Antibiotic use in livestock going up, up, up

By Avinash Kar, NRDC health attorney 

Posted April 10, 2015

This morning, the U.S. Food and Drug Administration (FDA) released the latest report on sales of antibiotics for livestock use, that is, for use in meat and poultry production in 2013. The news follows the trends of the last few years, showing yet another increase in the numbers. Some lowlights:

• Livestock antibiotic sales have gone up from about 16,115 tons in 2012 to a little over 16,300 tons in 2013, an increase of 1% (see Table 9).
• Use of antibiotic classes that are considered important in human medicine has increased even more, from about 9,800 tons to nearly 10,140 tons, an increase of 3% or 3 times the rate of the growth in overall livestock antibiotic use (see Table 10). Approximately 70% of medically important antibiotics sold in the US are sold for livestock use.
• About 95% of the medically important antibiotics sold are added to the food and water of animals, up slightly from 94% in 2012 (see Table 4). Since 2009, feed and water use has grown faster than any other kinds of uses, all of which have declined (see Table 11a).

Use of medically antibiotics to produce meat and poultry is troubling because when the antibiotics are routinely given to herds and flocks of animals, some bacteria become resistant to the antibiotics. When these "superbugs" multiply and spread, they threaten people's health by contributing to the growing crisis of antibiotic resistance. Antibiotic-resistant infections can result in longer illnesses, more hospitalizations, the use of antibiotics with greater side-effects, and even death when treatments fail. Growing resistance also puts complicated medical procedures such as heart surgery, organ transplants, and chemotherapy in jeopardy, because they rely on the availability of effective antibiotics.

Overuse of antibiotics by both humans and in food animals contributes to the problem. The Centers for Disease Control and Prevention has been blunt about the seriousness of the threat, calling antibiotic resistance one of the five greatest health threats facing the nation.

The trend of increasing antibiotic use in meat and poultry production continues to throw into relief the inadequacy of the federal approach to antibiotic overuse in industrial meat and poultry production. Both the recent National Action Plan For Combating Antibiotic-Resistant Bacteria and the FDA's voluntary guidance, on which the National Action Plan relies, fail to stop the routine use of antibiotics in animal feed and water as a substitute for better animal husbandry. Even the pharmaceutical industry says that they don't expect FDA's guidance to make a significant dent in sales or use.

That's because FDA's guidance has a giant loophole. The FDA guidance seeks to stop the routine use of antibiotics in meat and poultry production to speed up animal growth but would not stop the overlapping routine uses of antibiotics to counter the disease risks that are exacerbated by crowded, stressful, and often unsanitary conditions. Because "growth promotion" and "disease prevention" uses overlap significantly, stopping only growth promotion uses would allow the continued routine use of antibiotics at low doses in the feed and water of large numbers of animals that are not sick. We need the federal government to do better with real action that stops meat and poultry producers from misusing these life-saving drugs, but no such action is on the horizon.

This is why we need leadership from the states. In California, Senator Jerry Hill has introduced a bill concerning the livestock use of antibiotics. That bill currently replicates the federal loophole. We are working closely with the Senator's office to close the loophole. Bills to stop the routine use of antibiotics in meat and poultry production have also been introduced in Maryland, Oregon, and Minnesota this year. In the absence of meaningful federal action, states need to step up and lead the way.

Resuming Normal Activities after Hip Replacement

Once you get home, you should stay active. The key is to not do too much, too soon. While you can expect some good days and some bad days, you should notice a gradual improvement over time. Generally, the following guidelines will apply:

Weight Bearing

Follow your doctor's specific instructions about the use of a cane, walker, or crutches and when you can put weight on the leg. Full weight bearing may be allowed immediately or may be delayed by several weeks depending on the type of hip replacement you have undergone and your doctor's instructions.

Driving

In most cases, it is safe to resume driving when you are no longer taking narcotic pain medication, and when your strength and reflexes have returned to a more normal state. Your doctor will help you determine when it is safe to resume driving.

Sexual Activity

Please consult your doctor about how soon you can safely resume sexual activity. Depending on your condition, you may be able to resume sexual activity within several weeks after surgery.

Sleeping Positions

Depending on your surgery, your doctor may ask you to avoid certain sleeping positions or to sleep with a pillow between your legs for a length of time. Ask your doctor which sleeping positions are safest and most appropriate for you.

Return to Work

Depending on the type of activities you do on the job and the speed of your recovery, it may be several weeks before you are able to return to work. Your doctor will advise you when it is safe to resume your normal work activities.

Sports and Exercise

Continue to do the exercises prescribed by your physical therapist for at least 2 months after surgery. In some cases, your doctor may recommend riding a stationary bicycle to help maintain muscle tone and keep your hip flexible.

As soon as your doctor gives you the go-ahead, you can return to many of the sports activities you enjoyed before your hip replacement:

• Walk as much as you would like, but remember that walking is no substitute for the exercises prescribed by your doctor and physical therapist.
• Swimming is an excellent low-impact activity after a total hip replacement; you can begin as soon as the sutures have been removed and the wound is healed.
• In general, lower impact fitness activities such as golfing, bicycling, and light tennis, put less stress on your hip joint and are preferable over high-impact activities such as jogging, racquetball and skiing.

Air Travel

Pressure changes and immobility may cause your hip joint to swell, especially if it is just healing. Ask your doctor before you travel on an airplane. When going through security, be aware that the sensitivity of metal detectors varies and your artificial joint may cause an alarm. Tell the screener about your artificial joint before going through the metal detector. You may also wish to carry a medical alert card to show the airport screener.

Dos and Don'ts To Protect Your New Hip

Dos and don'ts (precautions) vary depending on your doctor's surgical technique. Your doctor and physical therapist will provide you with a list of dos and don'ts to remember with your new hip. These precautions will help to prevent the new joint from dislocating and ensure proper healing. Here are some of the most common precautions:

The Don'ts

• Don't cross your legs at the knees for at least 6 to 8 weeks.
• Don't bring your knee up higher than your hip.
• Don't lean forward while sitting or as you sit down.
• Don't try to pick up something on the floor while you are sitting.
• Don't turn your feet excessively inward or outward when you bend down.
• Don't reach down to pull up blankets when lying in bed.
• Don't bend at the waist beyond 90 degrees.

The Spark People Infographic

The Dos

• Do keep the leg facing forward.
• Do keep the affected leg in front as you sit or stand.
• Do use a high kitchen or barstool in the kitchen.
• Do kneel on the knee on the operated leg (the bad side).
• Do use ice to reduce pain and swelling, but remember that ice will diminish sensation. Don't apply ice directly to the skin; use an ice pack or wrap it in a damp towel.
• Do apply heat before exercising to assist with range of motion. Use a heating pad or hot, damp towel for 15 to 20 minutes.
• Do cut back on your exercises if your muscles begin to ache, but don't stop doing them!

Sources:
American Academy of Orthopaedic Surgeons
The Spark People Infographic

"Terminal" breast cancer survivor channels recovery through writing

With National Cancer Research Month approaching in May, as well as National Women's Health Week from May 10-16, millions of people in the United States affected by cancer will be reflecting on this life-threatening illness.

After doctors diagnosed her advanced-stage breast cancer as terminal, San Francisco Bay-area author Alice Salerno started writing as a means of channeling a life parallel to the seemingly shortened one she was currently living. Following her diagnosis and throughout planning for inevitable hospice care, Salerno maintained a positive outlook on life and her continued personal interest investigating hopeful intimations of quantum physics, which ultimately developed into a new fantasy novel, "Jennifer Arthur and All the Gone."

Salerno’s masterfully created world in "Jennifer Arthur and All the Gone" reaches out to readers with a subtle invitation for them to color their own worlds with creatively positive thought patterns. Aiming to alleviate the alarming rate among young people toward destructive relationships and even near-epidemic suicides, she hopes to counteract the overwhelmingly dystopian trend in much of today’s literature.

“It appears more and more certain that we create, both in our personal worlds and our entire world, what we give our attention to,” Salerno said.

Despite forgoing radiation and chemotherapy treatment in hopes of a better quality of life, Salerno is in her 80s and miraculously living out her senior years cancer-free. She is now in three research programs with doctors to determine how she beat the odds.

Half of Home Projects in America Left Unfinished

HomeAdvisor Releases 2015 True Cost Report

April 6, 2015 (Golden, Colo.) – Almost half of homeowners put off home projects when they don’t have reliable cost information, according to HomeAdvisor’s 2015 True Cost Report*. The report provides insight into how cost influences homeowners’ approach to home projects, as well as the struggles homeowners face in planning and budgeting for projects. The report, comprised of data submitted to HomeAdvisor’s website and True Cost Guide, as well as results from a recent survey* conducted among homeowners, also includes an interactive infographic that compares costs for more than 50 home projects at the local and national level.

Leah Ingram

“What the report uncovered is that homeowners want a better way to research home project costs,” said HomeAdvisor’s personal finance expert, Leah Ingram. “More than a third of homeowners don’t know how much it will cost to hire a professional for home projects and sixty eight percent of homeowners are concerned about overpaying without a reliable source for cost information.”

Highlights of the 2015 True Cost Report include:

• Two thirds of homeowners are concerned about overpaying for a home project, and more than one third of homeowners don’t know how much it will cost to hire a professional for home projects.
• The majority of homeowners paid for recent projects with available funds as opposed to financing.
• Homeowners plan to spend roughly the same amount on home projects in the upcoming year as in the past year.
• Women are significantly more concerned about overpaying and finding a reliable cost source than men.
• Millennial homeowners, more than any other group, either put off a project when they don’t know how much it will cost or attempt to complete the project on their own.
• When asked to provide estimates for home projects, homeowners have a tendency to estimate that projects cost less than the actual cost.

The True Cost Report interactive infographic includes current cost trends for more than 50 popular home projects. Project cost trend highlights include:

• Homeowners paid the most for a bathroom remodel in San Francisco, Los Angeles, Memphis and San Diego.
• The average national cost of painting a home exterior is $2,500, with most homeowners spending between $1,500 and $3,600.
• The average national cost of remodeling a kitchen is $19,935, with most homeowners paying between $10,957 and $30,000. 


Click here to see the full 2015 True Cost report.

True Cost Guide gives homeowners guidance on what they can expect to pay for home projects in their local area by providing cost information for more than 350 projects based on  data reported by real homeowners.

About HomeAdvisor

HomeAdvisor.com is a local services home improvement marketplace providing homeowners the tools and resources for home repair, maintenance, and improvement projects. HomeAdvisor’s patented ProFinder technology matches homeowner’s projects to the nation’s largest network of over 85,000 pre-screened home professionals; Pro Reviews lets homeowners read verified customer reviews of home professionals; Instant Booking allows homeowners to schedule services with background-checked home professionals online, as well as see pricing for jobs prior to booking; True Cost Guide provides the average cost of home projects coast-to-coast based on data from real homeowners; and the interior design app DesignMine provides an inspirational and collaborative platform for remodeling projects. Additionally, the field service management software mHelpDesk helps professionals streamline their business through scheduling, managing, and invoicing tools. Access to all of HomeAdvisor’s resources is free for homeowners, with no membership or fees required. HomeAdvisor is based in Golden, Colo., and is an operating business of IAC (NASDAQ: IACI).

*Data included in the True Cost Report is based on the number of service requests submitted through HomeAdvisor.com from March 1, 2014-March 1, 2015; project cost data submitted to True Cost Guide from April 4, 2008- March 1, 2015; and a survey conducted by Hanover Research on behalf of HomeAdvisor. The survey was conducted among 367 homeowners, age 25 or older, from February 2-4, 2015. All survey participants were involved in purchasing decisions related to home maintenance and improvement projects completed in the last 12 months.

Hip replacement - Three weeks

My hip replacement occurred three weeks ago.  Usually I would have seen a doctor after two weeks. Last week I contacted a Boise surgeon's office who told me that he wouldn't need to see me unless I was having problems. Then I called my surgeon's office in Utah.  The nurse told me after three weeks I could take the outer bandage off and start showering with my wound open.  The steri-strips that hold the incision together would fall off on their own.

I've been showering almost daily since the hospital with my wound covered by a plastic. Today I pulled off the outer gauze and with it came two of the six steri-strips. It was the first time I saw my incision which is about six inches long.  It looks like a purple marker was used to show the surgeon where to cut. It seems to be healing well. Completely closed, with no redness and no swelling. It was nice to shower without having to apply a plastic cover.  The AquaGuard plastic covers left a brown film of glue in a square that is about 8 1/2 by 11. It will take a couple of showers before that comes off and before the rest of the steri-strips come off.

Nexcare gives the following instructions for removing steri-strips:

"Peel the both edges of the steri-strips towards the incision. Once you peel the sides up, begin at the top and remove them gently from the top to the bottom of the incision. Some dead skin may come off with thesteri-strips. It is not recommended to remove steri-strips like you would a normal bandaid."

I'm now have nine pills left, enough for three days.  Maybe I can stretch them further.  My thigh stings almost constantly, although it is much better when I am rested. My ankle also hurts from the stress. Yesterday I overdid physical therapy and then strained myself closing a window when I got home. I was miserable for most of the day. At about 10 p.m. I was cold and so my son made me pepperiment tea and I got into bed.  I slept for a few minutes then watched some television.  About 11 p.m. I took a pill and ate a peanut butter and jam sandwich.  I still couldn't sleep so I spent about 2 hours grading.  Finally I fell asleep. Two hors later I was awake and in pain so I watched more TV.  I saw the 1941 movie "Yankee in the RAF" with Tyrone Power and Betty Grable.  His character Tim Baker was such a selfish jerk. Betty Grable as Carol Brown was as beautiful as ever, although she looked a little chunky and short on my flat screen.

When the movie was over I turned on BBC TV and learned that a plane had crashed in the French Alps flying from Barcelona to Dusseldorf. Last year my wife and I spent seven days in Barcelona, flying in from Paris and departing for Milan before going to the Balkans. It was surreal to see a plane crashing on almost the same route we flew.

At 7:30 a.m. I was finally so tired I went to sleep. I woke up at 9:30 when my wife called me.