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Myths about Common Symptoms & Signs
Antibiotics are often
given by doctors for coughs, colds and flu. These symptoms occur due
to various conditions and does not mean you have an infection that
need antibiotic. Viral infections often produce very high
temperature and does not mean to say you are very ill. Most
bacterial infections (pneumonia, meningitis, appendicitis) produce
mild temperature because they release a toxin which will make you
loose heat from your body.
Viral infection does not
go away from your body in 1-2 days. They usually present in the body
for a week if not more. Some viral infections make your body very
weak (ME, Glandular fever) and this can last for a long time.
Prescribing an antibiotic
for all these symptoms is making MRSA & other antibiotic resistant
bacteria stronger. Their cell wall is said to become more thicker
and no drug can penetrate to kill them. This is likely to make
things worse for scientists to develop new methods to stop them
spreading and killing health adults. Partially treated bacterial
infection can be more serious than the ones which you don't treat.
Once these bacteria colonizes in your body, you will not be able to
get rid of them. They pose danger to you and the loved ones who are
in contact with you.
We know 48% of doctors
and nurses managing MRSA infected patients are colonized with the
same bacteria. Washing hands and cleaning nose will reduce this
number to 23% and they can never eradicate this colony.
I am publishing these
information in my website because the medical journals,
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Red Throat
Most common symptom which
parents complaint and patients suffer from.
Virus
infections, screaming loud (crying babies), excessive coughing, and
any throat irritation (using lozenges) can make the throat go red. Redness in your throat is
due to excess blood circulation and can be due to irritation. If you have dry throat in the morning and have been snoring
all night because your nostrils were blocked at night, please check
out your throat, it is likely to be red and sore. Diagnosis of
Streptococcus throat infection can only be made after blood test (ASOT)
or throat swab cultures. Spots on tonsils does not
mean to say the infection is bacterial. infectious mononucleosis
(glandular fever) and other viral infections produces white patches
on tonsils.
Streptococcal infection (Bacteria) produce mild increase in
temperature and the patients is often toxic (facial flushing,
feeling faint and tired). They also feel hot and cold (chills &
rigours) because the body thermostat control (hypothalamus) will
increase blood circulation in the skin to help reduce body
temperature and so produce sweating) tonsils and neck glands are
painful and large (not due to infection but because the white blood
cells are fighting the invading bacteria). Most patients with
bacterial infections die due to shock and not due to very high
temperature
Streptococcus throat infection was a major problem before penicillin
was invented in 1940s. The doctors relayed on clinical assessment to
diagnose because toxins, meningitis, or rheumatic fevers could
result in death. As a child, my doctors used iodine swab on my
throat to killed germs living on the tonsils. Since antibiotic
became available, the problem of long term complications was not a
major threat.
This bacteria can produce what was known as "Rheumatic
fever" due to the toxins resulting in damaged heart valve
(mitral stenosis) and also meningitis, nephritis and arthritis. Unfortunately
the bacteria will release toxins before you recognise the symptoms.
Giving antibiotic to patients does not prevent the damage occurring
in all, because some have developed signs later in life and are on
long term antibiotic prophylaxis to prevent relapse.
Unfortunately due to this fear and litigations
and huge compensation payments awarded by courts, doctors started
prescribing antibiotics for every patients presenting with sore
throat. If a doctor refuses to prescribe antibiotics, the patients
will seek help from another doctor and start taking antibiotics. The
dose prescribed is often low (penicillin 250 mg) and the patients do
not complete the course. This abuse of antibiotic has now resulted
in resistant strains and is likely to threaten our existence.
In future, please think twice before you waste
your money and abuse antibiotics. We must not push our luck any
further. I think it’s already too late even if God appears on this
earth to save this planet, He will be confused on how to fight this
bacteria.
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Green Phlegm
Green phlegm used to be
associated with bacterial infection in 1940s & 50s. The reason this
was done was because the doctors did not know a lot about virus and
bacteria. These days we can get spot test to see if bacteria is
present and treated appropriately.
Often doctors give Amoxil
(Amoxicillin, Penicillin, Cephalosporin) for such infections. The
dose given is often low. This results in partially treating the
infections resulting in muted antibiotic resistant bacterial
infection colonizing in your body.
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Swollen Tonsils
Most children do have
swollen tonsils because they are often working hard and filled with
white cells learning to fight infections. Babies do not know how to
breath through their mouth, the sleep with their mouth open allowing
bacteria's and viruses to enter. Babies & infants introduce objects
into their mouth when they are cutting teeth of simply when they are
shy. Some children suck their thumb or dummy until they are 2-3
years old. Millions of bugs live in their hand and will rapidly
enter mouth, this is the reason the tonsils have to work harder and
so swell up and look as if the throat is going to close.
Some parents insist on
getting tonsils taken out but they do not know that the surgeons can
only pluck out the top bit but not the roots. This is a very
important organ to prevent infection entering your voice box and
lungs and so not entirely a good idea to take them out.
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Cough
Cough
is a reflex and not a disease. If we don't have coughing relax, we
will all be buried in our own secretions. Our lungs must be free
from secretions to help absorb oxygen. In Asthma, our lungs produce
excessive secretions due to some irritation (allergy). These
secretions are produced to wash out the allergens and so need to be
coughed out. The passage through which the secretions are coughed
out have cells which secrete secretions, they are swollen and so the
airways are closed.
Taking
inhalers helps to open the passage for accumulated fluid to be
coughed out. People stop using inhaler because the inhaler makes
them cough more. Having a good bout of coughing fit after taking
inhaler is a good thing because most of the secretions are coughed
out. Drugs do not stop our lungs producing excessive fluid (if we do
we can cure your asthma). Some people start using cough mixtures to
stop coughing, this is not a good thing to do because the secretions
which are accumulated in the lung must be coughed out to feel
better.
Normal
air way for air to enter lungs
Collapsed air with mucus blocking passage
Some doctors prescribe antibiotics if you tell them your cough is
getting worse after using inhalers. Inhaler is to help you open
airways and coughing is necessary to clear the chest. We must avoid
temptation to treat this with antibiotics. Asthmatics may need steroids, antibiotics
only if they are not responding (have wheeze, dry cough and still
breathless) after using inhalers.
Pneumonia produces cough but the coughing is seen only when you
are getting better. Initially the lung becomes hard, people cant
breath but start grunting and have air hunger. They often are pale,
blue and struggling to breath. Once this stage pass off (antibiotic
in large dose help), the liquefied lung tissue with dead bacteria
must be coughed out.
Cough due to viral infections (even in HIV patients) are often
dry. This is because the lung walls thicken up and the air cannot
pass through. They do not cough out phlegm and have dry hacking
cough almost bursting out your tummy to produce hernias
Cough
due to allergy occurs spontaneously and in the beginning of your
illness (Cold, Runny nose, Hay fever, aspiration) where as cough due
to serious chest infections (Pneumonia, TB) occurs when the
infection is getting better. Using cough mixture to suppress cough
is not a good idea. The body is trying to get rid of excessive
fluid, dead bugs and mucus from your chest. By suppressing cough
(using cough mixture) you will prolong the discomfort and your
symptoms.
Some
believe Inhalers are addictive, unfortunately they are necessary and
are not associated with addiction.
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High Fever
Monitoring temperature
was the best method used to diagnose infections. Most of these
illness (measles, mumps, rubella, chicken pox, typhoid, malaria and
TB) are now not so common in western world. The way they were
diagnosed was based on the life cycle of the bacteria or virus in
your body.
Rapidity in which the temperature increase will result in fits not
very high temperature. Very high temperature may make you or the
child behave odd, speak some thing irrelevant or talk to themselves.
The best treatment to do is to give a bath / shower with luke warm
water (not cold water) and never use fan or aircooler to cool them
down (this may precipitate a fit)
Parent / patients have a
tendency to give antipyretics only after they find the temperature
is high. It would be better if antibiotic was given on a regular
basis (4 times / day). Drugs have to be absorbed and circulated in
the body before they start working. If you give paracetamol after
you notice high temperature, this will generally take few hours to
start working and when the drug effect wear off temperature will
spike again. You need to give the correct dose to make it work, so
please check the Childs requirement, adults will need 1 gram every 6
hours.
Some
Illness & High Temperature
Malaria - They were named
after their temperature charts. Tertiary (once in 3 days),
Quaternary (once in 4 days.
Typhoid (Salmonella):
Temperature increase but the pulse rate goes down (Reflex
Bradycardia)
Mumps: Rapidly increased
high spiking temperature (often resulted in fits), then the
temperature settled for 2 - 3 days, later we saw rash on the skin
and the temperature went high again for 3-4 days.
Rubella: Similar to
measles but they had milder form and a lymph node was swollen being
the neck
Mumps: High temperature
spikes, facial swelling in front and below ears
Chicken pox: High
temperature with chicken pox spots
TB: Temperature was
slightly high in the evenings and was associated with sweating
Bacterial Abscess:
Spiking temperatures but will have localised abscess. If the abscess
is internal (often in patients staying in hospitals and have had
penetrating injury. This may become a common feature in the future
if patient develops MRSA abscess.
Temperature
chart of some viral infections
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Ear Pain
Except
for well-baby visits, ear infections are the most common reason for
trips to the pediatrician in the USA. Ear infections affect 2 out
of 3 three children in the USA by the age of two and are the most
common cause of acquired hearing loss in children. It accounts for
nearly half of all antibiotic prescriptions written for children.
The cost of treating middle ear infections in the USA has been
estimated at over $2 billion a year.
Ear
pain does not mean you have infection and babies pulling the ear
does not tell us there is some thing wrong in the ear. Doctors is
the past used to use the auto scope and connect them to a hand pump
to check for pressure behind the ear drum. This is now not used but
most auto scope still have a small nozzle on the body for doctors to
attach the hand pump. I am sure your doctor does not know why this
nozzle exists nor have they used to check if you really have
infection which needs antibiotics.
Red
ears drums can occur if the child cries for 2 minutes or you blow your nose hard,
sneeze or scream loud. Wax present in the ear is not dirty, it is
there to prevent insects entry and for protecting your ear drum. You
must not use ear buds to clean them or make attempts to remove wax.
If you try to clear wax using an ear bud, more wax will be produced.
Ticklish sensation you feel when introduce an ear bud to clean will
stimulate the glands in your ear to
produce wax.
These
days, it may not be a good idea to see a doctor to get your ear examined
and check if you have ear infection. Bacteria colonises in the instruments, stethoscope, computers
and is likely to be present in patents visiting doctors surgery. If
you have a viral ear or throat infection, your immunity is likely to
be low and so will quickly get secondly infection from other
patients or the doctors use un-sterilised equipment, touch computers
and then examine your ear using un-sterile auto scope.
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COLD = Chronic Obstructive Lung Disease, this was olds term used to
explain asthma. Medical literatures do not classify cold as a
disease but use the term "Common Cold". Common cold can last about
one-two weeks and may start with a cough and bringing up phlegm
(note in Pneumonia cough occurs when you are getting better; end of
the illness).
It’s very common children to get coughs and colds, especially when
they go to school and mix with other children. If the symptoms
persist and you are concerned, see your doctor but you shouldn’t
necessarily expect to be prescribed antibiotics.
Recurrent colds is more likely due to be Asthma (this is not a
disease but a illness with collection of symptoms) and is not
necessarily due to virus or bacteria. Here the cough is usually dry,
occurs more often in the early hours every morning, may be
precipitated with cold wind. Children often cough after they run or
when they are playing or performing exercise, swimming. The best
treatment will be to take inhalers (for dry cough) and nasal spray
(for runny nose) and see if the child or you find it helps. Constant
runny nose will result in "Harrison sulcus" a horizontal line on
your nose when the child grows up. This is because the child is
constantly using the fore arm to wipe the snot out from the nose.
People often tell me, they catch a cold (runny nose often used
synonymously with cold), it goes straight to the chest. Yes, it does
because the nose is connected to the air ways and water dripping
from your nose will drip backwards when you lay down (postnatal
drip) and irritate the lungs. If we did not have cough reflux, we
all would be drowned with our own secretions. The body tries hard to
keep our air ways clean from dust, allergens and fluid over load.
Common Cold are due to various viral infections, they are much more
common than bacterial infections and are not serious. Antibiotics do
not work against infections, such as colds, caused by viruses. There
are many over the counter remedies to ease the symptoms –
paracetamol, for example.
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Antibiotics
Antibiotics are important medicines used to treat infections caused
by bacteria. Bacteria can adapt and find ways to survive the effects
of an antibiotic. They become ‘antibiotic resistant’ so that the
antibiotic no longer works. The more often we use an antibiotic, the
more likely it is that bacteria will become resistant and stronger.
We cannot be sure we will always be able to find new antibiotics to
replace the old ones. In recent years fewer new antibiotics have
been discovered.
By only using antibiotics when it’s appropriate to do so. We now
know that most coughs and colds get better just as quickly without
antibiotics. When they are prescribed, the complete course should be
taken in order to get rid of the bacteria completely. If the course
isn’t completed some bacteria may be left to develop resistance.
We must use appropriate antibiotics and in correct dose. This is
often not followed and so we have resulted in this situation. We
must give adequate dose and the right duration.
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Final Note
I always told my patients to take higher dose of antibiotics (only
when necessary) "You can't kill an elephant using a match stick, you
need a double barrel gun". To treat our trusted patients we must
also know what kind of gun we choose - a knowledge acquired and not
dictated or learnt using guidelines or protocol. To learn and
understand what symptoms mean, how to interpreter signs and how to
manage an illness, we must have good basic knowledge of
biochemistry, physiology, pathology and pharmacology.
If we continue what we have done in the past twenty or so years,
manage illness with a callas attitude, sorry to say but medical
profession will soon be obsolete. We must first remember, Doctors
are not "God" but human with knowledge of illness and heart craving
for gratitude. Our job is to help people alleviate pain and
suffering and not even contemplate we are saving life.
After working with sick and dying children in acute and intensive
care units for almost twenty years, I am now trying to remember the
number of children's life I might have saved. To tell you frankly,
"I don't think I have, but I am proud to say that I have alleviated
pain and suffering in few".
I remember all my three failed attempts at resuscitation, once
because I could not get the fluid required to resuscitate a child
dying with meningococcal septicaemia and twice because the
antibiotics did not work in a child dying with severe septicaemia
(turned out to be MRSA).
This is scary, and hope I will never be in the shoe of a doctor
managing a child dying with this infection. Its not only hard to
remain calm but very difficult to cope with grieving shocked
parents. This is worse than managing a child dying due to car
accident, worst than drowning or burnt in a house fire. Parents look
up to us (doctors) and expect us to do something but we are and will
remain helpless for a long time.
Dr Kadiyali
M Srivatsa
Please
email me a note with your comments (Good or Bad)
Please note this information is intended to help you understand
your symptoms and not my advice for your illness. We will and not
accept any liability for any injury caused by this information. Our
mission is to educate and help you and not published with commercial
interest. Infect this information I have provided is likely to
reduce our income and probably hated by my medical colleagues.
"Truth must be shared, no matter how
uncomfortable it may be"
"We
accept lies with comfort and believe them"
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