DEAR DR. ROACH: Would you be able to write something about sepsis? I recently spent almost a week in the hospital being treated aggressively with IV antibiotics for this. Did it used to be called blood poisoning? How does one get it? Is it contagious? What are the chances of it recurring? I am told I was very lucky to be diagnosed early, as it has a fairly high mortality rate. Oddly enough, it was extreme pain in my neck and upper back that made me go to the emergency room. Could the sepsis have stirred up my arthritis? — S.S. ANSWER: Sepsis is a severe reaction to a generalized infection. In a serious infection from any cause — such as skin infection, urine infection or pneumonia — certainly there is danger from the bacteria (or other germ, such as virus, fungus or parasite), but also from the body's excessive response. Treatment of sepsis must include treating the infection while simultaneously treating the effects of excessive inflammation. For example, many of the substances released by both the bacteria and the body during sepsis cause the veins to relax, which, if severe, can lower the blood pressure dangerously. Thus, IV fluids are an important treatment of sepsis. Severe sepsis has a very high mortality rate, so treating early is critical. "Blood poisoning" is an imprecise term, but might include sepsis, especially from a skin source. Whether sepsis recurs depends on the site and type of the initial infection. That's why it's so important to find and treat any underlying causes. Neck and back pain are a bit unusual. Muscle spasms certainly can occur, and perhaps that is what stirred up your arthritis. DEAR DR. ROACH: I have degenerative disk disease, spina bifida, spinal stenosis, curvature of the spine and disk herniation. A friend told me that a friend died after having back surgery -- from rusting of the rods that were put in. Is it possible for rods to rust after implantation? Any help would be appreciated on back surgery. — G.C. ANSWER: There are many reasons to be hesitant about back surgery, but rusting of the rods is not one of them. The materials used don't rust inside the body. You have so many back issues (spina bifida is when the bones of the spine don't completely grow around the spinal cord, although there are many different types) that you need an expert to discuss your possible treatments. Infection is the most feared complication whenever artificial materials are placed in the body. In general, have a healthy skepticism when hearing about medical issues from a friend of a friend. DEAR DR. ROACH: I recently had an initial appointment with a physician who has an on-site lab. I'm a healthy 61-year-old female coming for a wellness exam. At the end of the visit, he told me the phlebotomist would be coming in to draw my blood. This was a 1 p.m. appointment, and I had eaten both breakfast and lunch. I informed him that I had eaten and told him I would prefer to be fasting. He said that was fine and I could come back at a later date. The blood work included cholesterol testing as well as blood glucose. ANSWER: Fasting cholesterol and glucose levels have different interpretations from those after eating, but both provide useful information. Fasting results are better standardized, but normal results after eating are reassuring. Since some people never come back for their blood tests, we often prefer to get what readings we can, and repeat only if the levels are abnormal.
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