Sinus Infections:  Myth and Reality

There is probably no more confusing problem amongst common problems than sinus infections and sinusitis.

The confusion comes from the rapidly growing trend to call a cold a sinus infection to open the door to use of antibiotics.

Here is what is typically taking place across the nation.  A person gets a cold, a runny nose and cough follow.
After some number of days, the runny nose and/or cough become so annoying that medical help is sought to relieve the suffering.  So far everything makes sense.

But the next step is where the trouble begins.  Once at the doctors office, either the person or the doctor raises the question of a sinus infection.  Often, the doctor will say one is present and prescribe an antibiotic.

Now, it turns out that antibiotics kill bacteria very well, but if your infection is from a virus, they do no good, only harm.

So what is the story with the "sinus infection?"  What is it, a viral or bacterial infection?  For many, many years, the assumption has been that it is bacterial and antibiotics are needed to get rid of it.

But, finally, someone actually tested that idea.  They took 166 adults who met all the rigorous criteria for having a sinus infection.  A random half got 10 days of antibiotic, the other half got placebo.  And what they found was that the two groups did about the same.  Both missed the same number of days of work, both got better about the same rate, only a slight improvement advantage on day 7 was noted for the antibiotic group.
http://www.nytimes.com/2012/02/21/health/research/in-sinusitis-antibiotics-are-as-effective-as-placebos-study-finds.html?_r=1&pagewanted=print

So, the study is clear, what we call sinus infections do not get better with antibiotics any faster than with sugar pills.  This makes it very likely that sinus infections are viral.

This actually makes a lot of sense.  Every cold, after all, is a sinus infection.  Viruses that cause colds never just infect the nose, they always also infect the spaces behind the nose, the sinuses. That's why when we have colds there is such a great, huge amount of mucus!

Now, it turns out that sometimes that mucus does get infected with bacteria and the mucus turns to pus.  As this study proves, that does not happen very often.  So how do you know when it does?

We would say if  your sinuses start getting very painful that may be a sign.  We do not mean the discomfort we all get with colds, but a shift to a very painful situation where tapping the face is very, very hurtful.

Just as importantly, there are several signs that many think indicate bacteria are now causing infection, but these signs do not mean you have a bacterial infection:

• mucus turning from clear to yellow or green
• having cold symptoms for a long time
• fever
• even white material filling the sinuses on CT or MRI scan- radiology images cannot distinguish between the mucus of a viral infection and pus of a bacterial infection.

This is why the study reported in the NY Times is so important.  It actually took nearly 200 people, each of whom met very stringent criteria for having sinus infection, each of whom had every reason to believe that their nasal congestion, runny nose, and cough indicated they had moved from a viral cold to a very bacterial infection, and none of them did.  Not a single person responded to antibiotic in a fashion seen in people with bacterial infections.   As noted the antibiotic did about as well as a sugar pill!

Bottom Line

So when you get a cold and have a runny nose, congestion, misery, cough, nose pain, you should know that almost certainly have an infection with a virus.  The very concept of a bacterial sinus infection is becoming suspect, and in most circumstances is simply an excuse to try a course of antibiotic, the famous "Z-Pak," for example.

Colds last a lot longer, create a lot more yucky mucus, and cause far more misery than we expect, or certainly more than we would like.

But we should respect the facts, and avoid use of drugs that we know will not work.

Key Point:  If you are infected with a virus, use of antibiotics can only harm, they do no good.

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

The Case Against Tylenol Strengthens

                                                        Image via Wikipedia

The Case Against Tylenol Strengthens

In September of 2010, Advanced Pediatrics cited a growing body of evidence that acetaminophen, the main ingredient in Tylenol, which is also found in many cold remedies, might actually cause asthma to occur in children.   http://advancedped.blogspot.com/2010/09/acetaminophen-serious-question-leads-to.html

Since that time there have been reports in The New York Times and now on February 20, 2012 on NPR, that it really is time to stop using Tylenol and any other remedy that contains acetaminophen.

http://www.npr.org/blogs/health/2012/02/20/147002356/does-tylenol-worsen-asthma-for-kids

The issue is that studies demonstrate a clear trend.  When we look at any group of children, the more acetaminophen they take, the higher the chance they will develop asthma.  Further, when a country adopts use of acetaminophen, that country's incidence of asthma goes up.

These are the two facts that led Advanced Pediatrics in 2010 to advise stopping use of acetaminophen.  Now we are hearing that study after study has found the same observations, time and again.  This has led a highly respected pulmonologist at Akron Children's, Dr. McBride to adopt the same line of advice Advanced Pediatrics offers:  Stop Using Tylenol and other drugs containing Acetaminophen.  This is the recommendation featured in the NPR story.

In the NPR story, some doctors correctly pointed out that we do not yet have proof that acetaminophen causes asthma to develop.  The data so far establish an association, children who take lots of acetaminophen develop lots more asthma.  But that may because those kids have other problems more than others, problems that really cause the asthma.  Further asthma, they point out, is likely caused by many factors.

But in our experience, whenever a drug, particularly an optional drug, is observed to cause a problem the more you take it, we find it prudent to stop using it until it is know to actually cause the problem or not.

BOTTOM LINE
We strongly recommend all families stop giving their children acetaminophen at this time.

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Arsenic and Our Food

Arsenic and Our Food

A investigator from Dartmouth College has done us all a favor and exposed the fact that certain foods we give our children have elevated levels of arsenic.

http://www.latimes.com/health/boostershots/le-heb-arsenic-20120216,0,1251060.story

Two key conclusions can be drawn from his findings:

1. The level of arsenic found in these foods was clearly over the permitted level.  The reported concentrations in the food were as high as 10-12 times the permitted level.
2. The level of arsenic has not been shown to have caused any harm in any known individual.  This is a very important point.  Every substance has a toxicologic profile, meaning that there is an amount under which it is harmless and over which it begins to cause harm.  Obviously, if your exposure to a given substance is under the level that causes harm, the exposure will not be harmful at all.   We do not know if anyone exposed has had an amount of arsenic that will cause harm.

The Arsenic contaminated products

All of the products containing arsenic trace the arsenic to a brown rice syrup.   If a food you have contains no brown rice syrup, this warning is not for you.

Here is a list of those products we have ascertained contained the arsenic via the brown rice syrup.

YOU SHOULD DISCARD ALL SUCH PRODUCTS IN YOUR HOME NOW.

1. Organic infant formula-  two brands of 17 tested had arsenic both had brown rice syrup as an ingredient.  One of those brands is Baby's Only Organic Formula
2. Cereal Bars- again arsenic limited to those containing brown rice syrup
3. Energy Shots- three brands tested, one had arsenic, and as before, contained brown rice syrup

Many wonder, how did a poison like arsenic end up in infant formula, especially an organic brand?  The answer is that all these foods were grown organically and so none had any arsenic applied to them.  But arsenic is present in the Southern rice fields from the days when those fields grew cotton.  Cotton is not eaten so nearly unlimited amounts of toxic pesticides can and are applied to those plants.  The arsenic applied in those times remains in the soil forever, and rice is a plant quite adept at sucking up arsenic in the soil.  And so, even on an organic farm, rice planted in arsenic containing soil will have arsenic in it.

Should you be worried?  No.

The next question now is just how much to be worried?  The answer is, not much.

The real impact of this finding is that we need to track the presence of toxic elements like arsenic in our food supply.  The fact that arsenic is present makes me think we should look for it and reduce its levels in our food.

The story mentions that arsenic is in some foods up to 12x the level set as safe.  Keep in mind that the level set as safe, as noted above, may be much lower than the level that will actually start causing symptoms.  We have actually heard from Dr. Brian Jackson, the lead investigator on this study from Dartmouth, who is an expert on arsenic.  A family in the practice has been in touch with him and passed these words from him along, "...you don't need to panic here, these are not acutely toxic concentrations."

No one has been reported with even one symptom or sign of any harm from arsenic exposure from these foods.  And, the scientist most concerned about arsenic states there is no reason for concern of any harm being done, as long as the food is no longer eaten.

Bottom Line

• Scientists at Dartmouth have found arsenic in organic foods containing brown rice syrup.  These include 2 brands of infant formula (Baby's Organic Formula is one), cereal bars, and energy shots.
• The amount in these foods exceeded safety thresholds, but was too little to cause any acute harm.
• All foods with brown rice syrup should be eliminated from your home, but it appears no harm has been done to date.
• This episode pushes me to want rules in place to keep arsenic out of our food and drink.

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

An Important Advance In Understanding Memory

An Important Advance In Understanding Memory

This week The New England Journal of Medicine published an observation that dramatically illustrates that 

we live in the era when the mind may very well be figured out.

http://www.nejm.org/doi/full/10.1056/NEJMoa1107212?query=featured_home

The observation had to do with memory.  Memory is one of those concepts that everyone knows about, but 

that we actually do not understand too well.

We all have learned facts that we can recall later in time, but just how does the brain take in that information, how does it get stored, and what allow us to retrieve the facts when we need them?

Researchers at UCLA and Tel Aviv University had the opportunity to stimulate a specific area of the brain and see what impact that had on the person's memory.  They were able to do this because one accepted treatment for very severe epilepsy is to thread a tiny wire deep into the brain to a spot where the seizures are generated, and then by running a very small electrical current, stop the seizures.

The researchers were able to place the wire at one spot in the brain of 7 adults who were going to have a wire placed for seizure control anyway.   The region of the brain is called the entorhinal cortex, which is the area around the yellow squares numbered 28 and 34 in this illustration from Wikipedia:

(this section of the post is rather technical, feel free to skip to the bold-faced heading for a summary of the discoveries)


The entorhinal cortex is the part of the brain that connects the hippocampus to the pre-frontal cortex.  That's important because we know that new stories and facts are converted into memory in a structure called the hippocampus and then these newly minted memories are placed into various parts of the brain.  The pre-frontal cortex is the area in the front of the brain that has much to do with consciousness- being aware of thoughts, conscious decision making, feelings.

As you might imagine, anything that connects being able to form new memories to the ability to think and feel would be central to memory function, and that is the case with the entorhinal cortex.

What They Found
So when the electrical stimulation was on, the 7 adults were able to solve challenging visual brain-teasers more quickly and using shorter routes.  The researchers also saw changes in the adults' EEG that showed a difference in the flow of electrical information from the nerves of the brain.
Interestingly, if electricity was applied to the actual seat of new memory formation, the hippocampus, memory was not improved for this task.

What it Means
Two items jump out from this work.

The first is that the door is opening on a world in which we can change the underlying abilities of our mind.
In this instance, a current applied changed a person's ability to solve complex visual puzzles, a clear instance of changing a person's power of memory.
Other work has demonstrated that the mind can change its power of working memory, and phoneme recognition.
As time goes on, more and more functions of the mind will be open to improvement, offering hope to some of the most heartbreaking challenges people face- impaired thinking.

The second is that our understanding of just how the mind works really is growing.  This study illustrates that increasing the activity of nerves in one area of the brain leads to improvement in one type of memory.  Such information allows us to begin to really understand how memory really works.  What physically must happen for a fact or story to get recorded in our mind and recalled whenever we want it?

Of course, our hope is that as our knowledge of how the brain grows, not only will we be in a better position to help those whose thinking is impaired, but we will be able to help our children learn more easily and more effectively.  Schools will one day be places of expertise in neuroscience where teaching is designed to help children form memories that allow them to achieve wonderful levels of ability across a range of fields.

As with all realms of scientific progress, attention to making sure this knowledge is used appropriately will need to grow with the knowledge itself.

Dr. Arthur Lavin

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.

Weak Flu Epidemic this Year

Weak Flu Epidemic this Year
Good news!  The number of people infected with the influenza virus this year is very small compared to other years.

The influenza virus typically causes about 1/3 of all respiratory infections (e.g., colds, sinus infections, ear infections, pink eye, bronchitis, and pneumonia) during the winter.  Usually, it hits our region of the world around December through April.

In most years, during the winter, we see a big explosion of respiratory infections as the influenza arrives, but not this year.

Good data from the CDC support the observation that there is barely an influenza epidemic in the US or Ohio this year, with dramatically fewer cases seen.

Now, why are we so lucky?

There are two possible explanations, both could be true together:

1. This just happens to be a light year.  Influenza infections are sometimes more common in one year than another, and this may just be a light year.  Personally I am skeptical of this explanation because the drop in number of cases is so dramatic, but time will tell.  If it is a random drop off, we will see the more typical epidemics in winters to come.
2. The flu vaccine is working.  Clearly, if enough people in a community or nation get the flu immunzation, it could actually eliminate influenza infections, or at least, sharply drop their numbers.  We (the US) has been promoting influenza immunizations enough to suspect this is the cause.

One explanation that is very popular is one that we know is not true:  there is less flu because the winter is so mild.

Influenza infections occur only because of the influenza virus, and that virus sweeps across our region every December-April no matter the temperature, snow level, rain etc. We have seen very bad epidemics in warm winters and mild ones in cold winters.  So weather, temperature, and moisture levels likely play no role.

Bottom Line:  The winter of 2011-12 turns out to be a dramatically light one for influenza infections.  Flu vaccine likely helped make that happen.  Enjoy the lifting of the burdens of cold winters and of winter flus!


Dr. Arthur Lavin


 

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*Disclaimer* The comments contained in this electronic source of information do not constitute and are not designed to imply that they constitute any form of individual medical advice. The information provided is purely for informational purposes only and not relevant to any person's particular medical condition or situation. If you have any medical concerns about yourself or your family please contact your physician immediately. In order to provide our patients the best uninfluenced information that science has to offer,we do not accept samples of drugs, advertising tchotchkes, money, food, or any item from outside vendors.