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Urine Testing: If It’s Not Captured Via Catheter, It’s Not Accurate

After eight years of hospitalist medicine and seeing inaccurate urinalysis results day after day, year after year, I’ve come to the conclusion that the straight cath vs clean catch debate is not a debate.  If the urine didn’t come from a straight cath, I have zero faith in the accuracy of the results.

I know, I know.  It takes time and effort for a nurse to perform the straight cath.  It’s not comfortable for the patient to have a catheter inserted into their urethra.  Plus, with bad nursing technique, one could introduce bacteria into the bladder when performing a straight cath urinalysis.

All that aside, if I’m a physician trying to make medical decisions based on accurate data, then having bad urine results that don’t represent the true picture is worse than not having any data at all.  For example, here’s a classic case of what I have to deal with day in and day out when trying to make medical decisions on my patients.  Below is a snap shot of three UA results obtained from Happy’s ER over two visits.  I’m sure it’s the same no matter where you get your care in this country.  The first two urinalysis results came from a clean catch sample of a horribly weak 89 year old female who presented with family complaints of “fever and weakness”, both days. Read more »

*This blog post was originally published at The Happy Hospitalist*

Cranberry Juice For Urinary Tract Infections? Evidence Is Still Lacking

It always somewhat surprises me how some interventions never seem to die. One therapy that refuses to be put to rest, or even to be clarified, is the use of cranberry juice for urinary tract infections (UTIs). PubMed references go back to 1962, and there are over 100 references. Firm conclusions are still lacking.

There is a reasonable, but incomplete, basic science behind the use of the cranberry juice for UTIs. E. coli , the most common cause of UTIs, causes infection in the bladder by binding to the uroepithelial cells. To do this, they make  fimbriae,  proteinaceous fibers on the bacterial cell wall. Fimbriae are adhesins that attach to specific sugar based receptors on uroepithelial cells. Think Velcro. Being able to stick to cells is an important virulence factor for bacteria, but not a critical one — it is not the sine qua non of bladder infections.

Are all E. coli causing UTIs fimbriated? No. It is the minority of E. coli that cause UTI that have fimbria, and the presence of fimbriae may be more important for the development of pyelonephritis (kidney infection) than cystitis (bladder infection). Read more »

*This blog post was originally published at Science-Based Medicine*

Vaginal Steam Baths: A Medical Opinion

A spa in California is offering vaginal steam baths, in which spa-goers squat or sit on open stools over a tub of hot steam, as a cure-all for menstrual, digestion, and mood disorders:

The V-Steam: Inspired by an ancient ritual practiced for many years in Korea. The steam from the herbal tea rises and absorbs into your skin & orifice. This steaming treatment stimulates the production of hormones to maintain uterine health, aids regular menstrual cycles, helps correct digestive disorders while soothing the nervous system. The natural antibiotic and anti-fungal properties are said to help maintain internal health as well as keeping your skin looking young. (30 min: $50. Series of 6: $180.)

It’s a douche, folks. A $50 douche made with mugwort and 13 other herbs and having a fancy Korean name: Chai-Yok. True, the water gets up there as steam, and if you don’t squat just right over the steam bath, I imagine it may not get up there at all. But in the end, it’s a douche.

We docs strongly advise against douching since we know that women who do it have higher rates of vaginal and pelvic infections. Not to mention that the vaginal mucosa is highly-absorptive surface, meaning anything you put in there is likely to end up in the rest of your body. And so I ask: What herbs are they using, at what doses, and what side effects might they have? Not to mention what might be growing in those wooden tubs they have you squatting over? Read more »

*This blog post was originally published at tbtam*

UTI and “Eat, Pray, Love”

Eat, Pray, LoveI really didn’t expect to like Eat, Pray, Love. In fact, since its publication in 2006, I’d been avoiding it like the plague. “Typical new-agey, Oprah-y, girly-book,” I thought. Nothing in it to speak to me.

Then I saw the trailer for the movie, and I was hooked –- probably because I, like mostly everyone, love Julia Roberts. I immediately downloaded the book on my iPhone using the Kindle App and began to read.

First, let me say that Elizabeth Gilbert writes exceptionally well, and the book is actually a joy to read. I, of course, loved the Italy eating part. But more surprising to me, I wasn’t turned off by the whole yoga, Guru, find-yourself stuff. This is because Gilbert writes it all with a reporter’s curiosity and a skeptic’s eye, and frames it not as a belief system, but as a tool for self-discovery and peace. (Plus, I’m really good at skimming if I get bored.)

Too bad Gilbert’s curiosity and skepticism does not extend to the healthcare she receives while in Bali. She accepts the curative powers of a warm leaf placed on an oozing, infected cut without even wondering what leaf it might be or how it might have worked. Was it the heat (most likely) or something else (possibly)? I was dying to know.

She Xeroxes pages and pages of traditional medical treatments without sharing a single one with us in any meaningful way. While I’m pretty sure 99 percent of what was in there was bunk, there might be a few gems that would serve medical science. Unless Lizzie made a second copy, we’ll never know, will we?

But it was the UTI that really got to me. Read more »

*This blog post was originally published at tbtam*

Herbal Remedy For UTI? If You’re A Lab Rat, Maybe

Lab ratA patient came into the office the other day carrying a small clipping from a reputable women’s health newsletter touting new research on an herbal remedy for urinary tract infection. Having recurrent bladder infections, my patient naturally was wondering if this was something she should try.

The article was entitled “Herbal Remedy Effective for Urinary Tract Infections” and began with this startling revelation:

The common herbal extract forskolin can greatly reduce urinary tract infections and could potentially help antibiotics kill the bacteria that cause most bladder infections. 

But the article advised that the “popular” remedy was not FDA approved for this indication, so you should “ask your doctor.” Read more »

*This blog post was originally published at The Blog that Ate Manhattan*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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