Antibiotics

Nurse Dave,
What's the deal with antibiotics?
Zack, Taylor, NJ

Zack thanks for the question. The first major antibiotic discovered was penicillin. The discovery made by Alexander Fleming was that a certain kind of mold could inhibit bacterial growth. This mold contained what Fleming dubbed penicillin. This new wonder drug could actually cure disease rather than just treat it. The drug made use of the natural defense mechanisms of microbial organisms to treat infections in humans.

It might help to think of microbes as junior high students. Junior high students have to come up with various defense mechanisms against each other to survive the harsh environment. Some might turn to choir or become heavily involved in band. This way they have a safe part of the junior high school building where there is no reason to fear (kind of like how billions of bacteria make a home in the average human colon, its safe in there). Other defense mechanisms may include humor, sports, drugs, science fiction, harry potter or finding a place to hide in the library. These defense mechanisms allow the student to survive Junior High. Microbes have their own defense mechanisms they use to fight other microbes, to make antibiotics we harvest those defense mechanisms and use them to help humans.

But sadly Zack the deal is that bacteria can develop resistence to antibiotics. There are numerous bacteria out there that can't be treated with standard antibiotics. So now we must use antibiotics wisely and as prescribed or else there may be trouble in the future.

Sometimes you might feel like a woman

Nurse Dave, Last night, I received the following text from a fellow reader:

10:35 p.m. thursday night, at subway, eating an italian sub, by
myself, 'man, i feel like a woman' by shania twain blasting on the
overheads

What is your diagnosis?

Seth
Arlington, VA

Thanks for the question Seth, obviously things aren't going well for this reader. At this point in time any decision that leads you to sitting alone and listening to Shania Twain has to come into doubt. It makes me think of other situations I've observed or even been a part of. The time I spent an hour inside a Best Buy playing Mario Kart because I didn't have anything better to do. The time I saw an overweight man wearing a Batman cape sitting alone in an amusement park. The time a former roommate of mine went out back to repeatedly hit a boat with a paddle in intense frustration. The boat wasn't the problem and really the subway sandwich isn't the problem either.



My nursing diagnosis (which is an actual thing, you can look it up) would probably involve situational low self esteem, powerlessness or possibly personal identity disturbance.

Some nursing interventions that might work -
- Encourage patient to identify strengths. (This can be tough when the patient is listening to Shania Twain)
- Assist the patient to reexamine negative perceptions of the situation. (For example a comment like, "Hey that sub looks pretty good!")
- Encourage increased responsibility for self. (Sign the patient up for cooking classes, get patient to look in the mirror, etc...)
- Implement individualized strategies to provide hygiene, diet, and sleep. (A text like the one above can only mean its been days since the patient has last bathed)
- Give the patient control over his or her environment. (For example let him choose the music when riding in the backseat of your car)
- Avoid using coercive power when approaching patient. (Careful here, the urge to shake the patient and demand that he turn his life around can be pretty strong)
- Assist with creating a timetable to guide increased responsibility in the future. (Just don't give him too much responsibility too soon. I don't know if he's ready)

Good luck Seth!

Why the ice?

Dear Nurse Dave,
Why do people ice their ankles after a sprain and is there anyway you can connect the answer to Syllvester Stallone?
Robert, Hackettstown, NJ

Well the answer is pretty simple really. The ice is used to reduce swelling and pain. The cooling action of the ice actually constricts the tiny blood vessels providing blood to the ankle. Therefore less fluid is able to get out into the ankle and fewer parts of the inflammation cascade can actually occur. This reduction in swelling comforts the ankle and reduces pain. In Cliffhanger Stallone also uses ice to take care of a problem that is bothering him. But instead of using it to soothe a swollen joint, Stallone impales a guy through the chest with a giant icicle.

Kid fights!

Nurse Dave,

Thanks for the advice on Polyglandular Addisons Disease. You were right. Coldplay really does work for not getting me excited about anything.

On a completely different note, have you seen this video of two toddlers (Korean I am assuming) engaging each other in the ancient martial art of Taekwondo?



What do you think of children engaging in fighting sports at such a young age, and how would it affect their physical, mental, and emotional growth?

Bill, Slinger WI

Thanks for another great question Bill. Like most people I enjoy watching little children have adorable fights. And like most people I believe in choosing the destiny for your child at a very young age. Frank Lloyd Wright's mother decided he'd be an architect when he was born. What happened to him? Well I don't know he just became the greatest American architect ever. Tiger Woods, he started golfing at 6 months. Buzz Aldrin started with astrophysics at 3 months old. The list goes on. Just look at what's possible when you introduce an infant to reading. The sooner we set goals for our toddlers the more successful they will be and what could be more developmentally appropriate then massive success.

A word of caution though for toddler fighting, a lifetime of fighting can eventually lead to a scene like this.

My wife who is getting a master's degree in infant mental health disagrees with my opinion somewhat. She questions the wisdom of teaching toddlers to fight when they have other developmental milestones they should be working on. She also wonders what the results are of teaching a toddler that other toddlers are his enemy (though she hopes it would turn out kind of like that movie Enemy Mine).

Aliens?

Nurse Dave,
I'm just going to throw this one out there. Alien abductions. What do you think?
George, Hollister, CA

George this is an interesting question. If you were to look at it from only a mathematic or scientific perspective the answer would have to be that Aliens exist. If the universe is billions of years old, is infinite in size and constantly expanding than there would be an infinite amount of planets out there with an infinite amount of opportunities for life to exist. Logically life would have to exist elsewhere because there is an infinite amount of opportunities for it to do so.

But that only answers part of your question. I think you're talking about this and I'm more than a little skeptical. I mean why would Aliens hide their existence from us? Clearly they are more advanced if they have the technology to visit our planet. They have no reason to fear us. I think they'd probably just come down an introduce themselves rather than terrorize us with secret probes. Although then there is the terrible risk of this happening (hint: there are twins and its the second baby that really makes the scene awesome). Also how much are probes really going to teach the aliens about us. There has to be a more effective way of learning about humans and if an alien race has the technology to travel faster than light speed they probably have the ability to study humans that are more advanced than probe insertion. It seems to me that any reasonable Alien race would just introduce themselves or just ignore humans entirely.

In conclusion George I just don't believe there are aliens out there playing weird mind games with us. I would hope that an advanced alien race would have better things to do than kidnap Mulder's sister. But Travis Walton would probably disagree with me.

Basketball and Lasers

Dear Nurse Dave,
Does your knowledge of healthcare help out in picking a winner for the NCAA tournament? Also I lost my car keys. Where do you think they are?
Carl, New Haven, Connecticut

Carl I once saw a reconstruction surgery of a femur that had been broken. The surgeon ended up placing a thick metal rod through the femur to give it support. How did he get the rod in there? He took out a drill larger than anything I'd ever seen and drilled right into the head of the femur. The drill looked like a bizarrely large power tool that I'd use at home to drill gigantic holes into the dry wall. Later in the day this patient had to have woken up in a whole new world of pain. So I'd have to advise against picking any team with a star player that just broke his femur. He's not going to come back from that for a while. Also always pick a team if they have a player with the last name Laser. Unfortunately for the Eastern Illinois Panthers Tyler Laser is out for the season with a back injury that's probably why they didn't make the tournament. At least it isn't his femur.


(Tyler's head isn't tiny, its just a big hat. At least that's what I'm assuming.)

And about the keys. Pants pocket. They are always in a pocket. Check even the ones deep in your closet. You never know.

Lip Rash and Baseball

Nurse Dave,

I suffer from photosensitivity on my upper lip region. I've tried many different types of ointments and creams to treat the pinkish red skin that is sometimes accompanied with unflattering blisters but nothing seems to help my condition. I've found that the only thing that truly works has been to grow out my upper lip facial hair. This not only shields my skin from the harmful effects of the sun but also gives me a distinguished and educated look that seems to command respect wherever I go. A win, win.

I love baseball. I love watching live baseball games so as to smell the sweet aroma of fresh cut grass. My budget does not allow me to attend many professional games so I find myself strolling the local parks to watch little league baseball as often as I can. I've noticed though, that I've been getting a lot of looks from the parents that are there to watch their young sons play baseball. Could my moustache be failing at hiding my pink, photosensitive upper lip and this is why I'm getting nervous stares from my fellow baseball-lovers?

Regards,

Noble Moustache Wearer
Lehi, UT

The first thing we need to establish is that not everyone is in agreement on what a mustache means. We can thank Tom for all the positive things he's done for mustaches but we have to be aware that mustaches aren't always used for good in fact they can be used for evil. So somewhere in this confusion over mustaches I think lies your real problem.

To understand this problem we need to go back in time. In the 70's a mustache meant that you were an extremely good looking man with lots of hair on your body. In the 80's a mustache probably meant that you played professional baseball. Mustaches took a bad turn in the 90's where they suddenly began to mean that you were a creepy man looking to prey on the innocent thats why there was also an explosion in goatees in the 90's. Men have to have facial hair and if denied a mustache they'll go to a less tasteful goatee (it even happened to Tom). The problem is we're still stuck in the 90's when it comes to mustache interpretation. Sure there are plenty of hipsters sporting ironic mustaches but no one is wearing them like they did in the 70's. I think people are looking at your face through a 90's colored lens. People see you're facial hair as evidence of some degree of inner creepiness and thus the parents at the little league games aren't noticing your lip rash but are actually noticing your lip hair.

My advice to you would be to soldier on. Throughout all history nobel men have worn mustaches and we can't stop now just because a few creepy men also have worn mustaches. That'd be like refusing to wear shorts just because you heard that John Wayne Gacy Jr. loved shorts. We can't let the actions of others dictate our own fashion decisions. Just remember if someone has a problem with your mustache they don't have a problem with you, they have a problem with themselves. Either that or you could try wearing a wide brimmed hat.


(Me on my wedding day)

Worms?

Dear Nurse Dave,
I heard some people actually want to get worms, you know in their bodies. What's the deal with that? In addition could you give me your thoughts on Stallone's masterpiece Over the Top.
Kevin, Raleigh, NC

Well Kevin did you know they used to sell tapeworms as a weight loss product? Its true. But i think you're getting at something different here. The basic idea is that the human body actually lives in harmony with countless bacteria and parasites and that the relationship is mutually beneficial. Some people take this as far as actually introducing parasitic worms into their bodies to help control their immune systems. The idea is that an over active immune system can be held in check by placing more junk in the body for their immune systems to deal with. Thus introducing the worms prevents the body from having excessive allergies or other immunological disorders.

Kevin to really discuss Over the Top first we've got to talk a little bit about the Switch. All Stallone has to do is turn his hat around backwards and then he can truly focus and prepare to destroy his opponent. Just this simple act enables Stallone to make the Switch from a poor and lonely truck driver to an arm wrestling champion. A similar thing in my life is when I put my stethoscope on I become Nurse Dave and nothing can break my focus during the full body assessment.

The thing is though that Stallone isn't just trying to win an arm wrestling tournament he is also trying to win back the love of his estranged son and with the help of Kenny Loggins he is able to do it. The Switch involves Stallone putting all fear and doubt out of his mind and he prepares to rip somebody's arm off but the heart of the movie is that Stallone can't just run from his emotions he has to face them in order to win back his son. Plus Stallone has a sweet weight set in the cab of his truck so that he can bulk up his right arm. Stallone powers through this movie while overcoming the direction of Menahem Golan (director of Eagles Attack at Dawn, Enter the Ninja and Mack the Knife). Its hard to believe Stallone can pull it off but he does.

Whistling and Furniture purchasing

Dear Nurse Dave,
I went to a furniture store the other day looking for a couch. As soon as I stepped in the store a salesman introduced himself to me and I told him I was just looking around. For the next 10 minutes he followed closely behind me singing and whistling but never saying anything. Eventually I got so uncomforable with him following me and whistling that I left the store. On my way out the door he saw a coupon in my hand and asked if he could have it. Is there some kind of medical condition that would explain this salesman's bizzare, socially unacceptable behavior?
Marcy, Savannah, GA

There are many potential explanations. The salesman could have been suffering from some kind of electrolyte imbalance such as hyper or hyponatremia. Both of these conditions can affect the central nervous system leading to a sedation or other CNS changes. Imbalances in neurotransmitters could also cause bizarre behaviors. Also exposure to large of amounts of gamma radiation have been known to have strange effects on the central nervous system. But more likely than not this man simply suffers from a classic clinical case of desperation. The man obviously lacks some basic social skills required for social interaction and as time has moved on his lack of sales began to induce this clinical desperation. A common symptom of clinical desperation is distorted thought process where ideas that are obviously bad suddenly seem reasonable. This same process of thought can even occur in a normal person who is just very hungry. Suddenly McDonalds can actually sound like a good idea (this is an awesome idea). So in his mind following you closely was just a way of making himself available. The whistling was probably rationalized as a way of seeming friendly. The salesman was working with the same disorder that these guys obviously also suffer with in Provo UT. September 6, 2009: Two male subjects were knocking doors in the female area of Wyview Park. They identified themselves as missionaries. When the police arrived the two male students said they thought it was a novel way to meet girls. The only known treatment for this disorder is to ignore the person that has it but unfortunately that can sometimes just make it worse (for instance my wife initially tried to ignore my phone calls but that didn't help her).

Stallone = emotional distress?

Nurse Dave,

I think I might have Polyglandular Addison's Disease, which means I could suffer an instantaneous death triggered by sudden emotional distress.
Do you have any suggestions on how I can protect myself from situations where this may happen?
Also, what are your thoughts on the Stallone's 1986 movie "Cobra"?

Bill
Slinger, WI

Bill the first thing I would tell you is to avoid watching "Cobra" at all costs. The excitement and emotional distress that would come from a screening of that film might be too much for you to handle. Stallone gives the performance of a lifetime. He stands in the back of a pick-up truck and with a machine gun mows down guys on motorcycles. You might wonder why the motorcycle guys keep coming at him even though he is clearly going to kill them. This question would likely cause emotional distress. Also in the film Stallone has little regard for doing things "by the book" and the casual disregard for authority may cause agitation. And he holds grudges. Stallone just can't let things go until he gets the last word or kills somebody. These are not things you need in your life right now Bill (even though it is probably a 4 1/2 out of 5 star movie).

I'd have to suggest that you look for entertainment in more tame or even boring areas. For music listening I'd suggest Coldplay or anything from Toad the Wet Sprocket. For movies you've got to avoid Stallone, Paul Walker, Vin Diesel and Bruce Willis. Instead you need to focus primarily on Hugh Grant features. Television should probably be restricted to Antiques Roadshow on PBS (word of caution: it gets pretty entertaining when the person with the antique thinks it is going to be worth $20,000 and it turns out to be worth around $500).

Some other suggestions for making life have less emotional distress: go into accounting, use sunscreen, attend any free lecture that is offered in your town, get your hair done at Supercuts (they always come through with a great haircut), read books about gardening but don't actually garden and finally avoid making eye contact with anyone.

Oh here's a radio story about a guy with a similar problem to you, emotions make him pass out (its the last of the three stories in this episode). Good Luck Bill. "Music and Lyrics" is actually an okay movie if you're into that sort of thing.

Blue Bottoms?

Dear Nurse Dave,

I've been reading a lot about babies lately and I've read that Asian babies are born with blue bums. Is this true? If so, what's that about?

Thanks,
Amanda

Amanda I think you're talking about mongolian spots which contrary to the name can occur on more than just mongolian children. In fact the bluish area around the buttocks and sacrum can be common on any dark skinned child. These spots tend to fade as the child grows up and aren't a lifelong concern. Other birthmarks however can last a lifetime. Just think of port wine stains which were made famous by Mikhail Gorbachev in the 1980s.



Other causes of blueness in babies include lack of oxygen and low body temperature. In general bluish skin can probably be considered a bad thing. My personal favorite cause of bluish tint to the skin would be this.

GI Joes and Skin Rashes

Dear Nurse Dave,
If you could be any GI Joe character who would you be? Also I think I've got some kind of skin rash, what should I do?
Fred, Gary, Indiana

Thanks for the question Fred. I think the obvious choice would be Snake Eyes but there are some problems there. Snake Eyes of course looks awesome dressed in all black, wearing a cool mask and using a couple of rad ninja swords. There's no question that he is cool. Its just that he never talks and never takes his mask off. We don't know what he looks like under there and we really have no idea if he can even read. There's just too much at risk with that character. The next obvious choice would be Duke. Duke is in charge of all the missions and gets to date Scarlet. But if things go wrong than who gets all the blame? Duke does. If someone dies on the mission who carries all the guilt? Duke does. I'm not necessarily looking for all that pressure. So I would go with Flint. I'm unsure of what his rank is but I think he's second in command to Duke. He gets almost the same amount of respect, gets to wear a beret and he gets to date Lady Jay. Flint gets to be cool without all the pressure. Sure if Duke goes down then Flint is in charge but you don't expect that much from him. Plus you can't overrate his radical suspenders.


(Duke, Snake Eyes, Roadblock, Scarlet and Flint)

About the rash I'd go see a doctor or a nurse practitioner. Failing that try a high school wrestling coach they know all about rashes. Good luck with the rash Fred.