Juliet Asher, MD, P.C.

Internal Medicine

Health News for the Well-Read Patient

Issue 4, 2019

Dear Patient:
The 2020s are upon us, and their synonymousness with perfect vision is particularly apt. As you anticipate a new year, and the start of a new decade, we hope you’re envisioning one filled with beloved people, meaningful activities and most importantly, good health to enjoy it all.
Explore our latest read, with information on becoming antibiotics aware during the upcoming cold and flu season, and a look at new treatments for the age-old problem of headaches. If you’ve wondered whether to sample the latest trend of Impossible and Beyond burgers, we’ve laid out all the facts for you to digest. Wishing you a happy, healthy and joyful holiday season,
Juliet Asher, MD, P.C.

Are You Antibiotics Aware?

Spurred by Alexander Fleming’s serendipitous discovery of penicillin in 1928, antibiotics have rightfully become wonder drugs, often able to change the course of deadly bacterial infections in a matter of days. But in recent years, their unmatched healing power has become overprescribed and overutilized, leading to concerning findings like these: Nearly 23% of antibiotic prescriptions filled in 2016 were unnecessary, and an additional 36% were prescribed for conditions for which an antibiotic is only sometimes recommended, according to a recent study from the Agency for Healthcare Research and Quality.

The unintended consequences are far from benign. Patients may needlessly experience the drug’s side effects, such as rash, dizziness, nausea, diarrhea or Clostridium difficile infection (C. diff), which can cause severe diarrhea and may be life-threatening. On a larger, global scale, overuse leads to antibiotic-resistant bacteria, a growing danger that occurs when bacteria that have been exposed to an antibiotic mutate, rendering the drug ineffective against them. The Centers for Disease Control estimates that at least 2 million people are infected with antibiotic-resistant bacteria each year in the US, resulting in approximately 23,000 deaths. In fact, Fleming himself predicted the possibility in his 1945 Nobel Prize acceptance speech, saying:“It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body.”That’s why the World Health Organization’s annual “Antibiotics: Handle With Care” campaign, launched in 2015, and the United States’“Be Antibiotics Aware” program, launched the following year, are more important than ever in raising awareness as to why antibiotics aren’t always the answer. Becoming knowledgeable about the difference between bacterial and viral infections, and why an observational (“watch 
and wait”) approach to antibiotic treatment may be considered for conditions like sinusitis or ear infections, is critical to stemming the tide of overuse. Below is a look at when antibiotics should be the treatment of choice, when they should be considered only after watching and waiting, or when they are not called for at all. Note that antibiotic drugs effectively kill bacteria but not viruses, which is why they are never recommended for viral infections such as colds or flu. However, not all bacterial infections require the use of antibiotics. As always, check in with our office regarding what’s best for your individual health.
Sources: Up to Date, CDC .

About that penicillin allergy…

Most people who believe they’re allergic to penicillin can take it without a problem, either because the rash they experienced was part of a virus or because the allergy resolved over time. You may want to get tested by an allergist to be certain, as research shows that patients identified as penicillin-allergic are more likely to receive very powerful antibiotics with greater side effects, and are also at higher risk of developing resistant infections that require longer stays in the hospital. It’s interesting to note that when skin tested, approximately 90% of people will test negative for a penicillin allergy.




Sore throat

Only if diagnosed with group A streptococcal pharyngitis (the cause of just 5-10% of adult sore throats)

Over-the-counter (OTC) pain relievers
s such as aspirin, ibuprofen and acetaminophen; throat lozenges

Oh, My Aching Head

A dull pressure, a sharp pain, an uncomfortable pounding, a vise-like sensation – all can signal the start of a headache. A painful part of the human condition since the beginning of time, more than 150 different types of headaches have been identified, categorized and treated in increasingly effective ways. Following is a look at how to cope with the most common headaches, as well as when your symptoms indicate immediate attention is needed.
Tension. It’s the rare person who hasn’t experienced the tight feeling or band-like grip around the head that characterizes a tension headache. Stress is frequently the trigger, so staving them off with recognized stress management strategies such as deep breathing exercises, yoga, meditation, and progressive muscle relaxation may help. For immediate relief, gentle massage and use of warmth or heat to ease tense neck and shoulder muscles often work well. Over-the-counter medicine such as aspirin, ibuprofen or acetaminophen may also be used judiciously.

Cluster. Seen more often in men, these headaches cause intense pain on one side of the head or around one eye; are often accompanied by nasal discharge or teary eyes; and occur in bouts of frequent attacks over weeks or months, followed by long periods of remission. Treatments include inhaling pure oxygen through a face mask, which often relieves pain within 15 minutes, and injectable triptan medications used to treat migraines (see sidebar).Exertional. Headaches experienced after strenuous exercise may result from being dehydrated or overheated or simply from overexertion, and are usually resolved quickly with rest and adequate hydration.
Sinus. The pain, pressure and fullness in cheeks, brow or forehead, often accompanied by stuffy nose, fatigue and an upper toothache, can indicate a headache from sinusitis or seasonal allergies, but be aware that in many cases it is actually a migraine. Rest, fluids, decongestants and over-the-counter pain medications help alleviate headaches caused by sinusitis; those caused by an allergy will usually be treated with a 
nasal spray.
Each headache has its own “flavor,” but if they occur more frequently or more severely, seem to worsen with use of over-the-counter drugs, and interfere with your normal activities, please contact us…and consider starting a headache journal that you can bring to your appointment. Track if they are occurring at certain times of day, or after specific activities or foods; e.g., after a workout, a sleepless night or a change in diet. Also note the duration of each headache; where the pain is located; the intensity and type of pain; other accompanying symptoms, such as gastrointestinal distress; and medications you used. Preformatted trackers can be accessed online at sites such as headaches.org.
When to seek help promptly: If your headache can be described as one of the worst you’ve ever experienced and is accompanied by trouble seeing, speaking or walking; fainting; high fever; numbness, weakness or paralysis on one side of your body; stiff neck; or nausea or vomiting.  

Meaty Topics: Impossible Burger & Beyond Meat

They’re 2019’s most sizzling success story, found 
everywhere from grocery freezer to fast food counter. Impossible Foods and Beyond Meat have brought the plant-based burger from fringe to mainstream with remarkable rapidity. So quickly, in fact, that despite their ubiquity, questions abound regarding the burgers’ 
benefits. What exactly are they made of? Are they flavorful? How do they compare nutritionally with a turkey patty or an all-beef quarter pounder? Are they meant for a healthy planet and a healthy body? Both feature a lengthy list of ingredients that may seem far from natural, but Impossible Burgers and Beyond Burgers were formulated to recreate the meaty, juicy mouth feel of a hamburger. As hundreds of taste tests and rave reviews have demonstrated, expectations were exceeded. Ironically, many vegans haven’t embraced these plant-based burgers precisely because their taste, smell and texture evokes a beefy authenticity they’ve long eschewed. 

Impossible Burger is made primarily of soy protein concentrate, coconut and sunflower oil, binders, vitamins, minerals and the key ingredient – soy leghemoglobin, or “heme” – which makes the burger “bleed” and brown like meat. Beyond Burger, recently reconfigured to promise an even meatier flavor and chew, features an elaborate combination of plant proteins including pea and mung bean; fats for cooking sizzle, such as coconut oil and cocoa butter; minerals like calcium and iron; potato starch to bind; and beet juice extract for a beef-like red color. The nutritionals paint a somewhat mixed picture. The good news is the burgers contain approximately 
20 grams of protein (equivalent to ground beef); a healthy mix of vitamins and minerals, including B vitamin, zinc and iron; and no cholesterol. However, they may not be the best choice for people following a heart-healthy diet, as they are higher in saturated fat than turkey burgers and contain substantially more sodium than lean beef burgers. Consider creating your own vegetarian burger with beans, whole grains, herbs, seeds and nuts as a healthier option. “These burgers offer good amounts of antioxidants and certain vitamins and minerals, but they aren’t quite the same as a whole-foods veggie burger made from beans,” explains Registered Dietitian Ginger Hultin, spokesperson for the Academy of Nutrition and Dietetics. “In order to mimic meat well, they use a blend of ingredients that includes saturated fat, similar to a beef burger, but from coconut oil.” The verdict? “They’re interesting, delicious products that can fit into a balanced diet, and have benefits in the form of supporting the environment and saving the lives of animals,” she says. That is, in fact, the real fuel driving these companies, both of which are on a mission to reduce meat consumption and ensure a sustainable global food supply by giving people what they enjoy most – big, juicy burgers.

4 oz. Portion

Impossible Burger

Beyond Burger

85% lean burger

90% lean burger

Turkey burger

Total Fat

14 g

18 g

15 g

10 g

10 g

Sat. Fat

8 g

6 g

6 g

4 g

3 g


0 mg

88 mg

15 g

65  mg

92 mg


370 mg

390 mg

72 mg

66 mg

400 mg

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