Posts Tagged ‘habits’
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Ear infections (otitis media) are serious business, whether you’re a parent or practitioner. Approximately 75% percent of children have one by the age of three and almost half of them have 3 or more ear infections by that age. By the age of 7, 93% of children have experienced an ear infection. This led to a total of 8.8 million ear infections in children during the year 2006, and most of those were in children 7 and under. These infections cost those of us in the US approx $5 billion dollars annually to address, and are the primary cause for childhood antibiotic prescription.
In fact, the typical situation involves an upper respiratory infection, which leads to a visit to the primary care provider. This in turn results in a peek into the ears and, quite often, a diagnosis of an ear infection as well. In some cases, the ear infection causes pain, and the child’s complaints spur the visit to the care provider. Regardless, this diagnosis usually results in a prescription for an antibiotic, and in many cases, the antibiotic of choice is stronger than the drug used to treat the previous infection. The prescription begins and within a few days, the symptoms subside and parents once again are increasingly grateful for the benefits of modern medicine.
While this scene plays out all across our country, many parents don’t realize that this standard practice is in direct conflict with evidence-based medicine, AAP guidelines, and the standard of care for ear infections across the world. Even fewer parents realize that this standard practice may be causing our children more harm than benefit.
Here’s the catch. Actually, there are a couple:
1. Ear infections are not always correctly diagnosed. According to the AAP, “The diagnosis of AOM, particularly in infants and young children, is often made with a degree of uncertainty.” (AOM = acute otitis media) Each year, thousands of prescriptions for antibiotics are written for conditions that never were ear infections.
2. Studies show that antibiotics don’t have a benefit in most ear infections. The vast majority of ear infections resolve on their own without antibiotic treatment. This takes a couple of days in many cases, and can coincide with antibiotic treatments, leading many parents to believe the antibiotic is actually curing the infection, furthering the belief that they won’t go away on their own.
3. Because antibiotics are overused in ear infections, we’re now having to use stronger drugs than we could have used in previous generations. This means more side effects and more resistance. According to the AAP, “Greater resistance among many of the pathogens that cause AOM has fueled an increase in the use of broader-spectrum and generally more expensive antibacterial agents.” For more info about the very real risks of antibiotic overuse, see here.
4. Antibiotics don’t relieve pain or distress. They will not make our little ones feel better sooner. Pain relief treatments are responsible for that. Reducing the inflammation and the accumulation of fluid will make our little ones feel better; an antibiotic does neither of those things. However, a study published in Pediatrics in 2003 does show that an herbal ear oil treatment can help to relieve the inflammation, reduce pain, and reduce the duration of the illness, faring much better than the antibiotic test group.
5. The AAP has clearly recommended since 2004 that practitioners use the “wait and see” approach for most children. Given that 61% of children naturally have decreased symptoms within 24 hours, with or without antibiotics, and that 75% of children have a decrease in symptoms within 7 days, the official recommendation is that antibiotic use be delayed for the first 48-72 hours in most children. This will dramatically reduce the use of needless antibiotics, reserving them for the small percentage of children that would receive the most benefit. Additionally, studies show that immediate antibiotic treatment does little to reduce the duration of the infection and does nothing to reduce pain or distress in the child.
So here’s the crux of the problem – why does this matter? So what if antibiotics don’t work on most ear infections and we’re using stronger antibiotics than ever before? Parents need to feel like they’re doing something and this gives the parent comfort. And after all, some ear infections do need antibiotics.
The problem is – antibiotics have risks. In fact, the risks of antibiotic treatment, according to several studies, outweighs the potential benefit. According to the studies, initiating antibiotic use at the first visit may reduce the symptoms by 1 day in between 5% and 14% of children. However, it will cause adverse effects in 5% – 10% of children, it can cause infrequent but serious side effects, and it increases the risks of antibiotic resistance. These side effects are numerous and can lead to chronic health concerns. When it takes between 7 and 20 prescriptions for 1 child to benefit, and each of those prescriptions have clear risks, the overall situation just isn’t worth it. That, coupled with the success of wait and see approaches in European countries, played a role in prompting the AAP to make those recommendations years ago.
So the keys for ear infection management include: prevention (breastfeeding!), obtaining an accurate diagnosis or having clear conversations about the degree of certainty with a diagnosis, focusing treatment measures on comfort and the natural options that have clear records of success (many natural options do not have clear records of success and some are risky), and keeping an eye on the infection for the first few days to seek advanced help if indicated. Not only does this benefit our own children, it helps to reduce the overall antibiotic load, reducing our community risks of antibiotic resistance.
Sources:
NIH Pub. No. 97-4216 July 2002
Gates GA. Cost-effectiveness considerations in otitis media treatment. Otolaryngol Head Neck Sur. April 1996. 114 (4): 525-530
Soni, A. Ear Infections (Otitis Media) in Children (0-17): Use and Expenditures, 2006. Statistical Brief #228. December 2008. Agency for Healthcare Research and Quality, Rockville, MD
Rosenfeld RM, Vertrees JE, Carr J, et al. Clinical efficacy of antimicrobial drugs for acute otitis media: metaanalysis of 5400 children from thirty-three randomized trials. J Pediatr.1994;124 :355– 367
Del Mar C, Glasziou P, Hayem M. Are antibiotics indicated as initial treatment for children with acute otitis media? A meta-analysis. BMJ.1997;314 :1526– 1529
Glasziou PP, Del Mar CB, Hayem M, Sanders SL. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev.2000;4 :CD000219
Rosenfeld RM, Kay D. Natural history of untreated otitis media. In: Rosenfeld RM, Bluestone CD, eds. Evidence-Based Otitis Media. 2nd ed. Hamilton, ON, Canada: BC Decker Inc; 2003:180–198
Subcommittee on Management of Acute Otitis Media Diagnosis and Management of Acute Otitis Media Pediatrics Vol. 113 No. 5 May 1, 2004; 1451 -1465
(intro note: If you haven’t read part 1 and part 2, you’ll want to read though those to get the full background of the situation and why resistance is such a growing concern.)
So, it’s easy to talk about antibiotic resistance and antibiotic overuse without clearly defining the situation. Does anybody really think they overuse anything? We all generally feel that we only use medication when necessary, I’ve never met with a parent that believed he or she overuses antibiotics, even if their family uses them once a month. After all, if we didn’t use antibiotics, what would we do instead? And that’s exactly why so many of the campaigns by the World Health Organization and other medical professionals appear to be falling short.
What are we doing that could be changed to lessen the trend of antibiotic resistance? And what can we do in place of those habits? We’ll look at our current habits first, then cover the solutions in the next installment.
Before we dig into specifics that cause antibiotic resistance, I want to make it absolutely clear that these habits are learned and have been taught–even by medical professionals at times. They are not indicators of bad parenting or uneducated individuals–they are habits that were passed down from generation to generation, based on the initial excitement about the new wonder drug that would end all disease. So, there’s no judgement here – but we can’t save antibiotics without looking at the habits that are risking this valuable drug’s future.
1. Viral Infections - Many Americans believe that even though antibiotics are ineffective against viruses, they may still help fight a viral infection. However, studies show that not only are they ineffective, they worsen viral infections! So, in addition to contributing to antibiotic resistance, antibiotic use for a viral infection does more immediate harm than good.
2. Just in case – Many parents want an antibiotic “just in case” for an infection. Yet, (again) studies show that antibiotics can actually make viral infections worse… longer lasting and with stronger effects. If the infection is not determined to be bacterial–and even if it is–antibiotics may not be the best treatment option. Many infections are best treated without antibiotics. This again ensures better health now, and the longevity of antibiotic options for our children.
3. Ear infections – Professional organizations have been saying for over a decade that the wait and see approach to treating ear infections is medically superior to treating with antibiotics. Not because they shouldn’t be treated, but because antibiotics can actually cause recurring ear infections! Clinical trials show that antibiotics rarely do any good, and some alternatives have fared better than standard antibiotic treatment. (Additionally, many ear infections are not bacterial; most are viral.)
4. Patient Demand - When polled, physicians listed “patient demand” as the #1 cause of prescribing antibiotics. Physicians know that parents will turn around and find another provider to prescribe these drugs if they don’t. And in their short 15 minutes of visit time–or even less on a phone call–they don’t have the time necessary to educate the parent on the misuse of antibiotics. So, many have admittedly just given in. This is one key reason that public health agencies such as the CDC and WHO have initiated awareness campaigns that attempt to educate the public about the antibiotic crisis. However, many parents still consider a physician to be a “good” physician if they’ll prescribe an antibiotic over the phone without an office visit. This has also contributed to care providers prescribing antibiotics when they’re not needed under the assumption that the patient is requesting one.
5. The Wrong Antibiotic – Antibiotics are not all the same. Most individuals now know some are stronger than others, but they differ in many different ways. Initially, they were designed to be effective against single diseases. Bacteria can be classified as gram positive or negative, and antibiotics are often more effective against one or the other. Some antibiotics are broad spectrum antibiotics or effective against a lot of bacteria, both gram positive and negative. These antibiotics should be reserved for extreme life saving situations when there is not time to properly identify the offending bacteria, but are often used as a short cut to save time.
6. Incorrect Prophylactic Use – This is the idea that a constant dose of antibiotics will prevent infection. In other words, instead of waiting for the infection to begin, this means treating it before it begins–assuming that it will. Not only is that usually based on bad science, it greatly contributes to resistance and often results in lasting harm to the individual. I’ve worked directly with numerous individuals that are experiencing the negative results of previous prophylactic use. Acne, infection prevention and other common causes of long term prophylactic use are generally better treated with other safer and more effective measures.
7. Animal Husbandry – Animals are among the most common recipients of prophylactic antibiotics. Constant treatment with antibiotics will often result in a faster growing animal and are thought to prevent infections (see #6) However, in reality, this habit is not good for the animal or the individuals that consume the animals–and it contributes significantly to resistance.
8. Antibiotics in the Home / Hand Sanitizers – These habits are directly related to the notion that we can sanitize our lives, eliminating disease. We can’t–and don’t want to–sanitize our lives. Bacteria are our friends in most cases, and experts have determined that the use of antibiotics in the home and in portable sanitizers actually acts as a stimulant for the mutation of bacteria and the development of resistance. It actually hastens the cycle exponentially. With the information we now have about the benefits of routine bacteria exposure, these habits are doubly harmful to children.
WHY are these habits bad? In addition to the situations where the treatment is worse than the disease–or worsens the disease–they contribute to antibiotic resistance. Resistance–if not halted–will result an a post antibiotic era, thrusting us back to a time in which we don’t have the option of antibiotics to treat disease. Imagine yourself 10 years from now. What routine but life saving procedures would not be available to you without antibiotics? What diseases would you fear without antibiotics? The fear parents experienced decades ago with the looming threat of diphtheria and other pre-antibiotic era diseases can and will return unless something changes.
Fortunately, we do have evidence that this cycle can be not only halted but reversed. Countries that have banned routine animal antibiotic use, restricted the availability of antibiotics and implemented public awareness campaigns (like the CDC has with the Get Smart campaign) find that older antibiotics are once again useful; the trend has been halted in places.
In the next installment, we’ll look at practical ways to respond to each of the situations listed above. There are simple and effortless tools available for each of the issues–things that result in wellness without risking one of our most valuable tools!
Antibiotic resistance is a hot topic right now. We’re finding that new superbugs exist – more dangerous than the last. And we’re finding that resistant bacteria is everywhere – including our food supply! This issue isn’t a new one… far from it. We’ve been warned for years that this is a big concern – Alexander Fleming even predicted it decades ago! We teach about responsible antibiotic use and prevention of resistance in our courses – and have since the formation of the school in 2007.
So, I’m prepping a series about resistance. Just the facts… how this happens, why it’s a concern and what we can do to protect our children and their children from entering a pre-antibiotic era soon. We also have some fabulous guest posts from Elizabeth Battle, a Clinical Master Herbalist student with Vintage Remedies on some antibiotic herbs that make great options. Interested? Stay tuned… and if you have specific questions, I’m still tweaking the posts and would love to fit those answers in for you. Just leave your thoughts or questions in the comments below.
With the launch of our big new project a mere 2 days away, we’re working overtime here at the Vintage Remedies office. There are so many important details about the new program that we don’t want you to miss. So, even though we can’t tell you what it is just yet, we can give you some pointers of things not to miss when it comes out. (And you might just call these subtle hints about the awesomeness of the new launch!!)
1. Giving Back. We’ve always dreamed of having a one-to-one aspect to Vintage Remedies, but haven’t had just the right project to make that work. Now we do and we’re so excited about this feature of the new launch. So, when we make our big announcement Tuesday, don’t miss the “Giving Back” tab on the right!
2. Connections. This new launch will have its own facebook fan page, twitter page and newsletter – completely separate from the regular Vintage Remedies pages. On these new pages, we’ll post even MORE practical tips for natural living. Don’t forget to sign up, like us and follow us! (And here’s a hint – you’ll earn more entries in our giveaways when you do!)
3. Benefits. This new launch is extremely versatile! It benefits the workplace, medical professionals, families, childbirth professionals and so many more people! (Confused yet? It’ll all make sense Tuesday…) So, if you’re a medical, childbirth or wellness professional, an employer, a mom or a part of a family (that’s everyone!) be sure to click on the “Benefits” tab to see how this new launch will best benefit you and your unique needs!
4. Completely Unique. Sometimes we take a concept that’s already being done and do it better. We did that with our Herbalist courses, and are proud to offer the best available! But sometimes, we get a little creative and come up with a completely new idea that’s never been done before. Like Vintage Remedies for Girls, Guys and Kids. We love both types of projects, but this one is completely unlike anything else. Make sure you read through the description to fully explore all of the great features and components of the new launch. Trust us – having worked on each individual aspect of the project, we know there are features galore!
5. Exclusivity. We’re thrilled about this new launch and expect it to be a HUGE hit. To share our excitement, the first 25 to participate will benefit from some special savings. Unlike our previous releases where the pre-release phase was determined by a specific date, this one is restricted to the first 25, so you don’t want to delay. Plus, there are big benefits to being the first in your area… you’ll see why on Tuesday!
Excited yet? We are! We’ll be posting more giveaways soon. The next three will have a combined retail value of OVER $500! Definitely stay posted, enter the giveaways and join us Tuesday for the big announcement. We know you’ll love it as much as we do. See you then!
One of the most popular talks I give is on the subject of vaccination. With so many scare tactics, misconstrued facts and anecdotal stories whirling around, finding accurate information about the risks and benefits of vaccination proves to be difficult at best. Now parents have an additional concern – there is a pertussis (whopping cough) “epidemic” in California, and if it continues, experts say it could be the worst in over 50 years. (The first vaccine was introduced in the 1930s and the vaccine was widely used by the 1940s, so this does not take us back to the pre-vaccine era, but does come close.) As of June 15, 910 cases have been confirmed and another 600 have been suspected – though as you will see, this could be a dramatic underestimation.
The emerging epidemic, assuming it reaches those proportions, has parents reevaluating their vaccine decisions, and is adding confusion to the already cloudy subject. What is causing this? Should we get additional vaccines? Is this caused by the anti-vaccine crowd? etc, etc, etc… Like anything, the story goes much deeper and is much more complex than any simple answer can provide.
Here are some pertussis facts:
Pertussis is the name of a Gram negative bacterium (Bordetella pertussis) that causes the disease commonly known as whooping cough. Whooping cough is a very complex illness – and highly misunderstood, even by many health care professionals. It begins as a seemingly benign cold, and is typically ignored at first. During this time, the individual experiences sniffling, sneezing and other cold-like symptoms for approximately 7-10 days. Beneath the surface, the pertussis bacteria are multiplying in the respiratory tract, where they are attached to the cilia that line bronchial tubes. As they do so, they produce toxins that contribute to damage within the respiratory tract. This is known as the first stage of the disease. During this stage, certain antibiotics can successfully destroy the bacteria, reducing the amount of damage that occurs. This is also the stage when the illness is most transmittable, and when diagnostic tests are most accurate – because the bacteria are active within the body. Remember though, this is also the stage that is commonly confused with a routine cold or virus – and is therefore usually ignored.
The second stage begins after the cold symptoms subside, after the damage has built up within the respiratory tract. It generally takes two weeks for the cough to reach this stage fully, as it progresses slowly, based on the harm from the bacteria. While the system is complex, essentially the cilia have been somewhat paralyzed, if not destroyed by the toxins, which also can constrict bronchial tubes, and this can hinder normal respiratory function. The individual will feel fine throughout the day – plenty of energy, no aching and no real complaints – until a coughing episode strikes. When the individual begins to cough, the damaged respiratory tract cannot react as it typically does, and the coughing continues for up to 90-120 seconds at a time. This hinders breathing so the episodes end in a big inhalation of air, which is often so strong that it makes a whooping sound, hence the name. In older children or adults, this might merely seem to be an annoyance, but in small babies or susceptible individuals, the lack of oxygen can become problematic, and even life threatening. Many individuals also vomit after the episodes because of the gagging it causes. Infants and the elderly are generally hospitalized to enhance the oxygen intake and hopefully prevent harm from the lack of oxygen during the episodes. These episodes can occur anywhere from 2-50 times per day. Unless they inhibit sleep, the individual is usually able to continue normal functioning between episodes, as though nothing was happening. In other words, in between episodes, there are no symptoms and the individual feels and appears to be just fine. This phase can linger for several months, though the number of episodes diminish over time.
It is important to realize that the symptoms experienced during this time are not related to a current bacterial infection – they are the result of the damage that occurred during the initial two to three week infection. Antibiotics are seldom helpful during this time and the risks often outweigh any benefits. The coughing episodes will continue until the body has healed itself from the damage caused by the infection and this will vary from individual to individual. (However, antibiotics might be beneficial for the sole purpose of preventing contamination – especially for those that work with pregnant mothers, young children or with other at-risk population groups. Any antibiotic use should be carefully considered in light of the emergence of resistant strains and the negative effects of depleting one’s protective bacteria stores.)
When these children visit the doctor, they appear to be perfectly healthy – unless they happen to get lucky and have an episode in the doctor’s office. Upon examination, there are no visible symptoms, even the lungs sound normal. The coughing episodes are more likely to occur at night, so it is not uncommon for an individual to go throughout the entire day with no coughing episodes – making the disease extremely difficult to identify. Added into this confusion is the fact that most individuals believe whooping cough is an unlikely diagnosis and care providers usually have to be persuaded to perform the testing, which has an extremely high false negative rate, and is rarely accurate if administered after the first two to three weeks. Suddenly it is easy to see how pertussis can quickly spread throughout a community.
Furthermore, the vaccines (with a full course) are roughly 60-80% effective, depending on the study cited, and it is not long lasting, requiring boosters that are rarely received, so vaccinated individuals can still easily get pertussis. Yet, this fact is rarely communicated, and many have the false assumption that they are not at risk for pertussis based upon their vaccination status. With the relatively mild symptoms, it is easily confused (by individuals and practitioners) for a persistent cough, asthma or even a lingering case of croup. So, in plain terms, we have vaccinated individuals with undiagnosed pertussis walking around our communities, unaware of the illness they are passing along to others. (A previously documented outbreak occurred in an elementary school where vaccination status was quite high, so while vaccines can reduce the risks, they don’t come close to providing complete protection, especially during outbreaks.) To complicate the issue, vaccination is not without risk to young children as some studies have linked it with up to an 11 fold increase in asthma when compared to non vaccinated individuals. However, to promote herd immunity, adults are often able to tolerate the vaccine (booster) much better. The acellular vaccine does not contain mercury and is recommended by more conservative physicians for children near 24 months of age, if not older. (The routine schedule is 2,4 and 6 months of age.) (side note: Vintage Remedies does not promote any specifics on when or if an anyone should be vaccinated, as it is a deeply personal decision that should be undertaken on an individual basis. The risk-benefit analysis will vary from family to family – and individual to individual, so this is something best undertaken with careful research and consideration.)
Pertussis can lead to complications, though many cases go completely undiagnosed. Roughly 1 in 100 individuals develop pneumonia. However, young infants are at extremely high risk as they are not able to withstand the coughing episodes. Approximately 80% of infants (under 6 month) require hospitalization and the mortality rate is significantly greater among infants than any other people group. However, vaccination, even with a typical schedule, is not completed until 6 months – and is not initiated until 2 months. Yet, this age is the most at risk (not due to vaccinated status, but due to size and physical maturity) so prevention is the best form of protection for these little ones that are most susceptible. In the current outbreak, all deaths occurred in infants under 3 months.
Some important pertussis numbers:
- Only about 50% of individuals experience the “whoop” associated with pertussis. It is entirely possible to have pertussis and never whoop.
- Pertussis generally lasts anywhere from 3 weeks to 3 months. It has been called the “100 day cough” – average duration is 6-8 weeks.
- It is most contagious during the first two to three weeks, when the cough seems benign – it is rarely transmitted after the classic symptoms develop.
- It is very rare to obtain a positive culture after the first two to three weeks, so a negative culture does not rule out pertussis.
Due to the difficulty in diagnosing pertussis, some experts have suggested that the actual rates are up to 10 times higher than the documented rates. Having personally worked with many children with the illness – all of whom remained undocumented, despite attentive care from a physician, it is easy to agree with that suggestion.
Pertussis outbreaks are cyclical – usually occurring every 4-5 years and lasting around 18 months.
In conclusion – We strongly feel that it is important for ALL parents to become educated about pertussis and familiar with the sounds and symptoms of the illness, regardless of vaccine status. Obtaining the vaccine does not guarantee protection from the disease, and the protection it does provide will wane within a few years. Yes, most individuals experience little more than some inconvenience with the illness, but young children cannot tolerate it as well, and infants experience life threatening episodes. Knowing how to recognize and react to the disease protects not only your own family, but those around you – particularly the youngest infants that are most vulnerable. Our wellness courses provide detailed information on each vaccine related disease, including potential treatment options and how to work with physicians to ensure proper reporting and testing. For non-students, we recommend thoroughly researching the disease from direct sources (not various media outlets – direct sources) for accurate information on the risks and protection measures. Many holistic professionals are also prepared to assist in the personal decision making process for individual families.
UPDATE: Many of you have asked about natural ways to prevent pertussis and treat an infection. We will be posting some follow up information within the next few weeks to answer those very questions. Remember, pertussis outbreaks occur roughly every 4-5 years. The last big one was 2005, so this was not a surprise. What’s so newsworthy is the size of this outbreak as it is rapidly growing and has the potential to become the biggest since 1958. If more information becomes available about this outbreak – or why it is so large, we’ll also let you know about that and how you can protect your families and loved ones.