Antibiotics are used to treat or prevent certain types of bacterial infection. Antibiotics are effective only against bacteria. They do not work for viral infections. Also we have increased resistance to common antibiotics in our community, so this post.

We do not prescribe antibiotics in following cases.

  1. Mild bacterial infections which are likely to get better on their own.
  2. Viral infections

This policy has many positives. 

  1. By not taking antibiotic when it is not necessary, you are protecting your gut biome. 
  2. If you take antibiotic when it is not necessary, in future antibiotics may not work for you. (Antibiotic resistance)
  3. Body's immune system can fight small infections and using less antibiotic drugs means your immune system gets a chance to fight infections  

 

 

We prescribe antibiotics only when

  1. There is strong evidence that your infection is not likely to clear up without antibiotics
  2. You are actively infecting others
  3. You carry a risk of other serious complications

Please trust our judgment. When we say antibiotics are not required most likely they are not.

When we prescribe antibiotics 

  1. We do not shoot in the dark. We get a lab culture done to identify which is the strain of bacteria and we call medicine that works the best for that strain. These days we are using PCR tests to quickly identify the strain and we can often get the results next day itself.
  2. We ask you take a probiotic , so that your gut can repair itself. Many a time we prescribe probiotics. However home made yogurt is as effective as probiotic pills. So help yourself to large servings of yogurt. 

If you are on antibiotics,

You may notice side effects such as:

  • being sick
  • feeling sick
  • bloating and indigestion
  • diarrhea

Sometime you may develop very serious allergy (anaphylaxis) and may need immediate medical care. So if you are taking antibiotic for the first time, please plan time to watch out for any serious symptoms. 

Angular cheilitis, also known as perlèche, is an acute or chronic inflammation of the skin and contiguous labial mucosa located at the lateral commissures of the mouth. It typically presents with erythema, maceration, scaling, and fissuring at the corners of the mouth. Lesions are most often bilateral and may be painful.

Angular cheilitis is caused by excessive moisture and maceration from saliva and secondary infection with Candida albicans or, less commonly, Staphylococcus aureus . Angular cheilitis may occur at any age without sex predilection but is especially common in older individuals wearing dentures. Predisposing local factors include wearing orthodontic appliances or ill-fitting dentures, sicca symptoms (dry mouth), intraoral fungal infection, poor oral hygiene, and age-related anatomic changes of the mouth due to reduced vertical facial dimensions 

Diagnosis

Dr. Kamat will do the clinical diagnosis after looking at your skin. In some instances to rule out candida or other infections, we may take a swab and send it to the lab.

 

Treatment

In our community we have observed that one of the contributing factors is vitamin deficiency. So we ask patients to take multivitamins. Patients must also avoid smacking the lips. Patient can also  start using topical aloe vera, sun protection (hat),  topical hydrocortisone. If drooling is a contributing factor, please use vaseline before going to bed. Typically your inflammation must resolve in a week of treatment.

 

Prevention

  1. Continue taking multivitamins
  2. Improve oral hygeine
  3. Use moisturizer to avoid dry lips
  4. Improve denture  fit and cleaning(if using) 

Patient Questions:

  1. Where do I find a good Aloe Vera?

There are many Aloe Vera creams in the market. Look for something that has purer Aloe Vera and no fancy chemicals or mineral oils. Aloe vera is a moisturizer. Alcohol dries the skin. So if the product lists out alcohol along with Aloe Vera, it may not be very effective.   

You can get Aloe Vera at H-Mart in Aurora. You may also get this from other Asian and Mexican Markets.

If you buy Aloe Vera you can make Aloe Vera Gel at home following instructions from WellnessMama. (We have requested permission to share this link)

Insurance companies jack up the price of prescription drugs through sweet heart deals they write with their own prescription benefit management companies.  Till insurance companies go away we wont see any decrease in the healthcare costs. At this time we see prescription prices are sky rocketing because of "greed" of the third parties such as hospitals and insurance companies.  Here are some of the ways you can reduce your prescription costs. Dr. Kamat mostly writes generic prescriptions but with a certain insurance company that has a long name with no pauses, even generics cost an arm and leg.  Use these resources to reduce your prescription bills.

 

Benefits Checkup (National Council on Aging): This website gives people lists of services and programs for which they can apply. The lists include programs to help pay for medicines, but also programs that don't have to do with health care directly. For example, this site has information on finding housing, getting food stamps, and finding elder care. You can search for all types of programs at once or target your search to find a specific kind of service.
Needymeds: This is an independent non-profit organization that provides information about patient assistance from drug companies and the government. The site also offers people a discount card that they can use on prescriptions if they have no insurance or choose not to use their insurance. This card is especially useful in paying for medicines after you reach the Medicare coverage gap and Medicare is no longer paying for your prescriptions. (You reach the coverage gap, sometimes called the "donut hole," once you and your plan spend a certain amount of money for covered drugs. After that, you have to pay more for your prescriptions up to a certain amount.)
Medicine Assistance Tool: This is a search tool that helps people learn about cost-saving programs available through drug companies.
Rx Assist: This website lets you enter the name of a medicine or the name of a drug company to find programs that can help you get that medicine or medicines made by that company at a reduced cost. In many cases, the online applications for those programs are included.
  • Website: http://rxassist.org/patients
  • Email: This email address is being protected from spambots. You need JavaScript enabled to view it.  
Rx Outreach: This website offers medicines and diabetic treatment supplies at a reduced cost to people who make less than a certain amount of money each year.

Patient had been to multiple facilities with no clear diagnosis and lot of work up for other unrelated diagnosis.  (Sign of failed Healthcare System of America.. Lot of tests but no physician time that can save the patient from harm)

 

Patient presented to the clinic with complaint of cough and then during the discussion said "I also have swelling in the legs" . Physical examination revealed swollen lymph nodes and we saw that patient's earlier clinician(non-physician) missed the signs and instead diagnosed the swollen lymph nodes  as a  mass (it was not. It was  lymphadenopathy) and planned a biopsy and did that too (probably) with no conclusions.

Long story short we rescue the patients and we diagnosed active TB  in the very first visit itself and hence this post. 

 

First. TB is a preventable disease and, barring instances of extreme drug resistance, is 100% treatable. But making sure patient adheres to the treatment plan is the key.

 

Unlike other practices we focus on getting things right so we order Quantiferon gold test and only when required we order radiology tests to confirm. 

We have found that skin tests are prone to false positives due to earlier exposure to the TB disease. 

Once we have diagnosed, we make sure patient gets the best treatment at the Denver's best TB clinic and continue to monitor patient for all the primary care needs other than TB treatment. 

 

Symptoms of TB

Typical symptoms of TB include:

  • a persistent cough that lasts more than three weeks and usually brings up phlegm, which may be bloody
  • weight loss
  • night sweats
  • high temperature (fever)
  • tiredness and fatigue
  • loss of appetite
  • swellings in the neck

You should see a Dr. Kamat if you have a cough that lasts more than three weeks or you cough up blood.

TB that affects the lungs (pulmonary TB)

Most TB infections affect the lungs, which can cause:

  • a persistent cough that lasts more than three weeks and usually brings up phlegm, which may be bloody
  • breathlessness that gradually gets worse

TB outside the lungs

Less commonly, TB infections develop in areas outside the lungs, such as the small glands that form part of the immune system (the lymph nodes), the bones and joints, the digestive system, the bladder and reproductive system, and the brain and nerves (the nervous system).

Symptoms can include:

  • persistently swollen glands
  • abdominal pain
  • pain and loss of movement in an affected bone or joint
  • confusion
  • a persistent headache
  • fits (seizures)

TB affecting other parts of the body is more common in people who have a weakened immune system.

 

 

Treating TB

With treatment, TB can almost always be cured. A course of antibiotics will usually need to be taken for six months.

Several different antibiotics are used because some forms of TB are resistant to certain antibiotics.

If you're infected with a drug-resistant form of TB, treatment with six or more different medications may be needed.

If you're diagnosed with pulmonary TB, you'll be contagious for about two to three weeks into your course of treatment.

You won't usually need to be isolated during this time, but it's important to take some basic precautions to stop the infection spreading to your family and friends.

You should:

  • stay away from work, school or college until your TB treatment team advises you it's safe to return
  • always cover your mouth when coughing, sneezing or laughing
  • carefully dispose of any used tissues in a sealed plastic bag
  • open windows when possible to ensure a good supply of fresh air in the areas where you spend time
  • avoid sleeping in the same room as other people 

If you're in close contact with someone who has TB, you may have tests to see whether you're also infected. These can include a chest X-ray, blood tests, and a skin test called the Mantoux test.

 

Care Plan.

We work in Denver's TB Clinic to create an individualized care plan to treat and cure you.   Please talk to Dr. Kamat on what is your care plan and keep your follow ups with Dr. Kamat. 

 

 

What is depression?

Depression is a disorder that makes you sad, but it is different than normal sadness. Depression can make it hard for you to work, study, or do everyday tasks.

How do I know if I am depressed?

Depressed people feel down most of the time for at least 2 weeks. They also have at least 1 of these 2 symptoms:

They no longer enjoy or care about doing the things they used to like to do.

They feel sad, down, hopeless, or cranky most of the day, almost every day.

 

Depression can also make you:

Lose or gain weight

Sleep too much or too little

Feel tired or like you have no energy

Feel guilty or like you are worth nothing

Forget things or feel confused

Move and speak more slowly than usual

Act restless or have trouble staying still

Think about death or suicide

 

If you think you might be depressed, see your doctor or nurse. Only someone trained in mental health can tell for sure if you are depressed.

 

See someone right away if you want to hurt or kill yourself!

If you ever feel like you might hurt yourself or someone else, do one of these things:

Call your doctor or nurse and tell them it is urgent

 

Call for an ambulance (dial 9-1-1)

 

Go to the emergency room at your local hospital

 

Call the National Suicide Prevention Lifeline: ( dial 1-800-273-8255)

 

What are the treatments for depression?

People who have depression can get 1 or more of the following treatments:

Medicines that relieve depression

Counseling (with a psychiatrist, psychologist, nurse, or social worker)

A device that passes magnetic waves or electricity into the brain

 

People with depression that is not too severe can get better by taking medicines or talking with a counselor. People with severe depression usually need medicines to get better, and might also need to see a counselor.

Another treatment involves placing a device against the scalp to pass magnetic waves into the brain. This is called "transcranial magnetic stimulation" or "TMS." Doctors might suggest TMS if medicines and counseling have not helped.

Some people whose depression is severe might need a treatment called "electroconvulsive therapy" or "ECT." During ECT, doctors pass an electric current through a person's brain in a safe way.

 

 

When will I feel better?

Both treatment options take a little while to start working.

Many people who take medicines start to feel better within 2 weeks, but it might be 4 to 8 weeks before the medicine has its full effect.

 

Many people who see a counselor start to feel better within a few weeks, but it might take 8 to 10 weeks to get the greatest benefit.

 

How do I decide which treatment to have?

You and your doctor or nurse will need to work together to choose a treatment for you. Medicines might work a little faster than counseling. But medicines can also cause side effects. Plus, some people do not like the idea of taking medicine.

On the other hand, seeing a counselor involves talking about your feelings with a stranger. That is hard for some people.

 

If the first treatment you try does not help you, tell your doctor or nurse, but do not give up. Some people need to try different treatments or combinations of treatments before they find an approach that works. Your doctor, nurse, or counselor can work with you to find the treatment that is right for you. He or she can also help you figure out how to cope while you search for the right treatment or are waiting for your treatment to start working.

 Our Plan and Support for you.

Recently we realized that many of our patients have depression and hence we have started screening depression. Please ask for a depression screen every time you are in the clinic. If we diagnose depression we have in house tele-medicine to connect you to a caring counselor to start your sessions from the clinic itself. Please ask your clinician to help you set up with VICI.  Once you are set up with VICI your medication management can be done by us while you continue to improve using counseling.  We have seen remarkable improvement in patients who use counseling as well as medication.  We are also starting an integrative medicine approach using 5000 year old science called Ayurveda. Please talk to the front desk.