Monthly Archives: October 2013

Urinary Tract Infections (UTIs) are among the most common problems I see in my practice.  Since they are usually easy to treat, UTIs are sometimes a welcomed break from the more complicated, time-consuming issues I encounter.  Nonetheless, complications from UTIs (such as kidney infections and sepsis) result in more than 1 million hospital admissions annually in the U.S.  Cranberry juice blocks bacteria from adhering to the urinary tract.  So for decades cranberry products have been used to prevent UTIs.

An article in the most recent issue of the Journal of the American Medical Association (JAMA) analyzed 13 studies testing whether cranberry products really do decrease the incidence of UTIs.  The study concluded that “overall, cranberry products were not associated with lower rates of symptomatic UTIs.”  The study’s authors acknowledge that they cannot definitively conclude that cranberry products don’t prevent UTIs, only that there is not robust scientific evidence to support their use for this purpose.  The article hypothesizes that perhaps not enough of the active ingredient (proanthocyanidin) in cranberries was consumed to be able to prevent UTIs.  It states that “in theory, a patient would need to consume 224 to 280 grams of cranberry juice twice a day indefinitely to achieve any potential benefit” in preventing UTIs. 

If somebody with recurrent UTIs is interested in trying cranberry juice to address the problem, I see no harmful effect from doing so except for the increased sugar and calorie intake. 

So what does work to prevent UTIs?  A couple of common sense solutions are staying hydrated and urinating immediately after sex.   For women suffering from frequent UTIs, using a topical estrogen cream and/or taking a regular low dose antibiotic for prevention have both been shown to be effective.

Practicing primary care medicine resembles the off-and-on activity of the game of baseball.  The routine of annual check ups and minor problems can suddenly be interrupted by the discovery of urgent, life-threatening conditions like pneumonia, pulmonary emboli, and coronary artery disease.  As internist Danielle Ofri writes, “In contrast to specialists who have their diseases cut out for them—cardiologists get patients with heart problems, pulmonologists get patients with lung problems—the general practitioner has the far more challenging task of sifting out serious illness from the vast sea of aches and pains that afflict the human race.  And this is what we fear, that one of these hundreds of patients will indeed harbor some grave illness and that we will miss it.”

But preventing, detecting, and treating serious health conditions are not the only tasks that matter.  It’s also worthwhile and satisfying to effectively address the minor annoyances that afflict people.  Accordingly, I thought I’d share some pearls an esteemed dermatology colleague shared with me yesterday about brittle fingernails.  This occurs when superficial grooves in the nails lead them to split.  To treat this problem he recommends an over the counter Biotin 3 mg pill daily, applying moisturizer to the nails regularly, and avoiding excessive water exposure to the nails.  If this is not effective, there is also a new, expensive product called Nuvail that can be applied to fingernails to prevent friction on the nail surface and protect against the effects of moisture.

Nearly everyday in my practice I see the tragic, avoidable results of smoking:  A woman with emphysema that requires her to be constantly connected to an oxygen tank, a man with a cancer in his throat that has robbed him of the ability to eat or speak, fatal and debilitating heart attacks and strokes that occur at much too young of an age.  The list goes on and on.  Indeed, nearly 450,000 Americans each year die of complications of smoking.  Anything that can help avoid this great amount of human suffering deserves our consideration.

Accordingly, I offer the following reflections on electronic cigarettes.  First of all, what are they?  As a Medscape article explains:

“Electronic cigarettes — e-cigs — look like cigarettes in size and shape, but they are nonflammable, so you don’t smoke them. Instead, you “vape” them.”

While nicotine is the substance that causes pleasure and addiction to cigarettes, it is not what causes the manifold maladies that result from smoking tobacco.  Rather, it is the other noxious, toxic chemicals in tobacco that harm and kill.  So, do e-cigs have any of these toxic chemicals?  A new study in the journal Tobacco Control analyzed vapors from a dozen e-cig brands and also found some toxic substances.  But these toxins were found at levels 9 to 450 times lower than in regular cigarette smoke. 

While e-cigs don’t appear to expose people to the same high level of toxins that real cigarettes do, they effectively reproduce the nicotine rush produced by inhaling smoke from burning tobacco.  Thus, they have the potential to be a much less harmful way for people addicted to nicotine to continue to get their fix.  Thus, for my patients who are not interested in smoking cessation, I recommend they change to e-cigs as a less toxic option.

Nonetheless, I share some of the concerns voiced by others about e-cigs.  Since using e-cigs might seem to be a safe practice, they may promote nicotine addiction and possibly be a pathway to smoking tobacco.  People who otherwise might have quit smoking altogether may now transition to long-term e-cig use, thus inhaling the low levels of toxins the Tobacco Control study revealed.  Finally, there is the concern that e-cigs are used by some smokers, not to quit their habit, but as a way to smoke (or vape) in public places where smoking tobacco is banned. 

In sum, however, it appears to me that e-cigarettes offer a much less harmful alternative for tobacco smokers who are unwilling or unable to end their addiction.