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Posts published in “Columnists – Apple A Day”

Proper Use of Antibiotics


I ask you to imagine this setting: A mother takes her sick child to a medical clinic, and after an examination, the health care provider tells the family she has severe pneumonia. They are then told to prepare for the worst, because there is no effective treatment to offer the child.

You would probably guess that this episode occurred before the 1930’s and the advent of antibiotics. Although this scenario did play out many times before we had antibiotics, it is no exaggeration to state that this is not just a look back in time, but also a frightening glance into the near future.

The overuse of antibiotics has led to a serious crisis in which bacteria that were once easily killed by weak types of penicillin are now resistant to even the most potent synthetic “super antibiotics”. The scientific explanation for this phenomenon is that bacteria, although considered simple life forms, are “evolutionary geniuses”. They have a tremendous capacity to mutate and alter their genetic code to enable them to produce chemicals that can render antibiotics useless.

The primary cause of this crisis is that antibiotics are overused in this country at an alarming rate. There are many reasons for this state of affairs. Health care providers must shoulder the majority of the responsibility. We need to do a better job of educating and reassuring our patients regarding antibiotic use.

In addition, we must not bend to pressure from patients (and parents of patients) who sometimes insist, or even demand, an antibiotic when it is clearly not indicated. I appeal to each of you reading this article to work with your health care provider to slow down the rate of the development of antibiotic resistant bacteria.

Of course, there are instances where the use of antibiotics are clearly necessary and indicated. This includes strept throat, acute middle ear infections, and pneumonia that is determined to be caused by bacteria and not a virus. Simple and uncomplicated cases of sinusitis and bronchitis do not always require antibiotics in the early stages if there are no complicating factors. Each of these cases must be evaluated individually.

One method that we commonly use in our clinic is a “back up” antibiotic prescription. For example, if a healthy, non-smoking patient has an early case of sinusitis or bronchitis that does not appear to be getting worse; we often suggest treating only the symptoms for several days. We discuss the possible complications or reasons that an antibiotic might become necessary if the condition does not improve. At that time we will issue an antibiotic prescription with the understanding it will be filled only if the condition worsens and will be accepted at the pharmacy for 10 days. This has resulted both in high patient acceptance and satisfaction and a definite decrease in unnecessary use of antibiotics.

The next time you go to your primary health care provider with symptoms of an upper or lower respiratory condition (sore throat, runny nose, post-nasal drip, cough, etc.), please have a discussion with the health care provider as to whether your condition may be a viral infection or an allergy that does not warrant the use of an antibiotic. If this situation is to be reversed, be guided by the following slogan: “LOOK FOR EVERY OPPORTUNITY NOT TO USE AN ANTIBIOTIC WHEN POSSIBLE!”

Patricia Henderson MS, RN, C-FNP
Family Nurse Practitioner
Center for Family and Preventive Medicine
Affiliate of San Jacinto Methodist Hospital
14626 FM 2100, Ste. C
Crosby, Texas 77532


CHICKENPOX (Varicella)
By Patricia Henderson, MS, RN, C-FNP

Chickenpox (medical term is varicella) is a highly contagious disease caused by the varicella-zoster virus. It spreads from person to person by direct contact or through the air from an infected person’s coughing or sneezing. The person with chickenpox is contagious 1-2 days before the rash appears and until all blisters have formed scabs. It takes 10-21 days after contact with an infected person for someone to develop chickenpox. A person may get chicken more than once, but this is very uncommon. The infection is thought to offer lifelong immunity.

Symptoms of chickenpox include a blister-like rash, itching, tiredness and fever. The rash usually appears on the trunk and face first, but can spread over the entire body causing between 250 to 500 itchy blisters. Most cases of chickenpox occur in persons less than 15 years old. Before the use of the varicella vaccine, the disease had annual cycles, peaking in the spring of each year. Mild cases can be treated with anti-itching skin treatments and antihistamines.

Certain groups of persons are more likely to have serious symptoms with complications. These include adults, infants, adolescents and people with weak immune systems from either illnesses or from medications such as long term steroid use. These complications include secondary bacterial infections of skin, lungs, blood and bone.

Other complications are due to the chickenpox virus itself and can include bleeding, pneumonia, and encephalitis (infection of the brain). Chickenpox can cause death in previously healthy unvaccinated children and adults. It is never possible to predict who will have a mild infection and who will have a serious or even deadly illness. There are effective anti-chickenpox drugs available to treat active cases of the disease for those persons at high risk of complications, but the treatment must be started early in the disease to be most effective.

The good news is that chickenpox can be prevented by vaccination. The vaccine was licensed by the Food and Drug Administration in 1995 and is now widely available in private doctor’s offices and public health clinics.

Who should be vaccinated?
? All children between 12-18 months with one dose of vaccine.
? Children who have had chickenpox do not need the vaccine.
? Children between 19 months and their 13th birthday should be vaccinated with a single dose.
? Persons 13 years of age and older who have not had chickenpox should get two doses of the vaccine 4 to 8 weeks apart.

Vaccination precautions include:
? Pregnant women should not receive the vaccine, and non-pregnant women of childbearing age should avoid pregnancy for 1 month following vaccination.
? People who have serious reactions to neomycin or gelatin should not receive the vaccine.
? If you currently have a serious illness, are pregnant, or unable to fight off serious infection due to depressed immune function (cancer, long term steroid use, or HIV, etc.) it is best not to receive the vaccine.
? You should avoid the vaccine if you have received blood products (a transfusion, immune globulin, etc) within the past 5 months.

The chickenpox vaccine has a good safety record. The most common side effects are redness and soreness at the vaccination site or a mild rash and fever. These are generally mild and last only a few days. Severe reactions to the vaccine are rare (about 1 in 50,000 doses).

The vaccine is very effective and results in complete immunity for 8-9 out of 10 persons vaccinated. As with any new vaccine, the length of immunity can only be determined for as long as the vaccine has been tested. The dates gathered from the U.S. and Japan indicates that immunity lasts for at least 25 years.

The chickenpox vaccine is on the list of required vaccines for Texas school children. Exemptions are allowed only if there is written documentation that your child has had chickenpox. Exemptions can also be granted on religious or medical grounds.

For more information about the varicella vaccine or other immunizations call the National Immunization Hotline at (800) 232-2522. You can also log-on to the Center for Disease Control website at .

Patricia Henderson, MS, RN, C-FNP
Family Nurse Practitioner
Center for Family and Preventive Medicine
Affiliate of San Jacinto Methodist Hospital
14626 FM 2100, Ste. C, Crosby, Texas

Up in Smoke

An Apple A Day
Up In Smoke

Although public awareness about the dangers of tobacco smoke has heightened over recent years, the message has apparently not gotten through to many Americans. Approximately one-quarter of our adult population (over 40 million people) continues to smoke tobacco. Smoking is even on the rise among young Americans, with a thirty-percent increase over the past decade in teens.

Tobacco smoke contains at least 43 substances that cause cancer. Some of the chemicals in tobacco smoke include cyanide, benzene, formaldehyde, wood alcohol, acetylene, and ammonia. Nicotine itself is a poison that in large doses can kill a person by stopping their muscles of respiration. The health consequences of smoking are substantial, including a dramatic increase in diseases of the heart, blood vessels, lungs, and brain.
Tobacco smoke also elevates the risk of many types of cancer. In the U.S. tobacco causes 1-in 5 cancer deaths (nearly 440,000 deaths per year). Bottom line, smoking will kill you. However, it’s never too late to quit. The risk of heart disease in the ex-smoker is equivalent to that of the non-smoker after fifteen years of being tobacco free.
Smoking cessation is not easy! In fact it may be one of the hardest things that you will ever do. The end result, however, can be very rewarding. On average, it takes people about ten attempts before finally being able to quit.
There are several products available for smoking cessation in the way of nicotine replacement. Nicotine gum and patches are available over-the-counter. The nicotine nasal spray and inhalers still require a doctor’s prescription. There is also an oral medication called bupropion (Zyban) that is used for smoking cessation. This medication is similar to many of the prescription antidepressant medications. Bupropion can be used in combination with the nicotine replacement products. Always use these products according to the manufacturer’s recommendations.
No matter what method you choose to stop smoking, it’s important to pick a day to quit and stick to it! None of the above products are meant to replace will power. Because smoking is sometimes used as a “stress reliever”, it also helps to have an action plan in place for what to do instead of smoking during times of stress. You should also enlist the help of friends and family members. Let them know you’re attempting to quit and they’re likely to provide valuable support. You should also discard all smoking related items – cigarettes, ashtrays, lighters, etc.
Quitting smoking is not easy. Attempting smoking cessation, though, is worth the health benefits that your body will receive. Now is the perfect time to make the commitment to quit since November marks the annual Great American Smokeout. This is an event held on the third Thursday of every November, sponsored by the American Cancer Society. Ask your physician for advice in this matter and to help decide what methods of cessation are most appropriate for you. Further information can be obtained through the American Cancer Society web site ( Good luck and Happy Halloween!

R.G. Roach, D.O.
The Center for Family & Preventive Medicine

Overweight Children

By J.S. Henderson, M.D.
Overweight Children
We have addressed the issue of the epidemic of overweight children in the past. It is such a critical issue that we felt this update would be appropriate with the holiday season approaching. Weight gain is a year round problem, but much of the excess weight gained by American adults and children occurs between Halloween and New Years Day.
It is hoped that this information will help our readers with overweight children avoid a worsening of the problem over this coming holiday season and begin the process of making better eating and exercise habits a permanent change.
How do I know if my child is overweight?
Your health care provider may use a chart to find out if your child might be overweight. Your child is overweight if he or she is heavier than 85 percent of other children who are the same age and height. If your child has bigger bones, he or she may weigh more because of that, not because of too much fat.
What can I do to keep my child from being overweight?
Weight problems can be very hard to fix, so it’s important to prevent the problem from happening in the first place. Here are some tips to help you keep your child at a healthy weight:
· Don’t make your child eat when he or she isn’t hungry—it’s OK if not every drink or every meal gets finished.
· Don’t use food to comfort or to reward.
· Don’t offer dessert as a reward for finishing a meal. Doing this teaches your child to value sweets more than other foods.
· Offer your child a healthy diet. No more than 30 percent of all the calories your child eats should be fat calories. Ask your health care provider or a dietitian to teach you about the right kinds of food to feed your child. Your child needs to get lots of fiber from fruits, vegetables and grains.
· Don’t eat at fast-food restaurants more than once a week.
· Limit how much TV your child watches. Try to get your child to do something active instead, like riding a bicycle or playing ball.
· Spend time being active with your child—go on family walks and play outdoor games together whenever you can.
· Teach your child good eating and exercise habits now to help him or her have a healthy life.
How can I give my child better eating habits?
Most of what your child eats depends on what you bring home from the grocery store. Try not to buy foods that are pre-packaged, sugary or high in fat. Instead, buy foods that are low in fat and high in fiber. After your child is 2 years old, skim milk can safely replace whole milk. Make sure all meals and snacks are eaten at the table, and not in front of the TV. Get the whole family to start eating a healthier diet, so your child won’t feel alone. Also try to limit eating out – particularly at fast food restaurants.
How can I help my child get more physical activity?
One of the best things you can do for your child is to limit TV and computer game time. Instead, suggest playing tag, having foot races, skating and playing other active games. Encourage your child to join school and community sports teams. Take the whole family on walks and bike rides and to ball games.
J. S. Henderson, M.D.
Center for Family and Preventive Medicine
Affiliate of San Jacinto Methodist Hospital
14626 FM 2100, Ste. C
Crosby, Texas 77532