Did Your Doctor “Do Anything?”
By Andrew Ellsworth, M.D.
Perhaps this has happened to you: Your recent cough kept you up for another night, so you went to the doctor. The nurse took your vitals, the doctor asked you some questions, listened to your lungs, maybe looked at your ears and your throat, and recommended rest, fluids, over the counter treatments, and time. It all seemed fine until you got home and realized the doctor did not “do anything” for you.
Why didn’t the doctor prescribe an antibiotic? What could it hurt?
The use of antibiotics has been a blessing and a lifesaver. On the flip side, antibiotic resistance and opportunistic infections have been on the rise.
Our bodies naturally produce good, beneficial bacteria in our gut and on our skin. Antibiotics can kill off some of those good bacteria, causing diarrhea or a yeast infection. Other problems triggered by antibiotics are not immediately apparent. For example, normal bacteria on your skin may become resistant, causing methicillin-resistant Staph aureus or MRSA, which can cause a stubborn infection the next time you get a cut or scratch.
With less competition from normal bacteria in your gut, the bad bug Clostridioides difficile or C. diff can take hold causing severe diarrhea and inflammation of the colon which is hard to treat and even harder to eliminate. Or perhaps you may have an allergic reaction to an antibiotic, or worse, a severe sloughing of the skin called Stevens-Johnson syndrome and toxic epidermal necrolysis. All the above may cause hospitalizations and even death.
Most cold symptoms like a sore throat or cough are caused by viruses. Antibiotics are not effective against viruses, and early antibiotic use, often in the first week of symptoms, has not been shown to decrease the risk of a bacterial infection taking hold. In fact, if one does take hold, it may become even more resistant.
Your doctor wants to help you feel better. It would be quick and easy to immediately prescribe an antibiotic, but that may not be what is best for you and your health. After listening to you, reviewing your medical history, your medications, your vitals, and doing an examination, and after further conversation with you, I trust that if a test, an x-ray, or antibiotics are warranted, the doctor will likely recommend it.
If you feel like the doctor didn’t “do anything” for you, please consider the risks of antibiotics. Of course, if your condition does not improve, and you start to feel worse, notify the doctor. But, if you do get better without additional tests and antibiotics, consider being grateful. The human body is a marvel, often capable of doing the healing itself.
Andrew Ellsworth, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.
Choose Behaviors That Reduce Cancer Risk
By Kelly Evans-Hullinger, M.D.
Cancer is a broad term which encompasses many different diseases, and each type of cancer has different patterns and tendencies. But at its core, cancer means a group of cells which is growing uncontrollably, due to one or multiple genetic mutations.
Cancer prevention is a topic we see frequently in the media, and it can be hard to separate fact from fiction. Truthfully, many cancers occur at random, and even modern science does not yield any clues as to how to prevent such cancers. Supplements and products marketed as “cancer prevention” do not have sound medical data, and I would advise skepticism of any product purporting to “cleanse” or “detox.” However, there are environmental factors that increase the risk of many cancers. Let’s focus on those.
Smoking increases the risk of cancer – not just lung, but also bladder, kidney, cervical, and numerous other types of malignant tumors. Additionally, chewing tobacco significantly increases the risk of head and neck cancers. Quitting tobacco is the most impactful lifestyle change one can make to reduce their lifetime cancer risk.
Sun protection is essential for reducing the risk of most skin cancers, including melanoma and the more common basal or squamous cell cancers. Experts recommend sun avoidance, protective clothing, and use of sunscreen with SPF 30 or greater when out in the sun.
Human papilloma virus is a common virus which increases risk of cervical, penile, and many head and neck cancers. We have highly effective vaccines which can prevent this cancer-causing virus. The first vaccine is recommended at age 11 or 12, as it is most effective when administered in adolescence; but the vaccines are now FDA approved up to age 45.
Other components of a healthy lifestyle including a healthy diet, exercise, and lowering alcohol intake, can also reduce your lifetime cancer risk. Most importantly, have a yearly conversation with your primary care provider about age-appropriate cancer screening. In rare cases, a strong family history of cancer may warrant genetic counseling, as some inherited abnormalities merit more aggressive cancer screening. Thus, providing a thorough family history to your care provider is crucial too.
In summary, though many cancers appear out of sheer bad luck, there are many things one can do to reduce overall risk of cancer. None of those things include spending money on products touted as “anti-oxidant,” “detoxifying,” or “cleansing.” So, my advice: save your money and focus on the data-driven recommendations.
Kelly Evans-Hullinger, M.D. is part of The Prairie Doc® team of physicians and currently practices internal medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.
Does All Back Pain Warrant Imaging?
By Debra Johnston, M.D.
Experts estimate that well over 80 percent of people will experience back pain at some point in their lives. Perhaps ten percent of adults experience it at any given moment. Back pain is extremely common, and people with back pain can be extremely miserable. It may hurt to move, sit, stand, lay, even breathe. No wonder back pain accounts for so many visits to the doctor!
When people with acute back pain come to see me, they often have a preconceived notion of what will happen. They anticipate I will talk with them, examine them, and many expect x-rays or an MRI. They are often surprised, and sometimes worried, when I stop short of ordering imaging.
My first goal when I see someone with acute back pain is to rule out rare conditions that threaten life and limb. Could this be a fracture? Cancer? Infection in the bone or spinal cord? Severe and rapidly progressing compression of the nerves? These conditions could require imaging for diagnosis and urgent treatment. However, they are uncommon, and unless specific “red flags” are revealed during the patient history and exam, it is extremely unlikely a rare condition is responsible for the pain.
Most acute back pain gets better in four to six weeks. Unwarranted imaging only increases medical costs and the likelihood of invasive treatment like surgery or injections but doesn’t get people better any faster. For most people, the best approach for relieving back pain is to stay as active as you can, take an anti-inflammatory pain medicine if you don’t have a reason to avoid them, use a heating pad, and perhaps have manipulation by a chiropractor, osteopathic doctor, or physical therapist.
When imaging is used, it is important to realize that something seen on an x-ray or MRI might not actually be responsible for the back pain. Indeed, it has been found that as we age, it becomes more likely that, even with no back symptoms, we will have abnormalities on imaging. This is true in about ten percent of people in their 30s; among the very old, the likelihood approaches 100 percent.
There is no one-size-fits-all solution to chronic back pain. It takes a knowledgeable clinician to tease out what might be causing the problem and which treatment might help. I urge caution if anyone tries to sell you a treatment without careful analysis of your individual situation. Your money might be better spent on a heating pad, and a gym membership.
Debra Johnston, M.D. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at www.prairiedoc.org and on Facebook featuring On Call with the Prairie Doc® a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.
The Entire Cast and Crew
By Jill Kruse, D.O.
When you watch a medical drama on television the main characters are generally doctors, nurses, and patients. We rarely learn about the many extras in the background. In an actual hospital, patients are cared for by their doctors and nurses, along with a large supporting cast and crew. Many of these people on stage and behind the scenes rarely get their name in lights. I would like to introduce them now.
Before a patient arrives at the hospital, we often rely on emergency medical technicians (EMTs) and transport teams to safely bring them to the hospital via ground ambulance, helicopter, and airplane.
Once the patient reaches their hospital room, those providing direct patient care include nursing assistants and
patient care techs. They literally do much of the heavy lifting in the hospital. There is an entire team of therapists including physical, occupational, speech, and respiratory therapists who play a role in developing a rehabilitation plan for each patient. Wound care nurses help manage complex wounds and ostomies. Various radiology techs, phlebotomists and lab staff help administer the tests needed to diagnose patients.
Some play the role of teacher at the hospital. Dieticians, pharmacists, and diabetic educators help patients learn about their conditions, medications, and behaviors that can help them live healthier lives. Social workers and case management teams arrange after care plans including social supports, which take effect when the patient is discharged. Many hospitals have palliative care teams and hospice teams whose primary goal is reducing suffering and easing pain. Pastoral care teams help with emotional and spiritual support for patients and their family.
We perform our jobs in a clean, healthy environment thanks to the dietary and kitchen staff, maintenance crew, and housekeeping team. Without them we would be hungry, thirsty, and cold, without clean sheets, gowns, and towels.
Information Technology departments maintain patient portals and electronic medical record systems giving patients and their care teams access to essential information. Billing, coding, and insurance filers ensure the patient data entered is accurate and timely. And there are many others I won’t have the time to mention here.
As a hospitalist, I’m a big fan. I get to work with these professionals every day and each of them is a star of the show in my opinion. Television and movies may give doctors and nurses all the attention, but I hope I’ve successfully turned the spotlight on the entire cast and crew doing their part for a successful patient story. I hope you join the fan club!
Jill Kruse, D.O. is part of The Prairie Doc® team of physicians and currently practices family medicine in Brookings, South Dakota. Follow The Prairie Doc® at and on Facebook featuring On Call with the Prairie Doc®, a medical Q&A show celebrating its twentieth season of truthful, tested, and timely medical information, broadcast on SDPB and streaming live on Facebook most Thursdays at 7 p.m. central.