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Sunshine Corner: Stop asking your doc for antibiotics 😒🫣😬
82 Plays3 months ago
We’ve created a monster. It’s…a super bug 🦠🧫
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Transcript
Introduction and Sunshine's Corner
00:00:16
Speaker
So this is something different. So for all of the new listeners out there, I am Dr. Sunshine and welcome to an episode of chocolate with a side of medicine. So this is definitely different because usually there's all four of us. There's me, there's Amy Jo, there's Dr. No, no, there's Dr. Chris. And ah we all get together, we do our typical episode and we have, you know,
00:00:41
Speaker
our greetings and then the trending topics and then we do our main topic and then questions, things like that.
Antibiotic Overuse in America
00:00:47
Speaker
But this particular week, everybody's got a lot going on.
00:00:52
Speaker
And even though everybody has a lot going on, I kind of wanted to put out something called Dr. Sunshine's Corner, which I've kind of been toying with this idea anyway. And because everybody has a lot going on and it's difficult for us to all get together to record, I'm like, what better time than the present to put out a Sunshine Corner?
00:01:12
Speaker
So basically Sunshine Corner is basically something that usually I'll come across either from seeing patients or from doing research or things that just kind of come across my timeline that's medically relevant that I really feel like we should talk about. But it's not going to be one of our episodes where it's like,
00:01:28
Speaker
you know an hour long sometimes sometimes especially in the beginning you guys know the true fans know we're pushing like an hour and a half sometimes two hours for some episodes just because we had so much to say and there's four of us um so this sunshine's corner i just want to talk to you guys quickly about um antibiotics Now, the reason why this has come to my attention is because, well, first of all, antibiotics have always been a big deal.
Global Perspectives on Antibiotic Use
00:01:56
Speaker
Antibiotics have always been a big deal. And usually when we see some patients, when we see you guys in the clinic, one of the main things we talk to you guys about is, you know, what, what condition we think you guys have. Your first question to me as usual, well how do we treat it? Do I need antibiotics?
00:02:13
Speaker
um And the reason why I want to talk about antibiotics is because a bulletin just came out here in the United States where it basically talked about how Americans are overusing antibiotics. And I'm going to keep it jiggy with you guys. This is not just an American thing. Across the world, we use too many antibiotics.
Consequences of Over-treating with Antibiotics
00:02:31
Speaker
um And in other countries, you don't even need a prescription to get antibiotics. A lot of antibiotics are available like over the counter. For example, if you go to Mexico,
00:02:41
Speaker
you can get a lot of different antibiotics just over the counter. um so People who might live close to the border, either in Texas or California, they might just hop over the border, get some antibiotics and hop back. It's not just an American problem, but this article in particular was based in America. and Basically, what this article is talking about are the top health conditions that we over-treat with antibiotics. and By over-treating them, it is causing us to have concerning, serious, and urgent things that we need to address. Now, I use those three words because that's how the article classif classifies them. So basically, if something is concerning, that's the lowest level, which is, hey, this is a problem. We're bringing it to your attention. We still have time to solve it. Serious means, yes, like these issues in particular are really, really high on our radar. It's causing an issue. And urgent means it's already been an issue
00:03:37
Speaker
patients, doctors, we have to do something right now. And basically what the article talks about are conditions that we are over-treating antibiotics for when patients don't need antibiotics. The reason why this is important is because If you have a condition of any type, and if we treat it over and over again with antibiotics, your body your body is really smart. Really smart. And the bacteria and even the viruses which we treat with antivirals, same thing with bacteria, you get antibiotics.
00:04:11
Speaker
viral, you get antiviral medication. The viruses and bacteria are really, really smart. So if you keep treating it with the same thing, eventually it figures out how do I how do i get past this? How do I mutate myself in a way that this medication no longer works?
00:04:27
Speaker
and that's what keeps happening over and over and over again.
Health Conditions and Antibiotic Risks
00:04:30
Speaker
And it gets to the point where now we treat patients with antibiotics and the antibiotics don't work, which means that we as medical professionals and scientists have to figure out, oh my gosh, well if this antibiotic doesn't work, well then what's plan B? Do we have a different antibiotic? And then we have to start to look for new antibiotics and create new antibiotics because all of the natural antibiotics that we typically use to treat these normal infections, now they don't work and we're creating something called superbugs, which are basically super infections. It's a really, really smart bacteria.
00:05:05
Speaker
that you then get infected with. And it's so smart that we no longer have anything to treat it with, which is a huge problem because if we run out of treatments and you have a super bug, then you run the risk of not ever healing from this infection, which means you could become septic, which basically means an infection takes over your entire body and then you could die. So not to sound dramatic, but that's kind of how it goes.
Specific Cases: Strep Throat and Pneumonia
00:05:29
Speaker
Now in this article, they broke it up into three sections, so we're going to knock them out really quick. The first level, which is the lowest level, is this is what is concerning. So number one under concerning is strep throat. Now, patients come into the office all the time because they have a sore throat. I get it. Sore throats are annoying.
00:05:50
Speaker
sore throats interrupt your day. You can't focus. They also sometimes come with headaches and earaches and it just makes everything so irritated. But it's so important for you to go to the doctor.
00:06:02
Speaker
And hopefully you see a really good doctor, PA, nurse practitioner, whomever who does an actual culture. Now, the problem with the culture is, is that you're not going to get these results back immediately unless the office has a rapid strep. If they have a rapid strep kit that they can just do, which is like a little swab that they do right there.
00:06:22
Speaker
They sit it in the little solution, give it five minutes, it'll tell you do you have strep or not. So for those that don't know, strep is a type of bacteria. Strep is short for streptococcus, we don't need to go into all those details. Strep is a type of infection. Now, if you have a rapid strep test and you do it in the clinic, then you get your results right then and there. If it's positive, yes, you get antibiotics.
00:06:45
Speaker
If it's negative, then you don't need antibiotics. It's likely viral. It'll pass in the next seven to 10 days. Does it suck for seven to 10 days? It does, but you'll get over it. and It's fine. The problem is, is that a lot of offices don't have a rapid strep test and when you don't have the rapid one,
00:07:02
Speaker
then the regular strep test, you basically have to wait maybe two to three days for the results to come back. And the patients are always like, doc, but what if it is strep? If it's strep, you're just going to leave me out here for two to three days. What am I going to do? So a lot of doctors basically end up giving you the prescription, which is penicillin or a penicillin family. Um, there's a couple of different medications we can give, but it's penicillin based. Um, so a lot of doctors in which is giving you that Because you're right, there's a change. You could have strep, but more than likely it's probably viral. And if it's viral, you don't need any treatment at all. But because doctors don't want to wait for those results to come back and patients don't want to wait for those results and patients feel like, Hey, I've been suffering all this time, which might be, I don't know, three, four days.
00:07:44
Speaker
sometimes it's just easier or less difficult you know to just avoid all the rigmarole, the back and forth, and just prescribe an antibiotic. That's how we got to this issue in the first place, is people getting prescribed antibiotics that number one, they may not need, or number two, um they took and weren't advised to take. A lot of my patients have told me they've taken other people's antibiotics before, which is crazy.
00:08:06
Speaker
Or they'll say, hey, I got prescribed antibiotics last year. I had a little extra. I kept it. And then I got another infection. So I just took antibiotics and didn't talk to a doctor. That's bad too. All the above is bad. But number one under the concerning area is strep, which is sore throat. So that's one of the main ones that we're really keeping our eye on just because it's really common.
00:08:28
Speaker
And um because we know that it is so common, we're really trying our best to make sure that we you know do what we need to do. The next the next section they called serious. Serious basically means it's more than concerning, not as bad as urgent, but these are things that are coming across your office that we really need to make sure we're only prescribing antibiotics if you really, really need it. And this is a big one. Number one, this is pneumonia. Let me tell you why pneumonia is so big. Patients get sick all the time, you get the common cold, what's one of the most annoying parts of the cold, the cough, right? So you come in, you have a cough, you have a lingering cough, sometimes it's nagging, it keeps you up at night, sometimes it's phlegm, sometimes it's not.
00:09:14
Speaker
And the patients are like, doc, I have this cough. You have to give me something. By something, they usually mean something called a Z-pack. A Z-pack is basically a pack that they give you a prescription for. It's a pack of antibiotics. You take two on the first day, one for the next four days. And you take this antibiotic set for five days, and then it's supposed to treat you. It's actually the treatment for walking pneumonia. Walking pneumonia is very similar to the common cold.
00:09:40
Speaker
and um It's different than typical or what we call regular pneumonia, typical pneumonia because the symptoms aren't as severe. So actual pneumonia will have you having a really high temperature like 102, 103. You're going to feel like you can't even get out of bed. You're probably going to end up in the hospital because you're going to have difficulty breathing. The cough is bad. It's a really, really bad thing. And usually we see it on chest x-ray.
00:10:04
Speaker
um For the most part, if you come into my office and you're coughing and you don't have a fever and you don't have these other symptoms that we're looking for, like the extreme fatigue and you know a lot of the things that we typically see with normal pneumonia, then patients will be like, well, just give me a Z-pack, give me a Z-pack, give me a Z-pack.
00:10:20
Speaker
To be honest, a lot of the patients, especially if you do a chest x-ray, your chest x-ray is clear. like There's nothing in your lungs. you know You just have a cold and you have a cough. To be honest, all you're really supposed to do is take cough medication. Again, seven to 10 days, 14 if it's a really bad cold, or if it's COVID, or if it's anything else that causes you just... Usually, to be honest with you, nine times out of 10, it's usually viral.
00:10:45
Speaker
um And if you don't have any of the signs and symptoms of what we see to make us think that you really have a true pneumonia, you actually don't need treatment and it'll resolve on its own. um The only time that doctors really do want to treat you is if you have some other underlying conditions Like I might treat my patients if they're a smoker because smokers are more prone to get pneumonia because their lungs are unhealthy or if you have a condition where your immune system isn't as strong um if you are an older adult who hasn't been vaccinated against pneumonia is like 65 and up that type of thing and basically low immune systems and yeah am I might err on the side of giving you an antibiotic but for the most part most colds most coughs are viral and you don't need antibiotics for that and I get it you guys feel like I have a cough it's annoying give me the antibiotics but nine times out of ten you don't need it.
00:11:36
Speaker
but you don't need it. But if you go to the get that chest x-ray and then we look at that x-ray and it looks like pneumonia, then of course, yes, you'll get the antibiotics. And a lot of places have x-rays right there on site, so you don't even need to wait. You can just go right next door, get your x-ray, and if it doesn't look like pneumonia, you don't need antibiotics. As simple as that. You don't have a fever, your chest x-ray is clear, you're fine, you just have a cough, it'll resolve. The annoying thing about a cough is that coughs can linger. So even if you feel better from your cold in seven to 10 days, that cough can sometimes linger for three to four weeks, which is annoying, I get it. But long story short, you don't need antibiotics.
Food Poisoning: When Are Antibiotics Needed?
00:12:13
Speaker
But since we've been over treating these patients with antibiotics for a cough, now we can't just give you a Z-pack because now that's not the standard of care anymore because now, you guessed it, Z-packs don't work.
00:12:27
Speaker
Z-packs do not work because we've been treating patients with these Z-packs for decades and decades and decades to the point where anything that causes you to cough nowadays and it is a bacteria, it's probably a really, really strong one to give you a nasty pneumonia and a Z-pack can't even touch that because they've gotten smart and now you've got a superbug. So that's one of the biggest ones.
00:12:51
Speaker
But I feel like you guys really need to know that because you guys are expecting antibiotics every time you guys come into the office and have a cough. And that's not the standard of care. That's not the way it's supposed to go. And it's going to cause a really hard conversation. But do me a favor, get the chest x-ray. Let's both just be clear that your lungs either look like you have an ammonia or they don't. Once we get that information, then usually this conversation goes a lot smoother.
00:13:15
Speaker
So I recommend that. ah The next one that's also in this serious category is GI bacteria. So what does that mean? GI is your GI tract. So basically from your mouth all the way down to your anus, that is your entire GI tract. And it basically predominantly involves your stomach, your colon, all of that.
00:13:39
Speaker
What this is referring to is food poisoning. So basically, you go out to eat somewhere, you eat some bad tacos, bad Chinese food, you name it, street food, whatever it is. Next thing you know, you got the runs, like the runs. You are throwing up, you are on the toilet, you have diarrhea, you have vomiting, sometimes it's one or the other, and sometimes it's both. And you guys come to the clinic and you guys are vastly dehydrated, and you guys are like, oh my gosh, I need something. You have to cure it, you have to cure it, you have to cure it.
00:14:08
Speaker
Because along with that comes, of course, stomach cramps, the nausea, you know, it's it's a lot and it's very, very uncomfortable. Now, I will let you know right now, every doctor knows there is a checklist of things that we have to see in order to actually treat you with antibiotics for food poisoning.
00:14:28
Speaker
And usually these are not present. like you have to be You have to have like a raging fever. You've got to have bloody diarrhea. You've got to have symptoms for longer than 10 to 14 days, longer than that. um And it's actually really strict because we're not supposed to treat you with antibiotics for this. The reason why is because there are certain conditions where if we treat you with antibiotics, it makes it worse. And also, if we treat you with antibiotics, then the last thing we need is a superbug and a super infection in the colon, because the colon and the stomach are very sensitive areas. You don't need anything to like really irritate the colon or the stomach, because at the end of the day, if anything in the stomach or the colon goes from being inside those organs to being,
00:15:18
Speaker
outside of those organs in the body, it's a problem. So usually when you have food poisoning, as soon as all the food is eliminated from your body, your symptoms will pass. So usually within the next two to four days, you're going to throw all of it up. You're going to poop all of it out.
00:15:39
Speaker
and you're going to feel better. One of the main things you need to know about food poisoning is that if under any circumstances you can no longer take anything by mouth, as in you drink water, it doesn't stay down. You try to eat crackers, it doesn't stay down. If you go an extended period of time, and I mean like longer than about, I'll say six to 12 hours, and you cannot keep anything down at all whatsoever, then yes, you need to go to the hospital because if you can't even keep down water,
00:16:08
Speaker
then we need to hook you up to an IV and we need to give you IV hydration. As in, you can't keep yourself hydrated. You're losing all of these fluids, you're pooping your brains out, but at the end of the day, if you can't replenish that water,
00:16:23
Speaker
then no matter how you slice it, your your body is never going to recover because you can't you can't drink the water. And if you can't drink the water, then you need to go to the hospital. We will hook you up to an IV and we will put that fluid back into your body because you physically cannot do it yourself. So that's one of the main, main things I wanted to convey to you guys. But for the majority of the time, under this serious category,
00:16:50
Speaker
Pneumonias, which is basically the cough you're coming in with, and then food poisoning, which is that vomiting and diarrhea you come in with. We are not supposed to be treating you guys with antibiotics for these things because these things will pass.
00:17:03
Speaker
And that cough is likely viral. Unless we see some real signs of pneumonia, we're not slowly treating you guys with antibiotics.
STDs and Yeast Infections: Diagnostic Accuracy
00:17:09
Speaker
But because we're over-treating, again, superbugs. It's a problem. And you know we're not trying to have the next COVID come through here, which is probably inevitable. you know That's God's plan, not up to me. But if we can prevent some type of super-duper infection from happening, like we should try. The last category.
00:17:29
Speaker
which is considered urgent so this one means that this is already an issue we're seeing problems with it and it's causing patients to either come to the clinic repeatedly or have really really long hospital admissions so one of the ones on this list So two of them have to do with two of them have to do with the pelvis and genitals. So those are the two that we're really going to focus on because these two are highlighted. Number one,
00:18:01
Speaker
Candida. So for those that don't know what Candida is, Candida is the super scientific term for a yeast infection. So basically what this means is we have too many women. Ladies, this is for you.
00:18:16
Speaker
We have too many women that are over-treating yeast infections and it's making it so that now there is a super resistant yeast that's occurring out in the world. So basically what this means is Whenever a woman has any type of vaginal discharge, it's up to the doctor to get the woman into the clinic, and I have to swab it. I have to. Because basically what's been happening is women are having discharge, and they assume that it's yeast. They call their doctor's office. The doctor prescribes a treatment for a yeast infection, and then they take it. Then they do this over and over and over again, because they're like, oh, doc, it came back. Oh, doc, it came back.
00:18:58
Speaker
The problem is we might be giving you all these anti-yeast medications, but the problem is you might not even have a yeast infection. You could have an STD, you could have bacterial vaginosis, you could have something else, but since we keep over-treating you for yeast infections,
00:19:16
Speaker
It means that whatever yeast is present, if there is a yeast infection, it's been your body has been exposed over and over and over and over again to this medication, that now if you do get a yeast infection, it's going to be super, super resistant and something that's way smarter than what we've been giving you.
00:19:34
Speaker
because the problem is we need to we need to diagnose it and make sure that it is yeast before we treat you for it. We need to formally treat you for infections that we know that you have. We can't guess, because when you start guessing and you give the wrong treatments, now you're just creating this resistance in the body, and now we have a new wave of super yeast infections, which sucks. Basically, what that means is you're going to eventually need to see a gynecologist, like a specialist,
00:20:04
Speaker
And they have special swabs that analyze really, they do something called like a super yeast profile. And it's a really expensive test, but it is a swab. And basically it has them ah categorize the different types of yeast that you may have and what treatment is specific for that type of yeast. And it's a new test that basically has come around in the last two, three years, but we need it because of this problem.
00:20:31
Speaker
And the treatment for it is not like the treatments we normally give. The treatments we normally give are usually a shorter course of medication, um depending on how bad it is and how recurrent it is, maybe for like anywhere from five days to seven days, depending. A lot of these like super yeast infections, you'll need treatment for like a month, maybe longer. So it's a lot. So yeast infection, that's a big one. And this one here,
00:20:55
Speaker
This last one here is gonorrhea, and a lot of people probably already know about this. So in terms of sexually transmitted infections, gonorrhea is one that we talk about often. If you are unfamiliar, you can listen to some of our previous episodes, but we've talked a lot about gonorrhea.
00:21:12
Speaker
gonorrhea has become so prevalent that the treatment that we've always been using for gonorrhea no longer works. And we have had to change the treatment for gonorrhea.
00:21:25
Speaker
um And basically what that means is gonorrhea and chlamydia, they tend to travel together. And because gonorrhea and chlamydia tend to travel together, a lot of people are getting sexually transmitted infections. A lot of people keep getting reinfected or a lot of people keep getting treatment for infections they might think they have but don't really know that they have and they don't really know what's going on.
00:21:48
Speaker
So we used to have a standard of care for chlamydia and gonorrhea and I'm lumping them together because they travel together often. um And because STDs have been on the rise and because gonorrhea and chlamydia tend to travel together,
00:22:03
Speaker
um It's become very apparent to us that we're getting these resistant strains of chlamydia and gonorrhea. The long story short of this, we have changed the way that we treat a lot of SCDs and the guidelines have changed so that we can try to prevent a super SCD from taking over the United States.
Preventing Antibiotic Resistance and Future Pandemics
00:22:25
Speaker
so This is just a reminder, a gentle reminder, number one, to wrap it up.
00:22:29
Speaker
and practice safe sex as often as you guys can. um And if you do think that you might have an STD, please be open-minded when you talk to your doctor because your doctor is going to politely ask for us to test for everything. We can't just treat you blindly. Like sometimes we will treat you blindly. Like if you're a super high-risk patient and we think we'll never see you again and we run into you in the emergency room,
00:22:55
Speaker
and you might have something, then yeah, we'll we'll treat you because we might never see you again and not have follow-up. And what if something happens to you? You can't just walk around with gonorrhea or chlamydia for your whole life. like There's repercussions to that too. But for the most part, when you think you have an STD infection or you think you have something going on, allow your doctor to test you for everything. That might involve getting blood work. That might involve you um giving me urine and a cup.
00:23:20
Speaker
It might also have involve me swabbing the vagina, swabbing your penis, swabbing whatever I see. um But allow us to do the workup and allow us to treat you appropriately. So that was my quick little ah nugget for you guys. The take-home message is allow your doctors to do their due diligence in Treating you for the infection that they're trying to make sure that you have whenever we treat someone for infection that they don't have Your body is just getting exposed to antibiotics and then your body is just you know contributing to this problem that we have which is
00:23:57
Speaker
Everything's getting smarter.
The Importance of Voting
00:23:58
Speaker
you know All the bacteria are getting smarter. All the viruses are getting smarter. And we need to make sure that we only give you antibiotics when it's really necessary. Otherwise, we're just contributing to this evolution and mutation of all of these new viruses and all of these new bacteria that weren't really an issue years and years ago because we weren't really giving antibiotics at the rate that we're doing it now.
00:24:22
Speaker
um So ultimately, we just want a healthier today. We want a healthier tomorrow. We don't want the next COVID to happen. We don't want a weird super bug to just take over all of us. um And hopefully, even if ah another pandemic does happen, hopefully we'll be much better prepared for it than than we were at this past time because Lord knows we need to improve. So.
00:24:42
Speaker
That's my nugget. um Hopefully you and your doctors out there have a great relationship and you guys can see eye to eye on what you think the treatment plan should be. um I hope that everyone is happy and healthy and enjoying their summer. It's been very hot in some places. It's been very cold in other places. The weather's kind of weird. Tonight is also debate night.
00:25:01
Speaker
um So you guys are probably watching the presidential debate. um I urge everyone to register to vote everywhere. you know This podcast is nationwide. So whatever state you're in, whatever city you're in, please register to vote. Your vote matters. um We are all big sticklers on voting on this podcast, even though my ladies aren't here to support me.
00:25:22
Speaker
You know, they're here in spirit. where They're not here with me right now. They would all agree with me that we want you guys to register to vote. um And then we will catch you guys on the next episode, which we're goingnna which is going to come out in two weeks. um And that way we can chit chat and get back to our normally scheduled programming. So I wish you guys well. And I'll see you on the next one. Bye.