Health Newsletter

March 7, 2004

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Health Newsletter - BackupMD

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In This Issue: March 7, 2004

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• Using antibiotics sensibly

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Massages to relieve muscle tension

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• How long to treat a UTI?

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Health tip to share - Too many fluids

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• Reader submitted Q & A - Weight and OCPs

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Humor is healthy

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Using antibiotics sensibly

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Why not take an antibiotic when you have a cold,

sore throat or flu symptoms? It can't hurt you can

it? Yes it can hurt.

The overwhelming majority of upper respiratory

tract infections in otherwise healthy people

during the cold and flu season are caused by

viruses. Antibiotics have no effect against

viruses, only against bacteria. The viral caused

cold, flu or sinus drainage symptoms do not go

away any quicker when you take an antibiotic.

Viral infections are usually self-limited and do

go away on their own but the clearing of symptoms

is not because you took an antibiotic.

If you take left over antibiotics or pressure your

doctor to prescribe them when you really do not

need them, you run not only the risk of an

allergic reaction, a bowel infection or vaginal

yeast infection, but also you contribute to

letting other bacteria in your body become

resistant to that antibiotic. The bacteria

themselves form a defense against the specific

antibiotic. The next time you get a bacterial

infection, that antibiotic might not work. It may

take a week or more to find out that the

antibiotic does not work and all the time the

infection causes damage to your body. You may end

up needing hospitalization for the infection or a

more expensive antibiotic; there may not be any

antibiotics that are effective for the infection.

When antibiotics are overused, infections caused

by these bacteria may not respond. Illnesses from

the infection can last longer. Complications from

such an infection and even the risk of death can

rise. Failure of an antibiotic to treat a

particular infection leads to longer periods in

which a person is contagious. That person,

possibly your best friend, has a longer time to

spread the resistant strains to others.

Since most upper respiratory tract infections are

viral, assume that is the case until you have

reason to suspect otherwise. Then if you are not

sure, do not self medicate but rather seek a

medical opinion. If the doctor still thinks

antibiotics are not needed, go along with that

rather than pressuring for an antibiotic

prescription.

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antibiotics sensibly

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How long to treat a UTI?

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If you have ever have had urinary tract infections

(UTIs), you may know that sometimes you receive

antibiotics for 1 day, 3 days, 5 days, 7 days, 10

days or 14 days. You may think it depends upon

which antibiotic the doctor prescribes but many

times it does not. Doctors do not always know the

optimal length of time needed to treat

uncomplicated urinary tract infections.

A recent study in Canada looked at treating

urinary tract infections in older women who did

not have signs of a higher kidney infection

(pyleonephritis), diabetes, recent treatment with

antibiotics, urinary tract abnormalities or

contraindications to the specific antibiotic used.

In other words, they had uncomplicated UTIs. The

drug used was Cipro®(ciprofloxacin) and they

tested two doses: 250 mg twice a day for 3 days

and 250 mg twice a day for 7 days. The authors

looked at both immediate treatment success, as

measured by a urine culture two days after

completion of antibiotics and also the relapse

rate of infection by urine culture at six weeks

after treatment.

The investigators found that for the 3 day course

and the 7 day course, the immediate cure rates

were 98% and 93% (yes better in the 3 day group)

and the relapse rates were approximately 15% in

each group. In addition, the group taking only 3

days of antibiotics had significantly less (about

half) side effects from the antibiotics such as

nausea and vomiting, drowsiness, loss of appetite,

headache, abdominal pain or diarrhea.

This study suggests that at least for Cipro®

treatment of uncomplicated UTI, the duration of

treatment is best confined to only 3 days rather

than 7.

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to treat a UTI?

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Reader submitted Q & A - Weight and OCPs

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" Recently, my obgyn informed me that I have to

change my birth control pill because I am too

heavy (195 lbs). He informed me that a new study

indicated that heavy patients need to take birth

control pills with high content of estrogen

(35mg). I was using the Ortho Evra® patch which

was falling off my skin! Does taking high doses of

estrogen effect my chances of having any side

effects (breast cancer or blood clots formation)? "

" I am 26 years old and do not smoke! I am not on

any medications, I do exercise and am in a good

health " - KRA

The question you raise stems mainly from one

article in 2002 from the University of Washington

that suggests there is a higher risk for oral

contraceptive failure in heavy women (greater than

155 lbs or 70.5 kg). To understand what the

magnitude of risk is to you and whether switching

to a higher dose oral contraceptive (Ortho Evra

has only 20 mcg of estrogen) will lower your

pregnancy rate, you need to know a little

background of what the study actually found.

Failures of contraception that result in pregnancy

are measured in 100 women-years, i.e., 100 women

taking the pill for 1 year or 50 women taking the

pill for 2 years for example. Using that

definition, the overall failure rate of all oral

contraceptives is about 3-4%. This takes into

account all women, even the ones that tend to

forget their pills. The best case failure rate of

women who are " good pill takers " is about 1%

overall.

Most modern oral contraceptives come with estrogen

doses of about 20-25 mcg (very low dose), 30-35

mcg (low dose) and 50 mcg (high dose). Your patch

birth control would be considered very low dose.

In the 1960's, estrogen doses above 80mcg were

linked to increasing rates of blood clots

(vein thrombosis). Average doses came down very

quickly. In the 1990's there became questions

about different progestins (not the estrogen dose)

that seemed to have different blood clot rates. As

far as we know at these modern estrogen doses,

there is no higher incidence of thromboses. In

fact your weight alone is probably more of a risk

for thromboembolism. Also, there is no known

increase of breast cancer with any of these doses

either.

Doctors will still caution you to be on the lowest

dose possible and I agree fully with that. If we

look at the different weight ranges and the

pregnancy rates for the different estrogen doses

in the pills in the above mentioned study we see:

Pregnancy rate/100 women yrs

estrogen dose

20-25mcg 30-35mcg 50mcg =+

Weight in lbs

less than 125 1.8 3.2 1.6

125-137 3.4 2.7 3.3

138-155 2.3 2.0 8.2

155 and plus 6.8 5.2 5.4

As you can see, women over 155 lbs have in general

higher pregnancy rates (5-7%) than women under 125

lbs (1.8-3.2%). However, you do not gain very much

lowering in rate (6.8 to 5.2 or 5.4) if you, at

the higher weight, switch to a higher dose pill.

You will need to decide for yourself if these

differences are worth switching contraceptive

doses. Basically you are at slightly higher risk

for pregnancy no matter what you do.

Keep in mind one of the things we have mentioned

before, i.e., that the biggest risk for pregnancy

from pill failure is starting the pills LATE after

you have been off of them for 7 days. If you are

very good about prompt starting of a new pill pack

or patch, you may be a lower risk than the general

population on which this study is based.

To submit a question for consideration for our

weekly reader submitted medical questions:

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your medical question

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Massages to relieve muscle tension

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Did you know there a quite a few different types

of massages? Different massage types vary in how

the hands are used in the massaging stroke and

the amount of pressure applied to the different

muscles or parts of the body.

Types of massages

Swedish - long smooth hand strokes and kneading

movements along the skin

Deep - slow heavy strokes on deep muscle tissue

Sports - specific muscle directed massage both

deep and superficial

Craniosacral - focuses on the muscles and

ligaments of the head, neck and spine

Neuromuscular - concentrates on painful or trigger

point areas of specific muscles

Rolfing - significant pressure on connective

tissue throughout the body using the hands,

knuckles and elbows

Massages are not only for spa treatments but

medically they can relieve stress and muscle

tension, relieve anxiety, lessen muscle pain and

even stimulate the immune system. They can be

safely performed by licensed health professionals

such as a massage therapist, physical therapist or

occupational therapist.

If you have a massage, be sure to let the

therapist know if you have any skin burns or

wounds, or have had a recent heart attack, cancer,

arthritis flare, unhealed fracture or bone

thinning (osteoporosis). You do not want to have a

serious complication of massage such as internal

bleeding, nerve damage or temporary paralysis

which can rarely happen with an untrained massage

therapist.

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to relieve muscle tension

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Health tip to share - Too many fluids

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" The traditional advice to treat a cold with

bedrest and plenty of fluids may be at least half

wrong. Recently investigators have found cases in

medical reports in which excessive fluid intake in

people with upper respiratory tract infections has

produced a dangerous lowering of body salts

(hyponatremia). This could possibly result in

congestive heart failure, pneumonia and even

death. " - FRJ

If you have discovered ways of coping with a

disease or condition and it works for you, please

share it with us:

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suggestion form

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Humor is healthy

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Little Known Illnesses

HAIRPIECE SWIMPLEX

Rash caused by wearing a toupee in a pool.

HERPES CINEPLEX

Rash caused by movie tickets priced at $9.50.

VISACARDITIS

The heart-stopping sensation brought on by

exceeding your credit limit.

OREOPOROSIS

Disorder caused by too many cookies, not enough

milk.

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That's it for this time.

Your BACKUPMD on the Net.

Rick Jelovsek MD

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