Dear Concerned,
MRSA, or methicillin resistant Staphylococcus aureus, refers to a particular strain of bacteria that has developed a resistance to standard penicillin products. This may be a result of physician overprescribing of antibiotics and the gradual trend towards bacteria developing resistant genes. It has been in the press quite a bit lately secondary to its prevalence among athletic teams. Several members of an area football team, in fact, have been plagued with skin abscesses directly attributable to MRSA. Most commonly, MRSA affects the skin and causes large, often painful abscesses that often need formal drainage in order to heal. More virulent strains may affect immune compromised patients resulting in possible severe pneumonia or infections of the bloodstream. Generally, MRSA is spread via direct contact with a lesion, but many patients are nasal carriers who risk spreading it to others in close quarters. Nationally, most strains appear to be sensitive to antibiotic treatment with either sulfa drugs or clindamycin. I usually suggest treatment of the nostrils to eradicate a potential carrier state. Oftentimes, I treat family members as well. Recurrences are not uncommon and usually demand further intervention. Dear Dr. Spence, My friends have suggested B12 injections to "cure" my fatigue. What do you think? Signed, Sick and tired Dear Sick and Tired, Older physicians still utilize B12 injections as a way to boost energy. The reality is that no study has ever shown a confirmed benefit from B12 unless the patient has a true deficiency. I regularly check patients for B12 problems regardless of age. I have been shocked at how prevalent the condition is, especially in those with complaints of fatigue. Studies suggest 15 % of the population has a low B12 level. We are grossly undertreating this condition in my opinion. Of those I screen, close to 80% have a deficiency. B12 deficiency can result in fatigue, anemia, neurologic change resembling dementia, and general nerve damage. It is suspected that the deficiency stems from problems of malabsorption in the gut, a condition that becomes more demonstrable as one ages. For this reason, most physicians have relied on 1000 microgram injections each month in order to bypass the gut altogether. A reasonable alternative is to supplement with daily 1000 microgram pills (available over the counter). It appears that equivalent levels can be achieved with either the oral or injectable form; many may opt for pills to avoid a painful injection. I suggest close follow-up with B12 monitoring to ensure an adequate dosing regimen. Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.
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