Friday, July 21, 2017

Health Tip: C. Diff Diarrhea And Stool Transplantation?

Clostridium difficile (known as 'C. Diff' for short) is a species of bacterium that can cause severe diarrhea requiring hospitalization. This bacterium normally lives in soil, water, deli meat, and human feces and we are exposed to it on a fairly regular basis. It may not cause symptoms until our normal intestinal bacterial colonies are disrupted by illness or antibiotics.

Our intestines have over 2000 different kinds of helper bacteria, all living in harmony when we are well. They assist in fermenting food and keeping out harmful bacteria. However, when we take antibiotics for an infection (such as pneumonia, skin, or urinary tract infections) the medicine kills the bad bacteria curing those infections, but at the cost of many "friendly fire" casualties in our intestines. This allows the C. Diff to reproduce rapidly, manufacturing toxins that trigger diarrhea by infecting the intestinal lining.

Many of the risks of a C. Diff infection are the same for any severe diarrhea: dehydration, kidney failure, ruptured colon wall, and in rare cases, death. It is more common to catch C. Diff after taking antibiotics (especially fluoroquinolones, cephalosporins, penicillins and clindamycin), or being in a hospital (because many patients take antibiotics there). It is 10 times more common in people over the age of 65.

Symptoms usually develop 5-10 days after starting a course of antibiotics. Symptoms can be mild (watery stool, 2-3 times a day) or severe (diarrhea 10-15 times a day wi
th fever, dehydration, nausea, swollen abdomen, or blood or pus in the stool). C. Diff has a characteristic foul odor that is familiar to healthcare workers caring for patients with this infection (I can usually tell if someone has C. Diff when I walk into their room. Ew. I know). You should see a doctor if you have three or more watery stools a day and symptoms lasting more than two days or if you have a new fever, severe abdominal pain or cramping, or blood in your stool.

There is a new strain of C. Diff emerging that is resistant to some antibiotics. Fortunately there aren't any strains (yet) that are resistant to all antibiotics. Those who catch C. Diff have a 20-30% chance of being re-infected from within. These bacteria produce spores (a reproductive structure with a shell-like coating) that can live on dry surfaces from weeks to months. The spores are immune to alcohol-based cleaning agents, but are destroyed by soap and water or bleach.

C. Diff is contagious, but spread can be avoided by careful hand washing, clothing and bedding laundering, and bleaching of all surfaces that may have come in contact with the infected individual. Pro-biotics (found in acidophilus tablets, yogurt, fermented cultures, and Kefir) may prevent C. Diff infection by shoring up the helper bacteria numbers in the gut. C. Diff can be killed by strong antibiotics such as Flagyl or Vancomycin, but they may have unpleasant side effects such as severe nausea and a bitter taste.

Fecal transplants are an emerging treatment for severe cases of recurrent C. diff infections. This involves re-populating the intestines with gut bacteria from another person. It is not yet approved by the FDA because it is hard to be certain that these transplants are free of unwanted infectious agents and viruses, though donors can be screened. Perhaps one day in the future, those of us with exceptionally healthy bowels will volunteer to be stool donors. If the Red Cross has blood banks, will they also eventually have stool banks?

Although you may shudder at the prospect of stool banks, they may be life-savers for those with chronic or resistant C. Diff infections.  Until then, I wash my hands with soap and water and eat yogurt (with live cultures) every day - to keep the C. Diff at bay!


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Dr. Val Jones MD - Health Tip Content Editor

Friday, July 14, 2017

Health Tip Reader Question: What is Bursitis?

Did you know that our bodies have mini "air bags," located around our joints (the largest ones are in the shoulder, elbow, and hip) for protection? They are not actually filled with air - they are filled with fluid and are called bursae (plural). But they are designed to keep the joints buffered from impact. Sometimes these sacs become inflamed - usually from trauma or overuse.

When a bursa (singular) becomes inflamed, it's called "bursitis" - and it can look swollen due to expansion with extra fluid. So long as it doesn't also become infected, the treatment is rest and anti-inflammatory medications such as naproxen or ibuprofen. In chronic cases (longstanding bursitis), doctors will sometimes give a stronger anti-inflammatory - such as a steroid injection.

When a joint is infected, it usually becomes very red, warm to the touch, and the pain can be disabling. The infection can get into the blood stream and cause a fever.  If you think your joint may be infected, it's important to see a doctor right away.

Otherwise, if your "air bag" is acting up, the best thing to do is rest it and give it time to heal. Bursitis can be confused with arthritis (inflammation of the joint surface itself, not it's air bag) but bursitis is more likely to resolve, while large joint arthritis doesn't improve much without intervention (such as surgery) because the cartilage is permanently damaged.

For more information about how to tell the difference between bursitis and arthritis, check out the Mayo Clinic website.


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Friday, July 7, 2017

Sunglasses: Fashion or Function?

Sun safety - describes a range of behaviors that include wearing wide brimmed hats that cover the face and neck; the correct use of sunscreen of at least sun protection factor (SPF) 15 and limiting sun exposure during the hours of peak sun intensity, 10:00 AM to 4:00 PM. One other important "sun safety" issue is wearing sunglasses that filter out ultraviolet B (UVB) and ultraviolet A (UVA) light. Wearing sunglasses is so important in fact that it can be considered to be the "suntan lotion for the eyes." Let's look at some of the detrimental aspects of sun exposure to the eyes and important features in sunglasses for eye protection.

Dangers of sun exposure to the eyes
Ultraviolet light from the sun has been linked to the formation of cataracts, macular degeneration, skin cancer on the lids and pterygium, an abnormal growth on the eye's surface. Cataracts develop when proteins in the lens of the eye clump together, clouding the vision. Even though cataracts appear to different degrees in most individuals as they age, their development appears to be enhanced by exposure to UVB. Macular degeneration is the leading cause of blindness in the center portion of the visual field in the U.S. There is conflicting evidence as to whether exposure to sunlight contributes to the development of macular degeneration, but at least one study has shown that people who stay outside in the summer sun for more than 5 hours a day in their teens through their 30's are twice as likely to develop macular degeneration later in life. Just as in other areas of the body in which sun exposure increases the risk of skin cancer, melanoma, basal cell and squamous skin cancers can develop on the skin around the eye if not protected. A ptyerygium is a growth that develops on the white portion of the eye that can extend over the the pupil and obscure vision. These appear to develop as a result of prolonged UV exposure also.

Factors that increase your UV exposure, also increasing your likelihood of developing sun-related problems include: spending time on snow, sand or on the water, being outside at higher elevations or closer to the equator, staying outside between the hours of 10 AM and 4 PM and prolonged sun exposure, particularly in the Spring and Summer.

Will sunglasses prevent these problems?

 Sunglasses serve two major functions. They decrease the amount of sunlight reaching your eye for comfort and protect your eye and surrounding structures from the devastating damage of ultraviolet light. By wearing sunglasses regularly, you can decrease your risk of sun-related damage significantly.

 The following features will help you to select a pair of sunglasses that are both protective and appropriate for your needs.
  • Be sure that your sunglasses block 99-100% of UV light. Both plastic and glass lenses can be coated to so that they block essentially 100% of UV rays. This information should be available on the label.
  • The color or darkness of the lens has nothing to do with its ability to block UV rays as the UV coating is colorless. Color choice is personal decision. Green and gray lenses produce minimal color distortion and are probably best for all-round use. Brown offers high contrast and depth perception but does distort color. Vermillion lenses are best for defining water from other objects but distort color badly. Many skiers prefer "blue blocking" sunglasses (typically amber in color) which provide the best contrast in snow and haze.
  • Polarized lenses are the best for reducing reflected glare such as sunlight that bounces off of snow or water. Polarization, however, does not have any relation to blocking UV radiation. Wrap around sunglasses will help keep light from shining into your eyes from around the frames. During active sports, they provide some added degree of protection.
  • Photochromatic glasses will change from light to dark, depending on the amount of UV radiation that they receive. While most of them offer good UV protection, it can take time for them to "adjust" to different light conditions.
 Final considerations
  1. Remember that sunglasses are necessary even on cloudy days. Clouds might provide shade, but they are no barrier for UV light.
  2. You need sunglasses even if your contact lenses offer UV protection. A high quality lens can only protect the area it covers, and the entire surface of your eye needs protection.
  3. Children who cannot tolerate sunglasses should wear a wide-brimmed hat, which will provide some UV protection.
  4. Do not be misguided by higher priced sunglasses which may be oriented to fashion, not UV protection.
  5. With sunglasses, you can have it both ways. An attractive pair of sunglasses can also provide adequate sun protection. Be a "label reader" and make sure that your lenses offer the protective features mentioned above.
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