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TeresaJ
02-21-2016, 06:53 AM
What the hell is up with this?? Every goddamn time I take my kid to the doctor they say he has an ear infection. He's already been on four rounds of antibiotics. Practically every parent I talk to has a kid with tubes in their ears. What the fuck?

I mean, granted, if this were the pre-modern era, my kid would almost certainly not have survived his infancy, so I'm not saying that all medical intervention is completely unnecessary... but still. It seems really absurd to me that I have to constantly bombard his system with broad-spectrum antibiotics in order to prevent him from suffering hearing loss and furthermore that a substantial portion of other kids have to experience the same thing.

I have a prescription of antibiotics right now that's sitting on the shelf because I don't want to go down that road again. Meanwhile aside from fussiness he has no other symptoms. Some nights he's fine and other nights he wakes up crying.

I know that we have several parents and scientists here, so can anyone enlighten me? Am I being paranoid like some anti-vaxers or am I being sane like parents who want to keep their kids from developing allergies etc?

TeresaJ
02-21-2016, 07:14 AM
From some article in USA Today:


Q: What is the best way to treat ear infections?

A: "Be sure the diagnosis is accurate," Rosenfeld says. "A true ear infection has a distinctly bulging eardrum, which almost looks like a pimple that is ready to pop. Unfortunately, ear pain or discomfort alone, even with fever, is unreliable for diagnosis, so parents cannot make the diagnosis at home. What they should do is specifically ask their doctor if the eardrum is noted to be bulging or very full; if it is not, then it is likely not a true ear infection and certainly does not need antibiotics."

If the diagnosis is accurate, the most important treatment is pain medicine (acetaminophen, ibuprofen), especially at bedtime, for the first one to two days, Rosenfeld says. Some parents find analgesic eardrops to also be helpful.


The doctor never said anything about his eardrums bulging, just that they were cloudy and the area around them was red.

Ugh, I don't trust anyone... This is precisely why I need to become a nurse myself.

Robcore
02-21-2016, 07:27 AM
My boy had a few ear infections when he was one...but I think that medicating them is not so necessary as we're led to believe. One time, we took him to emergency, because he was in major pain, and the Doc on call prescribed him some meds...and when we went to the pharmacy to pick them up, the pharmacist commented that the infection must be very serious because of the dose and the type of antibiotic that was prescribed. We didn't end up giving it to him right away, and my wife had an appointment with our family doc the next day anyhow, and he checked out Ollie's ears while we were there and said that there was no sign of infection at all. Gone. nada...after the on call doc prescribed a heavy duty antibiotic because the infection was so advanced just the day before.

As for myself, I had a lot of ear infections as a kid, and I freaking loved the banana flavoured liquid antibiotics that I was prescribed.
...but as an adult, I only like to take medications as a very last resort...so when I had an ear infection several years ago, I looked up some natural remedies...one of which was a solution of lemon juice and water. I popped a few drops of that in the ear that was so in pain that I was in tears, and I heard a bunch of crackling for a few minutes, and within 5 minutes, my ear was perfectly fine.
...as I understood it, the infection was eliminated by creating a PH environment where it couldn't survive.

I haven't had an ear issue since then. After the experience we had with our boy's 'serious' infection disappearing overnight, I'm inclined to prefer home remedies like the one that worked for me. It seems less invasive, too, being that it was basically just topical (not sure if you can absorb lemon juice into your body through your ears...and the worst side effect I could find was having a bit of stickiness that required a gentle rinse or two, lol).

Maybe it'd be helpful to learn what an ear infection looks like and actually look in his ears to see what condition they're in. Can't be terribly advanced knowledge...Docs seem to diagnose ear infections with a quick glance in the ear. You could monitor things and evaluate better whether the treatment is required if you could tell that there was a pathology of worsening infection or not.

OrionzRevenge
02-21-2016, 07:35 AM
There's no reason in the world why you shouldn't buy your own "Dr. Mom Otoscope" (http://www.amazon.com/Dr-Mom-Otoscopes-Generation-Stainless/dp/B000J1FT4W) and diagnosis this for yourself.

http://cradlerockingmama.com/wp-content/uploads/2014/01/IMG_1221.jpg

This prior post explains the reasoning behind my saying you should have the child sleep with the uninfected ear pressed to the pillow so that the infected ear can drain as nature intended.
http://forums.intpcomplex.com/showthread.php?20-Little-rants-that-don-t-deserve-their-own-thread&p=144180&viewfull=1#post144180

TeresaJ
02-21-2016, 07:41 AM
I actually have one of those but I do not feel confident that I can correctly diagnose. For one thing the view is not nearly as pristine as in the pictures, and for another it seems a sort of cloudy grey in between infected and normal. And on top of that I'm still not certain that antibiotics are the best choice even if it is a genuine ear infection.

OrionzRevenge
02-21-2016, 08:01 AM
I actually have one of those but I do not feel confident that I can correctly diagnose. For one thing the view is not nearly as pristine as in the pictures, and for another it seems a sort of cloudy grey in between infected and normal. And on top of that I'm still not certain that antibiotics are the best choice even if it is a genuine ear infection.

A: Look at your fingertip with you Otoscope and then ask to check out the view of Otoscopes at your Drugstore. You may just have cheap plastic optics instead of quality glass.

B: As with any suspected anomaly with a paired anatomical feature, compare to the healthy counter-part.

C: A doctor's prescription for antibiotics in such matters carries a lot of clout with me. The bulging eardrum clearly indicates fermentation by microbes. Which means they are eating and belching. The redness and pain means they are eating flesh and not gunk in the wayward snot.

Losing some or all of the hearing in that ear would be bad enough. Losing your sense of balance (The xyz axis loops at the top of the snail) would be devastating.

TeresaJ
02-21-2016, 08:24 AM
I do need to do some more work with the otoscope, but I can tell that neither eardrum seems to be bulging with gas or pus. They also have a tendency to rupture, and that hasn't happened.

And as for scary consequences, antibiotics have side effects as well (http://seattlemamadoc.seattlechildrens.org/antibiotic-use-may-increase-risk-for-ibd/).

I at least want something more definitive than "well this ear looks worse that the other ear" (roughly what the last dr said) before embarking on a fifth round of antibiotics in less than six months.

OrionzRevenge
02-21-2016, 09:01 AM
I can understand your frustration and the sense of helplessness that comes with caring for your sick child.

Antibiotics, like most medicines, comes with risk, and not every doctor is a great doctor. Maybe you could call him/her and discuss you concerns about what seemed like a luke-warm diagnosis-prescription.

What you perceive as an epidemic of doctors shooting at the hip when it comes to childhood ear infections (where there are clear indications that it is bacterial and not viral) & antibiotics should be well considered.

As it seems the collective opinion of the profession is that treating such cases with antibiotics is the lesser of two evils.

Sistamatic
02-21-2016, 10:19 AM
With the constant recurrence, I'd be curious about the underlying cause. Let's say it is an infection, and the antibiotics cure it, but the thing that caused the infection is still occurring.

Does he have a frequently runny nose and if so, does he blow his nose really hard?
Does he hold his nose and sneeze?
Does he wear earbuds/headphones frequently.
Do you put antimicrobial solutions in his ear frequently?

Factoids to power your intuition drive:

The cells of the ear canal divide in such a way that if the earwax is left alone, it should move outward. Often cleaning the ears has the opposite effect, in that it moves the debris further in.

People with two copies of the dry earwax gene have horribly itchy ears, especially in dry air in the winter. There are times when we would almost willingly stick a wire bottle brush in our ear for relief...in fact, it sounds effing heavenly right now. As a kid, I had a tendency to try anything and everything to scratch my ear canals, and when the ear wax built up, it did so in hard, dry balls that rattled around in my ear and made me insane. I sometimes rubbed the inside of my ears raw, and it's a miracle I never punctured my eardrum. But only a very tiny fraction of non-asians have these genes, and on top of that, it's recessive, so you need two copies to have dry earwax, so the average ENT is probably not terribly familiar with it...plus two people with wet earwax can have a kid with dry earwax....in fact, often, in non-asian populations, that recessive allele pops up for the very first time in a family that has never even heard of such a thing. If someone would have put a single drop of mineral oil in my ears as a kid, I'd have been cured. I don't express lipids in my earwax because my gene for doing that is broken. So I add a tiny little drop of oil very occasionally. It doesn't take much. Problem solved. (just don't use food oils like olive oil because they can promote the wrong bacteria thereby defeating the purpose).

Our bodies and all our orifices are teaming with bacteria and that's a good thing...if it's all going well for them, you will never know they are there. Your bacterial ecosystem is so well adapted to you that other bacteria don't stand a chance. Wipe them out though, and other bacteria can move in and cause problems. Women who douche get more vaginal infections because if you wipe out the good bacteria, bad bacteria can colonize. People who use a lot of hand sanitizer tend to get infections in their cuticles...same reason. If you wipe out your eyelash fauna, you get an eyelash infection. If you sterilize your ear...same thing.

But all that being said, once you've gotten the bad bacterial infection, antibiotics may be necessary to wipe it out. The trick is to get the good stuff back back to health after you nuke everything. Someone should invent ear probiotics, lol.

But really, the best thing you can do for your ears under most circumstances is nothing at all. http://lifehacker.com/how-to-properly-maintain-your-ears-and-earwax-1665866980

Earwax has antimicrobials in it, so it might be best to leave it alone, even if it seems too much, and see if the ears can figure it all out for themselves.

All this, of course, is assuming he doesn't have an infection only antibiotics can fix.

SheepDog
02-21-2016, 01:45 PM
My understanding is that anatomy plays a large role. One of our sons had repeated ear infections and the other didn't.

There are stories in this thread where people tell of ear issues that were prescribed antibiotics but were cured without taking them. I can tell you a story of a friend whose child had delayed speech because his constant ear infections. These are stories that probably have nothing to do with your situation. Try to ignore them, although that's probably fruitless.

I'm in the camp of getting more information. I'd be all over the DIY otoscope. Otherwise, if you don't trust your Dr., then see a different doctor, or go to a specialist to see why there's what seems to be a chronic issue.

Sir Caveat
02-21-2016, 02:11 PM
Xylitol chewing gum may prevent ear infections. (http://www.webmd.com/children/news/20111117/chew-on-this-gum-may-prevent-ear-infections)


[Also,] Because it has been shown to curb the growth of some bacteria, some dentists recommend chewing xylitol-sweetened gum to prevent cavities.

My son had frequent ear infections, so frequently that the ENT suggested we consider putting tubes in his ear drums. We didn't put tubes in. We started using xylitol nasal spray. The frequency of ear infections did taper off as he grew older. Can't say for sure if xylitol prevented any.

I didn't see the net value of insering tubes. They're supposed to avoid the accumulation of fluid in the middle ear (and consequent growth of bacteria) when the eustachian tube is blocked, such as by congestion. Since children's eustachian tubes are narrower they're more prone to blocakage. But the inserted ear drum tubes also open up another avenue for liquid (and bacteria) to enter the middle ear when your kid is in a pool or in a tub. In my son's particular case, we knew that he wouldn't tolerate the ear plugs that would be necessary in the tub or at the pool.

oxyjen
02-21-2016, 03:45 PM
That sucks. I have been super fortunate in that my kid has never had (or been diagnosed, anyway) with an ear infection. But I don't usually take him in unless a) his fever is high enough to cause serious concern (not responsive to tylenol/ibuprofen), b) persists after 3 days, c) would have distinct signs/symptoms that concern me (ear tugging, refusing to eat/drink).

I think you have to decide if you think your doctor is misdiagnosing/"overdiagnosing" ear infections, or if you are dissatisfied with the currently prescribed treatment for ear infections and the outcome you are getting. One is easily remedied by getting a second opinion or a new pedi, the other is a little trickier likely, as it seems like antibiotics and then tubes is the treatment du jour for most medical professionals.

I have heard from a few other parents whose kids have had repeated ear infections that after the diagnosis appointment, a follow-up appointment is scheduled to evaluate the ears at the close of the antibiotics to see if they are eliminated. One doctor theorized that a particularly bad case may not be cured by the one prescribed round, and thus keeps repeatedly flaring up.

Linnea
02-21-2016, 04:16 PM
I had recurring tonsillitis and ear infections as a kid. The infections went away after I had tonsillectomy in my teens. Tonsillectomy is not an option for small kids though so mentioning it here is probably rather useless. You may want to think about it later though.

I ate multiple rounds of antibiotics and still associate certain artificial strawberry flavour with penicillin.

GnarlFox
02-22-2016, 05:11 AM
I keep getting middle ear infections. They go away within a week usually, but damn are they uncomfortable. Usually not in the I'm in so much pain way. It's more like I want to put a back scratcher down my ear canal. Almost anytime I put a finger, or q-tip down in there I get one. I should probably go back to the old method of using hydrogen peroxide but it doesn't fulfill the itch.

Lurker
02-22-2016, 12:12 PM
Sistamatic, that post is probably Everything You Need to Know About the Human Ear ;)


My understanding is that anatomy plays a large role. One of our sons had repeated ear infections and the other didn't.

Mine as well. I never had an ear infection, pneumonia, or the flu as a child (or adult). From what I know, this is very unusual.


There are stories in this thread where people tell of ear issues that were prescribed antibiotics but were cured without taking them. I can tell you a story of a friend whose child had delayed speech because his constant ear infections. These are stories that probably have nothing to do with your situation. Try to ignore them, although that's probably fruitless.

I'm in the camp of getting more information. I'd be all over the DIY otoscope. Otherwise, if you don't trust your Dr., then see a different doctor, or go to a specialist to see why there's what seems to be a chronic issue.

Yes, be very paranoid about hearing loss, which certainly can delay/generally affect speech.

Just to throw this in, it may have been covered, but make sure doc isn't treating for a bacterial infection when fungus is to blame. A friend of mine was ill for months because of a careless doctor's oversight.

Senseye
02-22-2016, 05:29 PM
But really, the best thing you can do for your ears under most circumstances is nothing at all. http://lifehacker.com/how-to-properly-maintain-your-ears-and-earwax-1665866980I agree with most of this article except:


Do not try either manual removal or flushing at home. Instead, leave both of these procedures to your doctor.That's nonsense. I also suffer from excessive ear wax build up and successfully flushing my ears at home saves me probably 3-4 trips to the doctor per year. The little rubber bulbs you get in drugstore ear wax removal kits have virtually zero chance of rupturing your ear drum (you just can't generate sufficient psi using them - I personally wish they were bigger).

Keep in mind that comment comes from a doctor. Doctor's almost always have to council against self treatment because some idiot is always capable of screwing him/herself up and then suing them (if they were to say go ahead and try it) and/or it's good business to recommend as many doctor visits as possible. So you always have to take such advice and apply common sense to it. So manual flushing ok, sticking sharp objects in ear, not wise.

Sistamatic
02-22-2016, 07:01 PM
I agree with most of this article except:

That's nonsense. I also suffer from excessive ear wax build up and successfully flushing my ears at home saves me probably 3-4 trips to the doctor per year. The little rubber bulbs you get in drugstore ear wax removal kits have virtually zero chance of rupturing your ear drum (you just can't generate sufficient psi using them - I personally wish they were bigger).

Keep in mind that comment comes from a doctor. Doctor's almost always have to council against self treatment because some idiot is always capable of screwing him/herself up and then suing them (if they were to say go ahead and try it) and/or it's good business to recommend as many doctor visits as possible. So you always have to take such advice and apply common sense to it. So manual flushing ok, sticking sharp objects in ear, not wise.

I don't disagree.

I can't really offer from-experience style advice for your ear wax buildup issues. When Dry earwax builds up, you sort of do need help to get it out. It turns into a dry ball the size of a pea that bounces around and sounds like thunder as it does, and it needs to be broken up and pulled out with forceps. Oh holy crap is it irritating. But I've only had it happen a few times, and no times since I stopped trying to q-tip my ears clean based on the advice and example of all the wild-type earwax people in my life. My parents both have wet earwax (dry is recessive), so mom had no clue when it came to helping me with my itchy ears. I guess I needed this treatment: http://www.livestrong.com/article/126879-asian-ear-wax-removal/

It comes with this warning: "The ear pick is an effective tool for removing the dry, flaky wax common to East Asians. It is not as effective on the tougher wet wax common to those of European and African descent. People with gooey cerumen-laden wax should use irrigation or have a doctor remove the wax."

I had my ears irrigated by a doc once as a child when they were impacted. I remember her commenting on how odd my earwax was and lamenting that it just wouldn't come out. It went on forever and it hurt so fucking bad. I have since learned that if you have dry earwax, you must soften it with mineral oil before irrigating. Probably SOP at a doc's office in regions where dry earwax is common. Since the trait pops up every once in a while in Caucasians whose parents have never heard of it, and since I bet most Asians living in the Americas and Europe have no idea that they may not have the same earwax as the average patient there, I'm betting I'm not the only kid who went through that. It's probably not part of the OP's issue, but it is worth ruling out.

OMG, you should have seen the look on my face when I found out some people's earwax has a smell. The conversation was about those Harry Potter jelly beans. I think Stiggy said something about them being spot on, and I just couldn't imagine it. He's got wild type. Let's just say if my initial squick was any indication, you don't want to mention your smelly earwax while you are in Asia. Type "my earwax smells like" into google and see how it autocompletes. Ewwww. Please tell me none of that is normal.

Senseye
02-22-2016, 07:26 PM
I can't really offer from-experience style advice for your ear wax buildup issues. NP, I have been dealing with it for years and I have it generally under control. I don't think I have the dry earwax gene, my earwax is generally viscous in the summer and flows out ok. But in the winter, the air is so dry it tends to harden before it can get all the way down the ear canal and can form a blockage. But if I get to it early, I can knock lose any blockage by flushing and then I am good for a while. I understand most people (even in my climate) can just ignore their earwax since even if it dries out due to cold dry air it just flakes off and deals with itself. My body just seems to produce quite a bit of it, so it needs more attention

Sistamatic
02-22-2016, 08:05 PM
Practically every parent I talk to has a kid with tubes in their ears.
Did a little googling and found this 2006 article:

http://www.nytimes.com/2006/08/15/health/15brody.html?pagewanted=print&_r=0

I also looked up the current clinical guidelines for ear tube surgery in children, including risks and benefits of both doing the surgery and not doing the surgery:

http://www.guideline.gov/content.aspx?id=46909

TeresaJ
02-23-2016, 01:46 AM
Thank you! I printed out the clinical guideline for treating acute otitis media today as well as a flow chart of when it's recommended to treat otitis media with effusion with surgery and I have an appointment with the Dr on Wednesday afternoon to go over everything. I'm also bringing my otoscope.

I want to get a more certain diagnosis with at least a pneumatic otoscope. Some issues I anticipate are: that his condition is in the grey area between AOM ( antibiotics useful) and OME ( antibiotics useless). Also the long term consequences of repeated antibiotic use are not well studied. And studies on the tubes seem to be contradictory, from what I've gathered.

I'm also not clear on whether or not antibiotics contribute to recurrence vs doing nothing. In other words, yes for an acute infection antibiotics will clear it up, but then is the next infection more likely to occur or harder to beat? I need to go over the literature again...

Catoptric
02-23-2016, 03:40 AM
I'm surprised no one mentioned dairy as a major culprit to avoid (I wouldn't be surprised if most all ear infections are the result of dairy protein sensitivity.) To be sure I looked it up, and perhaps most people in general are not as sensitive to it, though their is a link. (http://nutritionfacts.org/questions/dairy-and-ear-infections/)

For some time I questioned whether it was just the result of submerging my head in bath water which created an environment suitable for ear infection to occur, and just as recently I've been wearing headphones a lot of the time when at my desk which I would assume would create similar conditions; however it will only recur with consuming dairy products. . .

I also second Robcore's advice to be weary of proscribed antibiotics (and the capabilities of Doctors in general. . .) which should be avoided unless a very serious infection is obvious requiring such a thing, though just as the lemon juice drop was suggested, regular diluted hydrogen peroxide works well. I once assumed I only ever had one myringotomy procedure for my ears when I was little, but it turned out to be 3 procedures in both of my ears, two of which I was too young to be aware of.

I should also mention that avoiding milk is one of the healthiest things anyone in a modern diet can do (just as long as you get calcium from plant based sources (http://www.pcrm.org/health/diets/vsk/vegetarian-starter-kit-calcium).) I should also mention that calcium is not the main key to bone health (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2658806/). Best of luck.

OrionzRevenge
02-23-2016, 10:20 AM
...
I'm also not clear on whether or not antibiotics contribute to recurrence vs doing nothing. In other words, yes for an acute infection antibiotics will clear it up, but then is the next infection more likely to occur or harder to beat? I need to go over the literature again...

Assuming a patient uses the Antibiotics as prescribed for the duration mandated, then nature favors a lowering of the chances of recurrence. The Antibiotics act like sending in the Calvary after your own body has been waging war against the microbes for some length of time. The inflammation or systemic immune response has already primed a healthy immune system to produce antibodies in order to nip-in-the-bud any later infections by a genetically similar microbe presenting the same surface antigens (That the Y-shaped antibodies latch on to).

Typically starting a regime of Antibiotics should produce positive results in very short order if the infection is from a susceptible bacterial invader. If not, then that's when you should start waving red flags in your doctor's face. Or if there was a marked improvement followed by a relapse while still on the Antibiotic regime as prescribed.

The biggest problem in this regard is not Doctors willy-nilly prescribing Antibiotics for Viral or Fugal infections. Because, as noted above, the ineffectual-ness of the treatment typically becomes quickly apparent in the form of an ill and irate patient.

The biggest problem are patients, with a cynical view of the medical profession, that discontinue the antibiotic regime as soon as they note improvement and don't want to risk any further use of medication.

For society as a whole, it would be much better if such persons (and the children in their care) were not prescribed antibiotics based on an interview revealing said mindset. As this is the principle mechanism by which we get antibiotic resistant super-bugs.

And when it is obvious to everyone that shit has really gone south for a patient, then there are no Antibiotic-Atheist in that foxhole and we all want that miracle drug to still have magic.

Doctors (Especially Pedis) have become more aware of the need to work in partnership with the ill & their kin, but let's not forget what they are bringing to the equation:
From the AMA

The education of physicians in the United States is lengthy and involves undergraduate education, medical school and graduate medical education. (The term "graduate medical education" [GME.page includes residency and fellowship training; the American Medical Association does not use the term "postgraduate education.")




Undergraduate education: Four years at a college or university to earn a BS or BA degree, usually with a strong emphasis on basic sciences, such as biology, chemistry, and physics (some students may enter medical school with other areas of emphasis).
Medical school (http://www.ama-assn.org/ama/pub/education-careers/becoming-physician/medical-school/preparing-medical-school.page) (undergraduate medical education): Four years of education at one of the U.S. medical schools accredited by the Liaison Committee on Medical Education (LCME). Four years at one of the LCME-accredited U.S. medical schools (http://www.lcme.org/)http://www.ama-assn.org/resources/images/icons/ico-external.gif, consisting of preclinical and clinical parts. After completing medical school, students earn their doctor of medicine degrees (MDs), although they must complete additional training before practicing on their own as a physician. (Note: Some physicians receive a doctor of osteopathic medicine [DO.page degree (http://www.aacom.org/)http://www.ama-assn.org/resources/images/icons/ico-external.gif from a college of osteopathic medicine.)
Residency program (graduate medical education): Through a national matching program (http://www.nrmp.org/)http://www.ama-assn.org/resources/images/icons/ico-external.gif, newly graduated MDs enter into a residency program (http://www.ama-assn.org/go/freida) that is three to seven years or more of professional training under the supervision of senior physician educators. The length of residency training varies depending on the medical specialty (http://www.ama-assn.org/ama/pub/education-careers/becoming-physician/choosing-specialty.page) chosen: family practice, internal medicine, and pediatrics, for example, require 3 years of training; general surgery requires 5 years. (Some refer to the first year of residency as an "internship"; the AMA no longer uses this term.)
Fellowship: One to three years of additional training in a subspecialty is an option for some doctors who want to become highly specialized in a particular field, such as gastroenterology, a subspecialty of internal medicine and of pediatrics, or child and adolescent psychiatry, a subspecialty of psychiatry.


After completing undergraduate, medical school and graduate medical education (GME), a physician still must obtain a license to practice medicine (http://www.ama-assn.org/ama/pub/education-careers/becoming-physician/medical-licensure.page) from a state or jurisdiction of the United States in which they are planning to practice. They apply for the permanent license after completing a series of exams and completing a minimum number of years of graduate medical education.


The majority of physicians also choose to become board certified, which is an optional, voluntary process. Certification ensures that the doctor has been tested to assess his or her knowledge, skills, and experience in a specialty and is deemed qualified to provide quality patient care in that specialty. There are two levels of certification through 24 specialty medical boards (http://www.abms.org/)http://www.ama-assn.org/resources/images/icons/ico-external.gif — doctors can be certified in 36 general medical specialties and in an additional 88 subspecialty fields. Most certifications must be renewed after six to 10 years, depending on the specialty.


Learning does not end when physicians complete their residency or fellowship training. Physicians must complete yearly coursework and receive a certain number of continuing medical education (CME) credits per year to ensure the doctor's knowledge and skills remain current. CME requirements vary by state, by professional organizations, and by hospital medical staff organizations. The AMA’s Education Center (http://www.ama-assn.org/ama/pub/education-careers/education-center.page) offers a wide variety of CME opportunities.

TeresaJ
02-24-2016, 03:21 AM
Debating whether it's worth my time to respond to OrionzRevenge.... The polite way to say it is that either you haven't thought this through or you think I haven't thought this through. Maybe you should look a bit deeper into mechanisms of antibiotic resistance (http://cid.oxfordjournals.org/content/46/2/155.long).



Typically starting a regime of Antibiotics should produce positive results in very short order if the infection is from a susceptible bacterial invader. If not, then that's when you should start waving red flags in your doctor's face. Or if there was a marked improvement followed by a relapse while still on the Antibiotic regime as prescribed.

Viral infections resolve on their own, so it is entirely possible that a patient taking antibiotics will get better but not through the action of the antibiotic. It is also possible that if the patient doesn't immediately get better the doctor will just prescribe more and more potent antibiotics.

And the implication that doctors have studied their asses off for years, so I should just sit down and shut up? Yeah that... that pisses me off.

...Plus the insinuation that I misuse antibiotics due to cynicism. You might want to check your assumptions.

Fitz
02-24-2016, 05:12 AM
Growing up as a kid with chronic ear infections, tubes and antibiotic shots to the ass and the current fucked up ears and malformed Eustachian tubes to prove it....If I found out my Mom ever withheld antibiotics from me while knowing I had an ear infection I'd be severely downgrading her retirement home and insisting on the cheap diapers.

OrionzRevenge
02-24-2016, 08:11 AM
Debating whether it's worth my time to respond to @OrionzRevenge (http://forums.intpcomplex.com/member.php?u=24).... The polite way to say it is that either you haven't thought this through or you think I haven't thought this through. Maybe you should look a bit deeper into mechanisms of antibiotic resistance (http://cid.oxfordjournals.org/content/46/2/155.long).



Viral infections resolve on their own, so it is entirely possible that a patient taking antibiotics will get better but not through the action of the antibiotic. It is also possible that if the patient doesn't immediately get better the doctor will just prescribe more and more potent antibiotics.

And the implication that doctors have studied their asses off for years, so I should just sit down and shut up? Yeah that... that pisses me off.

...Plus the insinuation that I misuse antibiotics due to cynicism. You might want to check your assumptions.

I know you are a parent frustrated and deeply concerned for the welfare of your child. I get that. I can even directly relate to the experience (Albeit now over 2 decades under the bridge).

These threads, I think, are intended for the larger community to digest and ponder. I'm not attacking you specifically. These are important issues that concern humanity as a whole (with regard to Antibiotic resistance due to misuse), and just good FYI with regard to childhood ear infections. Too, when you do have concerns to talk over with the doctor, being informed from several different angles will get you a more nut & bolts explanation of what the doctor is weighing vs what to make the call he or she made.

No, I'm not telling you that you should shut-up and bow to the amount of training and education it takes to get an MD in western medicine. I'm saying you shouldn't forget to consider the credibility that comes with a MD vs whatever source might contradict your doctor's diagnosis & advised treatment.

TeresaJ
02-24-2016, 12:49 PM
I know you are a parent frustrated and deeply concerned for the welfare of your child. I get that. I can even directly relate to the experience (Albeit now over 2 decades under the bridge).

These threads, I think, are intended for the larger community to digest and ponder. I'm not attacking you specifically. These are important issues that concern humanity as a whole (with regard to Antibiotic resistance due to misuse), and just good FYI with regard to childhood ear infections. Too, when you do have concerns to talk over with the doctor, being informed from several different angles will get you a more nut & bolts explanation of what the doctor is weighing vs what to make the call he or she made.

No, I'm not telling you that you should shut-up and bow to the amount of training and education it takes to get an MD in western medicine. I'm saying you shouldn't forget to consider the credibility that comes with a MD vs whatever source might contradict your doctor's diagnosis & advised treatment.

Thank you.

What worries me about doctors is: when they don't agree, when they err on the side of short term benefit vs long term risk in order to cover their asses, and when they're limited by inadequately researched interventions.

TeresaJ
02-24-2016, 11:51 PM
So his doctor took another look at his ears and said that they had some cloudy fluid toward the bottom but were not bulging and did not appear to be particularly inflamed. In other words, they do fall in the grey area between acute infection (yes antibiotics) and clear fluid (no antibiotics). She said I shouldn't have anything to worry about if I choose not to treat with antibiotics - she's not concerned about damage to the ear with that level of what may or not be a persistent mild infection. She said that in Europe they do not routinely treat ear infections with antibiotics and they don't have any issues. The only thing she would worry about is if the fluid causes him to have trouble hearing, but as long as he seems to be hearing fine and he doesn't show any signs of an acute infection (high fever, inconsolable, etc) then I should have nothing to worry about.

All of this jives with what I've been reading, so I'm going to cross mild, persistent ear infection off the list of things I worry about (it's a short list).

Other things I've established: Her otoscope is way nicer than mine. I might try a bit more to get a good picture with mine, but it doesn't have any mechanism for focusing. I might give it a few more tries but if I don't have any luck soon I'm just not going to worry about it. Also my kid hates it with a passion.

Also it was much nicer not to be in a rush. I took time off of work vs stopping by the office for a quick ear check before work. Since like 90% of his office visits have been worrying about ear infections, this should make a big difference moving forward!

Still didn't have a big discussion about the extent to which possible long term side effects of repeated doses of antibiotics on young children have r have not been studied... but I can save that for nursing school.

To be clear, I'm not anti-antibiotics. They're life-saving drugs. But I do find that our society has a strong tendency to want to eliminate all major risks at the expense of quality of life, a tendency I try to temper. Also the societal cost of overuse of antibiotics is well known, and I don't want to contribute to that if I have a choice.

Sistamatic
02-25-2016, 03:02 AM
According to the first article I posted, Eustachian tubes will elongate at around age 3 or 4 and you'll have fewer issues. This made me curious, and I found this:

http://www.ncbi.nlm.nih.gov/pubmed/6637457

Also this: https://www.bcm.edu/healthcare/care-centers/otolaryngology/conditions/eustachian-tube-dysfunction


"Young children (especially ages one to six years) are at particular risk for Eustachian tube dysfunction, serous otitis media, and acute otitis media because they have very narrow Eustachian tubes. Also, they may have adenoid enlargement that can block the opening of the Eustachian tube. Since children in daycare are highly prone to getting upper respiratory tract infections, they tend to get more ear infections compared to children that are cared for at home.

Interestingly, the anatomy of the Eustachian tube in infants and young children is different than in adults. It runs horizontally, rather than sloping downward from the middle ear. Thus, bottle-feeding should be performed with the infants' head elevated, in order to reduce the risk of milk entering the middle ear space. The horizontal course of the Eustachian tube also permits easy transfer of bacteria from the nose to the middle ear space. This is another reason that children are so prone to middle ear infections. Most children older than six years have outgrown this problem and their frequency of ear infections should drop substantially."

So I get the feeling this is temporary. I have no idea how old your youngling is. I am not a mom, so maybe everyone already knows this and I'm only just finding out about it ... including the tilting the head up while bottle feeding thing. Had no idea, and no one told me when I was taking care of the youngest brother or when I've taken care of nieces and nephew and other babies.

TeresaJ
02-25-2016, 08:53 AM
According to the first article I posted, Eustachian tubes will elongate at around age 3 or 4 and you'll have fewer issues. This made me curious, and I found this:

http://www.ncbi.nlm.nih.gov/pubmed/6637457

Also this: https://www.bcm.edu/healthcare/care-centers/otolaryngology/conditions/eustachian-tube-dysfunction



So I get the feeling this is temporary. I have no idea how old your youngling is. I am not a mom, so maybe everyone already knows this and I'm only just finding out about it ... including the tilting the head up while bottle feeding thing. Had no idea, and no one told me when I was taking care of the youngest brother or when I've taken care of nieces and nephew and other babies.

Haha yeah that came up pretty early in my research.

When something is anatomically dysfunctional it always gets me thinking about evolution. Either something in our modern lifestyle is screwing things up (early weaning, a greater variety of germs) or we're dealing with the consequences of a new evolutionary state in which genes that would have been selected against wind up surviving and propogating. Or both. So kids prone to severe ear infections would have just died young before antibiotics.

I ran into this same thing with breastfeeding. If I had lived in a pre modern village, if I was lucky then village wisdom would have known how to handle my inverted nipples (nurse some child with a strong suck even if not lactating) but if the tribe didn't have that knowledge or it didn't work well enough and if no one else was available to feed my kid then my baby would have been shit out of luck.

It's surprising to me how many aspects of our biology have a very small margin of error.

Sistamatic
02-25-2016, 05:12 PM
Haha yeah that came up pretty early in my research.

When something is anatomically dysfunctional it always gets me thinking about evolution. Either something in our modern lifestyle is screwing things up (early weaning, a greater variety of germs) or we're dealing with the consequences of a new evolutionary state in which genes that would have been selected against wind up surviving and propogating. Or both. So kids prone to severe ear infections would have just died young before antibiotics.

I ran into this same thing with breastfeeding. If I had lived in a pre modern village, if I was lucky then village wisdom would have known how to handle my inverted nipples (nurse some child with a strong suck even if not lactating) but if the tribe didn't have that knowledge or it didn't work well enough and if no one else was available to feed my kid then my baby would have been shit out of luck.

It's surprising to me how many aspects of our biology have a very small margin of error.

I was thinking the same thing...my tentative hypothesis is that our giant baby brains caused some anatomical difficulties in the head region. The pace of brain enlargement happened at too great a pace and Eustachian tubes, which had been fine just the way they were for millions of years, lacked any appreciable diversity from which to evolve solutions. Insufficient lethality, differing germs, better trained immune systems, or the fact that developmental delays are short lived may have also slowed the pace of the solution. Or perhaps the short-lived nature of the developmental delays is part of the solution. Perhaps Eustachian tube problems is a major hurtle that big brained primates had to overcome in order to exist at all, and what we are seeing now is the new improved version of a much much worse issue.

All conjecture of course, but fun to think about anyway.