Sunday, July 05, 2009

Science Fact - Strep Club

Have you ever had a nasty sore throat for a couple of days where drinking orange juice felt the same as swallowing shards of glass? It's a horrible experience. But what's even more horrible is when you go to see your family doctor or a walk-in clinic and wait for 2 hours, only to be told to go home and rest. It made no sense to me why they would dismiss you that easily, sometimes without even taking a swab of the back of your throat. A few doctors will still blindly prescribe antibiotics to anyone with a pulse, but the majority these days will hold onto those magical drugs as if they were precious gems. So I wondered: Do doctors ever do anything for people with sore throats?


Since I have completed several hospital rotations, I've had the chance to be on the other side of the situation. Now that I understand the reasons for treating vs not treating, I can more properly take care of patients. And I'm a better patient myself whenever I have a sore throat. Let's walk through some of the science behind sore throats and then explore what doctors consider before sending you on your way.

The bacteria that we worry about the most with sore throats is Streptococcus pyogenes, aka Group A Strep. Why do we worry? It's not because the throat infection is particularly bad, or that you cannot recover from the infection on your own. The reason is that throat infections with Group A Strep ("strep throat") can spread from the throat to other areas and cause worse infections. There is a chance that the bacteria can enter the bloodstream and travel to the heart, brain, and joints. This is called acute rheumatic fever. People with rheumatic fever often have a fever and joint pain beginning 1-3 weeks after getting strep throat. The biggest concern from a medical point of view is that the bacteria can infect the heart tissue and cause major problems. You can end up with permanent damage to your heart muscle or valves.

So with all of this scary information about strep throats, why don't we treat every sore throat with antibiotics to prevent rheumatic fever? First of all, sore throats can be caused by viruses as well as bacteria. In fact, most sore throats are viral in nature. The common culprits are adenovirus and the common cold viruses (rhinovirus, coronavirus, parainfluenza). Antibiotics would have absolutely no effect in this case. Secondly, if the sore throat is bacterial, it may not be strep that's causing it. There are a few other bacteria that could be the responsible organism. To be fair, though, Group A Strep is the most common bacteria that causes sore throats.

Lastly, and this is a big point, most of the strep infections will be successfully eradicated by your own body. It's often the case where people with throat infections do not get medical treatment. Their sore throat resolves after several days and they move on with their lives. The reliance on antibiotics has been a recent development in our history, and we did quite well without them, especially with minor infections. It is NOT true that strep throat will always cause rheumatic fever if untreated. The prevalence of rheumatic fever is very low, and is even lower in developed countries like ours. In fact, some countries like England don't bother to test people for Group A Strep because they don't give antibiotics to patients with sore throats unless their mouth is about to implode. You can bet that there are numerous times when patients have strep throat and are not treated, but the amount of rheumatic fever in England is as low as it is here in Canada. This shows how rare it is these days to develop complications from strep throat.

This brings us to how we in Canada treat sore throats (known as acute pharyngitis in the medical community). There is no mystery behind it at all. There are 4 criteria that we look for which may indicate if strep is the culprit. Here they are:
  • 1. Fever (Temp >38°C or >100.4°F)

  • 2. No cough

  • 3. Swollen tonsils with exudate/pus

  • 4. Tender lymph node enlargement in the neck

If you have all 4 of these criteria, then you are about 40-60% likely to have strep throat. In this case, the doctor will prescribe penicillin to you right away, and likely get a throat swab to confirm the diagnosis. If, on the other hand, you have a sore throat with a runny nose and cough, no fever, no white stuff coming out of your tonsils, and no swollen lymph nodes, then your infection is almost certainly viral. In this case you would definitely be told to go home and rest. Even if you had one of these criteria, you'd still be sent home sans prescription.

If you have either 2 or 3 of the criteria above, the doctor will likely swab your throat and culture the goop to see if Streptococcus pyogenes will grow. This usually takes 2 days, and often by then the sore throat has resolved. If it hasn't and the culture is positive for strep, then the doctor will prescribe anitbiotics.

So what does this all mean for you, the patient? The next time you get a sore throat and are debating whether to go see a doctor, think about these 4 criteria. If you score a 2 or higher, you may want to go in and get swabbed, or antibiotics if you're lucky enough to get 4 points. But if you score a 0 or 1, stay home and get some chicken soup into you. Wait until tomorrow to see if you get better on your own, or if your score goes up. This may prevent an unnecessary doctor's visit. And more importantly, it will save you from an annoyingly long wait in the waiting room surrounded by other sick people and copies of outdated Readers Digest magazines.



* Click here for an online version of the criteria that you can fill out on your own and find out what to do!

Monday, June 29, 2009

Band/Album Names (Pt 23)

It only feels right to start off my posting with the 23rd set of band and album names. I truly hope that some of you will use these for your up-&-coming garage band, or at the very least for a mixed CD that you make for a friend (or your special lady). Here they are!

  • The Kitchen Skivvies

  • Largely in my Undies

  • Dirty Servant

  • Second Winter Burning

  • Nuts & Gum

  • Oh Hey Hey


And my favourite of the bunch:

A New Hope



This is it! The glorious return of Off The Contrary after over a year of being lazy/studying medicine/traveling. I was originally going to title this entry "Return of the Jedi", but I thought that was far too pretentious as I am a Padawan learner at best. The chosen title is more humble, and is far more fitting for a story that has taken a lengthy hiatus and now sets out on the second (and final?) saga.

In the coming weeks you can expect some medical tidbits, some random thoughts, possibly some answers to questions that you (my beloved reader) would like to ask me. And, of course, band and album names galore.

Oh, and before I forget, I have to give a shout-out to those who have stumbled upon my blog over the past year and have left me very interesting (and sometimes inappropriate) comments. I was even mentioned by other blogs like Broke-Ass Stuart's website, which blew me away because it actually looks like an established site! Well, at least it's way more professional than this one.

Stay tuned for the second coming of Off The Contrary!!

Sunday, April 06, 2008

Band/Album Names (Pt 22)

I know I haven't been writing much in terms of scientific education and hilarity, but after my crazy exams this week I'll be sure to write down the plethora of ideas that I've had while studying. In the meantime, I'll share with you a special installment of band/album names. Each one is medically themed and is a set of band & 1st album. Enjoy!!

  • Fat Legs and the Crackles     -     Hyper Trophy

  • Bolus     -     Push It

  • Pertussion     -     Whoop Dreams

  • Melena     -     Poop Out

  • Anal Tone     -     Sounds Like The End

  • Failure To Thrive     -     Small For Dates

  • XXY     -     Congenitalia

It's A Trap!!!

What's better than a short clip featuring an obscure Star Wars character? A short clip featuring an obscure Star Wars character AND a new breakfast cereal!! Check it out:



Or, if you don't like embedded videos, you can click here

Sunday, March 23, 2008

Band/Album Names (Pt 21)

It's been a while since I wrote in my blog, and so it just makes sense that I'm overflowing with high-quality band and album names. Take a good look through them. And if you're fancy is known to be ticklish, let me know which names tickle it.

  • Kindergarten Pop

  • Minutia

  • False Bravado

  • Royal Jelly

  • Sweet Melons

  • Begat

  • The Darning


And my personal favourite of the bunch:

  • Sometimes It's Never Easy

Friday, February 22, 2008

Party In My Tummy

I recently gave a presentation to a community group about healthy eating. It went well, and they loved the idea of making ants on a log, but I think it would have been better if we acted out this mind-blowing song.

Sunday, February 10, 2008

Science Fact - Sweet Action

I remember a brief period in high school when one of my friends believed that by eating pure sugar you couldn't gain weight. This theory was based on the fact that the chemical structures of sugar and fat were so different. My friend reasoned that if you weren't eating fat, then how could you store it in your body?


Glucose



Lipid (fat)


Well, as most of you know, that theory is utter crap. I never believed him, but it took me a couple more bio and chemistry courses to understand exactly how you turn sugar into fat. Sugar gets broken down in several step into smaller and smaller compounds in order to harness its energy, and one of these compounds (acetyl-CoA) can be taken away from the sugar-burning pathway and into the fat-making pathway. If you eat too much sugar than what your body can use, you will have too much Acetyl-CoA and end up producing lots of fat with it.

And then there was the artificial sweetener!! This sensationally sweet product has a different chemical structure than natural sugar, and because of this it can't be broken down into energy-producing molecules. Better yet, it can't get turned into fat! So it makes your coffee, pop, and cookies sweet without all of the added calories. Even if it does taste gross and leaves a weird aftertaste in your mouth...


You would think that artificial sweeteners, also known as sugar substitutes, should be encouraged with people who are trying to lose weight. It makes sense. Or does it?

A new study that just came out showed that rats who were fed artificial sweeteners (saccharin) actually gained more weight than rats being fed natural sugar (glucose). This seems counterintuitive, but the scientists had an explanation for it.

Normally, when you eat sugary foods your body senses this and gets ready to use the energy boost. It also tells you to eat less because you're probably eating a bunch of calories. But with artificial sweeteners, you confuse your body by tasting sweet without delivering a lot of calories. Because of this, your body stops trusting its "sweet sensor" and decides to eat a bunch of food no matter what, as well as reduce the amount of energy that it burns. Once this mistrust has developed, it's easier for you to gorge yourself on naturally sugary foods without slowing down or burning more calories to compensate.

Now everyone should take this with a grain of salt (also granular and white...) because the study was done on rats and not humans. And since body weight depends on about a zillion things, you shouldn't think that by switching back to natural sugar you will start to lose weight, or that you can blame your obesity on Sweet 'N Low. Just be aware that zero-calorie foods and additives may not be completely guilt-free.

Sunday, January 27, 2008

Who Are Mario and Luigi?

Back in the 80's, the news really knew how to get to the bottom of a breaking story, cutting to the chase and asking the toughest questions. An excellent example of this was Inside Edition TV when they uncovered a new craze called "Nintendo". Watch and learn.



I love Ron Leingang's part about level 3-1, and the CRAZY secrets that he reveals. Who knew that there was a beanstalk? Jack, I can picture you doing an amazing impersonation of him :)

So if you missed the answer to the eternal question "who are Mario and Luigi?", remember that "they are us".

Also, if you're in a Nintendo mood and have 10 minutes to kill, then check out this collection of 100 Nintendo games. But play your own music in the background.

Thursday, January 24, 2008

Science Fact – Broken Hearts are for Assholes and Post-Menopausal Women

Many of us have experienced heartache in our lives, and some would go so far as to say that they suffered from a “broken heart”. We have all heard this expression ad nauseum in conversation, literature, and in an abundance of songs. But is there any literal meaning to the term? Can your heart actually break when left by a lover, or when finding out that your child had died overseas?

Well, there is recent evidence suggesting that people who are faced with sudden, intense emotional stress can develop serious heart muscle weakness. This is called Takotsubo cardiomyopathy, stress cardiomyopathy, or simply “broken heart syndrome”. People with this condition can have symptoms that feel like a massive heart attack, including:

  • Shortness of breath

  • Severe chest pain

  • Low blood pressure

  • Congestive heart failure


Broken heart syndrome is a relatively new idea, so the mechanism isn’t well understood. However, it is believed to be caused by a huge release of adrenaline from your adrenal glands (the glands that sit on top of your kidneys) when you experience sudden emotional trauma. This massive amount of adrenaline will “stun” your heart muscle, preventing it from working properly.

Although stress cardiomyopathy is life threatening, it is surprisingly reversible. Unlike real heart attacks, you can recover from a broken heart in a matter of days to weeks with little to no permanent damage. The only problem is that you could have serious consequences or even die during the initial phase.

Is there any good news to this? Well, the symptoms are so severe that you’re unlikely to ignore it. And if you recover (which often happens) you shouldn’t have any permanent damage to your heart. Finally, there is no increased risk of recurrence. If you have one broken heart, you’re no more likely to suffer from another broken heart than anyone else.

Let’s finish off with some epidemiology. We all know that broken hearts are for assholes (thank you Frank Zappa for enlightening us with your controversial song). But now we can add post-menopausal women to this group. For some reason this is the most likely demographic to suffer from stress cardiomyopathy.