Antibiotics overused in Alzheimer patients

Should people with Alzheimer's disease/dementia be treated with antibiotics? According to a new study, they say that antibiotics are being overused in patients with dementia and antibiotic use should be considered more carefully especially in this time of antibiotic resistant superbugs. (AP)

The study raises ethical questions about when it's acceptable to withhold perhaps futile treatment and let people die, and whether public health issues should ever be considered.

"Advanced dementia is a terminal illness," said study co-author Dr. Susan Mitchell, a senior scientist with the Harvard-affiliated Hebrew Senior Life Institute for Aging Research in Boston. "If we substituted 'end-stage cancer' for 'advanced dementia,' I don't think people would have any problem understanding this."

People wouldn't have a problem understanding this? Of course, when you paint a picture like that. Here's the question, though- What is advanced dementia? There really is no consensus definition. Of course, really end stage cases even medical students can diagnose. But, the problem is that there is a spectrum of diagnosis. Where do you draw the line between moderate dementia and advanced dementia? There is no agreement with this.

I can see both sides of the end of life debate getting ready to do battle again. Remember Terri Schiavo? Remember Baby Emilio? Remember the use of chip implants in Alzheimer patients? The use of antibiotics in dementia/alzheimer patients is just another chapter in this debate.

One side is saying that the progression of antibiotic resistant organisms can be stopped by appropriately prescribing antibiotics - meaning not those patients with advanced Alzheimer's disease. The other side is saying once you limit antibiotic treatment for people with Alzheimer's, the danger is there to start using the same argument to stop treatment of other medical conditions (like high blood pressure). What's your take on this debate? I'm curious....

The Shamrock Shake

I have been a blogging slacker for the past few days. I do have a lame excuse, though. I was on call last weekend, and I have to tell you, there are a lot of ill people out there and the hospital has been hopping for the past few weeks.

Anyway, as I was making "rounds" at McDonalds yesterday, the friendly drive-thru chap asked, "Would you like to try a Shamrock Shake?" Wow! It's only February, and our local McD's has already gotten out the shamrock shake. This is great stuff! If you haven't had this before, you have to try it.

I do admit that I like the taste of mint. So, the shamrock shake is definitely delish to me. And, as Dr. Rob has stated recently that obsessing about anything is bad. I kind of get addicted to the shamrock shake - especially when they say "for a limited time only." Anyone with me on this? What do you think?

TBTAM on the Dr. A show

Thursday, February 21st, 2008 at 9pm Eastern Time

Join us tonight for The Blog That Ate Manhattan. At the bottom on this post, you'll see an embed from ustream.tv. TBTAM has a great promo post saying we're going to talk about "Big Pharma, dissecting the medical literature, giving out free medical advice and discussing the insanity known as gyno-food blogging. Who knows, I may even resurrect the Vagina Blogging song for the occasion!" Wow! I can't wait for this interview.

Take part in the chat room, which is the "show within the show." A great opportunity to interact with medbloggers you've only read about. You can even call into the show to talk and/or ask a question. See you tonight!

For first time Blog Talk Radio listeners:
*Although it is not required to listen to the show, I encourage you to register on the BlogTalkRadio site prior to the show. I think it will make the process easier.

*To get to my show site, click here. As show time gets closer, keep hitting "refresh" on your browser until you see the "Click to Listen" button. Then, of course, press the "Click to Listen" button.

*You can also participate in the live chat room before, during, and after the show. Look for the "Chat Available" button in the upper right hand corner of the page. If you are registered with the BTR site, your registered name and picture will appear in the chat room.

*You can also call into the show. The number is on my show site. I'll be taking calls beginning at around the bottom of the hour. Hope these tips are helpful!

Just venting

I've had all this pent up frustration in me this week because of last week's show. In this video post, I just wanted to get it all out in the open and out of my system. I didn't want to contaminate Thursday night's show without (kind of) resolving in my own mind what happened last week. So, I apologize for the whinnyness (is that a word?) of this video post, but at least I feel better and I can really focus on having fun again on The Doctor Anonymous Show.....

Med 2.0 blog carnival

I'm a big fan of Bertalan Meskó and his blog called Science Roll. If you haven't checked out his blog, I highly recommend it. He has an interest in genetics and in technology. And, I'm looking forward to having him on The Doctor Anonymous Show sometime soon in the future.

Many people are familiar with the blog carnival called "Grand Rounds." But, Science Roll anchors a blog carnival called "Medicine 2.0" where there are links and stories about web 2.0's impact on medicine and healthcare. I was pleasantly surprised to be included in the most recent edition of Med 2.0.

You should check out and follow the live shows of Doctor Anonymous.

There is even a BlogTalkRadio badge over on the Med 2.0 post. Thanks so much to Berci for mentioning the show and for including a BTR badge. I really appreciate it. I'm looking forward to when our schedules can match up for you to be on The Doctor Anonymous Show. So, if you've never experienced Medicine 2.0, check it out! You'll be glad you did.

You've been traded - To Japan

It's baseball spring training time again, and I've had enough of all the talk about steroids and congressional hearings and all that stuff. I heard about the video above last night. And, it's a practical joke that had one young recruit going until the last minute.

The way the video above goes, the young pitcher is brought into the managers office and is told that he is being "traded" to Japan for a player named "Kobayashi Iwamura." You can see that this guy is totally dejected - not only because he was traded, but because he's going to have to go to an entirely different country.

His next move is to let his teammates know what the news is. Of course, his team is in on the joke. Not only his teammates, but his manager, his agent, and the press who are interviewing him at the end of this video. Finally, to save him, one of his teammates say, "You've been Punk'd." I really felt bad for the kid, but in the end, it's all laughs.

Mac users are snobs?

This is according to this video report from The Street (via Insanely Great Mac and The Unofficial Apple Weblog).

The assertions made by this report include the following: Mac users more likely to use teeth-whitening products; Mac users bought on average five new pairs of sneakers in the last year; More likely to buy organic food; More likely to frequent Starbucks; More likely to own a hybrid car; Mac users are perfectionists; Prefer to drive station wagons; More likely to pay for downloaded music.

To me, this report is pretty funny. I hardly resemble any of the characterizations above or in the report. (I'll let you sort out which ones you think I am.)

But, I will not stand for this painting of a broad brush of all Mac users. There is too much discrimination going on in this country right now. Can't I stand on my own merits? Does the computer that I use determine the person I am and how you should treat me? I think not. I will not stand for this. I am a Mac, and I'm proud of it! YAY!

Flu Epidemic

(This is a continuation of part one from yesterday)

Last night got a little better for me. The coughing was still there, but not as bad. In fact, the coughing is still here right now as I write this. The muscle aches have pretty much resolved. And, to be honest, this was the main symptom that was bothering me. The headache and sore throat are continuing to improve. It's a good thing, because I'm on call tomorrow and the weekend coming up.

As I was doing more research this weekend, I found this article from the Associated Press from February 15th saying that this year's flu vaccine is effective for only 40% of this year's flu viruses.

Infections from an unexpected strain have been booming, and now are the main agent behind most of the nation's lab-confirmed flu cases, said Dr. Joe Bresee, the CDC's chief of influenza epidemiology. It's too soon to know whether this will prove to be a bad flu season overall, but it's fair to say a lot of people are suffering at the moment. "Every area of the country is experiencing lots of flu right now," Bresee said.

If you haven't seen it already, check out the map on my previous post from the CDC which states that most of the country is under the "Widespread Flu" designation. Now, I know what everybody is going to say, "Well, Dr. A, why even get a flu shot if it's going to be 40% effective?"

The way flu vaccines work is that they have to try to predict ONE YEAR in advance what the flu viruses are going to be. For the most part, they have been right. But, as I have been seeing in interviews over the weekend, researchers have been playing the "cover your butt" game saying things like - "We predicted that sometime in the future we would be wrong and there would be a flu epidemic."

In my book, 40% is better than 0%. Here are the facts from the CDC. Every year in these United States, 36,000 people die each year from the flu and more than 200,000 are hospitalized from flu complications. These complications may vary from dehydration to respiratory failure and needing to be on a respirator or breathing machine. Now, wanna flu shot? Well, it takes weeks to get working in your system. That's why the big push is in the fall to get your flu shot.

Another interesting observation is that the popular media has not really picked up this story yet. Usually, they are all over stories like this to cause panic in the public. They usually love driving patients to hospitals and doctors offices and having patients demand flu shots and prescriptions for meds like Tamiflu.

My prediction will be that when this flu story starts to intersect with the story of the presidential primary process - that's when you'll see headlines like "Flu Epidemic" all over the place. Three states vote on Tuesday and four states vote on March 4th (including my state).

You'll see headlines like, "Disenfranchised voters have the flu - especially elderly; unable to appear at voting station due to illness." Then, you'll see candidates trying to take political advantage of the flu. I hope I'm wrong. But, if not, you heard it here first. I'm Dr. A, and I approved this message....

Gov. Strickland has marching orders

This is definitely not a political blog. But since the US presidential nominating process is going to be rolling through my state 16 days from now, I thought that it may be interesting to make a few observations. Channel surfing this evening, I saw the interview above, which I thought was fascinating.

The interview has two governors from the same Democratic Party who are supporting two different candidates for the nomination. The first is Governor James Doyle from Wisconsin (pictured to left above) who is supporting Sen. Barack Obama for the Demorcatic Presidential nomination. The second is Governor Ted Strickland from Ohio (pictured to right above) who is supporting Sen. Hillary Clinton. I have particular interest in this because Gov. Strickland was my congressman before being elected to the Governor's Mansion.

Even if you don't know anything about politics or don't care about politics, I encourage you to check out this eight and a half minute interview. I think it will summarize what is happening in this race. You'll see Gov. Doyle enthusiastically supporting his candidate. He seems very calm and more conversational.

Meanwhile, Gov. Strickland seems very tense, and at times defensive. It looks like he was given the talking points to repeat time and time again during the interview. It looks like he's been put under a lot of pressure to deliver Ohio to the Senator from New York.

Finally, the most interesting answer I saw was when Gov. Strickland was asked whether he would accept the Vice-President position if it was offered to him. "I don't want to be Vice-President," was his first response. That's telling me either that he was told to say that, or he's looking ahead to 2012 for a Presidential run of his own.

One thing that I think will definitely happen is that if Ohio does go for Hillary on March 4th, and if she is eventually elected president, Gov Strickland will be moving back to Washington - probably in a high-up cabinet position - because, basically, that's how politics works. And, if anything else, Ted Strickland is a good politician. I'm Dr. A, and I approved this message....

Influenza Case Study: ME

The following is a anecdotal case study of a guy who has influenza. I apologize in advance for the long post. But, if you want to know how it feels to have influenza, read on. As you can see from the graphic above from The Centers of Disease Control and Prevention, the flu epidemic is practically nationwide.

Here's my story. I was on call the day before Valentine's Day. A typical busy day and night - having to go back and forth into the emergency room to see people. While making rounds on Valentine's Day, I was talking with some people who said the hospital was starting to see cases of influenza. Of course, those words passed right by me because I got my flu shot last fall.

A few hours before the worst. show. ever., I was starting to feel some muscle aches in my legs. And, then, I was feeling pretty tired. But, I always feel tired after being on call. I mean, you hardly get any sleep. I was hoping to sleep things off and feel better in the morning.

The next morning comes, and the muscle aches are still there. A new symptom, a cough, appeared over night. "Oh great," I thought to myself. "I'm starting to get another sinus infection." I'm getting a little sore throat. I'm getting that typical sinus headache. I'm thinking to myself that it's Friday and I can get through one more day of work and I can nurse this sinus infection over the weekend.

My first patient in the office is at 8:30am. As each hour goes by, the aches in my legs become more and more apparent. You know the feeling of overdoing a workout after you haven't been to the gym for a while. That's what my legs felt like - only I really haven't been to the gym in a while. The fatigue was starting to become overwhelming. "Why am I so tired all of a sudden," I'm asking myself. The cough develops more during that morning. So, much so that my patients started to remark on my cough.

Then, I did something that I have almost never done before. I went home to lie down so that I could try to get some energy for and entire afternoon of seeing patients. "Four more hours," I kept telling myself. Even I can get through four more hours and then take care of this illness over the weekend.

As each hour went by, I was walking slower and slower down the hall to and from my office. The body aches were bad, the headache was pounding, the cough was overwhelming at times. At three o'clock I heard from the front desk that three patients wanted to come in right now to the office if they could. Part of me really wanted to say, "Oh yeah, I'm feeling sick, too. And, I want to go home early today for the first time ever." But, I told them ok, I'd be happy to see them.

I finally finished past 5pm. I didn't do any of the paperwork (it's still sitting on my desk). As I was leaving the office, one of the other docs said, "Sounds like the flu to me." What? I had my flu shot. But, even Dr. Val says that It Doesn't Always Work. As like other docs, I'm a terrible patient and I hate taking meds unless necessary. But, I did start Tamiflu about 24 hours ago.

Last night was tough - tougher than the night before. The muscle aches, the cough, the headache, the fever and chills, the night sweats - needless to say, I did not get too much rest. I was even up in the middle of the night to watch reruns of MASH (what a great tv show).

Now, finally, I'm just starting to feel a little bit better - at least better than yesterday. The body aches are pretty much gone. The cough is still there but not as bad as last night. The headache and sore throat are still there, but not as bad as last night. The fatigue is still kicking my butt. I've been sleeping most of the day....

Whoa. That's all I have for now. Another wave of fatigue has gotten a hold of me. I'm feeling tired again. Going back to bed. Hopefully, more to comment on soon. We'll see what tonight brings.....