Baru-baru ini sebuah yahoogroups doktor-doktor dikejutkan dengan kematian seorang ibu yang juga kaunselor kesihatan meningal dunia selepas bersalin dirumah disebabkan pendarahan ( post partum haemorrhage [PPH] ). Kebetulan pula rumahnya di Setapak. Semasa saya mengandung anak ketiga , saya bertugas di Klinik Kesihatan Setapak dan tinggal di Setapak Gardens. Saya memang buat pemeriksaan mengandung di klinik ibu di Setapak dan ada menempah bidan kerajaan sebagai langkah berjaga-jaga , just in case saya tak sempat dikejarkan ke Hospital KL semasa nak bersalin. Pada 26 hb October 1982 awal pagi sebelum subuh saya mula sakit nak bersalin dan pada pukul 7 pagi sakitnya terlalu kuat dan dalam keadaan mungkin hadapi traffic jam, suami saya jemput bidan kerajaan kerumah dan saya mengalami home birth untuk anak saya ketiga. Mujur bidan kerajaan terlaltih itu amat cekap sebab, nak jadi cerita, anak saya susah nak keluar dan bila dah nampak kepala , masuk balik . Selepas ini berlaku kali ketiga bidan sedari bahawa ada tali pusat keliling leher bayi menghalang kelahirannya. Dia pun potong tali pusat yang belit sebelum keluarkan baby. Baby keluar pucat lesi hampir biru dan sudah tentu Apgar score rendah saat itu. Namun kecekapan bidan itu memulihkan bayi. Suami saya Dr Jaafar telah membuat suction dan sama-sama mereka pulihkan bayi. Syukur anak saya tidak ada cacat dan kini seorang pemuda salih serta tampan dan hebat kariernya . Bila saya kenang semula kisah ini, timbul kesedaran bahawa saya perlu banyak bersyukur bahawa keputusan saya untuk bersalin dirumah tidak menyebabkan kematian anak saya . Kini anak saya ada dua yang mengandung. Anak bongsu mengandung anak sulungnya, anak sulung saya mengandung anak ketiganya . Memang saya minat home birth tapi, dengan protokol cara gestapo pihak hospital dimana mereka dengan mudahnya mangambil baby untuk di masukkan ke NICU atas apa-apa alasan dan memberi antibiotik pada saat itu menyebabkan ramai ibu tidak mahu bersalin dihosital kerajaan . Apa pula halnya dengan hospital swasta?. Kawan sekolah saya Allayarham Dr Fik meninggal sebab post partum hemorrhage (PPH) selepas bersalin di hospital swasta. Hospital itu tidak lengkap untuk deal dengan PPH dan telah menghantarnya ke hospital kerajaan, sebelum sampai beliau sudah meninggal . Bukanlah semua kes begini, kebanyakkanya selamat tapi facilities yang paling lengkap di hospital kerajaan. Memang saya utarakan dalam yahoogroups tersebut , kalau ibi-ibu nak bersalin dirumah, kerajaan kena jadikan ia seselamat yang mungkin. Maternal mortality antara garis ukur WHO dalam menilai sistem kesihatan Negara dan KKM amat peka dan memantau Maternal Mortality dan saya disaat ini tetap menyuruh anak-anak saya bersalin di hospital kerajaan . Saya harap saya akan ada disisi mereka untuk menghalang taktik-taktik gestapo seperti melakukan episiotomy walapun tak koyak dan memberi pethidine serta anaesthetic walaupun tak perlu..
Month: November 2013
Antibiotics-Not the magic medicine?
“It is ironic that this humble fungus, hailed as a benefactor of mankind, may by its very success prove to be a deciding factor in the decline of the present civilization.”
-Dr. John I. Pitt, The Genus Penicillium, Academic Press, 1979
As a medical doctor, it is with mixed emotions that I write this article about antibiotics. It may seem that I have almost nothing good to say about antibiotics but I acknowledge that antibiotics have saved lives in the past when the bacterial resistance was not the big problem that it is now. Many antibiotics that I have used in the past are almost useless now because of bacterial resistance and alarming infectious states have developed because of this bacterial resistance .
Antibiotics are not the only way to treat infections as the following case might illustrate:
I saw a child of 5 years with multiple boils which were recurrent. For the past months, the child had been having crops of boils. She had seen the local general practitioner for every episode and each time was given antibiotics for the boils. Usually, week after a full course of antibiotics, the boils came back. This repeated itself again and again. Before coming to see me, she had gone to see the General practitioner again and this time was given three bottles of 3 types of antibiotics. For her mum, this was the last straw and she decided that antibiotics were not solving the problem. I took the case carefully and decided to give Arnica which is one of the remedy for crops of boils in homeopathic prescribing. On follow up several months later, the mother described the following: “After the first dose of Arnica, more boils came out but they were generally smaller and caused very little discomfort, broke open and dried up soon after. Before this, the boils would come back a short distance from the old ones but this time, there were no new boils and she had remained boil free!”
Antibiotics do kill bacteria and for boils, the culprit is certainly a bacteria. The antibiotic kills the bacteria and the patient gets better and then, the patient gets re-infected because the problem here is that the body’s immune system could not deal with the bacteria which are actually present all the time and will cause boils in susceptible people. Antibiotics are like mercenary soldiers sent in to kill the invaders when the real culprit is a poor defense mechanism. Antibiotics are usually broad spectrum which means they do not choose which bacteria to kill or inactivate, instead they kill all within the spectrum. What this means is that they can kill the commensals which inhabit our intestinal tract and are contributing to our immune system defenses. This means antibiotics may compromise the immune system and weaken it further.
We do need antibiotics in serious bacterial infections but what has happened over the years is that the antibiotics are not effectively killing the pathogenic bacteria anymore and, the bacteria are now getting resistant to antibiotics. Recurrent or frequent use of antibiotics leads to antibiotic resistance as well as proliferation of the bacteria which are not susceptible to the antibiotics used. The balance of bacteria to fungus in the gut is upset when antibiotics are used and this results in gut dysbiosis which in turn affects the immune system.
A recent report states that the last frontier of a broad spectrum antibiotic Carbapenems [i] which was the treatment of choice in hospital acquired infections is now no longer as effective since the hospital infections are now resistant even to this antibiotic.
This report has a personal meaning for me since I lost two relatives to hospital infections. An uncle who was admitted for bleeding in his gastrointestinal tract developed intermittent low grade fever after he was discharged. A few months later he was readmitted for sudden paralysis. There was an abscess in his spinal bone near his neck that had burst open. He died a few days later from septic shock. The infection that caused the abscess was acquired from the hospital when he was admitted for the gastrointestinal bleed. He had been put on antibiotics several times when he was having the low grade fever but it did not wipe out the infection.
An aunt who was diabetic had a coronary artery bypass operation and the operation was a success. She never came out of the hospital alive. The leg the vein was removed from became infected and subsequently and it was amputated. The other leg, which was perfectly good then became gangrenous and was also amputated. A week later she died of septic shock in spite of masses of antibiotics. The infection that came on after the bypass operation was a hospital acquired infection.
An adult human has three to four pounds of beneficial bacteria and yeast living within the intestines. These microbes compete for nutrients from the food eaten. The strength in numbers of beneficial bacteria keeps the ever-present yeasts in check and causes them to produce nutrients such as the B vitamins.
The use of antibiotics indiscriminately and repeatedly also causes a proliferation of yeasts in the gut. While yeasts are normal organisms in the gut, broad spectrum antibiotics kills off the beneficial bacteria and this imbalance causes the yeast to grow too much. Yeasts that grow beyond the normal balance become opportunistic organisms. As the intestinal bacteria die, yeasts thrive, especially when their dietary needs are met and yeasts thrive on sugar. They can use their hyphae to pierce holes through the lining of the intestinal wall. This results in leaky gut syndrome. Given their ability kill beneficial bacteria and upset the flora and fauna balance in the gut, antibiotics are also likely contribute to leaky gut syndrome.
It may also be that parasitic yeasts can also cause change in food likes and cravings and it may make a person want to binge on carbohydrates including pasta, bread, sugar, potatoes. This would indeed cause weight gain and all the health complications than come along with it.
The leaky gut also causes food allergies since the partly digested food can pass straight to the blood stream via the ‘holes’ in the gut. When these particles circulate in the blood, the body’s immune system identifies them as foreign bodies and hence attacks them causing food allergies and all its related reactions.
Even if we did not take antibiotics for any infections that we have, we are still faced with the fact that the animals we consume are routinely given antibiotics in their feeds and antibiotics are present in their meat! A solution to this would be to take organic meats and to buy meats which are certified antibiotic residue free.
I would not be fair to the reader if I did not offer my solutions to the problems resulting from antibiotics. I list below some of my suggestions.
1. Build up the body’s immunity by making sure we take prebiotics daily to feed our healthy gut bacteria and avoid taking processed foods which contain a lot of sugars. Sugar feeds the fungus, cellulose feeds the bad bacteria and insoluble sugars feed the good bacteria. Some good insoluble fibres are gum Arabic, lactulose and pectin. Making sure we have a balance of complex carbohydrates and adequate protein in the diet adds to our defenses and it would not hurt to exercise a little too!
2. Take probiotics after every course of antibiotics to build the body’s bacteria level back up and maybe even take some natural probiotic foods like kimchi and yoghurt.
3. Ask your doctor to prescribe nystatin to take along with your course of antibiotics since they keep the fungal population under control.
4. Go for natural treatments like Homeopathy, Acupuncture, Cellular resonance treatments, Magnetic pulse therapies rather than use antibiotics. These methods act through the body’s own defense mechanism to over the infection.
Nak rawat guna antibiotik ke?
Saya pernah merawat seorang kanak-kanak perempuan berumur 5 tahun yang mendapat bisul api satu badan berulang-ulang dengan mengunakan ubat homeopathy . Bisulnya keluar juga selepas rawatan homeopathy dan ibunya nampak perbezaan dalam cara bisul keluar selepas makan ubat homeopathy. Bisul semakin kecil dan cepat pecah serta kering. Lepas seminggu bisul terus hilang dan tidak datang semula. Sebelum itu dia mendapat rawatan dari klinik swasta. Setiap bulan keluar bisul kadang-kadang dua kali sebulan. Setiap kali anak itu akan diberitakan antibiotik dan ibunya memberi sehingga habis. Sebaik saja habis bisul datang lagi . Kali terakhir sebelum jumpa saya, doktor telah memberikan anak itu tiga jenis antibiotik dalam tiga botol untuk makan serentak . Waktu itulah ibunya rasakan dia perlu cuba cara lain dan berjumpa dengan saya . Kesian doktor tu, dia tak tahu cara lain untuk merawat. Bisul timbul sebab kuman dan rawatan paling wajar dalam pengetahuan dia adalah antibiotik sebab antibiotik bunuh kuman. Namun soalan yang tidak terjawab , kenapa kuman itu datang semula ?
Antibiotik ibarat askar upahan yang digajikan untuk bunuh musuh namun bila tamat tempoh perkhidmatan maka tamatlah kerjanya . Bila sempadan lemah, musuh serang semula . Maka, apa yang patut dirawat, sempadan atau pangil askar upahan ? Dalam kes anak ini, sempadan maksudnya sistem immune. Sistem immune yang lemah dan perlu dirawat .
Ubat homeopathy tidak bunuh kuman , ubat homeopathy menolong badan kukuhkan sistem immune dan yang nyahkan kuman adalah sistem immune badan sendiri .
Kalau kita cuba bunuh kuman dengan antibiotik, ibarat askar upahan dengan senapang bazooka dan semua ditembak mati, kuman pathogen dan juga kuman comensal ie kuman baik yang menolong sistem immune badan. Kuman-kuman lactobacillus yang dudukki usus kita amat penting dalam sistem immune badan tapi inipun bunuh oleh antibiotik.
Memang ada tempat untuk guna antibiotik dan antibiotik ada kalanya amat diperlukan tapi bukan untuk setiap demam selsema dan bukan untuk setiap kes tonsil bengkak dan bukan untuk kes setiap jerawat dan bisul.