Sepsis has high fatality rate
DEAR DR. DONOHUE: My brother recently died from sepsis. He went to the hospital with a simple stomach ailment. Since his death, I have heard of more than 20 people contracting sepsis in a hospital and dying. Why does this deadly infection occur in hospitals, and what is being done to clean up this mess? — J.B.
ANSWER: You have my sincere sympathy on the death of your brother. I don’t know the details of his stomach ailment, so I can’t comment on that. I can give you some information on sepsis.
More than half a million cases of sepsis occur yearly in the United States, and not all of them are associated with hospitals. Pneumonia, frequently acquired in the community, is a large cause of sepsis. Sepsis is a severe infection that causes extensive body inflammation and organ malfunction. Usually it comes from bacteria entering the bloodstream. Since so many hospitalized patients must have intravenous devices or must have surgery where the skin has to be cut, bacteria find their way into the blood in the hospitalized population. Hospitals are keenly aware of the problem and have infection control committees dedicated to ferreting out the causes of infections — including sepsis — and preventing them. That their results haven’t eradicated the problem isn’t for lack of trying.
A blood infection has many serious complications. The heart races, and breathing becomes labored and rapid. Blood pressure drops. The heart, kidney and liver falter, and often fail. The mortality rate from sepsis ranges from 20 percent to 50 percent, even when antibiotics are given in large doses and other medicines are administered to bolster the heart and boost blood pressure.
New techniques are constantly being evaluated to eliminate sepsis and improve its treatment. A 100 percent solution to this problem has yet to be found.
DEAR DR. DONOHUE: My letter is about my high level of uric acid and the gout that it causes. A specialist recommended Uloric tablets. I need a different medicine. I read the side effects of Uloric. They said the patient could develop a rash, shortness of breath or neurological symptoms suggesting a stroke. It’s important that I take a medicine that’s safe and not so expensive. — L.S.
ANSWER: Uloric is the first new gout medicine to appear in 40 years. The same side effects you read for Uloric apply to many, many medicines. You won’t find an effective drug that has no side effects. Even aspirin, something everyone takes without thinking about it, can irritate the stomach, cause an ulcer and lead to bleeding. Penicillin, one of the oldest and safest antibiotics, causes deaths every year. You have to realize that illnesses have side effects, and treating those illnesses with medicines is always a matter of some risk.
Gout poses a danger of heart disease. Gout, therefore, is more than a painful joint disease, and medicines are essential for its control.
Gout requires two different kinds of medicine — one for the acute attack, and another for prevention of recurrent attacks. Uloric is a preventive medicine. Allopurinol (Zyloprim), a preventive medicine, stops the production of uric acid just as Uloric does. It’s been around for a very long time, and most patients tolerate it well. Probenecid, another preventive medicine, increases the elimination of uric acid into the urine. It, too, has had years of experience with large numbers of people. Both of these medicines are less costly than Uloric.
DEAR DR. DONOHUE: I have a report that says I have osteoporosis in my left hip and that it has a high risk of fracture. My lumbar spine (lower back) has osteopenia with an increased fracture risk. What’s the difference between the two? And what is hyperlipidemia? — M.M.
ANSWER: Osteoporosis is the illness in which bones have lost most of their calcium and their strength. Osteopenia is a step below osteoporosis. It’s not the illness, but it’s a milestone on the road to osteoporosis. Both require vitamin D and calcium. Your doctor will talk to you about the need for medicines.
“Hyperlipidemia” means a too-high level of total cholesterol, LDL cholesterol (bad cholesterol) or triglycerides (fats in the blood). It also can mean a too-low level of HDL cholesterol (good cholesterol).
Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.