Author: Dr. Scott Rennie

Dr. Rennie is board certified by the American Board of Obesity Medicine and the American Board of Family Medicine. He is also an active member of The Menopause Society. He is located in Nevada, licensed to practice medicine in all 50 U.S. states and Guam. His focus is on providing expert medical care with personalized service in the realms of telemedicine, weight loss without the use of medication, urgent care, primary prevention, and whole-body wellness.
Woman holding her wrist beside a laptop at a home office desk

Finger and Hand Pain: Is It Carpal Tunnel Syndrome?

On By Dr. Scott RennieIn Orthopedic/MusculoskeletalLeave a comment
shutterstock_86604217Many patients come to the Urgent or their primary care office with complaints of hand/wrist pain, numbness, tingling or a combination of these symptoms.  They often wonder if it could be due to carpal tunnel syndrome. Carpal Tunnel Syndrome:  characterized by pain and numbness in the fingers and hands, and sometimes in the arms.  It happens when the median nerve in the wrist becomes pinched or squeezed.  The median nerve travels through a small “tunnel” in the wrist that is formed by bones and a ligament.  It’s a setup for this nerve to become pinched due to our normal anatomy, but may be worse in some people or due to certain conditions.  There is some thought that the nerve gets pinched possibly due to one or more of the following: 1)   Tissues that surround the surrounding tends in the tunnel harden 2)   Tendons that go through the tunnel get swollen 3)   People hold their hands in a position that causes the tunnel to get smaller. Parts of the hand affected by the median nerve: 1)   Thumb 2)   Index finger 3)   Middle finger 4)   Half of the ring finger 5)   The parts of the palm closest to the thumb Symptoms:  Pain, and tingling in the thumb, index, middle and ring fingers.  These symptoms may be present in one or both hands.  Rarely, the pain can travel up the wrist and forearm and even cause tingling past the elbow to the shoulder. The symptoms are usually worse at night.  Activities that may trigger carpal tunnel syndrome include: 1)   Typing 2)   Reading 3)   Driving 4)   Holding a phone 5)   Sleeping at night – many people bend their wrist while sleeping Testing:  Nerve conduction studies or Electromyography can measure the speed of the electrical nerve conduction of the median nerve or show whether muscles of the hand and wrist are responding appropriately to the electrical signals.  Most of the time the surgeons want these tests to be performed before they will consider surgical treatments for carpal tunnel syndrome. Treatment:  they are tailored to the individual patient and may include: 1)   Wrist splints keep the hands in a neutral position, where the wrists are not bent forward to backward 2)   Surgery is offered to patients who have severe symptoms and that involves cutting the ligament that stretches across the wrist to form the carpal tunnel. 3)   Steroid shots or pills:  The steroid medications that we use short-term are a group of medications that control inflammation and swelling.  Sometimes we will inject a steroid directly into the carpal tunnel, but this is usually done by a hand specialist because of the risks of getting the steroid directly into the median nerve. 4)   Osteopathic manipulation: There are techniques that an Osteopathic Physician (D.O.) may perform that can actually help increase the space inside the carpal tunnel ie. “carpal bone mobilization.”   I hope that you have found this information useful.  Wishing you the best of health,

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Trigger Finger: What Is Stenosing Tenosynovitis Exactly? Elbow Pain: Several Common Causes and Treatment Options Wrist Fracture or Colles Fracture: What Is a FOOSH Injury? How to Stretch Out Properly

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Mother examines a rash on a child’s abdomen while seated indoors

The Viral Rash – Exanthem

On By Dr. Scott RennieIn Infectious Disease3 Comments
shutterstock_137048072A rash caused from a virus that is widespread and usually occurring in children is called a exanthem.  The first four listed below are the “classic” childhood viral rashes, but we recognize others that can also cause virus, some of those are also listed below (see 5-7): 1)   Rubeola is also known as the measles and is caused from the measles virus and produces reddish macules and papules behind the ears and at the anterior hairline, coalescing and spreading over the neck and trunk and finally affecting the arms/hands and legs/feet. 2)   Rubella is also known as German measles and is caused by the togavirus.  The eruption presents with pink-red macules and papules on the face and spreads down the body over 24 hours.  The rash begins to fade after 1-2 days in the order of appearance and disappears completely in 2-3 days. 3)   Erythema infectiosum is caused by parvovirus B19 and has confluent reddish and swollen patches on the cheeks, with sparing of the bridge of the nose and areas around the eyes.  These so-called slapped cheeks fade over 1-4 days.  The rash may spread to the trunk, arms and legs and may change to look like a lacy reticular pattern.  This rash may be itchy. 4)   Roseola infantum is caused by HHV-6 and HHV-7 and has non-itchy, rose-pink 2-3mm discrete macules and papules that blanch on pressure and are surrounded by white halos.  The eruption is usually first seen on the trunk and then spreads to the arms and legs. 5)   Chicken pox or shingles is caused by the Varicella zoster virus 6)   Mumps is caused by the mumps virus 7)   Rhinovirus which also causes the common cold can cause rash 8)   Hand-foot-mouth disease caused by Coxsackie virus can cause painful ulcers in the mouth, and the rash in the mouth begins as 2-8mm reddish macules and papules that progress through a short vesicular stage to form a yellow-grey ulcer with a reddish halo. Oral lesions usually resolve in 5-7 days.  The skin rash is characterized by 2-3mm reddish macules or papules with a central gray vesicle that usually appear shortly after oral lesions.  The hands are more commonly involved than the feet. Immunizations have decreased the numbers of measles, mumps and rubella but we still see these infections in the medical clinic. Description:  Usually pink or red rash without a typical pattern. It may have red spots that are slightly raised.  It usually isn’t very itchy. They may be faint pink or more extensive, and usually blanches (goes white) with pressure.  If you place a drinking glass against the rash, you may see it disappear through the glass. Some other symptoms that may be present along with a viral rash include low-grade fever, headache, sore throat, malaise, nausea, diarrhea or joint pain. Treatment:  There is no treatment for a viral rash.  The rash will disappear as the body recovers from the infection. When to get medical help: 1)   The rash does not blanch with pressure 2)   The rash is extremely itchy 3)   The patient is very sick or you are concerned about a serious illness   I hope that you have found this information useful.  Wishing you the best of health,

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Measles is the one on this list that stopped being historical. If that is what brought you here, start with the current post rather than this one. Measles Is Back: What Clinicians Need To Watch For When to Use Telemedicine vs. Urgent Care: How I Spot the Sick One Scabies Infection – The Mite Bite Shingles – “You mean I have Herpes?” Measles in 2025: What Patients and Providers Need to Know Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Doctor talking with a patient across a desk in a clinic office

Bacterial Vaginosis: Most Common Cause of Vaginal Discharge

On By Dr. Scott RennieIn Menopause & Women's HealthLeave a comment
Bacterial Vaginosis (BV) is not a sexually transmitted infection.  It is the most frequent cause of vaginal discharge in women, but it can be difficult to know if the discharge is caused by BV or other types of vaginal infections. Definition:  Discharge caused by a large change in the number and types of bacteria in the vagina.  For some reason, the number Lactobacilli (which is a normal bacteria found in the vagina) are actually decreased while other bacteria are increased. Risk factors:  Multiple or new sexual partners, douching, cigarette smoking.  Again, BV is not a sexually transmitted infection, as it can occur in women who are not sexually active. Symptoms:  50-75% of women with BV do not have symptoms.  Those with symptoms may note an unpleasant, “fishy smelling” vaginal discharge that is more noticeable after vaginal intercourse.  The discharge is usually a thin, yellow-white color.  Most of the time it does not cause pain with urination or sex, vaginal itching or intercourse.  Self-treatment with over-the-counter medications such as yeast creams or deodorants are not recommended. Diagnosis:  Physical examination, which usually includes pelvic examination and laboratory testing may be used to test the vaginal secretions to determine if BV is present. Complications:  Bacterial vaginosis is usually not considered harmful but has been associated with some health problems such as: 1)   Increases risks for becoming infected with HIV, genital herpes, gonorrhea or chlamydia 2)   Pregnant women with BV are at higher risk of preterm delivery 3)   Untreated BV in woman who have had hysterectomy or abortion can lead to infection at the surgery site Treatment:  We commonly use one of two different treatment options for treating BV.  Either Metronidazole or Clindamycin can be taken in pill form or with a gel or cream that is inserted into the vagina.   There are more side effects possible if taken orally, but it is more convenient. Sexual partners:  There is no need to treat sexual partners of those infected with BV as it doesn’t decrease the risk of infection coming back.  BV is not a sexually transmitted infection, remember? Relapse:  Within 3 months after resolution of symptoms, 30% of women have recurrence.  More than 50% have recurrence after 12 months.  The reasons for recurrence are unknown.  Relapse may be treated with a more prolonged course of antibiotics and the CDC suggests a treatment regimen different from the initial treatment if recurrence occurs. Some patients use a preventative treatment with metronidazole vaginal gel twice weekly for 3-6 months if they get more than 3 episodes in 12 months. Prevention:  Some recommendations may include the following: 1)   Finish the entire course of antibiotics for the treatment of BV even if symptoms resolve rapidly 2)   Limit the number of sexual partners 3)   Do not douche.  There is no proven benefit to douching and the solution used to rinse the vagina may upset the balance of bacteria and actually flush other bacteria up into the uterus or fallopian tubes and cause other types of infections If you have vaginal discharge or questions, please contact your medical provider.  Do not attempt to treat yourself as this can actually make the situation worse.   I hope that you have found this information useful.  Wishing you the best of health,

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Vaginal Yeast Infections: Symptoms, Causes, Treatment STI Testing: Should You Get Tested for Everything? FDA Removes Black Box Warning From Menopause Hormone Therapy Vaginal Dryness After Menopause: Why It Doesn’t Go Away

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Pharmacist discussing medication with a patient at a pharmacy counter

Vaginal Yeast Infections: Symptoms, Causes, Treatment

On By Dr. Scott RennieIn Menopause & Women's Health3 Comments
shutterstock_128350532Patients frequently present to their health care provider with complaints of yeast infection symptoms.  Other terms that are used to describe yeast infections include yeast vaginitis or vaginal candidiasis.  The symptoms of this type of infection usually include itching and irritation to the vulva around the opening of the vagina. Yeast infections are more common during times of menstruation (having monthly periods) and also after taking antibiotics. There is no evidence that vaginal yeast infections are related to poor hygiene or tight synthetic clothing. Other symptoms of yeast infections: 1)   Pain with urination – can be confused with a urinary tract infection 2)   Itching or irritation around the opening of the vagina 3)   Pain with intercourse 4)   Watery or white colored vaginal discharge 5)   Red or swollen vaginal tissues The symptoms of yeast infection can be confusing because they can be similar to a number of other disorders such as a bacterial infection of the vagina, urinary tract infection, trichomoniasis, or common dermatitis (inflammation of the skin).  Most of the time the patient may not know if the itching or irritation is caused from yeast or another cause and this leads them to see a medical provider. Causes of yeast infection:  Candida is the name of the yeast that causes the infection and it normally lives in the intestines and vagina.  Most of the time Candida causes no symptoms.  If it grows out of control (which can be due to increased stress, antibiotic use, or stress to the immune system), it can overgrow and cause symptoms. Risk factors for yeast infection:  Often there are no underlying health problems that lead to yeast infections in women, but several factors may increase the chances of developing an infection including: 1)   Antibiotics – most antibiotics kill lots of bacteria including those that normally live in the vaginal area.  The bacteria that are normally found in the vagina help protect this area from being overgrown with yeast.  Antibiotics can kill off these bacteria and lead to an increase of the normal flora of yeast in the vagina 2)   Pregnancy can increase the chances of yeast infection because there is a normal increase in the amount of vaginal discharge. 3)   Diabetes causes an elevation of blood sugars which can lead to an increase in the likelihood of a yeast infection 4)   Hormonal contraceptives such as birth control pills, vaginal rings or patches that contain estrogen can sometimes increase the chance of yeast infection in some people. 5)   Contraceptive devices such as diaphragms, vaginal sponges and IUDs can also increase the chance of a yeast infection.  Spermicides usually don’t cause yeast infections, but can lead to vaginal irritation. 6)   Increased sexual activity can lead to a yeast infection.  The reason for this may be related to changes in the concentration of bacteria within the vagina that happen with sexual intercourse.  Yeast infections are not considered a sexually transmitted infection. Diagnosis:  Sometimes women who have symptoms of a yeast infection will diagnose themselves and seek treatment with over the counter medications.  One study showed that only 11% of women accurately diagnosed their infection.  Women who previously had a yeast infection were slightly more accurate (35% correct).  The general recommendation is for women who have symptoms consistent with yeast infection be be evaluated by a medical provider.  The exam usually consists of examination of the vulva and vagina and sometimes a swab is used to collect a sample of the discharge to look for yeast. Treatment:  You may be treated with oral or vaginal medication for yeast infection (or both). Vaginal treatment:  Most of the time the treatment includes a cream or tablet that is placed into the vagina at bedtime with an applicator. There are several different treatment options some of which are 1, 3 or 7 days in duration.  The vaginal treatment seems to be more effective in reducing the vaginal irritation quicker than the oral medications. Oral treatment:  Diflucan is a very common oral medication for treating yeast infections.  Most of the time only one dose is needed, however a second dose given 3 days or so after the first dose may be recommended for some patients. If you’re not feeling better within a few days after starting the treatment, make sure you call the office of your medical provider to let them know. Recurrent vaginal yeast infections:  There are about 5-8% of women who have vaginal yeast infections that come back repeatedly.  If the patient has more than 4 infections in one year, we call this recurrent vaginal yeast infection. There is no evidence that eating yogurt or other products containing live lactobacillus acidophilus or applying these products vaginally will benefit women with recurrent vaginal yeast infections. A persistent infection can be cause from a less common species of Candida called Candida glabrata or Candida krusei and in these less common species, we use different medications to treat them. Treatment of recurrent vaginal yeast infections:  Most of the time we use a longer course of anti-yeast medication in patients who have recurrent infections, often between 7 and 14 days for a topical cream or suppository or if the oral medication is used, it is taken with a 2nd dose 3 days later and possibly a 3rd dose 6 days later.  Some patients are started on preventative treatment with oral or vaginal creams once per week. Treatment of a sexual partner:  Vaginal yeast infections are not a sexually transmitted infection and most experts do not recommend treating a sexual partner. Prevention: 1)   Diabetes:  Keep blood sugars under good control in diabetic patients 2)   Antibiotics:  For patients who frequently get yeast infections after taking antibiotics, we often will prescribe a dose of fluconazole at the start and end of antibiotic therapy to prevent post-antibiotic vulvovaginitis. 3)   Patient awareness:  Patients who are using hormone birth control products or contraceptive devices should be aware of the increased risk of yeast infections with these products.   I hope that you have found this information useful.  Wishing you the best of health,

Related Reading

Bacterial Vaginosis: Most Common Cause of Vaginal Discharge Perimenopause and Menopause Symptoms and How to Manage Them Newly Diagnosed With Type 2 Diabetes: What You Should Know I hear it almost every day now. “I think I just need a Z-Pak.” Vaginal Dryness After Menopause: Why It Doesn’t Go Away

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Honeybee collecting nectar from a purple wildflower

Bee and Insect Stings

On By Dr. Scott RennieIn Skin & Wound Care1 Comment
shutterstock_116816458Patients often come into the urgent care clinic due to bee or insect stings as the weather improves.  Being stung is often painful and can also be anxiety provoking because some people have serious or life-threatening allergic reactions to stings and require quick treatment. Sting Reaction:  Immediately after being stung, most people have a sharp or burning pain as well as redness or swelling at the site of the sting.  The swelling and pain usually improve within a few hours.  About 10% of people will develop severe redness and swelling after a sting, and this is called a large localized reaction.  These large red areas may reach up to 4 inches in diameter over 1-2 days, and then slowly resolve over 5-10 days. If you have a large area of inflammation after a sting, this does not mean that you will have an anaphylactic reaction if stung again. Rarely, some individuals will develop a severe allergic reaction, called anaphylaxis.  Only 5-10% of people with a large localized reaction will have an anaphylactic reaction. Symptoms of severe allergic reaction (usually develop quickly): 1)   Hives, redness or swelling of skin away from the area that was stung – ie. face or lips if being stung on the hand 2)   Shortness of breath, hoarse voice or difficulty breathing 3)   Abdominal pain, nausea, vomiting or diarrhea 4)   Feeling lightheaded, dizzy or passing out Treatment for local skin reaction: 1)    If the insect has left a stinger, remove it as soon as possible after being stung.  Flicking or scraping the stinger out is sufficient. 2)    Apply a cold or damp washcloth wrapped around ice to the area 3)    Take an antihistamine such as Benadryl or Zyrtec if you develop itching 4)    A pain medicine such as Ibuprofen or Aleve may be helpful Treatment for severe allergic reactions:  These are a medical emergency that can lead to death if not treated quickly.  Do not drive yourself to the hospital – call 911.  A shot of epinephrine (adrenaline) may be helpful to prevent more severe allergic reactions in some patients.  Epinephrine is prescription only and should only be used if there is concern about a possible life threatening reaction.  Training on how and when to use epinephrine should be given at your medical provider or pharmacy. Prevention:  Usually bees or wasps are not aggressive when they are away from their nests.  The usually only sting after being hit, stepped on or swatted.  Wearing a white or light-colored clothing may help reduce the chance of being attacked if you are near a nest.  If you are eating outside, keep food and drinks covered and clean up spills quickly.  Watch for yellow jackets inside of drink containers.  If you find a nest near your home, do not try to get rid of it yourself.  Call a pest control professional. If you are being swarmed or stung, cover your mouth and nose with your hand and retreat to inside a building or an enclosed vehicle.   I hope that you have found this information useful.  Wishing you the best of health,

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Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Close-up of an eye with a red, swollen upper eyelid

What Is a Stye in the Eye and Why Does It Cause Eyelid Pain?

On By Dr. Scott RennieIn Eyes, Ears, Nose & ThroatLeave a comment
shutterstock_147818714A style (also called a hordeolum) is a red and painful lump on the eyelid.  This occurs when a small gland in the edge of the eyelid become infected or inflamed.  Styes can occur on the upper or the lower eyelid and usually get better on their own after a few days to week even if untreated. Symptoms:  Red or painful lump on the edge of the eyelid.  It often looks like a pimple, and can cause tearing as well as eyelid pain. When to see a healthcare provider: 1)   It doesn’t go away after 1 week. 2)   It gets large, bleeds or affects your vision 3)   The entire eye or eyelid becomes red/swollen 4)   The redness or swelling spread to your cheek or face Home treatments: 1)   Wet a clean wash cloth with warm water and put it over your stye for 10-15 minutes 3-4x/day 2)   DO NOT squeeze or pop the stye 3)   Avoid wearing eye backup or contact lenses Prevention: 1)   Wash your hands before touching your eyes or eyelids 2)   Wash your hands before putting in contact lenses and keep the lenses them clean 3)   Take off eye makeup at night if you use it 4)   Do not use old eye makeup or share with others Medical provider treatments:  Most of the time we prescribe antibiotic ointments or drops if the stye is not improving on its own.  If it persists or gets larger, a referral to an eye doctor is usually made who can drain the stye. The American Academy of Ophthalmology has a great resource for locating an ophthalmologist near you: http://www.aao.org/find_eyemd.cfm   I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Blue cushion on a wooden chair in front of a fireplace

Hemorrhoids Explained: Why They’re a Real Pain in the Rear

On By Dr. Scott RennieIn Gastrointestinal4 Comments
shutterstock_125891585Hemorrhoids are a common problem in both men and women who come to see their primary care or urgent care doctor.  Hemorrhoids are enlarged or swollen veins in the lower rectum.  They can cause pain, itching and rectal bleeding.  Sometimes you can feel or see hemorrhoids around the outside of the anus.  Other times they may be hidden from view inside the rectum (internal hemorrhoids). They are more common in older individuals and patients during and after pregnancy, those with diarrhea or constipation or in people who sit for prolonger periods of time. Symptoms: 1)   Anal pain or itching 2)   Tissue bulging around anus 3)   Painless rectal bleeding 4)   Difficulty cleaning or leakage of feces after bowl movement Diagnosis:  Your healthcare provider will examine the rectum and anus to inspect for hemorrhoids.  This exam may include inserting a gloved finger into the rectum.  The reason for the digital exam is to inspect for possible rectal cancers and also to collect any stool that’s present and test for blood.  If there is blood present, your healthcare provider may use a special tube called an anoscope, that is clear and allows visualization of the rectum/anus. Treatment:  If hemorrhoids are diagnosed, one of the most important steps is avoiding constipation because they can lead to rectal bleeding or tearing the anus (called a fissue).  Also, it is important to avoid pushing or straining during bowl movements because that can worsen existing hemorrhoids and risk causing development of additional hemorrhoids.  Reducing constipation can be done by: 1)   Increasing fiber – increasing fruits and vegetables contain fiber.  In addition fiber supplements such as Metamucil may be helpful. 2)   Laxatives – These are not “addictive” or increase your risk of constipation in the future. 3)   Warm sitz baths – soaking the rectal area in warm water for 10 minutes 3x/day improve blood flow by relaxing the internal anal sphincter. 4)   Topical treatments – Suppositories are creams with hydrocortisone may be helpful to relieve pain, itching and irritation. More invasive procedures: 1)   Rubber band ligation – a rubber band or ring is place around the base of the internal hemorrhoid which restricts the blood supply to that area.  This shrinks the hemorrhoid and reduces it. 2)   Laser surgery – uses a laser or infrared light to destroy internal hemorrhoids 3)   Sclerotherpay – a chemical solution is injected into the hemorrhoidal tissue causing it to break down and form a scar 4)   Surgery – hemorrhoidectomy is the treatment of choice for patients with large internal hemorrhoids. A gastroenterologist is a doctor who specializes in the gastrointestinal tract.  If you are looking for a gastroenterologist in your area, the American Gastroenterological Association has a locator:  https://secure.gastro.org/GILocator/locator.asp   I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Mother holding smiling baby beside folded diapers and nursery supplies

Elimination Communication: Potty Training a Diaper Free Baby

On By Dr. Scott RennieIn Other Diseases and Conditions1 Comment
Have you heard that some parents almost completely stop using diapers with their babies as early as 3 months of age?  The idea is not new, and I’ve heard the theory explained as “early potty training” or “a gentle, natural, non-coercive process by which a baby, learns with the loving assistance of parents and caregivers to communicate about and address his or her elimination needs.” The thought of not needing diapers is certainly appealing, considering the cost involved and the fact that cleaning diapers is still considered a rather “messy” process.  There are those that believe that with the advent of larger and disposable diapers, parents have become less “tuned into” their babies’ sometimes subtle signs that they are ready for help with elimination.  I became interested in doing a bit of research in the topic as my brother and sister-in-law just had their second baby (Nathan) and they are back in the word of diaper changing again after a 2+ year break from their first child (Jacob). So what do the experts think about elimination communication or the “Diaper Free Baby?” Potty-training success hinges on physical and emotional readiness, not a specific age. Many kids show interest in potty training by age 2, but others might not be ready until age 2 1/2 or even older — and there’s no rush. If you start potty training too early, it might take longer to train your child. Some of the potential benefits of being diaper free or at least wearing diapers less often may include: 1)   Reduces the risk of diaper rash 2)   Is less messy than conventional diapering. Eliminations are in a toilet or potty rather than on the baby. 3)   Reduces the use of disposable diapers, a major contributor to landfill. 4)   Reduces the use of disposable wipes used to clean baby’s bottom. 5)   Has been practiced for centuries around the world. 6)   Is more enjoyable than changing diapers. 7)   Encourages the development of a trusting relationship with children through communication about a basic human need. 8)   Increases comfort of carrying a baby: there is less bulk than a diaper and it feels better for both caregiver and baby. A discussion about toilet training from the Mayo Clinic Website: Is your child ready? Ask yourself these questions: Does your child seem interested in the potty chair or toilet, or in wearing underwear? Can your child understand and follow basic directions? Does your child tell you through words, facial expressions or posture when he or she needs to go? Does your child stay dry for periods of two hours or longer during the day? Does your child complain about wet or dirty diapers? Can your child pull down his or her pants and pull them up again? Can your child sit on and rise from a potty chair? A quote about toilet training from the American Academy of Pediatrics Website: “There is no set age at which toilet training should begin. Before children are 12 months of age, they have no control over bladder or bowel movements. While many children start to show signs of being ready between 18 and 24 months of age, some children may not be ready until 30 months or older. This is normal.  Most children achieve bowel control and daytime urine control by 3 to 4 years of age.” A quote from the Seattle Times article “Early Potty Training, a New Experiment” October 9, 2005 “Even if you’re getting them to go in a pot as a young infant, I don’t know if it will have any long-term impact for all the effort you have to go through,” said Dr. Mark Wolraich, author of the academy’s “Guide to Toilet Training” (Bantam Books, 2003). “The risk is, if it’s not working and the parents are frustrated, they’re creating more negative interactions with their child.” A parent using “Elimination Communication” says the following on the topic: “By the time Simon was three and a half months old he had proven to us that EC is more than just ‘parent training.’ He started signaling his need to pee by making his own imitation of our ‘sss’ cue! We were delighted to be in such two way communication with him.” –       Rachel, mom to Simon, began EC at birth Some parents might be curious about my opinion on the topic.  The subject is certainly controversial here in the U.S. but I like the potential advantages, especially the fact that it’s more environmentally friendly, less messy and encourages the parents to be more in tune to their babies.  In my patients who come here from other countries, it seems more intuitive. In the end, I think it might be reasonable to try and I support parents who wish to get their children out of diapers sooner rather than later.   I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Passenger pinching her nose and covering her ear aboard an airplane

Eustachian Tube Dysfunction: Ear Pain Without Infection

On By Dr. Scott RennieIn Eyes, Ears, Nose & Throat6 Comments
shutterstock_742214The Eustachian tube connects the middle ear to the back of the throat and nose.  It equalizes the pressure of the ear and is often responsible for the pop sensation that you may feel as you are gaining elevation if you ride on an airplane or drive your car up a mountain pass.  If there is a problem with the Eustachian tube, the air pressure inside the middle ear becomes different than the outside air pressure.  This leads to pain and a pressure sensation of the ear drum.  It can also caused decreased hearing on the affected side.  In the medical profession, we use the term “barotrauma” to describe this phenomenon. Symptoms of Eustachian tube dysfunction (ETD): 1)   Ear pain – this can feel just as painful as an ear infection 2)   Trouble hearing 3)   Ringing in the ear 4)   Feeling dizzy 5)   Feeling pressure or fullness in the ear Most of the time Eustachian tube problems are not serious and they get better on their own.  They rarely can lead to a more serious problem such as: 1)   Middle ear infection 2)   Torn eardrum 3)   Hearing loss If a child has Eustachian tube problems for long periods of time, they can have language or speech problems as a result of not hearing well. Causes:  Anything that make the Eustachian tube swollen or inflamed such as recent upper respiratory infection or common cold, allergies, sinus infection or sudden air pressure changes (happens when people fly on an airplane, scuba dive or drive in the mountains). When to seek medical help:  If the symptoms are severe, getting worse or are not improving within a few days. Treatment:  The treatment of Eustachian tube dysfunctions is tailored to the individual patient and the cause of the disorder.  Some possible treatment options might be: 1)   Nasal sprays – for example Flonase, Nasonex, or Rhinocort 2)   Oral antihistamine medications such as Benedryl, Zyrtec, Claritin or Allegra 3)   Oral or topical decongestant medications such as Sudafed or Afrin nasal spray 4)   Surgery:  Most of the time ear tubes are not needed for this problem, however some people do have tube placed in the ear drugs to help with this disorder 5)   Special ear plugs that are used on an airplane, or when driving that help decrease the pressure on the ear drum. Otolaryngologists are doctors that specialize in the Ears, Nose and Throat (ENT).  If you are looking for an Otolaryngologist in your area, the American Academy of Otolaryngology has a useful locator on their website: http://www.entnet.org/   I hope that you have found this information useful.  Wishing you the best of health,

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.

Staphylococcus aureus culture plate with antibiotic discs and inhibition zones

Antibiotic Side Effects and Resistance: The Real Cost

On By Dr. Scott RennieIn Infectious DiseaseLeave a comment
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This page has carried a warning about antibiotic resistance since 2012. The warning held up. What changed is that we stopped guessing. There are counted deaths now, surveillance from 104 countries, and forecasts out to 2050, and none of it argues for handing antibiotics out more freely.

I practice family medicine and obesity medicine entirely by telemedicine, so antibiotic requests reach me on video and in message threads, usually from someone who feels awful and wants this settled today. The request makes sense from where you sit. The refusal makes sense from where I sit. This post closes that gap with numbers instead of a lecture.

The global count, briefly

In 2021, bacterial antimicrobial resistance was associated with 4.71 million deaths worldwide, and 1.14 million of those were directly attributable to resistant organisms (1)(2). The forecast for 2050 is 1.91 million attributable and 8.22 million associated deaths in that year, with 39.1 million attributable deaths cumulatively between 2025 and 2050 (2).

The shape of the burden shifted in a way that rarely makes headlines. Attributable deaths in children under five fell 60.4% between 1990 and 2021, while deaths in adults 70 and older rose 89.5% (2). Vaccines and better newborn care did the first part. The second is what happens when more people live long enough to pick up a bloodstream infection in a hospital. MRSA alone went from 57,200 attributable deaths in 1990 to 130,000 in 2021 (2).

One in six

WHO’s 2025 surveillance report found that roughly one in six laboratory-confirmed bacterial infections worldwide in 2023 was resistant to the antibiotic meant to treat it (1)(3). Between 2018 and 2023, resistance rose in more than 40% of the pathogen-antibiotic combinations under surveillance, at 5% to 15% a year (3).

Two organisms carry much of that. More than 40% of E. coli and more than 55% of Klebsiella pneumoniae are now resistant to third-generation cephalosporins, which are first-choice treatment for those bloodstream infections (3). In the African Region the Klebsiella figure passes 70% (3). WHO’s 2024 priority list puts carbapenem-resistant Acinetobacter baumannii and carbapenem-resistant Enterobacterales in the critical tier, next to rifampicin-resistant tuberculosis (4).

One caveat. In 2023, 104 countries reported, up from 25 in 2016, and 48% still reported nothing (3). Some of the rise is real. Some of it is us finally looking.

What an antibiotic does to your own bacteria

Here is the part that gets skipped when resistance is framed as a planetary problem. A meta-analysis of 24 studies found that people given an antibiotic in primary care carry resistant bacteria afterward. Among urinary organisms, the pooled odds ratio for resistance was 2.5 within two months and still 1.33 at twelve months. Among respiratory organisms, 2.4 at both points (5).

Your bacteria. Your next urinary tract infection. That is the honest reason a just-in-case prescription is not free, and you are the first person who pays, months later, when the cheap oral drug is likelier to fail. The global statistic is a sum of small personal debts.

If you are the one asking for a Z-Pak

A study of 15.5 million outpatient antibiotic fills in 2016, among 19.2 million privately insured Americans, found azithromycin was the most commonly filled antibiotic in that group, at 19.0% of fills. Only 12.8% of fills were classified as appropriate. Another 23.2% were inappropriate, and 28.5% carried no diagnosis code at all in the three days beforehand (6). Nearly a third of prescriptions, no recorded reason.

Azithromycin is also not a neutral molecule. In a Tennessee Medicaid cohort, a five-day course carried an estimated 47 additional cardiovascular deaths per million courses compared with amoxicillin, rising to 245 per million in the highest decile of cardiovascular risk (7).

When a patient asks me for a Z-Pak and it is not appropriate for what they have, I tell them that plainly. Then we go through the side effects: nausea, diarrhea, a yeast infection, a rash. The last piece is the one worth the time. I explain what azithromycin is actually good for, and what it is not good for, and a sinus infection sits on the second list.

Notes for clinicians, particularly those of us working by video

Telemedicine earned an early bad reputation here. In 2015 to 2016 claims data, children seen for acute respiratory infection at direct-to-consumer telemedicine visits got antibiotics 52% of the time, against 42% at urgent care and 31% in the primary care office. Guideline-concordant management ran 59% for those video visits and 78% at the office (8).

That finding is seven years old and it has not simply replicated. An Australian study of 2,392 general practice registrars covering 21,384 respiratory infection diagnoses from 2020 to 2023 found telehealth carried lower odds of an antibiotic for sore throat (OR 0.69, 95% CI 0.55 to 0.86) and for upper respiratory infection (OR 0.64, 0.51 to 0.81). Otitis media, 0.47. No difference for bronchitis or sinusitis (9). The authors found no damage to stewardship.

My read is that the modality is not the variable. What matters is whether the visit sits inside a relationship where a callback is possible, and whether you are paid the same for a no as for a prescription. Get those right and video is fine. Leave them broken and a bricks-and-mortar clinic will overprescribe just as fast, with the added problem that the patient drove there and wants something for the trip.

The respiratory complaint I would actually write an antibiotic for is a sinus infection, and the conversation that goes with the prescription is where the cost stops being abstract. I tell the patient what to watch for. Diarrhea, which can turn bloody, and bloody is the one that points at Clostridioides difficile. A yeast infection. Rashes. Swollen lips, which is the allergic signal, the angioedema end of it. And symptoms that get worse, or that simply have not changed, at 48 hours.

That list is the whole argument in miniature. A patient who needed the drug is accepting those risks in exchange for something. A patient who did not need it accepts every one of them in exchange for nothing.

Where the alarm runs ahead of the data

Overselling this teaches patients to discount all of it, so here are the weak spots. Attributable deaths did not explode over three decades. They moved from 1.06 million in 1990 to 1.14 million in 2021, and associated deaths drifted down slightly, from 4.78 million to 4.71 million (2). The 2050 figures are models. The azithromycin cardiac signal looks real in high-risk patients, but a Danish cohort of more than a million treatment episodes in adults aged 18 to 64 found no increase in cardiovascular death against penicillin V (10). ECDC puts the EU and EEA toll above 35,000 deaths a year and ties more than 70% of that health impact to healthcare-associated infections (11), so your outpatient azithromycin is not what drives the worst resistant infections in intensive care.

It still counts, the way a single vote counts, and mostly it counts against you.

The Bottom Line

One in six bacterial infections worldwide already resists the drug meant to treat it (1). Third-generation cephalosporins now fail against more than 40% of E. coli (3). Those figures were assembled out of individual prescriptions, nearly all of which felt reasonable to somebody at the time. When I decline an antibiotic for what is clearly a virus, I am not rationing your care and I am not doubting how bad you feel. I am declining to raise the odds that your own bacteria stop listening, and that bill arrives at your address, not the world’s. Ask me what should happen if you get worse. That answer is worth more than the prescription.

Sources

1. WHO. Antimicrobial resistance fact sheet, updated 16 July 2026. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance

2. GBD 2021 AMR Collaborators. Global burden of bacterial AMR 1990-2021, with forecasts to 2050. Lancet, 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11718157/

3. WHO. Warning of widespread resistance to common antibiotics, 13 October 2025. https://www.who.int/news/item/13-10-2025-who-warns-of-widespread-resistance-to-common-antibiotics-worldwide

4. WHO. Bacterial Priority Pathogens List, 17 May 2024. https://www.who.int/news/item/17-05-2024-who-updates-list-of-drug-resistant-bacteria-most-threatening-to-human-health

5. Costelloe C, et al. Antibiotic prescribing in primary care and resistance in individual patients. BMJ, 2010. https://pubmed.ncbi.nlm.nih.gov/20483949/

6. Chua KP, et al. Appropriateness of outpatient antibiotic prescribing, insured US patients. BMJ, 2019. https://pubmed.ncbi.nlm.nih.gov/30651273/

7. Ray WA, et al. Azithromycin and the risk of cardiovascular death. NEJM, 2012. https://pubmed.ncbi.nlm.nih.gov/22591294/

8. Ray KN, et al. Antibiotic prescribing during pediatric direct-to-consumer telemedicine. Pediatrics, 2019. https://pubmed.ncbi.nlm.nih.gov/30962253/

9. Antibiotic prescribing for respiratory infection, telehealth versus face-to-face. J Med Internet Res, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC11950701/

10. Svanstrom H, et al. Azithromycin and death from cardiovascular causes. NEJM, 2013. https://pubmed.ncbi.nlm.nih.gov/23635050/

11. ECDC. Health burden of antibiotic resistance, key messages. https://antibiotic.ecdc.europa.eu/en/get-informed/key-messages/health-burden-antibiotic-resistance

Related Reading

Why Won’t Antibiotics Cure a Viral Infection? Doctor Explains I hear it almost every day now. “I think I just need a Z-Pak.” Antibiotic Superbugs CRKP and MRSA: Who Is at Risk? Tuberculosis in 2025: Kansas Outbreak, Vaccines, and Staying Safe

Scott Rennie, D.O.
Board Certified in Obesity Medicine and Family Medicine

This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.