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 V.19 No.50 | December 16 - 22, 2010 

Miss Diagnosis

Germicidal Tendencies

The sore throat starts on Monday. Tuesday adds a headache and congestion. On Wednesday, you ask to leave work after almost hacking up your lungs onto a client, but your boss is being uptight. So you tough it out and go home exhausted, skipping dinner and falling into bed. You feel a little better on Thursday, so off to work you go. But by Thursday night, you feel like the victim of a hit-and-run. So you call the doctor early Friday. She can squeeze you in that afternoon. You ask your boss if you can leave early for a doctor’s appointment. He gives you a disapproving look like you’re a naughty 4-year-old, informing you that he’ll need to see a doctor’s note.

When you reach the clinic, you’re running on empty. You drag yourself into a crowded waiting room. Despite the fact that you arrive 15 minutes early, you sit there for 45 minutes, and then in the exam room for another half hour. You don’t know what you have. Maybe it’s bronchitis or strep throat. So you wait patiently, eager for the relief the doctor will provide with the swoop of her pen upon her prescription pad.

The doctor finally arrives. She looks at your vital signs, asks you a few questions about your appetite and your phlegm, listens to your chest, and then sends you along your merry way with instructions to rest and drink lots of fluid.

“What!?” you’re screaming on the inside. Or maybe, if you’re really ticked off, you’re screaming out loud. “I waited two hours for that? I paid $30 to be told to drink water and rest?” You’re wondering, Shouldn’t I at least get an antibiotic?

You’re exhausted and ill, and now you’re $30 lighter. All for nothing. Your weekend will be wasted in bed. And you forgot to ask for a note for work. Without a prescription for an antibiotic, who’s going to believe that you’re really sick?

Culturally, antibiotics have powers that go beyond mere germicide. A prescription for antibiotics is a validating certificate of illness. Antibiotics symbolize scientific proof of your suffering and guaranteed restoration to health. So when your throat feels like it was clawed by rabid animals and your body can barely maintain an upright position, why on earth would your health-care provider deny you these life-sustaining medications?

Infections come in different flavors, the two most common being bacterial and viral. Bacteria are single-celled organisms that grow, reproduce and die like other life forms. Bacteria can make you ill by invading your tissues and releasing harmful toxins, thus activating your immune system.

Bacterial cells differ from human cells. They have a different type of DNA, different proteins and a host of unique features. These differences allow us to create drugs that kill the bacteria without killing our own cells. For instance, penicillin targets bacteria by preventing them from growing a proper cell wall. Human cells have flexible membranes instead of walls, so they’re unaffected. But a bacterium without a cell wall is like a person born without skin. Death ensues.

Over time, bacteria find ways to outsmart our antibiotics. For instance, bacteria that cause bladder infections learned how to produce a substance that disables penicillin. As a result, we no longer use penicillin drugs to treat urinary tract infections. Bacteria are so skilled at adapting to our drugs that taking a single dose of an antibiotic puts a person at risk for developing resistant strains for up to a year.

Antibiotics come with a slew of hairy complications, from life-threatening reactions (like a skin-melting rash called Stevens-Johnson syndrome) to ruptured tendons to some gnarly diarrhea. In certain situations, the risks of antibiotics outweigh the benefits. For instance, antibiotics typically shorten the course of an uncomplicated ear infection in a child by only one day. Research tells us that, in many cases, treating the child with pain-relieving eardrops and lots of TLC is as effective and less risky than prescribing antibiotics.

Antibiotics are completely ineffective against viruses. Viruses are tiny protein envelopes stuffed with genetic material. Unlike bacteria, they cannot grow or replicate on their own. They must highjack the cellular machinery of the cell they infect to reproduce. Antibiotics can’t kill viruses because viruses don’t have the same parts as a living cell. Like zombies, viruses aren’t technically alive, so they’re a bitch to kill.

If you don’t receive antibiotics because you have a viral infection, it doesn’t mean that you’re somehow not actually sick. Viral infections can be just as nasty as bacterial ones. HIV, swine flu, herpes and the deadly hantavirus are all examples of viral illnesses. Even common cold and flu-like viruses can cause fever, chills, loss of appetite, muscle aches, sore throat, congestion and cough. While these viruses usually aren’t life threatening, they definitely make you sick. Unfortunately, antibiotics don’t help.

Several illnesses are repeat offenders when it comes to inappropriate antibiotic prescriptions. The Centers for Disease Control and Prevention recommends against routinely using antibiotics to treat sore throats, sinus pain and cough. These infections are far more likely to be viral than bacterial.

Millions of boogery, sore-throated, coughing Americans will head to the health clinic in search of relief this winter. The majority will leave empty-handed. Was the trip a waste? I’d argue no. Sick people should have someone check their vital signs, listen to their lungs and grill them about their symptoms to rule out something more concerning, such as pneumonia. But it would be doing everyone a disservice to prescribe an antibiotic for a viral illness. So when your health-care provider tells you to go rest and hydrate, dammit, we mean it. Park yourself in bed, and don’t go spreading your germs around. Here’s your note for work. And trust me, we all wish we could do more.

Despite its brilliant name, this column is not intended to prevent, diagnose or treat herpes. Or any other diseases, for that matter.

Whitny Doyle is a family nurse practitioner grad student.

The opinions expressed are solely those of the author.
 
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