drug pseudogout

>> prevention is worth several pounds of cure. preventing infectious disease, tonight, "on call with the prairie doc." >> good evening and welcome to "on call with the prairie doc." spanning everything from a cold and flu to ebola and zika, infectious diseases can threaten individuals and entire populations. how we react to the threats and work at prevention are key to how we deal with them. first, let's take a look at this week's prairie doc quiz question. true or false: after a regular flu shot, those

older than 65 produce 50 to 75% less antibodies to flu than do younger folks. viewers who call in the correct answer will be entered into a drawing to win a signed copy of our book, "the picture of health." each of my essays, originally written for this show, comes with a wonderful accompanying photograph by dr. judith peterson. we will announce the answer and the winner at the end of the show. remember, you only have 10 minutes to get your answer in! joining us tonight from the u.s.d. sanford school of medicine is dr. archana chatterjee, professor and chair

of the department of pediatrics, as well as senior associate dean for faculty development. >> also we have dr. jawad nazir, who practices with infectious disease specialists, pc in sioux falls. >> thank you both for joining us. arcmana, you're from where originally? >> originally from india, been here in the united states since 1989. >> since 1989, you did your residency in pedes and then infectious disease? >> that is correct. i did my ph.d. first, followed by --

>> so a ph.d -- >> neonailing, actually >> neonailing, wow. and then my residency in pediatrics and fellowship in infectious disease ins pediatrics. >> so, how long have you been in south dakota? >> three years this time around. i actually was here earlier, after i finished all my training, my first faculty job was at the medical school in south dakota.

this was in the late 1990s and i wasn't here very long, just a year and a half, but then i went back to nebraska where i had trained and then came back three years ago. >> saw the light. >> absolutely. the northern lights. [laughter] >> so tell us a little bit about you, jawad. you're from where originally? >> i'm from pakistan, originally did my medical school and residency in internal medicine in pakistan

and then came to usa and here i did internal medicine residency at usd -- >> again, because you have to do a residency in the states. >> ã©l. >> so you repeated yourself. did you learn more? >> well, i think i learned more in certain areas and i think back home in pakistan which is a third-world country, a lot of experience with infectious disease problems, was very productive and that is the basis of my interest in infectious disease, so i think that completes my professional

growth, you know, of -- in that sense that i was training in pakistan a third-world country with a different push to diagnostics and then training in usa where we have a different approach to diagnose and evaluation. >> we speak to pre-med students before the show, we have them help us on the phones and so on, so forth, and the emphasis about the value of doing a careful history and a careful exam came out. i thought it was wonderful because as an older doctor, i think that's, you know, so important, so very important.

so good for you, i was rooting on that comment. but both of you, you do adult infectious disease and you emphasize pediatric infectious disease so let's look at what are the things you see commonly in a normal week, archana? >> you know, the thing about our practice is that we never have common things that we see in a normal week. there is no such thing as a normal week in our practice. [laughter] you see whatever you get consulted to see. it might be a very sick patient in the icu, in the neonatal

intensive care unit orthopedic atrick intensive care unit or it might be a patient in the outpatient clinic who's got a persistent problem or undiagnosed problem that we're faced with, so our practice runs the gamut between very serious infections, sometimes buzz else which other physicians. been able to figure out, sometimes they're not actually infections at all but a patient who's having chronic fatigue or a fever that no one has been able to figure out the cause of. so it's very, variable and varies day to day as to what we see.

>> jawad. >> i think in the adult population, somewhat similar but i think one thing we have to remember is that aging, you know, we are aging more and more and people are living much longer than before but we are abling more at the expense of many newer medications were -- where i are sometimes immuno suppressives, so the medications help us live longer at the same time decreasing our system. >> and without our immune system, we have more infections. >> so a broad range of infections that we see in the

hospital that could be complicated in the morning, in icu, it could be a patient with kidney transplant who has undiagnosed fever, it could be a patient with joint infection, where you need to make a critical decision on treatment with the surgery. it's challenging to look at the complex cases and then sometimes simple cases where you see the antibody used is not really necessary and you can get them out of the hospital. >> i love the idea of having an unknown, i mean, to me, that was always in my whole

experience, particularly in the hospital, the greatest fun, particularly if you can get the answer and sometimes the most frustrating if you can't. one of the things i'm seeing more often, or i see as a big challenge for us is a lot more people are getting artificial knees, artificial hips. they're going pretty quick to those nowadays and i blame the boomers because we want to be active, we want to be able to do everything and medicine can solve all our problems, right? and so boomers have that expectation, demand more. i want that artificial joint, but then sometimes they get infected.

talk about that. >> yeah. so, i think, you know, there is a big number of patients these days who get these joint replacements but it's possible to get infections, but the one that gets infections really gets the complicated infections, so if you ever a process in your body that's just become a very risk factor for treatment of infection, for example, in your finger or your toes, you know, your hand, you have blood supply but then you put a prosthesis in, that's a foreign body knew, doesn't have blood supply so the whole

defense system which can clear any infection, it's gone when you have a prosthesis so, sometimes, you know, the treatment is very complicated it may require a hospitalization, prolonged hospitalization, or intravenous antibiotics for an extended period of time and can lead to many complications. >> i of -- well, the big lesson back in the old days when i was there, you got an artificial joint or an artificial prosthesis of some kind that doesn't have its own blood supply and it's an infection, it needs to go. you just have to take it out.

and i have a patient who had to live -- the artificial hip was removed and she's hopping around without one hip and there you have it. i mean, that's what you have to do. clear infection, start again. >> yeah, i think, you know, in most cases, that is true, you know. it also depends what type of bug caused the infection, some have a high -- they're more likely to cause infectious complications or make you septic, verses some bug that have a low -- those you can actually treat with antibodies.

in most cases, you do have good outcome each if you have prosthetic joint infection. >> let's talk about mris, though. this is the -- it's not the only super bad bug, the staph aureus, staph has been the first staph-resistant. any comment about msras, more virulent than the old staph and dangerous? >> yeah, so it depends. it depends on where the infection is. so mrsa has undergone an evolution, if you will, over time.

the initial medicine of resistance staph that we used to see was all in the hospital and we would typically see it in the types of patients that dr. nazir was describing who already have got underlying conditions, have been on antibodies, things like that. but around the mid-1980s or so is actually when we started to see these in the community and the first inkling we had was when we had four cases in children who all died from this infection. they were otherwise perfectly healthy children but they came in and had this infection in their bloodstream and nobody

realized that's what they had because you need different antibodes to treat mrsa. so that was in 1989 and ever since then, we've been dealing with this organism. the common type that we see in children often is the type that causes skin and soft tissue infections. it's a nuisance infection. they keep getting the boils and it does create problems for them because they miss school and their parents miss work and things like that they're amenable to treatment, but the more serious version of it which causes bone and joint

infections, infections of the heart valves and things like that, bloodstream infections, those can be very, very serious and threatening. antibiotics have been a wonderful boon for humankind. but with their benefit comes danger, danger from antibiotic resistant disease, as well as danger from life-threatening invasive over-growth bacteria. >> i can remember, it was december 14th, i had a sore spot on the right side of my throat, and had had the bump for about two weeks and i thought i probably should go get that checked especially since i have grandbabies that i was helping take care of.

went to the doctor and got a prescription for an antibiotic and i took it for five days and on december 19th got really, really bad diarrhea. finally monday about 5:00, i called the doctor who had prescribed the antibiotic and just said, you know, i've really been sick for the last three days with diarrhea what should i do? how long have you had it, that was too long and could i go to acute care that night. so i went to acute care and they did a sample and it was c-dif, so they asked if i would go over to the hospital and have a i.v., just because i was so weak and almost dehydrated.

so i went over and had the i.v., and that kind of perked me up that evening but they gave me vancomycin for the c-dif, took that for about two to three weeks. long story short, went back, got some more of the same medication because i had gone to the gastroenterologist and they had kind of taken me off it too soon so the c-dif came back and that's when the took the vancomycin again and thought i was over it and wasn't. so went in, and the doctor said, have you ever considered a fecal transplant.

so, thought this was kind of my best option. so went in to the e.r. and did it as an outpatient in brookings and had the fecal transplant and fortunately have not had c-dif sense. i would just be very, very cautious, going what i went through is very difficult to get over and to get to feel back to yourself again and, you know, i felt like you said a mild respiratory thing is something that you can get more rest, you know, get a lot of water, do a lot of different things naturally without taking an antibiotic.

i would strongly say that i would -- it would have to be quite serious before i would take an antibiotic. not a fun thing, i missed a lot of important things, christmas, new year's, my baby's baptism in wyoming. i just said i felt like i lost about three months of my life, so, yeah, i would really think twice. >> we answer your medical questions about prevention of infectious diseases as they are called in or sent to us via facebook or email. call in questions to 1-888-376-6225.

or send us an email to the address on the screen. we need your calls. this is your show, give us your call. that was very interesting. so she had a cdiff infection. >> it's the bacteria which lives in the gut, you know, we don't sometimes remember that we have a lot of bugs in our body, you know, in our -- >> we have bugs in our body, in our skin and our gut? >> we are full of bugs.

>> full of bugs. >> the lining of the gut is a defense mechanism to prevent infection as the skin is so when we use the antibiotics, they kill the bacteria in your gut. especially the c-different, which overgrows them and starts producing poisons and toxins, which are responsible for most of the manifestations of c-diff and -- like nausea, diarrhea -- >> and sometimes deaths. >> the c-diff is a little bit different. an interesting story, one of the charactersist of c-diff is

the recurrent nature of it, it can keep on coming back and back and patients can sometimes require multiple courses of antibiotics and we end up getting to transplant, you know. secondly, it can be very dangerous in elderly patients so the studies have shown that if you get c-diff. if you're above 65, you have the highest chance of dying from the infection, so that makes >> about what age? >> 65.

>> but the whole issue of immune compromising is a very important one. >> yes. >> so any other comments about c-diff, do you see it in kids as much as -- >> yes, this is an important point, these bacteria are part of our normal flora, the part of the normal bacteria that are there in our bowel, especially in children. so in children who are under a year of age, we consider them to be part of the normal flora and what sometimes happens is, children get diarrhea from some virus or other infection, we

have very powerful tests now that can detect this bacteria and we get questions from primary care physicians saying our 6-month-old who has die contrary awho has c-different, what should i do. the answer is, you shouldn't have tested for it in the first place, this is part of the normal floor oh, it's probably something else. having said that, we are seeing more children, they have underlying medical conditions, short bowel syndrome, those are concern who are at risk for real infections from clostridium difficile and we have fewer antibiotics we can use.

>> mentioning a great point but i think we have learned from research and the major risk factor is exposure to antibiotics. >> so there's two reasons to not use antibiotics when you don't need them. one of them is you can cause this terrible overgrowth problem and the other is resistance. let's talk about that. >> yeah, so i think resistance, is not a new problem, just getting more attention in the last decade or so, but now, you know, what we are learning it's become a major problem where we

don't have drugs to treat this multi-drug-resistant bacteria, there have been some reports about bugs causing urine infections, urine stream infections, but the antibiotic will work, called crv, the most extreme form of resistance we are seeing now. now, i think you have to remember, if you get an infection, you know, from an organism which is not resistant to antibiotics versus you get an infection from an organist which is multi-drug resistant or extremely drug-resistant what, is the difference? a few differences, infections are much more severe, your

chances of dying are much higher. your chances of getting hospitalized and being in the hospital is much higher and apart from all that, the cost of care is much higher. >> so there is a lot of reasons. we've got a lot of questions. we appreciate your questions, keep calling, but let's start in on some of these questions. and i just -- it seems to me that we need to be very sensitive to the overuse of antibiotics and, you know, stewardship is a common thing, we should be careful to not use

them until we really need them, but use them when we need them. >> absolutely. >> i think what the antibiotics stewardship means is to use antibiotics appropriately. doesn't mean don't use them or use them all the time but use them appropriately and when we say that, it means you have a reason to use them and use them in the right tools, right frequency, and the right duration so you don't cut them short or give them too long. sometimes the antibiotics are given too long, which leads to problems with resistance and c-diff.

>> do you recommend using a special cleaning of the skin of children for children who are prone to mrsa, like bleaching in the bathtub or such? >> we usually give a recipe for the parents to use. >> how much bleach and how much wart? >> a formula, i can't recall it off the top of my head but there are a couple of different things we do. there are special soaps that we use, the bleach bath and, by the way, they are diluted bleach baths, very toxic to the skin, especially in young children so we try not to use that, if possible.

sometimes we will combine that with other what we call hygienic measures, keeping the finger nails cut short because sometimes they'll scratch themselves and that's how they gets the infection and making sure they change their laundry every day, their bed clothes, night clothes that they wear every day and those are cleaned and washed. so it's a number of measures that we recommend, it's not just the diluted bleach bath. >> used to say betadine, hexachlorophene, there there is a new betadine, i forgot what it is -- i can't say it.

but what are we doing now, are we doing any topicals for people -- >> so we just an antibiotic, actually, called -- >> that's what i was looking for. >> and we use it typically intranasally, in the nose because, actually, a lot of these staph bacteria are sitting in the nose. the baths are intended to wash off the bacteria from the skin and the product we use is called hemacline. >> so there's the other question, whenever we have a cold or upper respiratory infection, people are blowing

in their hands to try to stop it from flowing and the result is their hands are all loaded up with bacteria and you're at church and shaking even's hand, you know what i mean? and my point is, hand-washing is a very good idea. what about the hand cleansers versus hands washing? i've heard hand-washing is a must for g.i. illnesses and the hand sanitizers work for respiratory. am i correct on that? >> the hand sanitizers work great for most infections.

the one thing we do want people to wash their hands for, what we were talking about earlier, which is c-diff because that germ actually produces what are called spores and spores are resistant to the hand sanitizer so you have to wash them off. >> this infection is particularly reason to use them. [talking at the same time] >> but c-diff, in hospital settings, we encourage health care providers to wash their hands with soap. >> there is generally an order, they say dogs --

my son who is a nurse in a nursing home, don't need to be a dog. i know that smell. >> there is. so, there's a question about pneumonia shots. there's been a new move because prevnar is available to adults older than 65 so give us the formula that one should do after you turn 65, what is the formula? >> do you want to state? so prevnar 13, which is the vaccine --

>> classically for the kids. >> yes, the original was developed and licensed in the year 2000 to prevent meningitis in children, actually, so that's what the vaccine was originally developed for, not as pneumonia vaccine. the bacteria are the same that cause meningitis and also pneumonia so we get a good side effects of reducing pneumonia with this vaccine and what was found was that this particular formulation that's actually intended for children does produce better antibodies in adults which is why it is now

being recommended for use in adults, even though initially it wasn't studied or intended for that purpose. >> i heard something like 20 or 30,000 adult elderly lives are saved every year for all the kids getting prevnar, i mean, that he's- >> that is what we call community immunity or herd immunity, or more common term for it, that if you vaccinate the children, you would reduce the burden of this infection in the community and they won't spread it to their older relatives. >> who are --

>> or contacts. >> okay. >> it also serves a bigger concept, you know, of preventing infections, if you prevent infections, you don't use antibiotics, and you don't use them, you won't get resistance to c-diff. that's the scheme of things, it's a great tool to prevent infection so you cut down antibiotics use, too. >> so this one talked about do you recommend pneumonia shot for people 65 or older, does it change from year to year, what

strain are you using for the flu shot? so the flu shot is paid for, right? >> you can get influenza vaccine paid for by any health system for nothing. actually, under the current law, the affordable care act, all preventive care is supposed to be covered so all vaccines actually should be covered. >> so now we're recommending, if you had the pneumovax, 23 valent, right? 21 valent, 23? then you should follow after one year and get the previous that are which is 13 >> prevnar 13. >> but if you haven't had either one and you turn 65, get the prevnar first, wait a year...

>> and the reason for that is because of the difference in the immune response. you get a better immune response if you follow prevnar 13 with the pneumococcal 23 valent. >> or if they have chronic lung disease or heart disease, follow the same pattern, the prevnar -- >> that's correct and we do it for children, as well, who are over two years of age, children under two don't respond to the pneumovax, the 23 valent vaccine, so children under two -- over 2 who have underlying medical conditions can get them. >> so you don't have to be 65 if you have a lung disease, pneumonia, asthma... [all talking at the same time]

>> you should follow the same protocol. >> so this is interesting, with expanding world population, how much will infectious diseases increase? to me, that's the whole story. i mean, remember the plague that struck through europe and it basically kills off half the europeans and the ones that lived probably were resistant and it wasn't just the plague, probably mumps and measles and all these other things. you've heard that story. >> right.

>> so then they come over and basically sterilizes north america because it kills 90% of the american indians. >> mostly smallpox, yes, a lot of different diseases, measles, it's unknown, really, what infections came from the old world to the new world but clearly had a huge impact on the population here in the americas. >> yeah, i think things are changing in this globalization so, you know, people are traveling much more, i think, 20 years ago, they were not traveling as much but they are traveling a lot into different countries and with computers and it's a global world now.

i think when you travel, you know, there is a high chance of bringing in infections, you know, so i think it's very important to have awareness about the global aspects of infectious diseases, you know, so you are well-prepared to diagnose infections related to travel history and i think ebola and zika, it's important to recognize them in a timely fashion for that reason. >> we lean on our health department for that, and thanks to lon kightlinger for his help in that regard. >> exactly.

>> shingles can be a painful recurrence of the chickenpox virus. while it usually shows up in older patients, it can strike any age, and it can strike anyone. >> in february of this year, became ill for a couple of days, had a fever, muscle aches, laid around, felt miserable and then all of a sudden, i had this rash break out on my left forehead and within 24 hours, developed a fairly typical lesions that you see with shingles, and, unfortunately, had a full-blown event.

most people don't know the first couple days but once the rash breaks out and the pain comes on, then most people figure out, you know, they have shingles and so i called my physician and he did start me on some antii vie roll -- viral oral medication so it is important to start that to decrease the severity and length of the illness. the most miserable complication of shingles the is post-repeatic neuralgia where the root remains inflamed each after the skin clears up and that's what you want to avoid.

so i did have the vaccine about six months prior to having shingles and the intent of the vaccine is to reduce the severity and lingth of the illness, or eliminate it entirely but people can get shingles after having the shingles shot, which i did, but i did not have the complication of the post-repetic neuralgia which i'm very thankful for. it cleared newspaper a couple of weeks and i was fine gape. you carry that in your body from chicken pox as a child and it comes back out as shingles, so you harbor that virus in

your bodies your entire life and i think there's several things that can set it off. sometimes it's illness, physical exhaustion, things like that, can be factors that set it off. the intent should have the shingles shot, you hope you never get shingles but you can. once you've had shingles, you can get them again. it's pretty rare to get them a second or a third time. we do recommend anyone over the age of 50 get the shot and if you have symptoms, call your doctor and get started on the anti-vie hall treatment or medication as soon as you can. clear

>> thank you, david. the older you are, the worse it can be. the post-repetic neuralgia is the worst part. i jump on it when it's an older patient. >> 50 is not old. >> the closer you get to it, the less old it seems. >> we were talking that one in three people in the united states will get shingles. there's three of us here and i've had shingles. >> you've had it. >> i've had it, unfortunately.

the situation was that i was actually traveling in india and i had been on a long road trip and i started having this pain in my side and i thought it was -- i had been sitting all day and maybe that's why it was hurting. i put a warm pack on it and within a few minutes saw this horrible rash so i knew right away what it was. went and got an antiviral right away and started treatment immediately and i was also very fortunate, like the case that was presented, in that i did not develop the post-repetic

neuralgia but it is very debilitating condition for people to have. and the vaccine, while it's not 100% protective is still protective and it should be given to anyone over 50, really. >> i've heard it reduces the incidence of shingles in half and if you do get the shingles, it reduces the severity in half. >> the severity and the duration. >> the chances of getting post-repetic neuralgia which can be very disable and painful. >> and higher incidence as you gets older.

>> didn't gets that because you had the vaccine before. i think in our discussion, we have talked about the immuno suppressed patients so i think patients who are immunosuppressed, if they have organ transplants, or are taking medications, and i think even before 50, they can have it. and they can have a severe form of it. it could be disseminated, you know, so even immunosew prayed patients it can be very severe. >> yes, important lesson. >> this is your show, your questions are key to our show discussion.

call in your questions at 1-888-376-6225 or send us an email to ask@prairiedoc.org. we have an email, a 63-yard man asks to discuss -- virus. >> i'm happy to discuss it. it's not commonly associated with diarrhea necessarily, some enteroviruses are. they belong to a family of viruses, some people don't know they long -- entero viruses commonly in children cause things like hand, foots and mouth disease, fever illnesses, meningitis, lots of different manifestations as we see from enterovirus in children. in adults, they can cause very similar things, actually,

particularly as we were talking about in people who have underlying medical conditions who are debilitated in some way, who have imno deficient see. >> we have so many viruses out there, it can be anything or everything >> it yes, it could be. most of the organs can be infected, diarrhea, pericarditis, a broad range of infections. >> arthritis. >> you generally don't die from it even if you're immuno suppressed.

>> the children -- deaths in children are caused in children whose mothers get entero infections before they deliver. what happens in that situation is the mothers is infected, has no immunity, passes a boatload of virus to the baby, baby has very little defenses themselves when they're born, they develop what we call a sepsis and very high mortality. >> there is no antiviral treatment for -- >> unfortunately, there is not. there were a couple of antivirals developed in the

1980s and '90s but they had so many adverse effects -- >> antibiotics don't work -- >> antibiotics don't work... there are some antiviral medicines that work for certain viruses, just not for this one. >> can shingles be passed through a blood transfusion? jawad. >> that's a tough question but i think it can be. i think many viruses can be carried -- we had the case where west nile was transferred through a blood transfusion so i cannot rule it out completely. >> very unlikely to be because this is a virus that travels along the nerves.

in cases of chicken pox, there are two times when it goes through the bloodstream, we call it a primary or secondary but that's in children with chicken pox. >> chicken pox can be spread, a virus. >> if you had a child who for some reason was donating blood, you might get it from there but in general, with someone who has shingles that, virus -- unless they have disseminated disease, in which case they would be sick, they would not have it. [ indiscernible ]

>> extremely rare. [all talking at the same time] do we need to use antibiotics before dental work if we've had a joint or valve work replaced? >> that's a good question. what's the answer to that? >> i can the recent guidelines suggest you should not. i think this is one of the common questions -- actually, they had question today, you know, somebody getting a joint replaced and his surgeon is recommending a treatment of antibiotics and they could end up with c-diff, you know, so i

think there is no evidence that taking antibiotics before the procedure will lead to decreed risk of infection in holding that prostheses. and if they have history of congenital heart disease, endocarditis, unless they have that kind of history -- >> big bad heart valve is -- >> the american heart association publishes guidelines based on scientific instructions as to which patients should receive antibiotics if they going to have dental procedures. and that's what we go to to say, in this situation you need it,

in these situations you don't need it. >> 6-year-old woman from huron has a boil and diagnosed staff and they put her on bactrim for 30 days twice a day, is that a good approach? >> that's too much. too long. especially in someone who's immuno incompetent, you may not need any antibiotic. >> drain it. >> so i think 30 days is very long duration. bactrim is not a safe drug, it has a lot of toxicities, it can affect your kidneys. >> suppress the bone marrow.

>> typically we'll recommend between five to seven days of antibiotics at most, if antibiotics are needed at all. >> that's changed, used to be ten days for everything, you know. >> unfortunately we went to that with not much evidence that was required. >> it was the way we had to do it. >> seven days max >> i've often thought that bactrim was an underutilized medicine because it helps. >> we use a lot of... [ indiscernible ]

where it's cheap and develop antibiotics in undeveloped countries, it's good for... >> it's one of my favorite words. [ indiscernible ] 69-year-old man from sioux falls, physician guilty of using too many tests and broad spectrum antibiotics in general. physician guilty of using too many tests and broad spectrum antibiotics in general. what did you say? yes, we probably -- >> we were talking about this earlier that there is a -- there is a choosing wisely campaign which the american college of physicians

has developed and actually is being adopted in other countries, i just found out that in canada, there is a department of pediatrics, six kids in toronto that's using it. it's basically to minimize unwanted, unneeded tests and treatments that don't help the patient, that really don't improve the quality of care and do in fact put the patient at risk for adverse effects and, of course, add to the cost. >> add to the cost. let's ask the elephant in the room, too, and that is the use of antibiotics in animals, veterinarians have now been -- they've changed things, radically,

and said, now you can't feed antibiotics to herds unless the veterinarian writes the prescription. and one of the reasons we've always said that the majority of antibiotics prescribed in this world are from animals but one of them is really a pro-bug encourager, when an animal has multiple stomachs, that type of thing and really is an antibiotic, doesn't count. on the other hands, i sense there is extensive use. and there's evidence that says doctors will prescribe it if the parents wants it 63% and won't in the parents don't care 13% of the time, so will that happen with the veterinarians. what's your comment about that?

>> i think it's a different issue with animal husbandry. majority of antibiotics that are used in raising animals is really for group promotion and that's what we think is not appropriate. obviously if animals are sick and need to be treated, they should be treated if they have an infection and that's under the care of a veterinarian. the who has published a list of antibiotics, they've been doing this since the early 2000s of antibiotics which are important for human use, where we don't have lots of different options. fluoroquinolone actually tops that list, cephalosporins, peptides, these are classes of...

where you have infections, we don't have any antibiotic left to treat, so the w.h.o., world health organization really wants us to restrict the use of these antibiotics, particularly for growth promotion purposes. >> i completely agree. i think with growth promotion, you have to be very careful and i think it has the impact on resistance in human beings, also, and we end up with multi-drug resistant... >> but you can't blame the farmer for wanting to have a productive herd and it does well, and that that's on his or her mind.

you can't blame him for pushing for it but reality is, there's danger out there from this. >> a public health risk. >> i like the idea -- >> education, you know, at that level. >> i like the idea of encouraging grocery stores to say, this is antibiotic flee, never had antibiotic free chicken, this is antibiotic flee turkey, antibiotic free beef and promote that. and we'll pay a little bit more but i think it's worth it. and i don't want to offend farmers, they work very hard,

the last thing i want to do is the wrong thing and i'm very sensitive about this issue. it's just that it's a human -- it's a physician and a veterinarian issue that we need to be conscious us off. >> awareness. >> caller has friends that won't vaccinate their children. do you have advice on what i should say to them to convince them? [ laughter ] >> we have a show that's only an hour long and we need several hours

to deal with this discussion. [laughter] but i think addressing this in context is important so certainly there are people who do not want to vaccinate their children and do not want vaccines for themselves. the data show it's less than 1%, first of all, of people in the united states that feel that way so -- >> there's not that many people. >> not that many people. the other thing is a lot of them are what i call the worried well, so these are

people who have concerns, they've seen something in the media, they've heard something somewhere about vaccines being associated with adverse effects, which they're not based in facts, at all, or based in science. these are myths that have been propagated over time. i don't even mention the myths because that's when people start thinking that's what's going to happen. there are a small portion of people who despite all the scientific evidence you provide are convinced and you are not going to change their mind.

what we advise opposed trish answer or people taking care of primary children should do, work with the family as much as they can, to be open-minded, to ask questions to see why they're concerned, what their concerns are, and if they can actually address them. then that is the best way in my mind to do it, and recognizing that there's going to be a small proportion who are not going to make it -- no matter what you show them. >> somebody plotting against them and there it is. >> if they get convinced down the road, there is a schedule which can be utilized --

>> this is why the academy of pediatrics recommends you maintain a relationship with the family so you have opportunities down the road and i've personally experienced that where the first time i met a family that had not vaccinated their child, they say absolutely not, we're not going to do it and the next time i saw them, i said, have you reconsidered and, you know, would you like to at least have your child receive one of these vaccines, so sometimes you have to break up the schedule in a way that's acceptable to them. it's not ideal, it does place the child at risk, they put

other children at risk, adults at risk but you do the best you can with these families. >> i think that's the take-home, the reality is you don't get a vaccination for you, you get it for all those people who might be affected. 57-year-old man had msra numerous times, on antibiotics all the time, provider cut antibiotics in half, mrsa came back, going forward, is it more beneficial to keep on antibiotics or to cut in half again and risk return?

that's a toughie. >> that's tougher but i think when you cut antibiotic in half, you know, i think you're doing something -- you're not clear what you're doing, not getting optimal doze or treating, prophylaxising, so i think if someone is getting recurrent infections, you have to take a step back and see why that's happening, you know, if there is a complicating factor, you know, what's the nutritional status, the blood supply to that side, you know, you have to take a bigger picture, take a step back, try

to evaluate the reason of recurrence as well as continuing the antibiotic. >> i would say that a lot of leg ulcers, people with diabetic -- you will never get them healed until you get a blood supply. forget about it. >> i think in a fellowship, our mentor asked this question, what is the number one reason why antibiotics fail, you know, and the answer was if they're not able to get to the site of infection. that is number one reason the antibiotic failure. >> a man from white owl, how can c-diff cause pseudo gout. i have not heard of that.

>> i have not heard of that, either. >> a pseudo gout is -- >> maybe they had gout and c-diff at the same time. >> i was worried they may have an infection in the joint but c-dive, i don't understand that one. 76-woman from ipswich, my husband -- i love that word, ipswich. my husband had to pay $138 for d.t. and whooping cough vaccine. where can adults gets free immunization and 90-year-old woman from sioux falls asks why are shingles vaccines not paid for?

ideas about payments? >> they're complicated for adults. for children, there is vaccines for children program so all children through the age of 18 can get all of their vaccines paid for. for adults, there's probability more problems, i would recommend that they contact their county public health office to try and get that. >> and now for the winner of tonight's prairie doc quiz question. true or false. after a regular flu shot, those older than 65 produce 50 to 75%

less antibodies to flu than do younger folks. the answer is true! it was bruce boman who answered the question correctly. thank you, bruce, for participating and a book will be in the mail to you soon. a high-dose vaccine has been developed to try to solve that problem because older people don't have immune system but there is some question as to when it has more side effects or -- are you recommending, the adult -- >> i'm recommending it.

>> high dose, i think you gets a better immune response and more protective to prevent the infection, so i think at our practice, we make that recommendation for patients above 65 for high dose. >> it is true that there are more side effects at the injection site but other than that... >> all right. we'll be right back after this. >> it's with regret that i inform you that the ends is near for me. i'm old, i'm tired, i'm weak. but don't go thinking you've won the war, flu. before i go to that big petry dish in the sky, i'll find a suitable replacement. be warned.

with the advent of antibiotics in the 1930s and '40s, we saw a true change in longevity and a reduction in premature deaths from infectious diseases. now we are seeing deaths from bacteria which are resistant to every antibiotic and it's not just the sick and decrepit who are affected. recent studies show many more people are dying in the u.s. from antibiotic-resistant bacteria than from aids. it's a real crisis from too much of a good thing. resistance is due to excessive and over-use of antibiotics, which are often incorrectly seen as the cure for whatever ails us.

the most glaring example is when antibiotics are given for what is obviously the common cold, making absolutely no difference in the course of the illness. often i hear from the patient, "why not start an antibiotic to keep this viral bronchitis from turning into pneumonia?" to that question i usually answer, "you are correct. when bacterial pneumonia occurs, it often follows a common cold, but studies show antibiotics don't prevent that pneumonia following the cold. it just becomes a pneumonia resistant to treatment."

so why are we over-using antibiotics? certainly an effective sales effort by the pharmaceutical industry is part of it, but what's most to blame is patient or parent expectation. one study showed that 65% of the time children get antibiotics if the doctor perceives the parents expect them, but only 12% of the time when antibiotics are not expected, even when the children are similarly ill. ultimately, the doctor is responsible, but too often influenced to provide unnecessary treatment.

another huge reason for growing antibiotic resistance has resulted from past regular use in animal and poultry feed which boosts growth and profits. now that is being limited for use only when a veterinarian prescribes them. also, there is strong encouragement for veterinarians to prescribe the newer broader spectrum antibiotics only for the care of sick individual animals, not the herd. these new moves are a start, but monitoring of reduced use needs to occur. the good news is that in countries where efforts to use

less antibiotics are successful, then, over just a few years, antibiotics become effective again. so, there is something very important you can do. first, never push your doctor for an antibiotic. make it clear you would be happy without the stuff unless it's necessary. second, please push your grocery store or your restaurant for antibiotic-free meat. if we are willing to pay a little more for antibiotic-free products, farmers will provide. let's not take antibiotics for granted. by avoiding the overuse of antibiotics, we can save ourselves from a real crisis.

>> a big thank you to our guests, archana chatterjee, and jawad nazir. thank you both very much. >> thank you very much for inviting us. a final note on zika in south dakota. through the end of september, south dakota had reported two zika cases, both travel-related. this summer's surveillance found none of the aedes albopictus mosquito that is a potential transmitter of zika. with the colder weather, we should be okay unless we travel to places where it is still being transmitted.

and many of us probably will. the cold weather does signal a season change and as far as flu is concerned, we reported our first lab-confirmed case last week, an influenza a in pennington county, and also the first flu-related hospitalization, an influenza b in potter county. it is here, folks! do not delay, get your flu vaccine now to reduce your chances of catching the flu bug this season. that does it for tonight. from all of us here at

"on call with the prairie doc," until next time, stay healthy out there, people. >> no, even better, it is our own marvelous -- next time "on call with the prairie doc."

drug pseudogout 2017-02-02T03:09:00-08:00 Rating: 4.5 Diposkan Oleh: Ramdani Sanghiang Wibawa Tunggal