Archive for March, 2015


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.

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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.

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