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Introduction
Dr. Bob: And welcome to The Dr. Bob Show. Thank you
so very much for gathering around your television to learn
a little bit more about your health and your life. That's
what we try and do on The Dr. Bob Show. I'm Dr. Robert Overholt
and I'll be your host for the next 30 minutes and we've got
a show that's jam-packed with information, health information
just for you. We'll spend most of the time talking about different
types of infections. Why are we getting so many resistant
bacteria? I had a patient in my office today who lost three
friends in the last year because they picked up an infection
that they shouldn't have and weren't able to respond to treatment.
Is that going to be the course of the future-resistant bacteria?
We'll learn a little bit more about some of the fears of the
"super bugs." We'll also be talking about the common
cold. We'll be talking about some type of vaccines that can
help your health. So, you'll want to stay tuned. I have an
outstanding guest. My guest is Dr. Stephanie Hall. Dr. Hall
is a long-time friend of mine and is a public health officer
and she's a pro at the information we just talked about.
Later on we'll be talking about osteoporosis. If you take
estrogen at the time of menopause, does it really protect
you? Why do women have more problems with osteoporosis the
first seven years after menopause? We'll be talking about
another woman's problem-those hot flashes. What causes them
and what can we do for hot flashes? If we have time, we'll
be talking about diet versus exercise-which is best for you?
And how to get a good night's sleep. And remember, be sure
that you're exercising 20, 30, the last doctor told me 60
minutes every day, seven days a week. Start the day off with
a breakfast of fruit and fiber, eight hours of wonderful sleep
and most of all, we like laughter in your life. It will help
your health. So, stay tuned. We've got a lot of information
for you.
Dr. Bob: Common colds, super bugs, resistant bacteria.
We're talking with Dr. Stephanie Hall, public health service
officer. Stephanie, welcome to The Dr. Bob Show.
Dr. Hall: Thank you.
Dr. Bob: Tell me about super bugs because I did have
a patient today that three people, and I thought that was
unusual, but three people in her life in this past year had
died because they picked up some resistant bacteria. Now,
two of those had cancer and were sort of weak already and
they died because of this bacteria that didn't respond to
treatment. What are super bugs and why are we getting them?
Dr. Hall: Well, they're called super bugs because
they seem to survive all sorts of antibiotics and that's really
the essence of the problem. These are bacteria that have become
resistant to treatment with every sort of antibiotic that
we have available to us. So, essentially the person is infected,
there's no cure, and in some circumstances, they do die.
Dr. Bob: Now, I used to…I can remember telling
patients 15 years ago that it really doesn't matter what kind
of infection you get, we've got antibiotics that can clear
your infection and there's nothing that you can get that we
can't really heal with medications. That's becoming different
now. What are some of the super bugs that we're seeing and
under what circumstance?
Dr. Hall: Sure. I think the one that we're concerned
most about in the community right now is a bug called pneumococcus.
It's a very, very common bacteria that gives children acute
ear infections, that causes pneumonia, things like that. But
there are other bacteria that we're worried about also. Some
things that may not be common but we've heard of is tuberculosis,
drug resistant tuberculosis.-something that none of us want
to have. Another is gonococcus, which is a sexually transmitted
disease, that's increasingly resistant to antibiotics; and
then there's a bug that's been around for along time, staphylococcus
that's become resistant in the hospital environment to many
antibiotics. But just in the last decade we're starting to
see that same bug with the same resistance out in the community.
So, there are a number of bacteria that are causing problems
because we don't have the antibiotics at hand to treat them.
Dr. Bob: What does this mean to the patient?
Dr. Hall: Well, the patient is more vulnerable and
that's really a key point. People are losing their protection
and it is related to the use of antibiotics. I'm sure you're
going to ask me about that.
Dr. Bob: Yeah, that's what I'm thinking about. What
is the cause of the problem?
Dr. Hall: Sure. It really is associated with overuse
of antibiotics. And it relates to you and me individually,
not just the population as a whole. If you take an antibiotic
when you don't need it, you essentially kill off some of the
healthy, friendly bacteria you have living in your body. The
bugs that are intrinsically resistant to the antibiotic that
you're taking have a chance to just grow and take over because
you wiped out the good bacteria. So, every time you take an
antibiotic, you run that risk. Every time you take an antibiotic
when you don't need to take an antibiotic, you're really taking
a risk you don't need to take.
Dr. Bob: Prime question. How do I know if I need to
take an antibiotic? I've got a fever, chills, don't feel good,
I'm aching, I'm down in bed, I want to get back to work. So,
do I need an antibiotic?
Dr. Hall: I think a general rule of thumb is most
of the things that we're coming down with these days in terms
of upper respiratory infections, sinusitis, bronchitis, colds,
they are all caused by viruses. They don't respond to antibiotics.
They respond to time, fluids, bed rest, all of the things
that your grandmother and your mother told you about. But
taking an antibiotic doesn't help.
Dr. Bob: In our society, people want a quick fix and
sometimes if you've got a viral infection, you're just not
going to. There's just nothing we have that really works well.
Is that correct?
Dr. Hall: Well, there are some things that you can
take for symptomatic relief. But, no, there's nothing that's
going to cure a virus at this point. Even the pills that we
have for viral infections (not antibiotics but different kinds
of pills) are meant to shorten the course of, say for example,
influenza, but not absolutely cure it for you.
Dr. Bob: Now, are we getting into a problem because
the doctor is writing too many prescriptions or because the
patient is putting too much pressure on the doctor to receive
an antibiotic saying, "If you don't give it to me, I'll
go down the street."
Dr. Hall: Well, it's some of both. We know that we're
a society that likes to have prescriptions and antibiotic
prescriptions, in particular. And there is some expectation
because of past practice on the patient's part that they'll
get a prescription for an antibiotic when they go in. But
interestingly, when you look at surveys of patients, they
actually don't go in saying, "I have to have an antibiotic."
Patients go to the doctor saying, "I want reassurance
that I'm not really sick, that I don't need an antibiotic
and I want some information about how to make myself feel
better." If you look at physician surveys, the physicians
honestly think the patient is coming in expecting an antibiotic
and that they will be letting the patient down if they don't
do something like that. So, there is some miscommunication
there but we know that doctors are, in fact, overwriting prescriptions
nationwide.
Dr. Bob: More problems with pediatrics or with adults,
as far as developing resistant bugs?
Dr. Hall: Well, it's really a pediatric problem in
that more prescriptions are written for kids and this one
bug that I talked about, pneumococcus, is a bug that causes
many more children's infections. So, in that sense, yes, we
really want to target doctors who write prescriptions for
kids, and parents who take their kids in and give them some
education about what's a viral infection. You don't want an
antibiotic for this and educate them about what really does
need an antibiotic.
Dr. Bob: Are there any vaccines against these pneumococcal
bacteria?
Dr. Hall: Yes…..
Dr. Bob: And that's what we're going to come back and
talk about with you for just a little bit. There are some
vaccines that will help prevent getting some of the super
bugs, some of the resistant bacteria. And we'll be talking
about that.
Announcer: You're watching the Dr. Bob show, finalist
for the 2002 Telly Award for excellence in television programming.
Dr. Bob: It can be a real problem for you if you're
taking too many antibiotics. You may be setting yourself up
to get one of those resistant bacterial infections. We're
talking with Dr. Stephanie Hall. Dr. Hall is a public health
service officer and is giving us excellent information and
Stephanie, I want to give you just about a minute or a minute
and a half. What is the difference between viral and bacterial
infection? What are some of the keys differences between those?
Dr. Hall: You're probably asking about the symptoms
so if I'm a patient, how do I tell which I've got? And unfortunately,
the general rule is that most of it is viral so, even if you've
got a cough, it's probably viral. Even if you think you have
bronchitis, that's usually viral. Sinusitis is usually viral.
The green stuff that comes out of your nose that we always
thought was bacteria is usually viral. So, in fact, as for
the bacterial stuff, there aren't many things that you have
to worry about. A prolonged fever for over five days, that
you need to worry about. If you have a sore throat and if
you get a rapid strep screen that's positive and you have
a fever, then you probably need an antibiotic but not all
sore throats are bacterial, most of them are viral.
Dr. Bob: So, most of the time we really don't need
antibiotics. Mother nature is going to take care of it.
Dr. Hall: Sure.
Dr. Bob: How long should you wait to see your doctor
or how long should you wait before you get a little aggressive
and say," I think I need an antibiotic, it's been a week?"
Dr. Hall: Five to seven days. If you're not better
after that, then I think it's time to call your doctor, particularly
if you have developed a prolonged high fever. Lots of people
with a cold will run a temperature of 99 or so. Now, obviously
that's not true in an infant or a kid less than a year old,
although some kids that young who have just a cold can run
a fever that high.
Dr. Bob: So, every patient is different and every
infection is different. I want to get into vaccines. Let's
talk about the pneumococcal. That's the one that's the resistant
bug in certain areas of the country. 40% will be resistant.
What do we do about that and what are some of the vaccines
that are available?
Dr. Hall: Well, we've had Pneumovax around for a long
time and that was a great vaccine for anybody who was over
2. It was particularly good for older people who are more
susceptible to getting pneumonia from this particular bug.
But we also know that that same bug, pneumococcus, really
causes a lot of infections in young kids. More recently a
vaccine, a great vaccine called Prevnar, has come out in the
childhood alimentarium of vaccinations and if we begin to
see Prevnar used in the general childhood population that
will probably significantly impact the problem of resistant
streptococcal infection, resistant pneumococcal infection
in kids,.
Dr. Bob: Now, what is the difference between this
vaccine and the Pneumovax?
Dr. Hall: Well, aside from the fact that Pneumovax
can't be used in kids under two, Pneumovax actually protects
you against 23 cousins and a huge family of pneumococcus.
It's actually not one bug, it's a big family of bugs. Prevnar
actually protects you against seven different kinds of pneumococcus
but those seven kinds tend to cause about 85% of the pneumococcus
infections we see in kids.
Dr. Bob: Any danger with these two vaccines?
Dr. Hall: No, they're great vaccines.
Dr. Bob: That's a simple answer.
Dr. Hall: Yeah.
Dr. Bob: (Laughter) So, who should be getting who
the Prevnar.
Dr. Hall: O.K. Prevnar is indicated for everybody
under the age of two. It's a series of four vaccines for kids
between two and six. High risk kids still need to get it.
Kids who have any kind of disease that compromises their immune
system…they don't have a spleen, have any high risk kid
like that. And then, additionally, there are some recommendations
for kids who are in daycare in that age group that they will
benefit from it as well as minority kids.
Dr. Bob: So, we're getting vaccines that are working
against some of these resistant bug families. For instance
now, there's the pneumococcal Flu vaccine…who should
be getting the flu vaccine?
Dr. Hall: Well, there are some new additions to that
this year. Everybody over 65 should get influenza vaccine.
It may not prevent influenza in that age group but it certainly
keeps you out of the hospital. You'll get a milder case.
Dr. Bob: There are about 10-15 thousand people a year
that will die of the flu.
Dr. Hall: More like 20 thousand.
Dr. Bob: And that's because…why? The infection
was so bad? Or the patient was older and wasn't able to handle
an episode?
Dr. Hall: The very old and the very young are much
more susceptible to the adverse consequences of having flu
and that's why there's one of the new recommendations which
is for kids 6 to 36 months. They consider those kids high
risk and they should be vaccinated for influenza. Everybody
in between with a high risk condition also should get an influenza
vaccine.
Dr. Bob: How are we doing in the United States with
our vaccination rates in children? Are we doing pretty well?
Dr. Hall: Well, we're doing really well in terms of
where we were 10 or 15 years ago. We're probably not up to
that 90% vaccination goal that we would like to be but probably
overall in the United States we have about 70 or 75%. So we're
getting better now-we're a lot better than we were before.
Dr. Bob: I would like to go into the common cold for
about 30-40 seconds.
Dr. Hall: OK.
Dr. Bob: Over-the-counter remedies…do they help
the common cold and why don't we do a better job in medicine
of getting rid of this common infection?
Dr. Hall: Sure. I would love to say there is an over-the-counter
medicine that really takes care of your symptoms. In fact,
the studies have shown that most of them aren't a lot of good.
Now, I have my personal favorites I won't go through here,
but taking care of some of the aches and pains with a nonsteroidal
inflammatory like Advil or something. Fluids and bedrest are
really the best. We can't develop a vaccine for the common
cold because there are hundreds of viruses that actually cause
the common cold.
Dr. Bob: So, that's the key.
Dr. Hall: Yeah.
Dr. Bob: There're different viruses that cause the
same grouping of symptoms.
Dr. Hall: Same kind of symptoms.
Dr. Bob: So, you may get one of those viruses today
and two weeks later get another one and…
Dr. Hall: Right.
Dr. Bob: How many common colds do we expect to get
every year?
Dr. Hall: Well, with adults, probably two or three
and with kids even more, six to ten a year because they're
out and about. They're in the schools. They're in contact
with all those viruses. Moms who take care of kids will have
more colds than the guys who aren't taking care of the kids.
Dr. Bob: Stephanie Hall, you're been a great teacher
and I've loved having you here. Our time is up and I just
wish we had another hour. Will you come back and talk with
me again sometime?
Dr. Hall: I sure will.
Dr. Bob: I want to thank Dr. Stephanie Hall for taking
her time to come and teach us about super bacteria, about
new vaccines and the importance of staying healthy and not
overusing antibiotics. You'll want to stay tuned because later
on we're going to be talking about, oh, maybe how to get a
good night's sleep. We'll be talking about osteoporosis. We'll
be talking about hot flashes. You'll want to stay tuned.
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