Antibiotics, bronchitis, sinusitis and the common cold

I am a simple family doctor. But I lay claim to being a specialist in warts, sore throats, colds and flu. Everyday, all year long I see patients with congestion, sore throat, sinus pain, chest congestion and cough. I know the common cold.
Many people think they know the common cold. Runny nose, sore throat, cough and congestion that goes away in 3 or 4 days right? Not quite. Although many colds do run their course in just a few days, the majority that I see last 1, 2 or even 3 weeks. It is still a common cold even after 2 weeks.
The medical profession is inconsistent in this regard. Although we all know the dangers and the uselessness of antibiotics for colds, we continue to prescribe. But, we change the illness. We diagnose sinusitis, bronchitis and otitis. Daily I will see a patient who says, "I just wanted to be sure I wasn't getting sinusitis or bronchitis." The fact, you do have sinusitis and bronchitis! The definition of sinusitis is inflammation of sinuses, bronchitis is inflammation of the bronchioles. This happens with almost every cold.
When then do you need antibiotics for sinusitis and bronchitis? Rarely. If you are in day 3-5 of an illness, the sinuses will be full and you will have pressure. This is the normal course for a virus. If you are day 14 and you are developing a new fever, you have sinus pressure on one side you may need an antibiotic. Bronchitis? There is no indication for an antibiotic. If you have cough, fever and on exam you have lower respiratory findings and on xray you have markings, you have pneumonia need an antibiotic.
Overuse of antibiotics has led to MRSA, VRE, C. diff and other bacteria that can not be treated by usual antibiotics. Antibiotics cost you money and give you diarrhea. If your doctor tells you to treat your cold with Tylenol and rest, thank him or her, skip the pharmacy and go right back home to bed!

Love. Truth. Self-discipline

Our teen group discussed core values for a Christian. The group meandered for awhile and stumbled upon a profound set of core values for a Christian.

Love. Truth. Self-discipline.

Yes, there are many important virtues: patience, kindness, faithfulness. But, can't these all fall under love? If we have love we will grow in virtue. Truth directs our love into the right direction. Self discipline gives love and truth legs so we can love in word and deed.

As David and I drove home, we listened to a speaker recalling the early Christian practice of rescueing Roman babies. The Romans would leave an unwanted baby out in the elements to die. Christians would find and save those babies taking them as their own.

What values did those Christians need to act that way? Love. Compassion for the child. Truth. They believed that life is a gift from God and not to be tossed aside. Self discipline. They had to go find the child and nuture that child for a life time.

Who knew?! It's the flu!

Flu season is in full swing in September thanks to school and swine.

Swine flu has been slowly percolating on our homeland since it's first appearance in NYC several months ago. It is now moving freely released to the general population at the opening of school this Fall.

It's really gone well with public health efforts. Initially we were all worried appropriately that a novel virus released on a naive population could wreak havoc. Shutting down schools at the first of the year helped cool the spread. Screening children at summer camps kept kids from sharing the virus with bunk mates. This has all set the stage for the advent of the vaccine for H1N1 virus. The effect has been a wave of cases of flu-like illness in September. A small wave is better than a tsunami!

I 've seen several cases in my office this month. The illness starts with sore throat, nasal congestion, cough and fever. It has been a mild one week illness in most cases. Asthmatics can have a worse time and the elderly of course can have more severe disease. When the vaccine is released for swine flu, it has been suggested that the elderly not get the vaccine because they may have immunity from viruses long ago. Interestly, I haven't seen many older adults with flu-like illness. Hmmm.

How Fit Feels

On the wall of a crowded nurses station was posted a photocopied phrase, "Nothing tastes as good as skinny feels". I want to change that to "nothing tastes as good as Fit feels". When I am at my best training for a marathon is the month before. I've usually gotten down to my low weight for the year and run 26 miles a week. I'm fit and it feels good. When I think about over eating, I realize the gross feeling from eating will envelope the temporary taste.
Debbie and I lost weight and exercised regularly in anticipation of our cruise this past winter. We have continued to try to eat healthy and exercise not just to reach a goal weight or be "The Biggest Loser", but to be healthy and fit.
This is a common refrain from my patients. After trying a crash diet for the past week and a half, they lament that they can't lose weight. For most, dieting is about losing weight. Lost for most is the idea of eating, exercising and living healthy. Fitness is a word learned and left in our PE 101 class in university. My advice for weight loss challenged dieters is thus: exercise and eat right for the next year then tell me how you feel. Deb and I have been doing our best to encourage each other for the last 9 months. I know, fit feels good.

Jon and Kate Separate?

Tonight, four million viewers will be invited to listen to Jon and Kate's anticipated conversation about their marriage. Amidst rumors of marital infidelity on both sides, Jon and Kate in a People magazine interview both separately declared their dedication to their children. "No matter what's happening between Jon and Kate, they are clearly going to rally around the kids," says a source close to the family in the People article. "I will not fail my kids," Kate said. "I will do anything to protect my family," said Jon.
I was recently talking to a 19 year old friend about parenting. He was telling me some thoughts and worries about being a father. He is very thoughtful and dreams of someday being that father that loves, cares and is there. He's studying me and others. My young friend watches how I handle my three kids and likes what he sees. I encourage him to learn from what I and others do well and from our mistakes.
But, I advised, first carefully consider the mother of the children and how you can be a good husband. Learn how to love your future wife and build a marriage that will last a lifetime. That is the best thing you can do for your children. Give them a happy home with a mother and father that love each other and love them.
Every parent will make the "I will do anything for my kids," endorsement. Problem is that many parents lack the foresight and ability to do that. Take for example the dozens of single mother's in my practice who every other weekend hand their precious little ones over to the care of someone for whom they have only contempt. I hear the stories of apathy and poor care by father's who are marginally involved in the children's lives because they have "moved on" or have another woman in their lives. The mother at this point is helpless to protect her child. He has the kids for the weekend. Would you like to have a beautiful baby someday and have that child spend half of her life in the care of your worst enemy. No one ever wants that. But, that is exactly the situation of so many men and women I see in the office. If you have a child and separate from the other parent, you will have to share that child. Talk all you want, but if that person is a nutjob, you are helpless. You may find yourself powerless to make good on your promise to protect your kids because they are out of your care and you are not there.
Thus, I get tired of adults who are getting ready to divorce and rip their children's lives in two, saying, "I will do anything for my children." We have normalized divorce in this country. Many have minimized the effect that a divided home has on kids. Yes, I know the reality that half of all marriages will fail. Yes, I understand that when two people can't live together it may be better to part. People currently going through divorce or separation have to do the best they can. It's a tough situation and I feel for those people. What I am pointing out to all the young adults dreaming about a family is this: if you will do anything for your children, start now. Choose the mother or father of your children carefully, be the best spouse you can be. I'm happy my friend is planning and dreaming. He is working today to build a family tomorrow.
I don't know what will happen with Jon and Kate. I don't even watch the show. I do know that if they separate, they will have a tough time fulfilling their dreams with their children.

Bristol Palin's Graduation by Fire

Bristol Palin has discovered that being a Mom is a lot harder than being a teenager. She's discovered that diapers and formula are expensive. The daughter of Alaska govenor, Sarah Palin, spent prom night at home taking care of her 5 month old son. She did however, make her graduation and now spends the summer days pushing a stroller and evenings working babysitting to pay for baby stuff.
I know this teen has had quite a ride during her Senior year. She spent the summer and Fall in the national spotlight as her mother rode the Republican ticket as the Vice Presidential nominee. Her pregnancy and relationship with the father of the baby have been publicized and scrutinized. Bristol deserves a reprive from public conjecture of her personal life. So why am I going on about her? Because she wants to be a lesson to other girls, "Girls need to imagine and picture their life with a screaming newborn baby and then think before they have sex. Think about the consequences", Bristol said in People magazine June 1, 2009. "If girls realized the consequences of sex, nobody would be having sex. Trust me. Nobody." Bristol now uses her experience to talk to other teens about sex. She does a mainly abstinence message but also discusses and encourages birth control. "I don't think anyone realizes that it really can happen to you, like, in an instant", she told a People reporter.
Bristol is showing the resiliency of a Mom. She has come through the struggles of the past year and is using her experience to grow personally and reach out to others. This is true virtue, true character. I applaud her for working to pay the babies expenses, staying home to care for her baby and still finding a way to help teens. Thank you Bristol for sharing your story and reminding kids that abstinence is the best option. Now my hope and prayer for you is that you can raise your baby, pursue a career and live your life in the privacy you deserve.

Swine Flu....(PC version "H1N1 influenza") ((My apologies to pigs))

Swine flu is similar to influenza A that circulates among humans every winter. So far in the US, it's virulence is no worse than winter time flu. The worry is that this is a new virus for humans and thus we are immunologically naive. Our immune systems have seen several influenza A viruses and each Fall, most of us get a flu shot and we are ready for the inevitable spread of the contagion. With swine flu, there is no vaccine yet and this being a novel virus, we are doubly unprepared.
At first glance, the world reaction seems a bit overdone. But, consider the above and also realize that without control measures, this virus might be spreading much quicker. Public awareness and isolation of cases, along with selected closures of public facilites may just buy us time for a vaccine and prevent many illnesses. This is public health in action.
Don't panic, the virus seems fairly tame. But do wash your hands and stay home if you get sick.

How far will Ellen Goodman go to make herself readable?

Ellen Goodman, syndicated columnist, recently offered a diatribe on abstinence-only education and loving fathers, equating them philisophically to hymen restoration. Briefly, she notes that in France, gynecologists are offering hymen restoration surgery to restore the appearance of virginity. The appearance of virginity in the marriage bed is important to many cultures especially Muslim. She goes on to denigrate abstinence only education and parents teaching their children sexual purity. "And consider the father-daughter Purity Balls dotting the country. At these deeply creepy events, fathers promise "to cover my daughter as her authority and protection in the area of purity".

A couple questions for Ms. Goodman. "Would you allow your 5 year old to surf the internet for pornographic chat rooms?" Okay, let me assume you said, "No". If I am correct, you just exerted authority over your child's purity. Can you do that as a parent? Yes! You should. We all have a duty to protect our children from what we as parents believe to be harmful. Now, a 5 year old surfing the net is a far cry from a teenage girl comtemplating sexual experimentation. So, my next question, "When is it right to let your child loose to experiment sexually?" Come now, when are you going to let your daughter stay over at her boyfriends house for the night? Will you allow it at 10? I doubt it. 12? Still, I hope not. 14? 16? What is your line to drop your authority for your daughters well being? Certainly you won't allow her at 14 to go to the 21 year old boyfriends apartment? Of course not, that would be illegal...and would you add immoral? if you agree that this would be illegal and immoral, you have just again exerted your authority over your teenage daughter and pressed your own beliefs on her.

Face it, we all teach our children our beliefs and we protect them from what we think harms. That is what makes us loving, caring parents. So, tell me then what is so creepy about a father that teaches his daughter to wait for marriage to have sex? Is it really so much different from what you do? What's the difference? A couple of years in age for the daughter and a partner that will or will not commit to caring for your daughter.

Wait, I think I understand. You got "creeped out" by the idea of a father "covering" a daughter. Did you think that meant something bad? True, I wouldn't have picked that term because I know many people, like you did, would read some physical, sexual implication to the term. It's too bad actually. People can't understand the pure love of a father for a daughter. I want nothing but the best for my beautiful, amazing, brilliant 10 year old daughter. I will protect her from harm. I will teach her to wait for marriage for sex. I will allow her to make her own decisions and give her independence as she grows and learns. I will love her no matter what decision she makes about her sexuality. In a world so deficient of good fathers, why would you criticize those who truly love and care for their daughters. You are right, we need a repair for our whole culture. Why not start with repair of your column?