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portrait of an young woman coughing with fist

Everyone has at one time or another experienced a common cold manifested by such symptoms as nasal and sinus congestion, runny nose, mild sore throat and cough.  This common infection may last from a few days to one to two weeks. It is always caused by a virus and therefore patience, and not antibiotics, is the main treatment.

Bronchitis can be thought of as any cough that is not caused by pneumonia or asthma.  The main symptom of bronchitis is a cough without a fever.  People with bronchitis usually just have a cough and do not feel particularly sick and are able to continue their normal daily activities.  One can expect coughing from bronchitis to last from one to three weeks. Again, this is a virus infection and antibiotics are usually not necessary. If a cough does last more than several weeks, or is associated with fever, it would be wise to visit your doctor.

Sinusitis is an infection of the sinuses which are air filled pockets around the nose in the skull.  This infection is usually preceded by a common cold.  It too is usually caused by a virus, but after lingering for one to two weeks may turn into a bacterial infection.  One of the key factors in determining the proper treatment for a sinus infection is the length of the symptoms.  If you have had a cold for one to two weeks and are experiencing pain or pressure in the sinuses along with yellow or green nasal mucus and perhaps a fever, then antibiotics may be helpful.

A sore throat is often a symptom of a cold, but can sometimes be a bacterial strep throat infection.  A good rule of thumb is that if a sore throat is associated with a bad head cold, and especially with a cough, it is usually caused by a virus and needs no prescribed treatment.  If however, one has a sore throat without cold symptoms or cough but does have a fever and a past history of prior strep infections, then the most likely culprit is the strep germ which needs to be treated with antibiotics. Strep is much more common in children than in adults.

Over the counter medications for adults can be helpful in alleviating the miserable symptoms of respiratory infections.  The following are the basic ingredients of all the myriad combinations of cold and flu drugs found on pharmacy shelves:

  • Acetaminophen (Tylenol) or ibuprofen (Advil) may be used to reduce fever and to alleviate aches and pains.
  • Pseudoephridine (Sudafed) is a decongestant to help relieve nasal and ear congestion.
  • Guaifenesin (Robitussin or Mucinex) is an expectorant to help loosen mucus. (Dinking lots of liquids may work just as well.)
  • Dextromethorphan is a cough suppressant which may help ease a persistent cough.

One may purchase a sinus rinsing system called Neil Med which can be found at all pharmacies. This is a natural treatment using a salt based solution to mildly flush out the sinuses helping to clear out the mucus as well as acting as a decongestant.  I have found this to be one of the very best treatments for bad colds and sinus infections.

See your doctor if you have a fever for more than 3-4 days or if your fever is 103 degrees or higher.  Your doctor will determine whether antibiotics are necessary to treat you.  At the very least, your doctor may prescribe medication which will help to alleviate your symptoms and make you feel more comfortable.

Palliative and Hospice Care

There seems to be some confusion when it comes to understanding the difference between palliative care and hospice. They are both distinctive medical disciplines and often work together.

Hospice care comes into play when a patient has a terminal illness and all treatment options have been exhausted. It is really for those who have been determined to be in their last six months of life. The goal of hospice care is not to cure the underlying disease but to support the quality of life. Hospice care is usually provided by a team of health care professionals who maximize comfort for terminally ill patients while also addressing physical, social and spiritual needs.

Hospice care is most commonly provided at a patient’s home, with a family member typically serving as the primary caregiver, but, it is often available where ever the patient is, whether at hospitals, nursing homes or assisted living facilities. The hospice care team is usually available 24 hours a day, 7 days a week.

Palliative care is medical care based on the goal to relieve pain and suffering, reduce symptoms, ease stress, and mainly to improve a patient’s quality of life during a serious illness and is not limited to end of life issues. People who are actively being treated for a disease can receive palliative care at any stage of their illness whereas hospice is thought of as end of life care.

This is an important distinction because many people think of palliative care as end of life care and therefore is often not requested when it’s most needed and helpful. Recent studies are showing the benefits of beginning palliative care soon after the diagnosis of a serious illness or when an ongoing illness worsens.

The palliative care team works closely with the patient’s primary treating physician in caring for the patient. While the patient’s treating physicians may be trying to prolong life, palliative care’s goal is to maximize quality of life. It has been shown that palliative care can actually extend a patient’s life for a number of months.

Identifying and managing pain is one of the main priorities of any palliative care program. Cancer is the most common disease which needs adequate pain control usually with opiate drugs like oxycodone and morphine and its derivatives. Palliative care also seeks to improve many other troublesome sources of physical discomfort such as shortness of breath, constipation, and insomnia.

With the help of a social worker, palliative care also deals with psychological and social services both for the patients and their care givers, as well as helping with practical problems like coordinating doctors visits and even arranging transportation.

Our community is blessed to have a number of top notch palliative and hospice care providers. Talk with your physician for further information.

Rare Diseases

Rare Disease Day

Kudos to state Senator Bill Monning who has introduced a resolution to the state Senate recognizing the last day of February as Rare Disease Day in California, coinciding with a similar national observance. This action should help to inform the public about the challenges faced by those living with rare diseases.

There are approximately 7,000 rare diseases that have been identified, which in reality, involve a very limited number of people. A rare disease is defined as one that affects less than 200,000 (and usually considerably less) people in the United States and where treatments and cures are equally rare, mostly because of lack of interest and funding.

I thought I would describe a few interesting sounding rare diseases from A to Z, most of which even I myself have never heard of (much less able to spell):

  • Aarskog syndrome is an extremely rare genetic disorder marked by stunted growth that may not become obvious until the child is about three years of age, facial abnormalities, musculoskeletal and genital defects, and mild intellectual disability.
  • Blue rubber bleb nevus syndrome (BRBNS) is a rare blood vessel disorder that affects the skin and internal organs of the body.
  • Dysplasia epiphysealis hemimelica, is a rare skeletal developmental disorder of childhood.
  • Fibrodysplasia ossificans progressiva (FOP) is a very rare inherited connective tissue disorder characterized by the abnormal development of bone in areas of the body where bone is not normally present, such as the ligaments, tendons, and skeletal muscles.
  • Keratosis follicularis spinulosa decalvans (KFSD) is a rare, inherited, skin disorder that affects men predominately and is characterized by hardening of the skin in various parts of the body.
  • Olivopontocerebellar atrophy (OPCA) has historically been used to describe a group of disorders that affect the central nervous system and cause a progressive deterioration of nerve cells in certain parts of the brain.
  • Paroxysmal nonkinesigenic dyskinesia (PKND) This group of neurological conditions is generally characterized by involuntary muscle contractions that force the body into abnormal, sometimes painful, movements and positions.
  • Trismus-Pseudocamptodactyly syndrome is a very rare inherited disorder characterized by the inability to completely open the mouth causing difficulty with chewing and/or the presence of abnormally short fingers.
  • Zollinger-Ellison syndrome (ZES) is characterized by the development of a tumor that secretes excessive levels of a hormone that stimulates production of acid by the stomach which can cause stomach ulcers or cancer. By the way, Dr.Ellison, who discovered this syndrome, was the chief professor of surgery during my days attending medical school at The Medical College of Wisconsin.

These are but a few interesting sounding rare diseases from which a limited number of people are afflicted. But for those unfortunate ones who are, and because of being so rare, treatments or cures are not easy to come by. Again, thanks to Senator Monning whose resolution could create a better awareness of rare diseases and increase desperately needed research.

Retirement

TerryHollebeckMD

Since a previous article concerning my relapse with multiple myeloma cancer and the effects of chemotherapy, and after much thought and soul searching, I have decided to retire from the practice of medicine.

Having just turned 70 years old and having practiced medicine for the past 43 years (28 of those years in my current practice of urgent care medicine in Scotts Valley), I think it’s time to move on.

At this time I do feel very well, all things considered. I look forward to having some more time to spend with my wife Beth and my daughter Emma, as well as to pursue other interests, such as restoring my good old ’71 Volkswagen bus.  Beth is a musician and music educator and I’m sure I’ll spend more time as her “roadie”.

Being a doctor is something that I had wanted to do since childhood, and it was an honor to follow in the footsteps of my father and grandfather. I have never regretted my decision to enter the medical field. I can’t imagine having pursued a more personally  rewarding and satisfying career.

The difficult part of this decision is that up to this very day, I have thoroughly enjoyed practicing medicine and never really thought about retiring. However,  besides the health issue, there is also the struggle with the time consuming and impersonal electronic medical record, the seemingly daily burdensome rules and regulations coming from a variety of sources, and the constant concern of  malpractice, all of which I will not miss.

But, what an honor and privilege it has been to practice medicine. I have found tremendous satisfaction in treating patients,  being able to alleviate suffering, curing illnesses of all sorts and even saving lives. I have enjoyed the one on one interaction I’ve had with patients and having the opportunity of getting to know them and appreciate them for who and what they are.

I’ve been in Scotts Valley long enough to have taken care of children who are now coming to the clinic with their own children. I’ve been saddened when people whom I have come to know have passed away but,  on the other hand, I’ve enjoyed watching families grow and witness their changing dynamics. In    the past 28 years at Scotts Valley, I figure I’ve had over 100,000 patient visits and therefore have been able to treat a significant number of people from Scotts Valley, the San Lorenzo Valley, and surrounding areas. I’ve always enjoyed walking into a local store or event and seeing the familiar face of a patient and be able to talk with them  and to see and know them outside of the medical setting.

I will miss my wonderful supporting clinic staff with whom I have spent much of my recent life and who had become like a family to me. I am also honored to have been associated with as fine a group of physicians as there could ever be, 30 of them when I first began my work with the Santa Cruz Medical clinic in 1987, and now numbering some 210 physicians with our Palo Alto Medical Foundation affiliation.

Most importantly, I want to thank each and every one of you patients who trusted me and allowed me to care for you over the years. It’s my interactions with you that I will miss the most.

However, I am not going away completely. I will continue this medical column as I have many more topics to share with you and much more to say. As I have previously mentioned, I plan to publish a book  incorporating the most interesting articles. I’m excited about continuing this work.

Since I won’t be seeing you in the clinic, I look forward to seeing you out in the community.

My very best wishes to you all and remember, life is a gift, gives thanks for each and every day.

NYResolutions

As we prepare to leave the old year behind us and greet the New Year, I would like to propose the following health related resolutions:

  1. If you smoke – quit.
  2. If you drink alcohol, do so in moderation and do not drink and drive.
  3. Develop a routine exercise program and stick with it.
  4. Improve your diet – increase fruits and vegetables and decrease fats and carbohydrates.
  5. Buckle up every time you enter your car.
  6. Don’t talk on your cell phone while driving – not only very dangerous, but now also illegal.
  7. Don’t climb ladders alone, have someone with you, (personal experience speaking).
  8. Get regular dental checkups and eye exams.
  9. If you are overweight try to lose weight, but if you can’t at least remain physically fit.
  10. Use sun screen when outside during the sunny months.
  11. Routinely exam your skin for any unusual changes.
  12. Keep your immunizations up to date including all the usual ones that babies and children receive, as well as a diphtheria-tetanus booster every ten years for adults and a yearly influenza vaccine.
  13. Have your blood pressure checked at every health care visit.
  14. Routine health maintenance screening exams to be discussed with your doctor and should include:
  • Pap test for women beginning at age 21.
  • Cholesterol level test starting at age 20.
  • Mammogram for women beginning at age 40.
  • Blood sugar test starting at age 45.
  • Colon screening (colonoscopy) beginning at age 50.
  • Prostate exam for men starting at age 50.
  1. See your doctor sooner rather than later if you have a strong family history of any significant medical problems such as cancer, heart disease, diabetes, high blood pressure etc.
  2. Avoid stress, relax, and do your best to try to enjoy your life whatever your circumstances.

ColdFluMeds

With the cold and flu season approaching, I want to repeat an article I did several years ago about what over the counter medications are available to help alleviate the miserable symptoms of the winter illnesses.  Almost all of the hundreds of products available over the counter contain at least one or a combination of the following ingredients:

  • Tylenol (acetaminophen) or Advil (ibuprofen) for aches and pains
  • Sudafed with either pseudoephedrine or phenylephrine, a decongestant
  • Guaifenesin an expectorant (thins mucus)
  • Dextromethorphan a cough suppressant
  • Antihistamines such as diphenhydramine or chlorpheniramine

We could probably get by with only five different bottles of cold medications on those pharmacy shelves, each containing one of the above medications. I think that taking these drugs individually rather than in combination is better so that one can tailor one’s symptoms to a specific medication and avoid taking something that might not be necessary.  Always read the label on the medication package to check on potential interactions with drugs you may already be taking and to know the possible side effects or warnings.

Here’s how these drugs work.  Tylenol or Advil work equally well for relieving the aches and pains of an illness as well as helping to reduce a fever. Read the directions carefully. The maximum daily dose for acetaminophen is 3000 mg. per 24 hours.

Sudafed, for those who do not have high blood pressure, may be helpful to relieve the swelling of the nasal/sinus passages and to relieve the pressure in the ears due to blocked eustachian tubes. Sudafed with the main ingredient pseudoephdrine, has changed from over the counter to behind the counter and it will need to be signed out for purchase through the pharmacist. It’s probably worth the effort. Sudafed with ingredient phenylephrine can still be purchased over the counter but may be a bit less effective than the pseudoephridine.

Guaifenesin is an expectorant which means it helps to thin out mucous in the nose and sinuses, as well as in the lungs, which makes it easier to either blow out or cough up the mucous.  Dextromethorphan is a cough suppressant which should help at least a little to lessen one’s cough. Honey has also been found to be effective in slowing down a cough. Neither of these remedies is strong enough to actually stop a cough and will not interfere with the healing process.

Antihistamines are really most useful for the symptoms of allergies like hay fever, but they may help colds by slowing down mucous production.  Perhaps they help most by their side effect of drowsiness, thereby helping one to sleep.

Another highly effective way to decongest the nose and sinuses is to perform sinus rinsing using either a netti pot or my preferred method, a Neil Med sinus rinsing kit found at most pharmacies. I have found rinsing to be highly effective to alleviate sinus symptoms and to even treat or prevent sinus infections.

In Summary:

  • For aches and pains from a cold or flu, use Tylenol or Advil.
  • For stuffy nose, sinus congestion or plugged ears use Sudafed.
  • To loosen mucous use guaifenesin such as Mucinex or Robitussin.
  • To help slow down a cough, use a medication with dextromethorphan, such as Robitussin DM or Vicks 44, or try a couple tablespoons of honey in a hot beverage.
  • Get plenty of rest and drink lots of liquids.

Closely follow the directions for proper dosage found on the medication labels.

These are some basic guidelines for choosing medications for the symptomatic relief of common cold and simple flu. I have to admit the effectiveness of these drugs is somewhat limited but worth trying. Adequate rest, liquids, and time still play a major role in recovery from these miserable conditions.

See your health care provider if you have a fever for more than 4-5 days, if you have a fever of more than 103 degrees, or if you have any significant concerns about your illness.

Medical Marijuana

Medical-Marijuana

My goal in this article is not to judge the use of marijuana as good or bad, legal or illegal or right or wrong. My intention is to provide information now available from current medical literature of its medical benefits, known side effects, and when not to use it.

Marijuana has been used for medicinal purposes for several thousand years beginning with the ancient Chinese. It was used at that time for a multitude of medical problems, from the treatment of malaria to the treatment of constipation.

Marijuana was introduced to the United States in the mid 1800s and was prescribed by physicians for its therapeutic benefits until 1937 when it was prohibited from being prescribed. Then in 1970 it was legally prohibited for anyone to even possess or use marijuana.

Because of public demand for the medical use of marijuana in California, in 1996 it became legal to use for medical purposes and soon other states followed suit.

The benefits of marijuana are attributed to its cannabinoid compounds of which some 100 have been identified. The two most researched and well known of these are tetrahydrocannabinol which is also the main component for the mind altering effects of Marijuana, and cannabidiol which causes less of a high.

Most patients smoke the dried plant for the quickest results. Marijuana’s active ingredients can also be delivered through capsules, vaporizers, liquid extracts, foods, and beverages. One major problem is that dosing can be unpredictable since the level of active ingredients varies between plants, as well as the fact that absorption of ingested forms varies among patients.

THC has also been synthesized and available in the U.S. for medical use under the generic names of dronabinol and nabilone, both of which can be prescribed by a Physician.

Although many users have found multiple health benefits from marijuana for the treatment of numerous health problems, there are really only of few that have passed scientific testing. They include:

  • Nausea, especially when caused by cancer chemotherapy and AIDS.
  • Chronic pain especially when due to neuropathy, cancer, or AIDS.
  • Glaucoma
  • Multiple sclerosis
  • Epilepsy
  • Appetite and weight loss in cancer patients.

Again, I want to emphasize that there is a myriad of other conditions that may be helped by marijuana but they, so far, are not backed up by scientific evidence. Most medical practitioners would prefer that patients first use traditional proven treatments for most health problems and to use marijuana for treatment failures.

There are known health risks to the use of marijuana including:

  • Impairment of thinking, problem solving skills, and memory.
  • Increased anxiety and panic attacks.
  • Reduced balance and coordination.
  • Increased risk of heart attacks, inflammation of heart muscle, and atrial fibrillation.
  • Possible hallucinations and withdrawal symptoms.
  • Lowering of blood glucose and blood pressure, and increased risk of bleeding.

Smoking marijuana, which is the most common method of use, has its own set of potential problems. It is associated with possible increased chronic bronchitis and lung cancer (although much less likely than smoking tobacco). A review of current literature shows agreement that the possible harm to the lungs from smoking marijuana does not endorse the safety of its use in this manner.

At this time experts recommend limiting the use of medical marijuana to adults older than 18 years of age. There are also other health related conditions where marijuana should not be used including:

  • History of schizophrenia or other psychiatric disorders.
  • Severe heart or lung disease.
  • Severe liver or kidney disease.
  • Pregnancy or planned pregnancy, and breast feeding.

Even with the possible side effects and the non uniformity of doses and strengths of its various forms, I would encourage the use of medical marijuana for the known conditions where it has been proven to be helpful. I can also accept its use in any number of conditions when more conventional treatments have failed.

As marijuana use becomes more widely legalized it should open the door to much needed research which would provide more information as to the best doses and delivery systems for medical use as well understanding the risks and benefits for all users. This information would be of great help to both physicians and patients.

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