Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
I wanted to continue on my series concerning what occurs in
an emergency, but the mail is piling up and I must answer it.
Also, some important news items must be discussed. From
Jerusalem, we are asked two separate questions. First, what
can you tell us about the winter scourges: influenza, URI,
bronchitis, strep and pneumonia. Influenza, URI and
bronchitis can be indistinguishable, and are caused by
viruses. They commonly have a low grade or no fever and are
over within a few days, although influenza may persist up to
2 weeks. A flu shot at the beginning of the season is
recommended, but expensive antivirals do exist that will
shorten the disease's course. Antibiotics are never indicated
for bronchitis, URI or influenza, and these all present with
a normal x-ray and normal lung exam. Strep must present with
a sore throat, although carriers are common where the bug is
in the throat and can be spread, although it isn't causing
disease at the present. It is extremely hard to eradicate.
Strep rarely presents with congestion or cough. A rapid strep
test is a good screen. Mouthwashes may help. Tonsillectomy is
done less and less these days, but frequent strep throat may
dictate this painful surgery.
Pneumonia is much more serious and, while less serious cases
exist, they commonly do well even without antibiotics. Two
exceptions to the rule. One is that the army agent Anthrax
can look like the flu early on and once it is obvious that it
isn't the flu, it is too late. Persistent cough is a feature
of viruses as well as recovering pneumonia, and usually no
treatment is required, but whooping cough is making a
comeback in adults. A blood test can help.
Fungi are plants that live off dead material, and love wet,
warm places, meaning they are strong in the summer. Between
the toes is a great place to get such diseases and especially
in shared showers. Keeping feet as dry as possible will
prevent this disease, and this includes absorbent socks and
drying the feet off well after bathing.
Toenail fungus seems to plague certain susceptible
individuals, and is extremely hard to treat successfully;
although inroads are being made, the most novel being a
lacquer that is put on the toenail akin to nail polish. Early
treatment probably is the best idea, along with the measures
In Israel, 35 percent of the males smoke as well as 15
percent of the females. Why aren't these people reading my
Best wishes to my friends and readers in Kiryat Sefer
regarding missed heart beats and a father who passed way at
39. You need a stress test and a Holter -- a twenty-four hour
test of the heart's rhythm now! Anyone with a family member
who died young needs to make sure that the heart is working
well, and that other risks are accounted for. Last week I
took care of a 19 year old whose mother had a heart attack at
a young age. This young man made the wise (?) decision to
take up smoking. He will be doing a stress test very soon.
Water parks and mikvaot are common places that adults
take young children, and the Journal of the American
Medical Association recently published a warning about
children with diarrhea that have even the slightest accidents
in these places. Crystoporidium and Giardia are two parasites
that can infect everyone in the water and are only mildly
susceptible to chlorine. Guidelines have been published, but
since they are unlikely to be followed, please protect the
public and leave sick or diapered children at home. We'll get
to more letters next week. Write me in care of the Yated.
A message from Glaxo, sponsor of this column. If you
do need antibiotics for strep or pneumonia, a wise choice is
Augmentin. Treatment failures are rare, and it is a twice a
day medication which is more convenient. A proven safe track
record exists -- Augmentin has been around for quite awhile.
Children can take this medication in syrup form.