Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
Still answering more letters that have come in.
A question was posed about urinary tract infections. We
basically dealt with this in the not distant past. I will
only add an answer to the question of this problem in
pregnancy.
Often these infections are without symptoms in pregnancy, as
cultures are often done. While cotrimazole (Resprim) and
Zinnat -- one of our sponsor's drugs -- are safe in
pregnancy, probably the best bet is nitrofuratoin
(Macrodantin, Uvamin). I question if Resprim is even still
effective in Israel.
Risks for more urinary infections include prolonged second
stage of labor in pregnancy, catheterizations, and poor
hygiene. Probably not urinating when one must is not healthy
either.
Eye care in older adults should include glaucoma screening as
this can lead to blindness and can sometimes be without
obvious symptoms. Other correctable causes of blindness that
should always be considered are poor control of diabetes and
temporal arteritis -- a cause of headache in the elderly. As
I have said many times: not taking diabetes seriously is
asking for trouble.
I promised to speak more about dialysis, and I did consult
with one of my kidney specialists and have realized that
technology in this area has boomed. Peritoneal dialysis --
that is through the stomach wall -- has become much safer and
in the hands of an intelligent and serious patient, it is
safe and convenient. Hemodialysis has also improved. I was
invited to tour the facilities to see how each work at this
point, but my busy schedule has not allowed this so far.
While kidney disease remains dangerous and often life
shortening, the technology is advancing.
I also received a letter from a lady whose husband
unfortunately developed kidney failure that many physicians
just did not pick up on. I am sorry to hear this and must
compliment her on her emunah. I would just like to add
however, that a lot of the problem in England is the NHS
which has shown itself to be a failure. Specialist care is
difficult to obtain as are proper tests. My British readers
have my sympathies and my prayers.
We should speak about the new disease called SARS which is
scaring many people. The disease guidelines change daily as
we learn more and more about it. At the moment it has been
identified as a virus, with a 20 percent death rate, and
higher in individuals who are not healthy. It can live 24
hours on door handles, something which is a bit unique.
The World Health Organization recently announced that the
disease is under control throughout the world and no longer
has any travel restrictions based on SARS to any part of the
world. We'll keep you posted as we learn more about this
disease. Write me in care of the Yated.
A message from GlaxoSmithKline, sponsor of this
column. Bactroban is a topical antibiotic that is so well
absorbed that it can fight infection often as well as
antibiotics by mouth. It can work well for impetigo, mild
localized cellulitis, infected wounds and infected burns. It
soothes as well.
