Dateline Health Show 479: Sepsis – Causes, Treatment, and Prevention

welcome to Dateline health this is Fred Lippmann coming to you from Nova Southeastern University and you know we always take our show topics from you the audience and people asked us about something called sepsis that causes treatment and prevention and I have two experts here I have dr. Jill Wallace Ross who is the assistant dean of the college of automatic medicine the Quran C Patel college of osteopathic medicine and she's the assistant dean for clinical education she's sitting right in front of me welcome thank you so much for having me dr. Lipman it's a pleasure to be here and someone that you've seen a number of times and we were talking about Zika yeah remember yes and you know everybody's forgotten the secret crisis but it's still around it's dr. Bindu Maya who is a professor of microbiology in the College of Medical Sciences welcome doctor thank you pleasure to be here good to have you so dr. Wallace Ross what is sepsis thank you for asking so sepsis is an overall response of the body to infection to the point where there is an organ damage or damage to the body in ways that sometimes can be fixed and sometimes can't be fixed there's a whole cascade of responses in the body to an infection that occur and as a result these the normal processes in the body go awry in a variety of ways so what happens with sepsis is somebody gets an infection and it starts to affect the entire body and a lot of the different organ systems in ways that can cause damage that are not expected when you first see somebody with a fever or a sore throat so dr. Bindu my you know a young professor of microbiology but I see in essence the issues of microbiology really also garnering the the required knowledge of biochemistry you're absolutely right so I'll start out by saying that was a great way of putting it describing sepsis so the old definitions definition is important because it allows it gives us direction to go to it so the old definition used to be that sepsis is a systemic inflammatory response syndrome that is created by the host that responds to the infection and this response is insufficient to clear the infection so in 2016 understanding that definition is so critical to give us to point us towards care in 2016 Europe the European Society of critical care medicine and intensive care medicine convened about 19 specialists and pulmonology Surgery infectious disease and critical care and came up with the new definition and the new definition says that sepsis is a life-threatening organ dysfunction that is due to it dysregulated host response to infection so much is packed into that definition what it tells us is it's life-threatening yes what it tells us is that the organs start failing and why the organs start failing is because there is a dysregulated response from our body towards the infection so this definition points us to it's better care and why did we come up with this new definition precisely what you ask me we understand so much more about the pathobiology of the infection so we understand better the immunology the microbiology the biochemistry the organ system itself how it functions what its morphology is the circulatory system all of this contributes to pathobiology so with this new understanding we've come up with this new definition and it points us towards better Diagnostics because we realized that we have to diagnose quickly if we speed up our Diagnostics then we also speed up how quickly we treat the patient and really exponentially increases the resolution rate you know this is something the reason I brought this topic to the show and so as we did a you know our viewers a pretty interesting and things they hear something oh so and so my my brother my my sister my child whatever ends up in a hospital you know with whatever a cut or gash or whatever where they were in a fall an accident and all of a sudden you know something's gone wrong and and the doctor says your person your child your brother your sister whatever has sepsis and and they asked me the question what is sepsis and that's why I brought you here dr. Joe Wallace Ross you know I would assume that the normal natural intervention into treating sepsis is starting to use certain antibiotics and things of that nature so let's talk about it sure so it with sepsis the first part that that dr. Maya was talking about in terms of defining what sepsis is is identifying that somebody is at risk for it or does have it so we would like to try to prevent it and catch people who are at risk beforehand however if somebody does have sepsis there's a lot of treatment that would go into the care with the understanding that it is of an infectious nature if the specific bacteria can be identified by doing blood cultures or other tests and we have rapid tests now that can help to identify the specific organism then yes the appropriate antibiotics would be provided to help to get rid of that infection bacterial could potentially be viral or otherwise in addition to that because the organ systems have damaged their maybe need for a lot of other things especially fluids when you have the damage to the blood vessels themselves they become very leaky so you need to make sure that the person has enough fluid within their blood system in order to provide circulation so generally somebody would need antibiotics fluids their blood pressure may be low so they might need medicines to increase their blood pressure their respiratory rate may be so decreased that they need outside assistance to help with breathing and need to have intubation or other external help with breathing and any other issues that occur if there's kidney damage somebody might need dialysis if there's liver damage they may need medications to help treat that component so depending on the outcome for that individual patient the treatment would be centered around that but it's very team oriented and multifactorial in the approach as there are so many components that can happen in so many organ systems that can be affected by sepsis you know I I just I can relate to do exactly what you're saying because I had a very close friend who was on a an escalator and somehow piece of luggage slept and went to get it and he came down on the escalator and gashed his thigh and you know and in the hospital they did what they had to do but after a couple of days the the gash was you know I don't know what to say but ugly so they started to debride it but that was the beginning of a sepsis involvement and he was I think he was very very fortunate in the fact that they had a very valuable infectious disease doctor inside that hospital if it wasn't for that ID person that infectious disease person my friend would not be alive today so really doctor my what's happening is it it involved all of the entities that you enumerated because it isn't just knowing what the organism is is as you have to know what the organism has done to certain organs in the body because the body is only trying to protect itself correct so I I do want to continue with dr. Jill Wallace Ross said the therapies itself are pretty complex what that means is you need aggressive early antibiotic intervention and typically that's a broad-spectrum antibiotic you have vasopressors over to and also you have to address the hypertension so fluid resuscitation so all of this adds to the cost of healthcare oftentimes patients with sepsis also have a prolonged stay in the hospital specifically in the ICU so if you consider just our healthcare costs here in the United States for sepsis patients it exceeds twenty billion dollars in a year that's a lot of money and more than 60% of patients will get re hospitalized within 30 days and that alone that rehospitalization alone costs over two billion dollars so there's a lot of care that goes into addressing a patient with sepsis while they are fighting sepsis but there is something that happens beyond resolution so let's say a patient comes in with sepsis it's addressed is cured of the substance incident what happens afterwards is oftentimes they are left with long term consequences physical psychological sometimes cognitive disabilities and all of these have significant implications when you consider healthcare and maybe even their social interactions there there was a paper that came out in 2016 in JAMA psychiatry that found a link between infections that you see in sepsis and the development of psychiatric disorders and also so your behavior so we of course need to do more studies to really investigate how strong this linkages and what what does this mean for us to follow up for these patients but we are learning a lot now about what exactly sepsis is and what that means for us is we can intervene early but we can also follow up and provide care as and when needed you know it's very interesting because again I refer to this person that I that I've known for a long time and it's been a seven-month that and I can understand you know intellectually psychologically and otherwise how how heavy that is on the individuals psyche this whole issue of sepsis the reason I wanted to bring it to the people out here is because I we heard so many comments from individuals you know we all hear of the elderly having you know seeping wounds and what otherwise which are based upon the aging of the the aging process but sepsis is so concomitant with active adults that we've heard it about I can't believe my son has been you know hospitalized five times six times I can't believe my niece has been hospitalized ten times over the last eight months and those are the comments that we heard so I figured well let's talk about sepsis it's not a very you know it's not something that's normally talked about but you know that's what this program is all about dr. jill wallace ross go ahead so one of I'm glad that you brought this topic up because I think that there is a big misconception about who is at risk for sepsis that we tend to think of a skin wound first and foremost that it has to come from an actual cut that the bacteria has to come in from that point of entry which is how it can happen but not the only way it could happen and there's a whole host of vulnerable populations that exist that are not just the elderly and just because someone is elderly doesn't necessarily mean that they're at risk just because they have an advanced age so some of the things that predisposed somebody to be at risk for sepsis are other things that would be wrong with their immune system so for instance if there is an immune deficiency of any kind whether it's an acquired deficiency like something like HIV or something that was and you know that they were born with an immune deficiency because there are a few genetic ones of those that would be something that would put them at risk for sepsis because their body doesn't have the ability to fight off the infection as robustly as somebody who has a healthy immune system likewise somebody who has diabetes say you have a six year old child who was diagnosed with diabetes it's not because of their their diet it's because of their pancreas doesn't work but the effect of diabetes on the body affects the immune system and so and the damage that happens with too much sugar within the blood system within the blood stream with the cells it causes damage so people with diabetes have a baseline level of inflammation and damage already so then when you put in an infection on top of that the body has a hyper response to it not all the time but in these people who are susceptible also individuals who have respiratory conditions such as asthma eczema emphysema rather and COPD those kinds of things can predispose somebody to get an infection in the first place within the respiratory tract which can then you know spread to the rest of the body to become sepsis so there's a lot a lot more people out there who could be at risk not just the elderly so it's important to think about the other populations in addition there's a lot of ways for us to prevent herself from getting sick to begin with from getting these infections that could lead to sepsis these are the simple easy things like staying away from somebody who's sick washing your hands and being careful about places where you go like the grocery store public places like the movie theater where you're touching and interacting with other people those are times where you really need to make sure you wash your hands so that you don't accidentally give yourself a simple sore throat which can then escalate to something a whole lot worse you happen to be vulnerable well I'm glad you brought that up because you know I I think you know going back I think three years ago when we had that that very interesting variant of flu when all of a sudden now you you got all these you know a Purell type of him sanitizers I mean we have them all over the university but you know when you really think of it you know and you watch the nurse professionals that are in critical care units and ICU is they're constantly washing in when they're in washing out when they leave and that's the reason because of the the transference of bacterial material which you don't see but is there correct right absolutely so to carry on where dr. Wallace Ross left off anyone technically is at risk of getting sepsis but certain individuals are at higher risk so for the rest of us the overarching message is prevention and the best way to do that is to keep your hands clean because this is the easiest way for us to Auto inoculate so hand hygiene great hand hygiene of soap and water I personally prefer soap and water but if it's not available and I'll go for hand sanitizer but there's also a correct way of doing it so according to the CDC if it's open water or hand sanitizer you have to scrub your hands in between the fingers the backs of your hands the palms the thumbs are often neglected areas so scrub it for 15 to 20 seconds and then wash off if it's open water if it's hand sanitizer you really want to keep rubbing until it's completely dry and if you don't do that if you just wipe it off it is ineffective yes so prevention make sure you have clean hands how important is that how often do we touch our faces unknowingly potentially transferring things to eyes nose mouth easiest way to auto inoculate they did a study where they showed that without us being aware we touch our face on an average 25 times in an hour and we don't even realize we do that so when I teach microbiology to our medical students I teach them to get into the habit of not touching your face because we are creatures of habit so at the end of a long day if we rub our eyes when we are tired we'll do that and if your hands aren't clean then you've potentially inoculated something so when we talk about subsys prevention let's say for the rest of us a hand hygiene is important staying current with vaccinations is important if you have cuts or wounds like your friend with the gash I hope he's okay now but keeping it covered and addressing it properly either with his own doctor or a wound care specialist whatever the case may be but to address it not to ignore it if something is read to the touch or if the redness keeps on spreading that is concerning so get that looked at by a doctor immediately sooner rather than later so there are things we can do to prevent it and prevention as possible and I say we should absolutely focus on that it's a dialogue that even when a patient comes in to see his physician maybe they could have it can this infection potentially become sepsis here are the warning signs this is how you should know and the warning signs if you were to think of them is in the spelling of sepsis itself so the s the first s could stand for shivering you have fever or you feel very cold the e stands for extreme pain or discomfort it's the worst ever feeling the P stands for pale or discolored skin the second S stands for sleepy the patient is difficult to wake up or they're confused so there's a change in Mental Status the I stands for I feel like I might die they feel so horrible and the last S stands for shortness of breath so these are all warning signs and the quicker you realize it and get seen the better it is you know to that issue and I try to an in essence almost preach to our viewers about the responsibility and that they to see their physicians on a responsible annual basis so I mean you know we all feel especially what I call that that Superman superwoman era you know when you have between ages 17 to 45 nothing's gonna happen to me nothing nothing's gonna happen but the reality is is that so much can be viewed by people who have knowledge ie the physician and ie other individuals because there are a certain element of prevention which allows you to fight the incursion of for example a damaged part of your body or an organ correct dr. Joe Wallace let's let's hear about what your suggestions is to our people out here relative to seeing their doctors I would be happy to and I have spoken about prevention and wellness in this venue before and I just want to recommend to them that they do exactly what you say regular visits with your physicians because you really want to know that you're doing the best that you can for yourself for your longevity for whatever goals that you have for your personal self and it's not only about you as well because certain things that you do for yourself could have an impact on those around you for instance if you happen to be a relatively new grandparent and you haven't thought about your tetanus vaccine in a while you may want to think about getting a tetanus booster because the boosters also protect against pertussis and your little grandchild could get very very sick but if they contract pertussis before they receive their fault immunizations so when going to your doctor think about your the entirety of your scope of your life who you're in contact with who you could potentially get sick who could potentially get you sick and also what other health concerns do you have and find somebody who will follow you on a regular basis to address all those concerns and of course I want to add to that and you know we it's now a major part of the College of Osteopathic Medicine and other programs there's the understanding about nutrition and there is a resultant element of what we intake everything from food to liquids and people just don't know I mean you talk about dr. Maya you spoke about the the the fluid volume you know but you know how does your heart really function without having the volume I mean you cause all kinds of problems relative to the valves themselves and I'm not you know I'm just talking as junkie citizen here and you know people don't realize you know especially in warm weather like we have here in South Florida I mean people are just not hydrating correctly they say oh well I drink when I'm thirsty no you don't just drink when you're thirsty because your body has not told you until it's in a a dispositive and a very difficult point in time they really need that the body needs to be hydrated long before you think you're thirsty correct you're absolutely right and the what the important point you mentioned was about nutrition and what proper nutrition does is give you a good gut flora so now we know that patients who have sepsis or go on to develop sepsis have a different gut flora when you compare them to individuals who didn't get sepsis or healthy healthy individuals healthy who are not patients and this is important for us to know because it opens up the avenue for treatment we already know about fecal transplant force Edith Clostridium difficile is a life-threatening illness that someone who's been on long-term antibiotics and has had frequent medical care can get so there was a study done that came out of China where they treated two patients one was 64 and the other one was 450 something I think where they did the fecal trial expand into these individuals who had sepsis and not only did it resolve them off sepsis but it also changed the gut composition and it gave them less sequel a afterwards those long term consequences that I was talking about now those were only two individuals but it highlights the importance of gut flora and we know enough about the gut microbiome now the composition of the gut the bacteria and all the other microorganisms in our gut to know that it affects every aspect of our health from fighting off sepsis perhaps to even our mental well-being so I cannot underscore the importance of proper nutrition and that of course also includes hydration yeah and we're down to the last three minutes of the show and I want to thank you both for offering some comment to this I know it's it might be a very special area but I felt responsible to try to answer the questions of the people ask me what's going on with my you know what ception I keep hearing this person going back and go back but I really think again you both have pointed out that a lot of what occurs can be altered or prevented based upon our own ability to be our own advocates Lourdes it's our responsibility to have our examinations with our physicians I think that 99% of our physicians are willing to listen to what you have to say why correct dr. Jill was wrong I would hope that the doctors that are out there saying patients are going to listen to what their doctors that the doctors will listen to what the patients have to say and there's an interesting new campaign out there about endometriosis where the woman is hesitant to speak up about her symptoms and on the commercial it says you know tell the doctor the truth and that's the same for really any symptom that you have especially when it comes to subsys because sepsis starts from something that seems like it's nothing or it seems like it's a smaller thing I have a small urinary tract infection it's a little bit burning I'll just wait and see if it get better and when we ignore those little things sometimes they can become the bigger things and that your doctor really needs to know about so I say report everything to your doctor let your doctor make heads and tails of what is really important let them ask the questions to try to figure out exactly what is going on and if something is just not getting better and it is persisting be persistent back and put the effort forward to try to get whatever help that you might need well thank you both for being here we're down to the last 25 seconds of this show and I want to thank dr. Jill Wallace Ross from the Quran C Patel college of osteopathic medicine and like to bindu my E by the way congratulations on being a full professor and professor of microbiology at our College of Medical Sciences you've both been a pleasure I hope folks that you got some answers to some of your questions I know it's been you know a little I was wondering whether we should do a show on this but really it relates to caring for yourself you got a rapport you got to talk to your doctors and you never know what's gonna happen I only wish you well but sometimes if you would let people know a little bit early it works out you change the oil in your car every 5,000 miles we'll get to see your doctor at least twice a year how's about that that's that's the last thing not to say okay so remember folks this is your show if you have any further thoughts or processes or whatever relative to what you want there's a email address and a telephone number right here and remember this show is called Dateline health it comes to you from Nova Southeastern University and my name is Fred Lippmann until next time see you you

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  1. Excellent

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