i. life with(out) the cage
ii. back on the bed
iii. sisyphus
Wednesday, February 18, 2009
Gram Negative
Deadly bacteria defy drugs, alarming doctors A new category of bugs becomes more resistant to treatment, and their toll -- which already includes a Brazilian beauty queen -- is expected to rise. LA Times, 2/17/09
Move over MRSA, there's another bully on the block.
Acinetobacter doesn't garner as many headlines as methicillin-resistant Staphylococcus aureus, the dangerous superbug better known as MRSA. But a January report by the Infectious Diseases Society of America warned that drug-resistant strains of Acinetobacter baumannii and two other microbes -- Pseudomonas aeruginosa and Klebsiella pneumoniae -- could soon produce a toll to rival MRSA's.
The three bugs belong to a large category of bacteria called "gram-negative" that are especially hard to fight because they are wrapped in a double membrane and harbor enzymes that chew up many antibiotics. As dangerous as MRSA is, some antibiotics can still treat it, and more are in development, experts say.
But the drugs once used to treat gram-negative bacteria are becoming ineffective, and finding effective new ones is especially challenging.
Tom Brady returned to Boston recently for a checkup on his surgically repaired left knee by team doctors, according to NFL sources. Those same sources also confirmed that the Patriots quarterback suffered a postoperative staph infection and remains on antibiotics. Staph is the most common kind of postoperative infection.
Doctors fear nothing more than the development of infections and blood clots. If not caught quickly and treated properly, such complications can threaten a patient's life, never mind the success of a surgery. In Brady's case, the infection was caught early and treated aggressively with wash-out procedures and IV antibiotics.
But it still constitutes a major setback, since infection delays rehab, increases the risk of scar tissue buildup, and leaves the patient more susceptible to long-term pain and stiffness. Restoring range of motion is the most important aspect of initial post-op rehab from ACL reconstruction, and there is a limited window of opportunity to work on it.
A new antibiotic being developed by a small San Diego company fared well in a clinical trial, holding promise in treating an intestinal superbug that is commonly spread in hospitals and is becoming more deadly.
In the trial, the drug developed by Optimer Pharmaceuticals to treat a bacterium, Clostridium difficile, worked better than the only approved drug on the market.
The bacterium kills thousands of Americans a year, and that number has been rising sharply, in part because a more virulent strain has emerged.
“C. difficile, if you look at the numbers, probably far outstrips MRSA as a hospital-acquired problem,” said Dr. Stuart Johnson, an associate professor at Stritch School of Medicine at Loyola University.
In the clinical trial, both Optimer’s drug and Vancocin were nearly 90 percent effective in initially clearing the infection. But only 15.4 percent of those treated with Optimer’s drug, called OPT-80, suffered a relapse within four weeks, compared with 25.3 percent of those treated with Vancocin.
The longer-term cure rate, meaning initial cure without recurrence, was 74.6 percent for OPT-80 compared with 64.1 percent for Vancocin.
Not a laughing matter
During last Thursday's Browns Broncos game NFL Network commentator Rich Eisen, made a staph related joke when referring to Brown's quarterback Brady Quinn and TE Kellen Winslow.
The joke went something like this: Quinn has already hooked up with Winslow twice for touchdowns, you might call it infectious.
Winslow, has suffered two staph infections since entering the NFL. The seriousness of staph infections has been recounted ad nauseam on the leg.
Not funny Rich. Eisen's inappropriate joke reminded me of SNF host Al Michaels, questioning weather global warming was a fact or not.
Two days after I said there was a lack of ranting in the NFL this year, Mike Singletary, the interim head coach of the San Francisco 49ers stepped up and saved the day.
Mike Singletary's week 8 post game press conference. The entire clip is good but it starts to get juicy at the the 1:40 mark.
In case you missed it, the player Singletary was referring to was tight end Vernon Davis. Davis slapped Seahawks safety Brian Russell, in the face mask after making a catch in the third quarter. He was assessed a 15 yard unnecessary roughness penalty, which prompted Singletary to send him to the showers.
Drop the interim, if I'm 49ers owner Denise DeBartolo York, Singletary is my head coach.
Shaking his head in the locker room, the 49ers tight end said, "Not in my head. I don't think I did anything wrong. But when the coach thinks I did something wrong, I gotta listen to him. He's the boss."
That's not the best way to get out of the doghouse Vernon.
NFL Europa
Things couldn't have worked out better for the NFL in London. I'm not sure how successful the NFL will ever be at attracting Britains to American Football and in turn selling more t-shirts and pay per view games, especially since the London Monarchs and Scottish Claymores folded even before NFL Europa closed it's doors in 2007, but the 32-37 shootout that featured plenty of spectacular catches and vicious hits was a better showcase than last year's 13 to 10 snooze fest. Last year the 0-8 Dolphins, who were on their way to trying to complete a winless season were led by Cleo Lemon on a day when Eli Manning threw for only 59 yards. I'm sure that this year's choice of two high powered offenses was not by mistake.
It's an old story line but I love that Drew Bree's was going against the team that let him leave in free agency following the 2005 season in favor of Phillip Rivers. Brees won the battle but the stat lines were pretty close.
PLAYER, CP/AT, YDS, TD, INT D. Brees, 30/41, 339, 3, 0 P. Rivers, 25/40, 341, 3, 1
I'm sure the incessant timeouts and the safety in the fourth quarter confused a few Europeans that are new to the game.
After the safety, I wouldn't have kicked anywhere near San Diego's dynamic return man Darren Sproles.
Maybe it was only funny to me but I cracked up at announcer Jim Nantz' line in the fourth quarter. After Fox flashed the final score of the Liverpool Chelsea soccer match he said, "We welcome those of you joining us from the Liverpool Chelsea game."
Liverpool won 1-0. It was Chelsea's first home loss since 2004.
I had forgotten the different scoring rules that NFL Europa had. Field goals of more than 50 yards were awarded 4 points, as opposed to the NFL where every field goal regardless of length is awarded 3 points. I kind of like that, I wouldn't want it in the NFL but I like it.
Unlike the sudden death overtimes in the NFL, in Europa overtimes each team was given at least one possession. I don't care for the rule since I think sudden death means a team must have a good defense and offense since possession is determined by a coin toss.
Unfortunately, like their parent league, Europa games could end in a tie. I've never liked that a regular season NFL game can end in a tie if neither team scores during the over time period. The game should be played until there's a winner. I've always thought penalty kicks are a horrible way to loose a soccer game but maybe they should have tried them in NFL Europe. Around the League
Dick Stockton and Troy Aikman were calling the Cowboys Tampa Bay snooze fest(Tampa 9 Dallas 13).
My friend that I was watching the game with said, "Does anyone nickname their son Dick anymore?" I know very Beavis & Butt-Head, but it made me laugh and I don't know too many Dick's under the age of fifty.
Watching Pittsburg Steelers long snapper Greg Warren's knee buckle as he tried to walk off the field was gruesome. I'm amazed the training staff let him try to walk off the field after they examined him. As violently as his knee buckled there had to be at least some instability that they could detect.
"Shake it off Greg"
"Rub some dirt on it." Staph
Staphylococcus epidermidis bacteria
I found the above photo on a Fine Art Prints web page. Why in the hell would someone want to hang a photo of this nasty little bastard?
Kellen Winslow's one game suspension without pay for conduct detrimental to the club is an absolute joke. He spoke up out of concern for he and his teammates' health about an issue the Browns obviously aren't taking seriously enough. His comments were detrimental to the organization and rightly so but not to his teammates.
At the time the of Winslow's hospitalization two weeks ago the Browns organization said the nature of his condition was being withheld at Winslow's request. In light of Winslow's statement to the press I don't buy it.
Shame on the Browns and general manager Phil Savage who said in a statement:
"Kellen has expressed his desire to be a productive member of the Cleveland Browns. His comments and behavior on Sunday evening, however, were unwarranted, inappropriate, and unnecessarily disparaging to our organization.
"His statements brought unjustified negative attention to our organization, and violated the team-first concept of our football squad. Therefore, disciplinary action will be taken in the form of a one-game suspension without pay for conduct detrimental to the club.
The NFL is learning the hard way that a microscopic foe can be much more imposing than a 300-pound lineman, as a sudden slew of staph infections has sacked several players in the game.
Early this week, Cleveland Browns tight end Kellen Winslow Jr. revealed that staph (short for Staphylococcus) infection had sent him to the Cleveland Clinic for three days, and he accused the Browns of asking him to cover it up. Pro football teams are notoriously reluctant to reveal any information on player injuries, but since six different Browns have caught the bug since 2005 — Winslow has had it twice — the team's medical management looked suspect to some observers. "There's obviously a problem [with staph] and we have to fix it," Winslow told the Cleveland Plain Dealer. "Just look at the history around here. It's unfortunate, because it happens time and time again." The Browns, who denied that they had kept the news of his infection from his teammates, suspended Winslow one game for his rant, which included his claim that he felt like he had been treated like "a piece of meat."
But the Winslow medical controversy wasn't even the worst of it for the league. In the past week, it has become clear that two of its most marketable stars, marquee quarterbacks Tom Brady and Peyton Manning, had gotten infections. The New England Patriots' Brady has had at least two additional infection-related procedures since his initial season-ending knee surgery in September. It's now possible that his knee will have to undergo another operation, which could delay his return until 2010. Staph seems to be the likely culprit, but neither Brady nor the Patriots will confirm that. During training camp staph infected a bursa sac, which acts as a cushion between bones, in Manning's left knee. The infection required surgery and forced him to miss most of the preseason. Though the Colts released a statement on Friday insisting Manning didn't contract a more perilous staph, the anti-biotic resistant strain known as MRSA (methicillin-resistant Staphylococcus aureus), the incidents should alarm the NFL. "The NFL, and all the leagues, should be diligent, and not let their guards down," says Dr. Robert Gotlin, director of Orthopedic and Sports Rehabilitation at Beth Israel Medical Center in New York City. "They've got to do better. It's got to be one of the top five priorities."
Many athletes shave their ankles, legs, and arms because they don't want athletic tape ripping hair off their bodies, but experts say they should lose the razor. "No matter how careful the shaving is, you can have nicks and microscopic cuts in the skin," says Dr. Daniel Sexton, an infectious disease specialist at the Duke University Medical Center, who consults for an NFL team and several college programs. "Any time you break that barrier, it becomes a portal through which bacteria can gain access." Staph prevention is pretty low-tech. "You know, this is pretty simple," Sexton says. "Hand washing remains the primary defense against the transmissions of most organisms, including staph. Most people don't think of a locker room as a place where hand hygiene is important, but locker rooms are also mini-emergency rooms."
In 2003, a team of researchers tracked the St. Louis Rams and found five players who caught eight MRSA infections. "We observed a lack of regular access to hand hygiene (i.e., soap and water or alcohol-based hand gels) for trainers who provided wound care," they wrote in The New England Journal of Medicine. Other offenses included "skipping of showers by players before the use of communal whirlpools; and sharing or towels — all factors that might facilitate the transmission of infection in this setting."
I'm concerned about Tom Brady's health. I could care less about his playing carreer. Take care of the infection and then we'll talk football.
While I've repeatedly tried to ring the MRSA/staph alarm bell and I don't think it's a laughing matter at all. A friend did have a great one liner regarding Peyton's announcement of his infection last week.
"He was jealous of Tom Brady." The World Series
During the game 4 of the World Series there was a Lincoln MKS commercial that featured a Cat Power cover of David Bowie's Space Oddity. Really David, a Lincoln? You let them use the song for a Lincoln commercial?
Researchers in Italy and the U.K. tested five major marijuana chemicals called cannabinoids on different strains of MRSA (methicillin-resistant Staphylococcus aureus). All five showed germ-killing activity against the MRSA strains in lab tests. Some synthetic cannabinoids also showed germ-killing capability. The scientists note the cannabinoids kill bacteria in a different way than traditional antibiotics, meaning they might be able to bypass bacterial resistance.
In the study, published in the Journal of Natural Products, researchers call for further study of the antibacterial uses of marijuana. There are "currently considerable challenges with the treatment of infections caused by strains of clinically relevant bacteria that show multi-drug resistance," the researchers write. New antibacterials are urgently needed, but only one new class of antibacterial has been introduced in the last 30 years. "Plants are still a substantially untapped source of antimicrobial agents," the researchers conclude.
I recommend against googling for images of MRSA. The pictures are not pretty. Or maybe the public needs to see images of MRSA's destruction, perhaps it would move them to call for more research and funding into superbugs.
I don't think the alarm bell for drug resistant infections can be rung loud enough. The world is facing an epidemic. Only one new class of antibiotics has been developed in the last 30 years. As many articles have pointed out big pharma is off in search of the next billion dollar pill, another prozac or viagra and has little interest in developing new antibiotics. The federal government under the NIH, FDA or another of it's myriad of alphabet soup agencies should be leading the charge.
While we wait for the baton to be picked up; please, please remember to wash your hands frequently. It's the first line of defense against superbugs.
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The New Yorker, ran an article on Superbugs in it's September 11th issue. Superbugs The new generation of resistant infections is almost impossible to treat. By Jerome Groopman
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Men's Journal, ran an article on Medical Marijuana in it's September issue.
Athletes Discover Pot For Pain Marijuana works wonders on serious pain related to major illnesses. But could weed also be a better option than over the counter drugs for sports injuries and muscle soreness? By Marc Peruzzi
The author used to take up to 20 Advil or "skier's Chiclets" a week to treat a back injury suffered while skiing. He eventually developed an ulcer attributed to Advil (ibuprofen), a non-steroidal anti-inflammatory drug (NSAIDs).
At the suggestion of an editor he decided to try replacing "Vitamin A (Advil)" with marijuana. He found that, "through my improvised clinical trial I discovered that, used in moderation, pot can be an affective painkiller for sports injuries. I was most impressed at how quickly it relieved muscle spasms . . . More than that, I found that smoking pot for pain might be a smarter choice than popping pills."
"Pot has anti-inflammatory properties similar to ibuprofen, and it won't give you an ulcer." -Dr. Donald Abrams, Professor of Clinical Medicine at the University of California - San Francisco Unfortunately, the article is not available online.
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Presidential hopeful Barack Obama, has said he would end federal raids on medical marijuana clinics. Obama's position was outlined in a San Francisco Chronicle, article earlier this year.
"Voters and legislators in the states - from California to Nevada to Maine - have decided to provide their residents suffering from chronic diseases and serious illnesses like AIDS and cancer with medical marijuana to relieve their pain and suffering," said campaign spokesman Ben LaBolt.
"Obama supports the rights of states and local governments to make this choice - though he believes medical marijuana should be subject to (U.S. Food and Drug Administration) regulation like other drugs," LaBolt said. He said the FDA should consider how marijuana is regulated under federal law, while leaving states free to chart their own course.
The infection was caused by methicillin-sensitive Staphylococcus aureus, or MSSA, Magaña said.
Another form of S. aureus, known as MRSA for "methicillin-resistant," tends to get more publicity because it has grown resistant to methicillin and some other antibiotics. But infectious disease specialists say that both forms can be deadly if they move from the skin, where they normally reside, into the bloodstream and organs.
Public health experts recommend hand-washing, showering, laundering towels and uniforms in hot water and disinfecting gym equipment to prevent transmission.
They also recommend keeping an eye on rashes and other bumps, especially if they are accompanied by fevers and chills.
CHICAGO - A woman dying of Alzheimer's has a fever. Should she be given antibiotics? Many people would say yes. But a provocative new study suggests that antibiotics are overused in people dying of dementia diseases and should be considered more carefully because of the growing problem of drug-resistant superbugs.
The study raises ethical questions about when it's acceptable to withhold perhaps futile treatment and let people die, and whether public health issues should ever be considered.
In the study, more than 200 people with advanced dementia from Boston-area nursing homes were followed for 18 months or until their deaths. Almost half died during that time. All the patients failed to recognize loved ones, had stopped speaking, were unable to walk or feed themselves and were incontinent.
Antibiotic overuse contributes to the rise of superbugs, so experts have been calling on doctors to curb the liberal prescribing of antibiotics in many types of patients, including children with earaches and adults with sore throats.
Once called "the old man's friend," pneumonia can be an acceptable end when a patient's quality of life is extremely low and everyone agrees the patient would want a dignified death, said another expert not involved in the study.
A new, highly drug-resistant strain of the “flesh-eating” MRSA bacteria is being spread among gay men in San Francisco and Boston, researchers reported on Monday.
In a study published online by the journal Annals of Internal Medicine, the bacteria seemed to be spread most easily through anal intercourse but also through casual skin-to-skin contact and touching contaminated surfaces.
The San Francisco researchers suggested that scrubbing with soap and water might be the most effective way to stop skin-to-skin transmission, particularly after sexual activities.
“This particular clone is resistant to at least three other drugs, clindamycin, tetracycline and mupirocin,” Dr. Chambers said in a telephone interview.
Of the alternatives recommended by the C.D.C. and the Infectious Diseases Society of America, trimethoprim-sulfamethoxazole (Bactrim), clindamycin and a tetracycline, “this strain is resistant to two of those three,” he added. “In addition, the new strain is resistant to mupirocin, which has been advocated for eradicating the strain from carriers.”
A cocktail of antibiotics including Bactrim knocked MRSA out of the leg.
If you're prescribed an antibiotic take the full dose.
Wash frequently with soap and water and let's hope someone with an NIH grant or big pharma is working on new antibiotics.
Great news; my Social Security case was approved. I was declared disabled from 10/28/05 through 6/07. It was the best possible outcome. I was in the hearing room for about 20 minutes. In an incredibly sad coincidence, the Judge had lost a son six years ago in a motorcycle accident. His son was 30 at the time, which was my age when I went down.
On top of that tragedy, he saw a report on MRSA (the infection I had) on 60 Minutes this past weekend. He kept saying how lucky I was to have survived the accident and MRSA.
I spoke more than my lawyer. After the judge's decision, he went off the record, gave me a lecture about motorcycles and then we talked about Boston and Iceland. He used to visit Boston regularly as a kid and has fond memories of a 6 hour layover in Iceland.
I should receive a written decision from SS shortly, explaining the financial side of things. SS will also contact Medi-Cal, my bills will be paid.
So after a little more than two years the saga of the leg is over!
THANK YOU again, to everyone, for all your love and support throughout this process.
I only received the decision a few hours ago but I can't believe it's finally over.
WASHINGTON - Drug-resistant staph infections that have made headlines in recent weeks come from what the nation's top doctor calls "the cockroach of bacteria" — a bad germ that can lurk in lots of places, but not one that should trigger panic.
It takes close contact — things like sharing towels and razors, or rolling on the wrestling mat or football field with open scrapes, or not bandaging cuts — to become infected with the staph germ called MRSA outside of a hospital, she said. But MRSA is preventable largely by common-sense hygiene, Gerberding stressed.
"Soap and water is the cheapest intervention we have, and it's one of the most effective," she told a hearing of the House Committee on Oversight and Government Reform.
Over time, germs evolve to withstand treatment. Most staph is no longer treatable by the granddaddy of antibiotics, penicillin. By the 1960s, staph also began developing resistance to a second antibiotic, methicillin.
MRSA mostly causes skin infections, such as boils and abscesses. But it can sometimes spread to cause life-threatening blood infections. Last month, the CDC reported the first national estimate of serious MRSA infections — 94,000 a year. It's not clear how many people die, but one estimate put the MRSA death toll at more than 18,000, slightly higher than U.S. deaths from AIDS.
Should every patient entering a hospital be tested for MRSA, and isolated if they harbor it? Some hospitals have begun that, but current guidelines call for that step only if hospitals fail to reduce MRSA infections by less drastic means, Gerberding said. *note: The leg was put in isolation for a month with MRSA. It was nice to have a private room in a county facility but the cockroach delayed my recovery and forced the doctors to revise the blueprints for operation rebuild.
Her concern: "Patients in isolation get less care." Doctors and nurses check on them less. They get more bed sores, opening the body to other life-threatening germs.
It seems like common sense but PLEASE, PLEASE wash your hands regularly or carry hand sanitizer and bandage your cuts and scrapes.
Dr. Gold looked at my x-rays and said, "You graduate today, not that we don't like to see you."
I asked if I needed to take any special precautions.
"Can I jump out of a plane and land on the leg?"
"Oh the leg's solid do whatever you want."
He did mention that the MRSA bug that I picked up in the early days of project leg may be lingering in my leg and that it could flare up at some point.
Dr. Gold took some final video of me walking down the corridor, I executed a pirouette and the medical part of, the saga of the leg, drew to a close.
There's a connection here somewhere, there always is; the Six Million Dollar Man, "No Glue Needed" (well in my case they used a little high grade spackle), the motorcycle
Jamie Sommers, the Bionic Woman and Steve Austin, the Six Million Dollar Man
I have a hearing scheduled in November with the Social Security Administration that will resolve the disability/financial side of the leg one way or another. Thank you to all the family, friends, medical professionals, administrators, access drivers and strangers that have helped me throughout the long journey back.
"Gentlemen we can rebuild him. We have the technology."
