A common question that I am asked in my urgent care practice is when to apply either hot or cold packs to treat injuries and pain.

Acute injuries are usually manifested by pain, swelling, and tenderness, whereas chronic injuries are usually manifested by lingering pain from an acute injury or from overuse of muscles and ligaments from too much exercise or heavy work.

Our necks, backs, shoulders, and knees are common sources of ongoing pain. Chronic pain may come and go, whereas acute pain from a recent injury is usually constant.

Ice is used to treat an acute injury because it helps to slow blood flow to the injured area, thus helping to reduce swelling and inflammation. Ice can be applied by using ice in a plastic bag, gel packs (from a pharmacy) or even from using a bag of frozen peas. In general, cold therapy can be discontinued when swelling is gone after an injury.

Heat treatment may begin several days after the injury. It works by opening up blood vessels, which helps by increasing blood flow to the injured tissue, thus easing the pain. The word heat is defined as very warm to comfortably hot, but not too hot. Heat can be applied by using a hot water bottle, a heating pad, a gel pack or a hot soak in the tub.

Be very careful using heat if you have diabetes or poor circulation as you may cause burns to the skin.

The use of products to apply to the skin overlying a painful body part such as “Deep Heat” or “Mentholatum” work by causing the skin to feel cool and then warm. These feelings on the skin distract you from feeling the aches and pains deeper in the tissue. This may be helpful for more minor aches and pains.

Both hot and cold compresses should be wrapped in a thin towel so that you neither burn nor freeze the skin.

Be aware that you may burn your skin if you fall asleep on a heating pad. Hot or cold packs should be used for 15 to 20 minutes at a time. For ice treatments, I recommend repeating every half-hour to hour if convenient, and for heat, every two to four hours.

In summary:

– Use a cold pack as soon as possible for immediate injuries such as sprains of the ankle, wrist, knee, back or any other injured joint or body part. Cold treatment can usually be stopped 48 hours after the injury or until swelling is gone.

– Use a hot pack for a painful injury that lasts longer than several days, for recurrent pain from previous injuries, or as a warm up of painful areas prior to exercising.


The media has recently warned of an unusually bad allergy season causing miserable symptoms to countless people.

Seasonal allergies are commonly referred to as allergic rhinitis — also known as “hay fever” — if the nose is mostly affected, and allergic conjunctivitis if the eyes are involved.

 Allergic rhinitis affects up to 40 percent of children and 10 to 30 percent of adults in the United States. It is referred to as “seasonal” if symptoms occur at particular times of the year or “perennial” if it occurs year-round.

Common symptoms of seasonal allergies include sneezing, itchy eyes, nasal congestion, headache, and fatigue. These symptoms can have a tremendous negative impact on the quality of life and on productivity.

American workers lose an estimated six million work days yearly to this disorder, as well as incurring costs of several billion dollars in medical care.

Seasonal allergies usually occur from spring to early fall, and are due to pollens from trees, grass and weeds. Perennial allergies, occurring throughout most of the year, are caused by indoor factors such as dust mites, animal dander, and mold.

Nasal stuffiness from allergic rhinitis can cause swelling and obstruction of the sinuses which can lead to a sinus infection.

There is a strong association between allergic rhinitis and asthma. Up to 50 percent of patients with asthma have allergic rhinitis. Sleep disorders in adults and a high proportion of ear infections in children are also associated with allergic rhinitis.

Treatment for people who think they have allergic rhinitis can begin with an over-the-counter antihistamine such as Benadryl or Chlortrimeton.

However, they are often associated with the bothersome side effect of drowsiness. They should be avoided in children below 2 years of age and in the elderly.

Newer oral antihistamines such as Claritin, Allegra, and Zyrtec, are now available without a prescription and cause significantly fewer side effects and are more conveniently dosed at once or twice a day. Steroid nasal sprays such as Nasacort and Flonase are very effective and are now sold over the counter.

Seasonal allergies can also affect the eyes causing redness, tearing, itching, and swelling of the lids.

This can be treated with cold compresses and with one of the newer oral antihistamines mentioned above. It would also be worth trying over-the-counter allergy eye drops such as Zaditor, Alaway or Naphcon A.

The above mentioned over-the-counter medications for allergy symptoms can be purchased for under $30 at your local pharmacy. If these treatments aren’t working sufficiently, see your doctor who can help you decide what treatment is best for your symptoms.


We are now seeing an increase in patients presenting with influenza and it is predicted that we are likely to see many more.

Influenza, the name of the virus for which the “flu” season is named, causes a highly contagious respiratory infection which often starts very quickly and may cause the following symptoms:

– Fever, headache, and extreme fatigue.

– Cough, sore throat, and runny or stuffy nose.

– Body aches, and sometimes vomiting and diarrhea.

As opposed to influenza, a bad cold — often referred to as an upper respiratory infection — may have symptoms of nasal and sinus congestion, a sore throat, and ear pressure. Bronchitis may have a very bothersome nagging cough, but neither of these illnesses are likely to have symptoms of fever or body aches as influenza does.

The flu can cause mild to severe illness and occasionally can lead to death. Most healthy people who contract the flu recover without complications. However, some people — especially the elderly or the very young, as well as those with chronic medical conditions such as diabetes, heart disease, and asthma, are at a high risk for serious complications of the flu.

One of the most deadly side effects of the flu is pneumonia which is a very serious lung infection.

The flu usually spreads from person to person from respiratory droplets when one who is affected coughs or sneezes. It also often spreads by touching some object that has the influenza virus on it and then touching one’s mouth, nose, or eyes.

A person coming down with the flu is contagious from one day prior to showing any symptoms and remains contagious for at least five days after the symptoms begin.

Although it has been reported that this year’s flu vaccine has not been very effective against the prevailing H3N2 strain of flu, experts still recommend getting the shot as it seems to add some protection. As it is said; “something is better than nothing.”

This vaccine is approved for use in people older than 6 months of age.

Almost everyone can benefit from the flu shot, but it is highly recommended for the following groups:

– Pregnant women and children younger than five years.

– People 50 years of age and older and those with chronic medical conditions.

– Those who live in nursing homes or other long term care facilities.

– People who work or live with those at high risk for complications of the flu.

The flu shot contains a dead virus which will cause a person’s immune system to create antibodies to help prevent one from getting infected, or at least to help lessen the effects of an infection.

It’s still worth considering, and not too late. Flu season can last well into springtime.


Having begun my career in a busy county trauma emergency room (ER) and now working in urgent care, I wanted to use this experience as an opportunity to explain how you can decide when to go to the ER and not to urgent care.

Emergency rooms see more than 300,000 patients daily in the U.S. To help diminish this large number of patients — many of whom do not have serious problems — urgent-care centers began seeing patients in the late 1970s.

There are now more than 9,000 urgent-care centers functioning across the country and the number is growing.

Because of lower overhead, urgent-care centers charge much less for non-emergency care than do emergency rooms where overhead to provide needed comprehensive care is much more expensive.

In general, ERs can utilize all that the hospital has to offer, which includes the ability to admit a patient, especially to the intensive care unit (ICU) for more serious problems. Also, a hospital-based ER is able to utilize state-of-the-art X-ray and imaging studies, as well as a full laboratory — which in most cases can obtain immediate test results.

ERs usually have a full complement of specialists on call to take care of a variety of medical, surgical, or pediatric problems.

In general, almost any condition which can be described as “severe” should be treated at an emergency room.

Coming to urgent care, even though it may be closer to you than the ER, with such a severe problem often leads to being sent by paramedics to the emergency room. This is not only very expensive, but can waste valuable time to begin much needed treatment. Once you arrive at urgent care, it is the on-duty doctor who determines whether your particular problem can be treated there, or if you need to be sent for more comprehensive care at the ER.

The following are some of the more common reasons to go to an ER rather than urgent care:

If you have severe:

– Chest pain.

– Abdominal pain.

– Headache.

– Backache.

– Vomiting and/or diarrhea.

– Difficulty breathing and/or shortness of breath.

– Burns.

– Trauma.

Or go to the ER if you have:

– An allergic reaction with trouble breathing, feeling faint, or severe hives.

– Fainting, sudden dizziness, or weakness.

– Sudden changes in vision.

– Confusion, change of mental state, or difficulty speaking.

– Suicidal thoughts.

– Uncontrollable bleeding. (Remember to always apply pressure to the wound until you receive treatment.)

– An injury to an arm or leg that causes a deformity, that is to say an arm or leg that is bent instead of being straight.

– Poisoning or drug overdose.

– Loss of consciousness.

– Miscarriage or a sick newborn baby.

– Illegal drug-related problems.

Call 911 if you consider an injury or illness to be very serious or potentially life-threatening.


Acute bronchitis is an infection causing inflammation of the lung’s airways and is one of the most common of human ailments.

It usually begins with head cold symptoms such as a runny nose, sinus congestion, or a sore throat. It is almost always caused by a virus and rarely by bacteria. If a cough is not due to pneumonia, influenza, or asthma, it is most likely what we call bronchitis.

Most people actually feel fairly well with bronchitis, except for having a persistent, nagging cough. Fever is rare and mucus production may or may not be present.

A very common misperception is that colored mucus — especially green — indicates a bacterial infection and therefore the need for antibiotics. Recent scientific evidence supports that virus infections also produce green mucus.

Those who smoke are much more susceptible to bronchitis because of the damage done by the smoke to the lining of the breathing tubes of the lungs. This allows germs to enter the lungs more easily, causing an infection.

Many patients request antibiotics in hopes of quickly ridding themselves of the cough and therefore visit their doctor as soon as symptoms begin so that they may “nip it in the bud.”

Some think that antibiotics helped them on previous occasions, but there is no proven benefit for these drugs in the treatment of bronchitis.

Inappropriate antibiotic use can cause unnecessary side effects — diarrhea and yeast infections to mention a few — increase the cost of medical care, and lead to the development of resistant germs.

This means that many of our commonly used antibiotics are no longer effective against many germs and there are very few new and extremely expensive antibiotics being developed. That’s a scary situation.

Treatment for bronchitis is directed towards relieving the symptoms. For the head cold symptoms that come with bronchitis, an oral decongestant pill such as Sudafed (pseudoephedrine) as well as a decongestant nasal spray, such as Afrin (oxymetazoline hydrochloride), can be used to combat nasal and sinus congestion.

Afrin spray works well to open up clogged nasal passages but should not be used for more than one week to avoid rebound (worsening) congestion. Tylenol (acetaminophen) or Advil (ibuprofen) can be used for the relief of aches and pains. Drinking plenty of liquids has proven to loosen mucus.

For cough symptoms, over-the-counter cough medicines with dextromethorphan, such as Robitussin DM or Vicks 44 may be helpful.

A recent study has recommended the use of a natural cough remedy using a mixture of 5 parts honey and one part instant coffee crystals. Take one tablespoon of the mixture in about 6 ounces of water every 6 hours for cough.

Also, for a cough that makes the lungs feel tight or wheezy, a doctor may prescribe a brief course of an inhaled medication commonly used for asthmatics.

In summary, most coughs that we call bronchitis can last at least 3 weeks, are almost always caused by a virus, and antibiotic treatment is not helpful. However, if at any time you have a cough with a fever, you should see your doctor.

Looking Back on 2014


Wow, what a year.

Early this year, I was told that I was in remission from the multiple myeloma cancer which had been diagnosed late last year. Two and a half months of chemotherapy did the trick. I didn’t have the stem cell transplant in February as was originally planned.

I spent the next 8 months dealing with the neuropathy in my feet, the persistent but much-improved back pain which was my initial symptom, a new heart problem from the inflammation that developed around my heart, and now hip pain as a late side effect from the chemotherapy.

Most of you have heard all of this before and I’ll spare you the details. Needless to say, I’m hoping 2015 will be a bit better.

What I realized the most through this experience was how different it is to be the patient and not the doctor. I was the one who had to take the medications, the therapy, the surgery, and the imaging studies. This time it was other doctors taking care of me. I’ve gained a lot of insight and understanding about how patients deal with and feel about their medical problems.

From the first moment I heard that dreaded word “cancer,” to eventually hearing the word “remission,” I knew that I was in very capable hands and had a fighting chance to overcome this disease.

I have a strong faith and knew that if God wanted me to survive, that I would. I have to admit that I know some people who also had great faith and yet didn’t survive, a mystery that I believe we will understand someday.

I’m back to work and am so happy to see the faces and to receive the heartfelt greetings of those patients I’ve come to know over the past 28 years. I love working with my wonderful staff and fellow providers. I hope to continue practicing medicine for as long as I am able to do so.

I just looked at the summary of all my medical expenses for this past year. Boy, am I glad I’ve got medical insurance.

We’ve come a long way in treating and overcoming diseases, but it ain’t cheap, and, unfortunately, it’s not going to get any less expensive.

We all, (that is to say, doctors, patients, administrators, drug and medical device manufacturers, and legislators) need to come together to devise a more affordable health care system.

This will only happen when these groups put aside any selfish interests and work toward a common goal. Obamacare is an attempt to improve the cost and delivery of health care but falls far short of what’s needed.

All that aside, I’m excited for the near future of medicine. I see the rapid development of new drugs, cancer treatments, surgeries, and cures for all sorts of diseases.

I think and hope these will be available to us in the very near future. We’re seeing the results already today. My being alive is a testament to this.

I think we have a very bright future in medical care, but it has to be made affordable and widely available.

Here’s wishing all of you from the bottom of my heart, a happy and very healthy new year.


With the holidays upon us, I wanted to take this opportunity to talk about holiday safety — especially for our children. I will discuss just a few of the many recommended safety precautions.

Poisoning: Contrary to popular thought, the poinsettia plant is not poisonous, but could make a little one quite sick if ingested. Mistletoe and holly are considered poisonous. Be careful with these plants.

Choking: Children have a natural tendency to put things in their mouths. The following are items to keep away from little children: small toys or larger toys that can be broken down into smaller pieces, small batteries, small decorations and ornaments, coins, and food such as peanuts, popcorn, and small hard candy.

Clean up carefully after opening presents as little ones can choke on scrap pieces of tape, wrapping paper, and ribbons. Look carefully around your living environment and be aware of children’s exposure to anything that will fit in their mouths.

Burns: Place candles in a safe location far from the reach of a young child as well as away from flammable objects such as curtains, decorations, and the good old Christmas tree.

Keep matches and cigarette lighters out of a child’s sight and reach. Do not leave burning candles unattended and especially remember to extinguish them before going to bed. Have a fireguard in front of the fireplace.

Do not burn wrapping paper in fireplaces and be sure that the area around the fireplace is free of combustible material. Look around closely for potential fire hazards. Keep hot drinks and food out of a child’s reach.

Injuries: Check new and existing furniture, TVs, and equipment, to be sure they cannot be tipped over easily. Ensure that outdoor play equipment is assembled properly and has a soft surface underneath.

I can’t stress enough the importance of children wearing a helmet when riding bikes, scooters, etc. Too many children are seriously injured or killed from a head injury which could have easily been prevented by wearing a helmet.

Tree safety: Make sure at time of purchase that an artificial tree is labeled “fire resistant.”

When purchasing a live tree, be sure it is as fresh as possible. This can be done by shaking the tree to see if an over abundant number of needles fall off.

Place the tree in a secure stand with water as soon as possible to keep it from further drying. Do not position it close to heat sources such as fireplaces, heating vents, and radiators.

Use only flame resistant or non-flammable decorations to adorn the tree.

And now, a word to adults.

Christmas is a fun and social season, when a fair amount of alcohol and salty food can be consumed.

A bit of overindulgence can cause “holiday heart” syndrome which is due to an abnormal heart rhythm manifested by a fast and irregular heart beat.

People with a history of atrial fibrillation are more susceptible to this condition, which although serious, is usually not life-threatening. If it lasts more than a few hours, or if you feel short of breath, have chest pain, or feel faint, go to the emergency room.

And please, if you decide to enjoy alcoholic beverages, do not drive. Have a designated driver. Being in an accident or arrested for drunk driving is just not worth it.

Have a very happy and healthy holiday season.


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