Wednesday, June 22, 2011

Swimmer's Ear and Then Some

Just the other day I had a patient come into my clinic to be seen for an acute external otitis (external ear infection typically called a ‘swimmer’s ear).   I was working in an urgent/acute care setting that evening, so she wasn’t one of my regular patients I saw. 
I’ll call the patient, Doris.  (real names of patients are never used)
As I walked into the exam room, Doris was sitting on the exam table cupping her left ear with her hand.  She looked at me with a sigh of relief.
“Hi, I’m Sharon, I’m a physician assistant, how can I help you?” 
“I think I have an ear infection.  My left ear really hurts, especially when I touch the outside of it or try to eat, “ said Doris.
“I see.  Well when did it start to hurt?” I asked. 
“Two days ago.  I’ve been swimming to try to lose weight and after my swim on Thursday evening, I went home that night and started noticing that my ear was beginning to bother me.  Then yesterday it really started to bother me, and now this morning I can’t even touch the outer part of my left ear without winching, “ spoke Doris.
“Okay, well let me ask you a couple of questions, then I’ll take a look at it.”
I went through Doris’ past medical history, the medications she took and her family history.  Besides her hypertension and high cholesterol levels, for which she was on medicines for, she didn’t have anything else that was of concern. 
I proceeded to do my physical exam on Doris and didn’t find anything out of the normal except her left external ear canal, which was quite red and swollen.  No wonder it hurt. 
“Okay, Doris you do indeed have an external ear canal infection.  I need to give you some antibiotic drops to put in your left ear canal twice a day for the next week.  Unfortunately you’re not going to be able to swim until you’re done with the drops in a week.  Your pain should start to resolve by tomorrow after you’ve been on the antibiotic for 24 hours,” I advised her.

Swimmer’s ear is a common problem during the summer months.  Patients want to cool off, they hit the pools, the beaches, or riding their inner tubes down the rivers.  I’ve seen many, many patients with this problem over the years, they forget about the simple solutions to prevent the external ear infections, such as using a hair dryer, or shaking your head from side to side as you are leaning over to the side. 
“Let me finish my charting and I’ll give you the prescription for the antibiotics.  You might find it handy when you return to the pool after a week to carry a hair dryer with you.  When you get out of the pool and are changing into your street clothes, take the hair dryer and blow some hot air over your ears for about 15-20 seconds each.  Make sure that the hair dryer is a good 12-18 inches away from your ears when you do this.  By doing this you will blow air into your ear canal and this will dry any remaining water in the canal.  It will then prevent any further occurrence of an ear infection for you.”
“Just a hair dryer is all I need to use after I swim for a few seconds each time?” asked Doris.
“Yep, nice and easy remedy,” I replied. 
“I’ll do it.  I didn’t realize it would be that simple.”
“While you’re finishing your charting do you mind if I use your scales to weigh myself?” asked Doris.
“Nope, go right ahead,” I replied.
As I was charting, I overheard Doris say to no one in particular, “I don’t like going to my own doctor because she gets down on me so much about my weight.  I can just hear her say, ‘now get on that scale!’  She just makes me so uncomfortable.”
I had to reply to her comment.   I turned away from the computer and asked Doris a question.  “Doris, how long have your been fighting your overweight status?”
“Years, I started having problems with my weight when I was a teen-ager, then it just slowly started getting worse.  I never lost the weight I put on after I had each of my two children.”
“Okay, so you’ve struggled with it for many, many years.  Therefore it’s not going to go away overnight or even after several months.  You’re slowly making the right lifestyle changes now that you need to make to permanently lose your weight.  You’re now exercising with your swimming and I assume that you have changed your diet, correct?”
“Yes, I’m now on Jenny Craig.”

Obesity is becoming a huge problem for the U.S. population.  A study done by the Johns Hopkins School of Public Health in 2007 stated that by 2015 75% of all adults in the U.S. will be overweight, and 41% will be classified as obese.

Much of the problem relates to how sedentary we have become as a population.  We love being ‘couch potatoes’, watching TV at night instead of getting out and going for a walk. Our jobs are no longer one in which we exert energy by doing manual labor anymore, instead we have become employees who sit in front of a desk and a computer all day.
We all need to change our lifestyles.  We all need to go for a walk, get some daily exercise in, climb the stairs at work, instead of taking the elevator, for instance.  We also need to change our diets.  We need to quit eating all those fast foods and start eating fruits and vegetables with a small portion of meat every day.  We need to lay off of the deserts, stop eating all those snack foods and begin to realize that what we are putting into our mouths needs to be nutritious for us, not just empty calories.

Our problem as a population with hypertension (high blood pressure), heart disease, high cholesterol levels, diabetes would be greatly reduced if not potentially resolved, if we all took into account how our weight plays a big part in our own health issues.    

So, take the first step of many, get out of your chair, go for a walk and then go for a walk every day.  Take the first step of many towards better health, you’ll feel better, your joints will feel better and you will have more energy to do all the things you love!

“Great.  Then what you need to remember it that you’re going to succeed this time.  Once you get down to your ideal weight, don’t stop the exercise program, stay with a nutritious diet, you might want to check in with Weight Watchers and see whether after you’ve lost your weight, whether they have a diet program for those who want to maintain their ideal weight.”
“The bottom line, Doris, is that you need to remember you are not a failure.  Your weight does not define you.”
“Thanks, for telling me that.  I do so try to lose the weight, I know it’s not good for me.  Too many other things get in the way, work, cooking for my husband, housecleaning, you name it.”
“Do you have a support group to help you out and keep you encouraged about it?”
“What do you mean?”
“Well you will probably find it helpful if you have 2-3 friends who will help you out.  Go walking with you, cheer you on, call you once a week, etc.”
“I hadn’t thought of that.”
“Another idea is to have a food journal.  Write down everything you eat, that’s been found to help people lose weight when they actually see what they have eaten every day.”
“I’m doing that.  But thanks for the idea of having friends involved.  Why doesn’t my physician help me out like you just did?  All she does is come down on me about my weight and not try to see how hard it is to lose the weight.”
“Well, I don’t have an answer about your physician.  All I know is that you’re heading in the right direction with your exercising and dietary changes.  Keep up the good work and don’t give up, this has to become a permanent lifestyle change for you.  So take it one day at a time. “
With that I turned back to my computer and finished charting, printed off her antibiotic prescription, handed it to her as I wished her well and exited the exam room.

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