston, because I was able to schedule an after-hours appointment. The doctor said that when she worked in Boston, they didn't even bother to do cultures because they were busy, usually just prescribed off of symptoms. Normally people just called and weren't seen.
Obviously, the refusal to do a culture in that case was not due to there being the likelihood of a negative result. They were just too busy.
I did have something called a pyogenic granuloma in my nose. The ENT scraped it out, but then he said that it was an infection and prescribed cephalexin. He didn't culture it, and I didn't ask him whether it could be viral or fungal.
I did have something called a pyogenic granuloma in my nose.
That's a nice brand of watch, right?
38. I got a tick bite and they wrote a prescription without me having to go in. We got the tick tested (a university tick testing lab was doing it for free as this has been a bad year). The tick had the hat trick: lyme, babesiosis, and borrelia.
That being said, not all bites infect you; lyme supposedly takes 24 hours of attachment, for example.
But I'm glad I got the antibiotics. I guess that makes me part of the problem.
That sounds like pretty responsible antibiotic use. Were the able to save the tick?
51: I don't know if you're part of the problem. Obviously most people think that they're better safe than sorry, but (a) what I think of as a regular tick -- the kind that becomes fat like a raisin as it drinks your blood -- is not particularly a Lyme disease danger, as far as I know; it's just the so-called deer tick, the teensy one the size of a flea, that's a potential problem, but a lot of people don't know that, and because of this, (b) self-reporting a "tick bite" to a doctor really should not result in an automatic prescription.
Obviously if you knew you had a deer tick, the tiny one, and if on top of it you showed a target-like circle around the tick site, then, yeah, become concerned. Some people just freak out at any old tick. A friend recently self-reported symptoms sounding vaguely like conceivable Lyme disease, and while he'd found no deer tick on himself, he'd had a number of regular ticks in the past, and the doc just wrote him a prescription. It seemed a bit premature.
I'm unclear from 51 whether you got a prescription before having the tick tested. Obviously that's fine if it was tested, and positive. I'm talking about being prescribed without any testing or any sign of relevant tick bite at all.
I found a deer tick on myself once. Disturbingly, it had attached itself to the part of the body that rhymes with tick.
Either I had your gender wrong or my anatomical knowledge isn't very good.
The former, I'll bet. Maybe my slide show needs to be more explicit.
So how about washing your hands? The soap in public restrooms is antibacterial right? Does that mean it's best not to use it unless your hands are very dirty?
I feel like I was supposed to have learned this by now.
re: 59
I think most are antibacterial in the way that bleach is antibacterial, or burning shit with fire is antibacterial, most of the time. But there is some controversy around triclosan.
Anti-bacterial soap in a consumer setting is double plus ungood. Doesn't improve hygiene or sanitation, but promotes the emergence of resistant strains of bacteria. Use soap and water, and, if you must, an alcohol-based hand sanitizer.
an alcohol-based hand sanitizer.
I prefer to dip my hands in grappa.
I don't understand why antibacterial soaps aren't just made with alcohol.
I like a thyme and lavender soap a lot. It's supposed to have antibacterial properties. I don't think I'm hurting my skin, but I don't want to unbalance the ecosystem oft skin.
64: Duh! Because we need the alcohol for drinking!
Alcohol-based sanitizer is just murder on my hands. If it were in soap in public restrooms, I'd start shitting in the sinks until the public change its ways.
A great way to generate alcohol-resistant fecal bacteria, of course.
Or better yet, fecal-resistant alcohol bacteria.
Public safety pedantry: The bull's eye rash does not necessarily appear above the tick bite or even at all.
I'm no materials science engineer, but wouldn't alcohol-based soap be, like, the wrong texture?
As for overuse of antibiotics in medicine, it is definitely an issue. It's not just the damn farmers feeding them to cattle (and those are really just the most basic, old antibiotics anyway, since they are given to animals because of mysterious weight gain effects, instead of because of their antimicrobial properties).
Our medical center is establishing an antimicrobial stewardship program. Doctors need to be able to recognize which infections are ALMOST GUARANTEED NOT TO BE BACTERIA and therefore "empirical" treatment is NOT antibiotics, in fact it would be the opposite. Antibiotics do have side effects, and that includes disrupting the normal mucosal flora which most famously encourages Clostridium difficile to colonize the gut, as well as the yeast infections mentioned above.
71.1: but are those contributing to the obesity epidemic?
And where do I buy skinny bacteria?
C diff really frightens me. I got all crunchy and took a probiotic after my 10 day course of antibiotics. Maybe it does nothing, but I wanted to do everything I could to rebalance my gut. (Are bacteria fauna?)
71.1: Do you really want an answer? Because I could give one, but it would be dull.
71.2 Thought the grain diet made cows have the wrong gut pH and have all kinds of low grade infection. Did Michael Pollan lie to us?
75: Folks seem to say "gut flora."
76: I know people say flora, but I had in my head that bacteria were neither animals nor plants.
Definitely neither animals nor plants (nor fungus for that matter), but nonetheless it's flora for what appears to be no particular reason.
Because fauna is grosser than flora.
Also, if you talk about your intestinal fauna people will think you have pinworms.
When I read up on tick bites a few nights ago (I was googling the best way to remove a tick, while the tick was still on me, of course) Lyme seemed pretty manageable if you got to it early. Rocky Mountain Spotted Fever was the terrifying one.
I was googling the best way to remove a tick, while the tick was still on me, of course
Do they still suggest lighting a match, blowing it out, and touching the still hot end to the tic's rear to make it let go?
I've never seen it done.
No, that's explicitly not recommended. Use tweezers to grasp it as close to the skin as possible and pull straight up firmly, without jerking it or squishing it.
I would draw an illustrative analogy -- to Hitler -- but I know the rules.
"And I was just following orders," continued Herr VW.
Oh god I'm resisting so hard being an asshole pedant in this thread since my mom does Lyme research and some of our projects are antimicrobials including a C diff program and I worked on the resistance policy recommendations. But anyway:
"lyme, babesiosis, and borrelia"
borrelia is Lyme. Perhaps you mean ehrlichia, the other bacteria common in deer ticks? Note that babesiosis is not bacterial but protozoan, more similar to malaria, so drink your gin and tonics.
And within the concept of "ehrlichiosis", it could be Ehrlichia, or it could be Anaplasma.
89: Oh god I'm resisting so hard being an asshole pedant in this thread....
I can't see what the downside could possibly be.
We have trolls like you wouldn't believe around here. I blame resistance to antibiotics.
89/90: Come on, unleash the pedantry! I like that SP is precise enough to use antimicrobials rather than antibiotics for a start.
71, 75: c diff sucks. Just getting over a year+ battle with that nonsense and still s l o w l y tapering of the (yes, it is ironic) antibiotic used to treat it. Stupid antibiotics.
Note that babesiosis is not bacterial but protozoan
If she were a president, she'd be Babraham Lincoln. If she were a microbe...
78. Flora I think because the expression is very old and modern systematics is very new.
89. Pedantry report!
I wrote the original post from memory. Having now looked at the report (done by UMass) again, the tests were for:
Borrelia burgdorferi sensu latu
Anaplasma phagocytophilum
Babesia microti
and all were positive. It was a seriously disease-ridden tick. Mind you, I didn't get any of the resulting diseases myself, it just could have given them to me.
One can pay more for other tests (mostly for variants of the three listed above) if one wishes. Tests for two varieties of Erlichia are also among them.
ps: I have nothing against pedantry.
(I was googling the best way to remove a tick, while the tick was still on me, of course)
When I got a tick, we were in the north east of Scotland, with very dodgy phone reception, and C had to go to the end of the road to google. The wiggling legs were really freaking me out - I very much wanted to scream and be a bit hysterical, but (a) it was the middle of the night and the kids were asleep, and (b) I'm really not that sort of person. I did end up digging its head out with a penknife after C's careful tweezering didn't work.
The one that freaks the shit out of me is this Powassan virus. We were just in Nantucket, disease-ridden tick capital of the east. Oh, and in addition to those rich people there are little bugs that bite you too. I checked all my kids every night and just from playing in the yard I found 7 on them in 3 weeks. But as long as you get them off within about 24hr, as noted above, low chance of transmission; even so, the diseases are treatable if you catch them early. I got Lyme from Nantucket last year, prescribed 2 weeks Doxy, gave me terrible heartburn to the point I couldn't eat (which if you know me is extraordinary), my mom let me in on the news that a recent study said 10 days is enough.
Powassan, however, shit- transmission in less than 12 hours, possibly as little as 15 minutes; no treatment or vaccine; 10% of diagnosed cases fatal, 50% with permanent neurological symptoms (although possibly not really that bad since it might be under-diagnosed.) If you tried to come up with a biowarfare agent you couldn't do much better, aside from the fact that humans are a dead-end host so there's no person-person transmission.
There once was a man from Nantucket,
with a tick who was trying to suck it.
And there's also the tick-borne disease whose most obvious symptom is that (a month or two after the bite) you develop an allergy to red meat. http://www.rifters.com/crawl/?p=4357
It says you can still eat monkey. I think that counts as red meat.
I think New World monkeys are still safe.
||
From the Department of Who Could have Anticipated Department: Excellent NYTimes article on how the "managerial" backbone of ISIS is full of former high-ranking Saddam military personnel*. Sleep well, Paul Bremer:
Bremer currently serves as Chairman of the Advisory Board for GlobalSecure Corporation, a company whose focus is "on securing the homeland with integrated products and services for the critical incident response community worldwide" and on the board of directors of BlastGard International, a Florida-based company that manufactures materials to mitigate the impact of explosions.
*Posted in this thread because the following quote made me think of a theoretically inappropriate** analogy to incomplete antibiotic treatments (and it even reflects the LB/ogged's wife-endorsed biggest-threat-is-"local" version of it).
These guys know the terrorism business inside and out, and they are the ones who survived aggressive counterterrorism campaigns during the surge," said one American intelligence official, referring to the increase in American troops in Iraq in 2007. "They didn't survive by being incompetent."**But by only mentioning it in a footnote within a Pause/Play comment I have rendered it non-objectionable.
86: Use tweezers to grasp it as close to the skin as possible and pull straight up firmly, without jerking it or squishing it.
Oh hey, I'm just tuning back in to this thread.
Right, the tweezer approach is best, but I've always heard that it's not just pull up straight firmly, but rotate counter-clockwise as you firmly pull. Dunno why (I'm not going to google), but it's always worked well for me, with all the cats and humans from whom I've removed ticks. That burnt match business is for the birds -- you just wind up singeing people as they squirm.
If a bird has a tick, I'm not going to try to remove it.
Sort of on topic: Somebody used homemade sunscreen and now has a sunburn. I failed at not laughing.
110: What on earth possessed them to try and make their own? Kind of relatedly, why are clothes being marketed for the outdoors by stating their SPF factor? Did regular old shirts stop blocking the sun?
The person I was talking to didn't make it, but used what a friend made.
To be fair, the Maker Faire pacemaker he has works great.
108: helps disengage the mouthparts, or so they say. But CDC advises against it - just pull straight up.