I recently reviewed an article discussing guidelines for diagnosing and treating ear infections, or acute otitis media (AOM) in otherwise healthy children.  These guidelines are based on studies looking at the risks and benefits of initial treatment with antibiotics versus watchful waiting to see if the illness improved on its own. 

 In many cases, watchful waiting results in similar resolution of symptoms as treatment with antibiotics.  Within 24 hours, 60% of children who are treated with antibiotics have decreased symptoms versus 59% of children who are not.  By 2-3 days, 91% and 87%, respectively, have improvement in symptoms.  Complete resolution of symptoms by 7-14 days is seen in 82% and 72% of children initially treated with antibiotics and children initially observed without antibiotics, respectively.  Overall, immediate use of antibiotics results in about 1 less day of illness- but no difference in the days of absence from school or pain scores.   With close monitoring by caretakers and follow up with their medical provider in 48-72 hours, there is no increase in the development of AOM complications such as mastoiditis (infection of bones behind ear), bacteremia (infection in blood), bacterial meningitis (infection around the brain) and persistent fluid behind the tympanic membrane (ear drum).

 In contrast, 5-10% of children treated with antibiotics develop diarrhea or a skin rash from the antibiotic.  Taking probiotics while on antibiotics may reduce some of the diarrhea or associated gastrointestinal problems.  Much more infrequently, children have true allergic reactions to the antibiotics that rarely can be life-threatening.  Possibly more important is the risk of promoting resistance of the bacteria to certain antibiotics.  More frequent exposure to antibiotics selects for bacteria that are resistant, making future treatment more difficult. 

 Not all children meet criteria for observation and, instead, should be treated immediately.  Close observation  is essential as some children do require antibiotics after the initial 48-72 hrs.  Treating pain is also essential and is unrelated to treating the infection with antibiotics.  Many methods of pain control are available.

 Most viral illnesses follow similar patterns and have similar guidelines as AOM.  Preventing or minimizing these infections may be where we should concentrate our efforts.  Breastfeeding for at least the first 6 months of life, avoiding “bottle propping,” and  reducing or eliminating pacifier use after 6 months of life have all been proposed  to reduce early infections.  Immunization with several vaccines that are targeted at some of the most common bacterial causes of infections like AOM may reduce the incidence somewhat, keeping in mind most infections are viral.  Avoiding exposure to tobacco smoke and regular handwashing are definitely the best methods we have for preventing respiratory infections and , therefore,  reducing the use of antibiotics, necessary or not.

 We hope that most of you remain free from significant illness this winter.  Nevertheless, Mike, Karen and I are here and happy to see you to do our best to help you recover as quickly as possible. 

 Take care,

Bryan

Note from Mike: Garlic oil (obtained from a health food store) warmed to body temperature and instilled in the painful ear can be a great pain reliever and likely has antimicrobial properties.

It has become clear to the Food and Drug Administration that people taking these bisphosphonates are much more likely then others to have otherwise rare but serious types of femur (thigh bone) fractures.  The majority of patients with these subtrochanteric and diaphyseal femur fractures have taken these medications for at least 5 years.  Also, a large number of the treated patients who eventually fractured had “warning signs”, specifically a “tell-tale dull, aching pain in the thigh or groin”.  The Black Box Warning is a reminder that physicians should now think very hard before placing patients on these drugs and should reserve treatment for people, usually postmenopausal women, at high risk of bone fractures due to osteoporosis.  And even in these patients, we should consider an “interruption in therapy” so that they are not on continuous treatment for five years or more.

I will save philosophical and editorial comments regarding over-marketing of medications for another time.  For now, please know that I will not be prescribing these medications except in the most dire circumstances.  If you are my patient and already on therapy, please make an appointment to discuss your current and future treatment.  If you are experiencing groin pain or hip pain while taking one of the above medications, please discontinue it at once and contact the office for an appointment.  

Also, please know that bisphosphonates are not the only option for preventing and reversing osteoporosis.  Maximizing Vitamin D levels, regular weight-bearing exercise, vitamins and minerals and some hormonal treatments have been quite promising.  There are several good books on this subject including The Myth of Osteoporosis by Gillian Sanson (MCD Century Publications), The Whole-Body Approach to Osteoporosis by Keith Mccorkmick (New Harbinger Publications), and Strong Women, Strong Bones by Miriam Nelson (Perigree Trade).  Check them out at the library to find out which is most appropriate for your level of knowledge and experience.  

To report adverse events related to bisphosphonates, contact MedWatch, the FDA’s safety information and adverse event reporting program, by telephone at 1-800-FDA-1088, by fax at 1-800-FDA-0178, online at http://www.fda.gov/medwatch, or by mail to MedWatch, FDA, 5600 Fishers Lane, Rockville, Maryland 20852-9787.

Many of you know that two-and-a-half years ago, at the age of 42, I had my right hip replaced (actually it was re-surfaced, but that is a different story) due to severe arthritis.  I suffered with increasing pain for several years before making the decision to have surgery.  I consulted three orthopedic surgeons and spoke to my family physician about my problem, and none of them could tell me why I had such severe degeneration in my hips.   

I began limping in high school.  I don’t want to say “I began having pain in high school” because I didn’t register pain.  My only symptom at that time was limping, particularly after soccer games.  My father asked me many times, “Why are you limping?”, and my answer was always, “I’m not limping.”  (I will address in future blog posts the issues I have with listening to my body.  Suffice it to say I wasn’t listening then.)

I eventually began experiencing actual pain in my right hip during my residency, now fifteen years ago.  I kept telling myself that if I just worked harder at getting or staying in shape, or if I lost some weight, the pain would go away.  I should tell you that I have been more or less “addicted to exercise” since I was a teenager–I was not a couch potato by any means.  The pain progressed to the point that I was forced to stop telemark skiing and take up snowboarding instead.  (I won’t argue whether that was smart or not, but at least it allowed me continue to enjoy time with family and friends during the winter months.)  I finally decided to have surgery when I was needing Vicodin to fall asleep most nights.  

Each of the doctors I consulted looked at x-rays of my hips.  “Yep, you have bad hip joints.”  I asked each of them, “Why do I have such bad hips?”  The best guesses were congenital deformity and chronic inflammation.  I tried everything I could think of for the arthritis–glucosamine, anti-inflammatories (natural and conventional), physical therapy, Yoga, massage therapy, Rolfing, you name it.  At one point I even tried an elimination diet that was gluten free.  My wife, Mia, and I faithfully adhered to the diet for three weeks before re-introducing gluten, though at the time, I did not notice a change in my pain level.

Now I have advancing pain in the other hip, and I have continued to search for a treatable cause of my arthritis.  Recently a physician friend challenged me to eliminate gluten for three months.  At the same time, a patient turned me on to this 7-minute video by Dr. Mark Hyman which I recommend highly.  http://www.youtube.com/watch?v=yLJSmJ0bMlk  (I have read two of his books, by the way, and I will tell you that I think Dr. Hyman is on the cutting edge of the future of medicine.)  

I am now two weeks into a gluten-free diet, and I am encouraged, though not yet convinced, that gluten is an issue for me.  Nonetheless, I believe that many of my patients with chronic problems, particularly inflammatory conditions, will improve when they eliminate gluten from their diets.  And while they may feel better within a couple weeks, the real pay-off will be down the line.  Inflammation is at the heart of many chronic diseases that plague our population: heart disease, cancer, obesity, diabetes, depression, osteoporosis, Alzheimer’s, and many more.  

I encourage you to think about gluten as a possible culprit if you have a chronic medical condition.  There are some antibody tests that may diagnose gluten allergy, but the tests are inconclusive, they don’t pick up all cases, and ultimately the best way to find out is if you feel better being off gluten for at least two to three weeks.  Please consider speaking to your doctor if you have questions or want to be tested.  It could make a wonderful difference in your life.

At Ultimate Health you will find full-spectrum family medical care, acupuncture, chiropractic, cranial sacral therapy, hypnotherapy, nutrition counseling, multiple health-related classes and group meetings and wellness counseling.

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We promise to practice medicine in an  ethical,  respectful way that honors who you are and your health journey.    We’ll treat  you and your family with respect and dignity, and provide the information, support and care you need to  be connected to optimal health.   We won’t share or sell your information,  we won’t take incentives from companies who want us to sell their products, nor will we encourage you to  purchase anything  solely for our financial gain.  

Our practice is an expression of our desire to be connected to our patients, advocates on their health path and partners in supporting patients to optimal health.

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