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Does Social Media Break Down Valid Health Information?

This is the era of evidence-based social media as more and more papers focusing on medicine and social media are coming out. An interesting paper was published a few days ago in the American Journal of Infection Control. Scanfeld et al. tried to reveal the rate of misunderstanding or misuse of antibiotics in Twitter messages in their study: Dissemination of health information through social networks: Twitter and antibiotics.

BACKGROUND: This study reviewed Twitter status updates mentioning “antibiotic(s)” to determine overarching categories and explore evidence of misunderstanding or misuse of antibiotics.

METHODS: One thousand Twitter status updates mentioning antibiotic(s) were randomly selected for content analysis and categorization. To explore cases of potential misunderstanding or misuse, these status updates were mined for co-occurrence of the following terms: “cold + antibiotic(s),” “extra + antibiotic(s),” “flu + antibiotic(s),” “leftover + antibiotic(s),” and “share + antibiotic(s)” and reviewed to confirm evidence of misuse or misunderstanding.

RESULTS: Of the 1000 status updates, 971 were categorized into 11 groups. Cases of misunderstanding or abuse were identified for the following combinations: “flu + antibiotic(s)” (n = 345), “cold + antibiotic(s)” (n = 302), “leftover + antibiotic(s)” (n = 23), “share + antibiotic(s)” (n = 10), and “extra + antibiotic(s)” (n = 7).

CONCLUSION: Social media sites offer means of health information sharing. Further study is warranted to explore how such networks may provide a venue to identify misuse or misunderstanding of antibiotics, promote positive behavior change, disseminate valid information, and explore how such tools can be used to gather real-time health data.

*This blog post was originally published at ScienceRoll*

Topical Medications And Bathing: A Source Of Water Pollution

I have written two posts in the past on proper disposal of unused medications, and I have always been mindful of the medicines as a source of environmental water pollution. This past week the American Chemical Society reminded (head-slapped me) that topical medications are a source of environmental water pollution from their active pharmaceutical ingredients (APIs). Yes, the simple act of bathing washes hormones, antibiotics, and other pharmaceuticals down the drain into the water supply.

Ilene Ruhoy, M.D., Ph.D. and colleague Christian Daughton, Ph.D. looked at potential alternative routes for the entry into the environment by way of bathing, showering, and laundering. These routes may be important for certain APIs found in medications that are applied topically to the skin — creams, lotions, ointments, gels, and skin patches. These APIs include steroids (such as cortisone and testosterone), acne medicine, antimicrobials, narcotics, and other substances. Read more »

*This blog post was originally published at Suture for a Living*

A Patient Encounter With Dr. Idiot

Earlier this week, I had a bit of a medical issue.  Painful urination, high blood sugars, and the constant need to pee.  (Ladies, I know you already know what’s up.)  Urinary tract infection looming large.  I was livid, because it was the day before I was scheduled to travel for this week’s business.

I haven’t got time for the pain, so I called my primary care physician, Dr. CT.  “Hi Nurse of Dr. CT!  It’s Kerri Sparling.  Listen, I’m pretty sure I either have a kidney stone or a urinary tract infection, and I need to rule it out before I leave for a week-long business trip.”

Dr. CT was on jury duty.  Damnit.  So I had to call a local walk-in clinic, instead.

The clinic was a hole in the wall.  Part of a strip mall structure.  My confidence wasn’t high, but my blood sugars were and my whole body was screaming for attention, so I knew I had to follow through.

The receptionist was very nice.  The nurse was even nicer.  They took my blood pressure (110/74), my temperature (98.8) and a urine sample (ew). THIS is not for urine, people!

I should have known from the moment the sample cup was given to me that it wasn’t going to be a fun visit.  The very kind nurse handed me this  —>

That is not a urine sample cup.  That’s like a party cup that you use for lemonade on a hot summer day.  Not for pee.  Oh God.

And then the doctor came in.  For the sake of anonymity, we’ll call him Dr. Idiot.

“Hi.  I’m Dr. Idiot.”

“Hi, I’m Kerri.”

“Kerri, I see you are here for pain when urinating.  Are you urinating frequently?  You see, you are spilling a significant amount of urine.  I believe we may have found the source of your troubles.”

He closed his file, proud of himself.

“Dr. Idiot?  On my chart there I wrote that I have type 1 diabetes.  I know my blood sugar is elevated right now, which sucks but at least it’s not a surprise.  But that’s not why I’m here.  I actually suspect that …”

He cut me off.

“I think we need to address this first problem.  You are aware of your diabetes, you say?  How many times a month do you check your sugar?  You know, with the glucose machine and the finger pricker?”

If I wore bifocals, it’s at this point that I would have slid them down my nose and given him a hard, Sam Eagle-type stare.

“I test about 12 – 15 times a day.  But the real reason …”

“You mean a month,”  he corrected me.

“No, I mean a day.  I have type 1 diabetes.  I wear a continuous glucose sensor.  And also an insulin pump.  I’m very aware of my condition, and I’m also very aware that it’s slipping out of control today because of this other issue, the pain issue.  Can we talk about that?”

He looked at my chart again.  “So you don’t use a meter?”

“Sir, I use a meter.  And a machine that reads the glucose levels of my interstitial fluid.  This is in addition to my insulin pump.  I don’t mean to be rude but …”

Now he gave me a hard look.  “Why the interstitial fluid?  Why not the blood directly?  I mean, you could have more precise readings with the blood.”  He picked up my Dexcom from the chair next to me and pressed a few buttons to light up the screen.  (Mind you, he did not have permission to touch it, but I’m again not saying anything.)

“You mean like a pick line?  I don’t know.  I’m sorry.  Ask them?”

“Yes, but it would make much more sense and …”

I just about lost it.

“I’m sorry.  I didn’t come here to talk about that.  I want to talk about the issue I’m here for.  Which is not diabetes.  Or your ambitions to know more about CGMs.  Please can we address what I’m here for?”

“The sugar in your urine.”  With finality, he says this.

“NO.  The fact that I think I have a UTI or a kidney stone.  Please.  Help.  Me?”

I kid you not – we went ’round and ’round about this for another ten minutes.  He didn’t believe me that I was at least sort of familiar with diabetes.  His ignorance included, but wasn’t limited to, the following statements:

  • “High sugar causes frequent urination.  Maybe that’s why you are peeing often?”  (Not because I was drinking a liter of water per hour to flush my system?  Nooo, couldn’t be that.)
  • “Did you have weight loss surgery?”
  • “Grape juice also causes high blood sugar.”
  • “That thing should really be pulling blood samples.  Pointless otherwise.”  (Meaning my Dexcom.)
  • “The urinalysis won’t be back until Friday, and in the meantime you should start on a regimen of insulin immediately.”
  • And also:  “I didn’t peg you for a pink girl.”  (Are.  You.  Serious??)

The end result, after an escalating argument that involved me yelling, “Stop.  Talking about my diabetes and PLEASE focus why I’m here!” was a prescription for Macrobid that I could elect to take if my symptoms didn’t alleviate, and the instructions to call back on Friday for official lab results.

“Thank you.  Really.  Can I go now?”

He at least had the decency to look ashamed.

I’ve had some wonderful doctors over the last 30 years, and my health is better for it.  But this guy?  Complete disappointment.

*This blog post was originally published at Six Until Me.*

Watch Out For MRSA In Your Community

“Community acquired” (that is, not acquired in the hospital, which would be “hospital acquired”) methicillin-resistant Staphylococcus aureus (MRSA) infections have not likely come about because germs that have evolved bacterial resistance by residing within hospitals have spread into the community. Rather, this bacterial resistance to methicillin appears to have arisen independently. The “community” now absolutely needs to be considered to include the outdoor community. Hikers, kayakers, divers, climbers and all other outdoors persons who share equipment or mingle with the general population are susceptible. From a reference entitled “Diagnosis MRSA – The Clinical Challenge of Multidrug-Resistant Infections,” authored by Peter DeBlieux and colleagues and published as a supplement to ACEP NEWS, comes some useful observations.

Skin and soft tissue infections are among the most common infections caused by bacteria that can develop resistance to bacteria. Persons at particular risk for such infections include males, certain geographies, time of year (during warmer months), and affliction with diabetes. Many of the infections are abscesses, in which there is a pus pocket that can be drained by making an incision. Such treatment is in fact important to help control the spread of MRSA infections, presumably by helping to cure the abscess(es).

The current thinking is that in the setting of an “uncomplicated” skin and soft tissue infection (e.g., no involvement of deep tissues, minor clinically: simple abscess, impetigo, pimple, or superficial cellulitis), incision and drainage of small, localized abscesses can be curative. However, this is not an absolute, so many physicians are of the opinion that adding an effective antibiotic is useful. Until we have more information, it remains the clinical judgment of the treating physician about whether or not to prescribe an effective antibiotic, such as trimethoprim-sulfamethoxazole.

In complicated infections, which involve deeper skin structures (such as infected tissue ulcers, rapidly progressive infections, diabetic foot infections involving MRSA), antibiotics are deemed to be essential. The oral antibiotics that are felt to be effective against MRSA are clindamycin, trimethoprim-sulfamethoxazole, doxycycline, minocycline, linezolid, and rifampin. The injectable antibiotics that are felt to be effective against MRSA are vancomycin, clindamycin, daptomycin, tigecycline, linezolid, and quinupristin-dalfopristin. Notably, the fluroquinolone category of drugs, which includes ciprofloxacin, is not recommended as an effective treatment for community acquired MRSA infection. The same holds true for the macrolide category, which includes erythromycin, as well as cephalexin, penicillin, and dicloxacillin.

To prevent the spread of MRSA, wounds should be kept covered with clean, dry bandages; hands washed with soap and water or an effective hand sanitizer after each dressing change; close contacts instructed to bathe regularly; no sharing be allowed of bedding, towels, washcloths, bar soap, razors, and so forth.

image courtesy of www.mrsatreatments.com

This post, Watch Out For MRSA In Your Community, was originally published on Healthine.com by Paul Auerbach, M.D..

Fluroquinolone Antibiotics and Tendon Rupture

Outdoor enthusiasts are often stricken with infections for which they might be prescribed antibiotics in the class known as fluoroquinolones, one common member of which is ciprofloxacin (Cipro). They should be aware that a fairly well accepted complication of taking a fluoroquinolone for more than a few days is development of tendinitis leading to tendon rupture, notably of the Achilles tendon. The risk is such that the Food and Drug Administration (FDA) requires the makers of such drugs as ciprofloxacin and levofloxacin (Levaquin) to publish a black box warning on the packages alerting users to potentially serious side effects. The full list of drugs affected by the warning include ciprofloxacin (marketed as Cipro and generic ciprofloxacin); ciprofloxacin extended release (marketed as Cipro XR and Proquin XR); gemifloxacin (marketed as Factive); levofloxacin (marketed as Levaquin); moxifloxacin (marketed as Avelox); norfloxacin (marketed as Noroxin); and ofloxacin (marketed as Floxin and generic ofloxacin). As new fluoroquinolones appear on the market, they will undoubtedly be included in the warning program. The warning does not apply to eye and ear drops – only to medications taken orally or by injection.

Many patients and health care professionals are not aware of this risk, which is very real, having been officially reported in literally hundreds of patients. Although the drugs are phenomenal in terms of their ability to fight certain bacterial infections, users should be aware of this possible side effect, so that they can discontinue taking the culprit medication and switch to an alternative antibiotic(s) if need be. If tendon pain develops (typically about a week after initiation of therapy) when a person is taking a fluoroquinolone antibiotic, that is the time to make the switch. Simultaneously, anyone affected should diminish or avoid exercise and cease stressing the affected area until such time as the situation is resolved, as would be determined by decreased pain and other signs of inflammation. Most patients can be expected to recover within 10 weeks after discontinuing the antibiotic, but it may take longer.

Fluoroquinolones are widely used to treat infections in adults. They are not commonly prescribed for children because of a risk for eroding cartilage; however, if the medical necessity is important, they can be used in young individuals. The tendon rupture problem is therefore largely a problem of adults, and typically affects the Achilles tendon, with onset of symptoms within the first few weeks after the initiation of antibiotic therapy. Other tendons, including those of the upper extremity, may be involved. It is perhaps the large forces placed upon the Achilles tendon that makes it so prominent in this particular medical situation. Furthermore, the risk of fluoroquinolone-associated tendinitis and tendon rupture appears to be greater in persons older than 60 years of age, in those taking corticosteroid drugs (“steroids”), and in kidney, heart, and lung transplant recipients.

This post, Fluroquinolone Antibiotics and Tendon Rupture, was originally published on Healthine.com by Paul Auerbach, M.D..

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