Silent Pandemic – Antibiotic Resistance

A dire warning from health leaders across the world are calling the silent pandemic- antimicrobial resistant (AMR) infections. According to the World Health Organization AMR is one of the top ten leading global threats to health facing humanity in the world.

CDC estimates about 47 million antibiotic courses are prescribed for infections that don’t need antibiotics, like colds and the flu, each year. That adds up to approximately 28% of all antibiotics prescribed. In addition, A study published in the Lancet found that antimicrobial resistance was the direct cause of 1.27 million deaths worldwide.

An ever-increasing number of bacteria, fungi and parasites are becoming resistant to commonly prescribed antibiotics, with some resistant to many different antibiotics.  In some cases, antibiotics are not effective, leading to impossible to treat infections. This is a chilling scenario we are facing.

Antibiotic resistance (AMR) occurs through either genetic mutation or by acquiring resistance genes- where the antibiotic resistance genes are transferred to the next generation.

Some of the most widespread and common examples include:

  • methicillin-resistant Staphylococcus aureus (MRSA) (The most common)
  • vancomycin-resistant Enterococcus (VRE)
  • multi-drug-resistant Mycobacterium tuberculosis (MDR-TB)
  • carbapenem-resistant Enterobacteriaceae (CRE) gut bacteria

Broad spectrum antibiotics- The good and the bad

Broad spectrum antibiotics are being used in more and more AMR cases. These are antibiotics that act on the two major bacterial groups, gram-positive and gram-negative or any antibiotic that acts against a wide range of disease-causing bacteria. They are lifesaving when no other antibiotic therapy is working.

 They do come, however with their own set of whole set of detrimental, long lasting health effects. Some of these include resistance to pathogens, altered gut microbiota and immune system dysfunction. This is especially detrimental in young children. Broad spectrum antibiotics can alter gut microbiota which in turn will disrupt and affect immune function and growth of the child.

Promising research to fight antibiotic resistance

A protein in antibiotic resistant bacteria called DsbA helps fold resistance proteins into the right shapes to neutralize antibiotics. This was discovered by researchers, including experts from Imperial College London, led by Dr Despoina Mavridou assistant professor in Molecular Biosciences at the University of Texas at Austin. By disrupting the DBsA protein the team was successful in neutralizing the antibiotic resistant protein. In addition the pathogen was more sensitive to common antibiotics. As of this writing, research has been limited to outside the human body. The team now plans on finding an inhibitor that can be safely used in humans providing the same effect.

How to prevent AMR

Until research can successfully develop therapies for AMR, staying healthy and using antibiotics only when necessary are our options. Also, avoid crowds during outbreaks. And if sick, stay home!

The most effective way to prevent AMR is to boost immune system through:

  • Quality sleep- Sleep is when the body actively heals and restores health. Practice sleep hygiene
  • Exercise- At least 30 minutes several times a week of active walking or other form of exercise can help boost immune system, regulate mood and decrease appetite
  • Avoid sugar-Sugar and refined carbohydrates help feed pathogenic bacteria
  • Vitamin D (with k2)- Vitamin D supports a strong immune system. Talk with your healthcare provider about vitamin D supplementation and checking vitamin D levels to make sure you are reaching optimum vitamin D levels
  • Avoid and manage stress- Deep breathing exercises can help when unable to avoid stressful situations.
  • Practice personal hygiene- wash hands after going to store, before eating, and any time your are exposed to anyone who is ill.

- Brooke Lounsbury, RN

Medical Content Writer

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After the Floodwaters Recede-Be Aware of Post-Flood Diseases

(Don’t be caught without your Jase Case)

California is again being slammed with record rainfall, mud and rockslides are forcing road closures. Widespread evacuations are still in place across the state. Snowfall is continuing to plague the Sierra mountains leaving many stranded without available help due to the amount of snow making roads impassable.

 In addition:

  • Water restrictions have ended for the 7 million residents in the Metropolitan Water District of Southern California. These residents had endured one of the most long and fierce droughts in recent history.
  • As of Tuesday, March 15, Santa Barbara County cancelled evacuation orders and issued warnings for residents to remain vigilant with some areas still flooding, rock and mudslide hazards and potential for more storm related damage.
  • However, evacuation orders remained in place for Monterey County after a 400-foot levee burst on the Pajaro River flooding communities and farms due to runoff after last week’s 10th atmospheric river. Crews are working diligently to repair the levee. Residents have been forced to seek shelter in local motels and evacuation centers.
  • Snowfall in the Sierra mountains near Donner Pass has totaled over 54 feet, along with another incoming storm expected to dump up to another 10 feet of snow in the mountains. This will result in the risk of further roof collapses, impassable roads and gas leaks and explosions.
  • Warm air in the mountains has triggered multiple avalanche and flash flood warnings.
  • Not to be outdone by the snow, rain, flooding and avalanches, an EF-1 tornado carrying with it 90 mph winds touched down in Tuolumne County on Saturday, uprooting trees, and producing 1 inch hail along with flash flooding.

The floodwaters will eventually recede, bringing with it post-flood disease outbreaks

Note: Follow your local health department and authorities’ instruction and guidance before reentering your flooded home or other buildings. Be sure to have gloves, mask (properly fitting N95 at the very least) and goggles along with protective boots or shoes when venturing into any post flood areas.

Receding floodwaters along with warmer air create an ideal breeding ground for disease outbreaks.

Sewage spills, contaminated waste floating in waters, livestock feces along with harmful chemicals settle in buildings, cars, and surrounding landscapes, polluting everything it touches. It will be almost impossible to not be exposed to some sort of health hazard post flood.

Local health departments, clinics and hospitals will have a high likelihood of being overrun with flood related disease outbreaks.

The following is a list of common disease outbreaks following a flood

Jase case antibiotics are listed in parenthesis- note that the antibiotics in the Jase Case can treat many of these diseases:

Viruses and bacteria– transmitted through contaminated water (ingestion or contact), food, items that hold food or water, or rodents.

C difficile- (Metronidazole)

Giardia-(Metronidazole)

Salmonella (Ciprofloxacin if symptoms are severe)

Skin infection (staph)- (Doxycycline)

Tetanus- (Doxycycline or metronidazole)

Tularemia- (Doxycycline or ciprofloxacin)

Typhoid fever- (Ciprofloxacin)

Hepatitis A- no known treatment, it usually runs its course

Vector borne diseases (mosquitos)

West Nile Virus- Supportive treatment only

Rotavirus- Supportive treatment only

Mold

Mold is a major health concern following a flood. It can be invisible and spread within a matter of days. If you have a weakened immune system, you can become seriously ill from mold.

At risk populations include

  • Those receiving chemotherapy
  • Have had an organ transplant
  • Using corticosteroids

In addition, if you have any respiratory issues such as asthma, don’t enter any building after a flood without proper safety equipment (this goes for everyone including at risk persons)

  • Properly fitting N-95 mask or higher level protection
  • Gloves
  • Goggles

- Brooke Lounsbury, RN

Medical Content Writer

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Vitamin E

Vitamin E is a popular over the counter vitamin supplement that has many uses. But just like any medication and supplement, there are a few things you should be aware of before supplementing.

Discovery of vitamin E

Vitamin E was discovered in 1922 by Bishop and Evans. However, it wasn’t until the 1940s when the use of vitamin E in the role of nutrition in premature infants was investigated. This led to examining intestinal absorption of vitamin E in premature infants to prevent intracranial hemorrhage, pulmonary oxygen toxicity, hemolysis and more. Since that time, the use of vitamin E in premature infants has helped save many lives.

There are eight different natural forms of vitamin E which can be subdivided into two separate groups: the tocopherols and the tocotrienols. Both are plant based and fat soluble and each of these have four separate analogues. Each analogue has a different potency and effect on health.

Tocopherols are the saturated form of vitamin E and contain the analogues alpha, beta, delta, and gamma. This form of vitamin E is the major source in the U.S. diet.

Food sources of tocopherols include oils derived from walnuts, hazelnuts, peanuts, sunflower oil.

Tocotrienols are the unsaturated form of vitamin E and contain same name but different types of analogues- alpha beta, delta and gamma.

Food sources of tocotrienols are palm and rice bran oil, wheat germ, barley, oats, grapefruit seed oil, and annatto oil.

Vitamin E

Synthetic vitamin E

Synthetic forms of vitamin E contain both tocopherol and tocotrienols and include the four analogs of each. However there is evidence to suggest that synthetic E isn’t  absorbed by the body as efficiently as natural forms.

How to tell if your vitamin E supplement is synthetic or natural

Most vitamin E supplements are derived from natural sources. The natural (D-α-tocopherol) contains the prefix “D”, the synthetic form (DL-α-tocopherol acetate) contains the prefix “DL”.

Vitamin E deficiency

Causes

Vitamin E deficiency is rare; however some causes are:

  • Some genetic disorders that can cause malabsorption of dietary fats
  • Cystic fibrosis patients have trouble absorbing the fat-soluble vitamins- ADEK
  • Malnutrition
  • Short-bowel syndrome patients
  • Surgical resection
  • Mesenteric vascular thrombosis
  • Crohn’s disease
  • exocrine pancreatic insufficiency
  • liver disease
  • Cigarette smoking depletes vitamin E

Symptoms vitamin E deficiency

  • Impaired balance and coordination
  • Muscle weakness
  • Retinopathy

Consult with your care provider before supplementing with vitamin E

Vitamin E toxicity

Vitamin E toxicity occurs by supplementation, not diet alone. Symptoms include excessive bleeding, nausea, vomiting and muscle weakness. If toxicity is suspected, discontinuation of vitamin E and administration of vitamin K may be initiated by your care provider.

Drug interactions and cautions when supplementing with Vitamin E

  • Vitamin E inhibits platelet aggregation and can disrupt vitamin K1 clotting. Use with caution when on anticoagulation and antiplatelet medications as there is the potential risk of bleeding when taken together.
  • Niacin: vitamin E supplementation can reduce effects of niacin

Medical conditions that may be contraindicated with vitamin E supplementation

  • History heart attack or stroke
  • Bleeding disorders
  • Diabetes
  • Vitamin K deficiency
  • Retinitis pigmentosa
  • Kidney disease
  • Anemia
  • Liver disease

- Brooke Lounsbury, RN

Medical Content Writer

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The Advantage of Telehealth During Bad Weather

The massive influx of historic, record-breaking weather that has swept the country has left many communities reeling. Power outages, impassable or treacherous road conditions illuminates how fragile our society is when infrastructure breaks down. Hopefully you have your basic over the counter medicines well stocked along with prescription medicines. You had topped off your preps, food, extra water, and a small indoor safe heater with fuel  in case of power failure.

If you haven’t considered or don’t have a generator check out the Jackery portable power station.. It has USB plug ins to keep cellphones recharged and can take care of basic electrical needs, such as keeping a min fridge cold, running small appliances and even your laptop. You can recharge it via AC outlet, solar panel or car outlet. This could prove invaluable during a power outage, by keeping your phone recharged to monitor weather, check in with family members and neighbors, and if needed, to contact your care provider in case of minor emergency or illness.

Medical preparedness

During inclement weather, you may not have access to in person, non-emergent health care. Power lines or trees may be downed and block the road, snow and ice storms can make a trip to the urgent care or clinic outright dangerous or impassable. Even Southern California experienced blizzard conditions and Portland, Oregon set a record for the second most snowfall to date.  In Oklahoma, tornados have left scores of communities homeless, many injured and without vital infrastructure needed to maintain adequate living conditions. During times such as these EMS workers are spread thin due to wrecks and other health emergencies, road crews can’t keep up with the massive amounts of snowfall and other road hazards. Staying home can be the safest and most prudent thing to do until after the storm passes and infrastructure is restored.

By now you should have medicines that you use on a regular basis, a well-stocked first aid kit and a Jase case (which covers a broad variety of infections) specifically for every member of your family.

Telehealth can help bridge the gap

Sometimes it only takes a phone call to the doctor’s office to answer a question or seek guidance for you or your loved one’s illness or injury. Other times a clinic visit would be preferable, however may not be immediately possible. Telehealth is an effective option for scenarios like this. For example, if your child had been exposed to strep throat while at school and has developed a sore throat while at home for snow days, a virtual visit via telehealth can determine if an antibiotic is needed. A virtual visit can keep you and your child safe, warm and not exposed to the elements.

Telehealth isn’t ideal for every injury or illness, however, if you are stuck at home with no availability to pharmacy or medical care, it is a valuable tool that has proven to be highly successful in diagnosing and resolving minor emergencies and illnesses.

Some common telehealth visits include:

  • Coughs
  • Colds and influenza symptoms
  • Earaches
  • Stomach aches
  • Diarrhea or constipation
  • Nausea and vomiting
  • Skin rashes
  • Sore throats
  • Conjunctivitis
  • Sprains or strains
  • Urinary tract symptoms (until you can get to the clinic for an urinalysis)
  • Food poisoning

Non emergent visits can  include chronic illness visits, prescription refills, weight checks, blood pressure checks and review labs.

How to access telehealth

While telehealth can be a valuable tool to access healthcare, nothing replaces the in person visit to your healthcare provider. Telehealth should be viewed as another valuable tool in your preparedness toolkit when healthcare isn’t accessible.

An increasing number of insurances are allowing telehealth visits. Even Medicare pays for telehealth visits. Check with your insurance company for a list of providers that offer telehealth as an option to in person visits.

Most all regions across the United States offer telehealth services as an alternative to in person visits. Check with your local health systems services, your care provider or health department.

- Brooke Lounsbury, RN

Medical Content Writer

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Seasonal Allergy Relief

As we emerge from the depths of winter and attention turns to the longer days that spring presents- more time outdoors, sports, gardening, outings to lakes and local parks can fill our leisure time.

Sunny days beckon us to spending more time outside, however many suffer from seasonal allergies. Seasonal allergies can make life perfectly miserable. Stuffy nose, swollen and teary eyes, clogged ears, sinus drainage, sneezing and cough add up to some allergy sufferers avoiding the benefits of being outdoors. In fact, seasonal allergies affect 19,2 million adults and 4.2 million children in the U.S.

What are seasonal allergies. And when ae they the most prevalent?

Seasonal allergies are also known as “hay fever” or seasonal allergic rhinitis. The immune system kicks into overdrive and overreacts to pollen or other substances. Symptoms happen during certain times of the year, when trees, grasses, and flowering plants  release tiny pollen particles into the air to fertilize other plants.

Spring allergies begin in February and last until the early summer. However, seasonal allergies can happen anytime, depending on where you live and what your body overreacts to.

What are common seasonal allergy symptoms?

  • Congestion
  • Sneezing
  • Itchy eyes, nose and throat
  • Runny nose and eyes
  • Puffy, swollen eyes
  • Postnasal drip (drainage in the throat)
  • Excessive sleepiness
  • Coughing
  • Brain fog

Some common seasonal allergens and when do they occur?

  • Tree pollen—May, June, July
  • Grass pollen—Depending on where you live – March through July
  • Ragweed- sage, mugwort, rabbit brush, etc- end of August through October
  • Mold—mostly in the fall, or in moist, warm environments and climates

How to control seasonal allergies

Environmental

Reduce your exposure to allergy triggers

  • Stay indoors on windy days during pollen season.
  • If the air in your home is humid, run a dehumidifier.
  • Remove clothes you’ve worn outside and shower to rinse pollen from your skin and hair. This is especially important after mowing lawn or working in the garden
  • Pollen can stick to sheets and towels, dry clothes inside.
  • Wear a face mask when outside.
  • Every city and area of the country has a pollen forecast. It can usually be found on weather apps on phone. In addition, your local tv or radio station may have pollen forecasts.
  • Keep doors and windows closed when pollen counts are high
  • Avoid outdoor activity in the early morning when pollen counts are highest.
  • Keep indoor air clean- portable Hepa filter devices can clear a room of allergens. These are very useful in the bedroom. Keep the unit on, even when not in the room to help keep air clean.
  • Use air conditioner in home, change filters on a regular basis
  • Damp mop all hard floor surfaces, thoroughly vacuum carpet with a vacuum equipped with a HEPA filter

Nonprescription medications that may help

Check with your care provider before using any over the counter or alternative treatments for allergy relief. Some over the counter medicines shouldn’t be used with high blood pressure patients, and there are interactions with any drug, over the counter or not.

Oral decongestants. Oral decongestants such as pseudoephedrine (Sudafed) can provide temporary relief from nasal stuffiness. Some allergy medications combine an antihistamine with a decongestant. Examples include cetirizine-pseudoephedrine (Zyrtec-D 12 Hour), fexofenadine-pseudoephedrine (Allegra-D 12 Hour Allergy and Congestion) and loratadine-pseudoephedrine (Claritin-D). Talk to your health care provider about whether the use of a decongestant is good for treating your allergy symptoms.

Oral antihistamines

Some oral antihistamines list sleepiness as a side effect (diphenhydramine and Chlorpheniramine for example. Be sure to read labels and precautions.

Antihistamines can help relieve sneezing, itching, a stuffy or runny nose, and watery eyes. Examples of oral antihistamines include loratadine (Claritin, Alavert).cetirizine (Zyrtec Allergy), Diphenhydramine (Benadryl) fexofenadine (Allegra Allergy) Chlorpheniramine (Chlor-Trimeton)

Corticosteroid nasal sprays. These medications improve nasal symptoms. Examples include and triamcinolone (Nasacort Allergy 24 Hour). fluticasone propionate (Flonase Allergy Relief), budesonide (Rhinocort Allergy) and triamcinolone (Nasacort Allergy 24 Hour. These are not recommended for long term use without medical supervision.

Cromolyn sodium nasal spray (Nasachrom). decreases inflammation in the nose and reduces substances in the body that release that cause allergy symptoms.

Try some home relief remedies

Neti pot

Neti pots can rinse sinuses out, clearing allergens in nasal cavity. They have a proven track record to relieve allergy symptoms. Use saline solutions from ready made pouches or if you use water, only use distilled /sterile water.  Do not use tap water, there have been rare cases of infections from bacteria or protozoa in tap water. It may be safe to drink because stomach acid will kill pathogenic bacteria, however sinuses don’t have that protection. Be sure to thoroughly clean and air dry neti pot after use.

Raw honey, royal honey, propolis

Raw honey has been proven to relieve seasonal allergy symptoms. Start honey before allergy season before allergy season starts. Do not use in children under a year old.

Natural antihistamines are found in:

  • Stinging nettle,
  • Butterbur, a marsh plant
  • Quercetin, found in citrus fruits, grapes, apples and onions along with other fruits and vegetables
  • Bromelain, found in pineapples

Probiotics

Probiotics have been studied and have shown to relieve allergy symptoms. L Casei is a probiotic demonstrated to relieve allergy symptoms, It is found in kefir, a cultured milk product and in a lesser extent yogurts(check labels). There are other probiotics that have been researched and have positive results, however there have been mixed results.

When home remedies aren’t enough, Seek help from your healthcare provider.

If you have bad seasonal allergies, speak with your health care provider if your seasonal allergies aren’t relieved by the above methods or your symptoms are bad. They may recommend skin tests or blood tests to find out what allergens trigger your symptoms. This will enable your care provider to target which treatments are likely to work best for you.

- Brooke Lounsbury, RN

Medical Content Writer

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Sepsis – A Medical Emergency

According to the CDC

  • At least 1.7 million adults in America develop sepsis.
  • At least 350,000 adults who develop sepsis die during their hospitalization or are discharged to hospice.
  • 1 in 3 people who dies in a hospital had sepsis during that hospitalization
  • Sepsis, or the infection causing sepsis, starts before a patient goes to the hospital in nearly 87% of cases.

What is sepsis?

Sepsis is an extreme medical emergency in response to an infection that has triggered an immune response that causes extensive inflammation throughout your body. This can lead to tissue damage, organ failure and even death. Sepsis occurs when an infection in the body weakens the immune system, and the body stops fighting the infection. At the same time your body stops fighting the infection, your body develops blood clots, leading to reduced flow to organs. This leads organ failure and in some instances even death.

Many different types of infections can trigger sepsis, which is a medical emergency. The quicker you receive treatment, the better your outcome will be. Most cases of sepsis start as a bacterial infection. Some cases of sepsis are from viral or fungal infections.

Symptoms of sepsis

The symptoms of sepsis are specific across populations, and can appear differently in children compared to adults- but can include:

  • Fever and chills
  • Very low body temperature
  • Peeing less than usual
  • Fast heartbeat
  • Nausea and vomiting
  • Diarrhea
  • Fatigue or weakness
  • Blotchy or discolored skin
  • Sweating or clammy skin
  • Confusion, change in mental status
  • Shallow breathing

Sepsis complications-if not treated or treatment started late

  • Kidney failure
  • Dead tissue (gangrene) on fingers and toes, leading to amputation
  • Lung, brain, or heart damage
  • A higher risk of infections over time
  • Sepsis can be deadly in between 25% and 40% of cases.

Risk Factors for Sepsis

Anyone can get sepsis, however the following groups more at risk for developing sepsis:

  • Over 65- as we age our immune systems weaken
  • Infants, very young children, pregnant women
  • People with indwelling catheters, along with respiratory devices, ports and IV sites-these are all entry points for infection.
  • Severe, open injuries- or extensive burns
  • Chronic conditions such as diabetes. Poorly controlled blood sugars feed infection. Other risk factors include cancer, lung disease, immune system disorders, and kidney disease.
  • Dementia and Alzheimer’s patients are unable to express discomfort or pain and are at risk for urinary tract infections-which can lead to sepsis if not treated.
  • Recently hospitalized or recent surgery
  • On steroid therapy- steroids weaken immune system

Sepsis is most commonly associated with the following types of infections:

Note: Sepsis is NOT contagious

  • Lung infections (like pneumonia)
  • Urinary tract infections
  • Skin infections (especially burns)
  • Infections of the digestive system

Prevent infections by

  • Practicing good hygiene- hand washing, keep infected wounds covered, wear gloves during dressing changes.
  • Take care of chronic conditions- especially immune system disorders
  • Diabetics are prone to infections- keep blood sugars under control
  • In the case of Alzheimer’s and dementia patients monitor urine for obvious signs of urinary tract infection.

Prevent sepsis by:

  • Monitoring any lung, urinary tract, wound or gastrointestinal infections and getting appropriate antibiotic therapy (if indicated) started before symptoms of sepsis emerge.

According to the NIH:

  • A single oral dose of the antibiotic azithromycin can reduce the risk of postpartum sepsis and death among women who deliver vaginally by one-third, according to a large multi-country clinical trial funded by the National Institutes of Health. Azithromycin is one of the antibiotics in the Jase case- use only on the instruction of your care provider.

If sepsis is suspected

Seek emergency care immediately

Sepsis symptoms can develop and deteriorate rapidly

The sooner an intervention is started the higher your chance of survival. If sepsis symptoms are mild, you may be sent home with oral antibiotics. Two antibiotics that may be prescribed are supplied in the Jase case- azithromycin and ciprofloxacin.

If sepsis symptoms are severe, you will be admitted to the hospital, given IV fluids, blood pressure monitored, given vasopressors (to constrict blood vessels, which in turn raises blood pressure) and antibiotics along with other supportive therapy.

- Brooke Lounsbury, RN

Medical Content Writer

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