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Archive for the ‘Colds and Flu’ Category

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.

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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.

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FLU

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.

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headcold

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.

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Winter-Cold

The winter “respiratory, cold, and flu” season is upon us. I have seen quite a spike in visits to urgent care with people suffering from coughs, nasal and sinus congestion, sore throats, and generalized achiness.

I believe that people, now, more than ever realize that there is no cure for the common upper respiratory infection also commonly known as “URI” or head and chest cold.

I am sympathetic to anyone who feels ill and I understand one’s desire to feel well as soon as possible, but there just is no quick fix to the common URI including bronchitis and sinusitis.

Unless one’s symptoms last longer than expected, as I will describe below, antibiotics will do no good and may even cause unwanted side effects and help to create germs that are resistant to antibiotics.

Here are some reasons why someone with URI symptoms should be seen by a doctor:

– You have a fever of 103 F or higher.

– You have any fever lasting more than three days.

– Your cough is associated with wheezing, chest pain, or shortness of breath.

– You are elderly or have a compromised immune system due to chronic disease or chemotherapy.

– You are basically well except that you have a cough for two to three weeks.

– Your sinus congestion with green nasal mucous doesn’t improve after 7-10 days.

Most all coughs, even with yellow or green mucus, are considered bronchitis and are caused by viruses which cannot be cured with antibiotics.

A recent large study concluded that bronchitis can last up to two or three weeks. If your cough lasts longer than this, you should see your doctor.

Another reason to see your doctor is if you have a cough associated with fever, shortness of breath, and feeling as if you’ve been “run over by a Mack truck” — then you could have either pneumonia or influenza for which treatment is available.

Regarding sinusitis, almost all sinus infections, even with green mucus production, begin as a common virus infection and will improve without antibiotics. If these symptoms last more than 7-10 days, then an antibiotic may be indicated.

When you do see your doctor, let them evaluate you by listening to what you have to say, examining you, and then determining what type of treatment is necessary to make you feel better.

P.S. It’s not too late for the flu shot. Influenza cases are just beginning in our area, and as is happening in other parts of the country, this disease may spread among us quickly. Better safe than sorry.

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map-enterovirus

Enterovirus (EV D-68) is an infection that is currently making its way around the United States and has recently been found in California.

As of Oct. 17, there have been 43 proven cases of EV D-68 throughout the state with one proven case in Santa Cruz.

Results of testing, where specimens are taken from a person’s nose or throat, can take 1-2 weeks. There may be many others with the disease without laboratory confirmation. Testing is done mostly on those patients with fairly serious symptoms.

EV D-68 affects mostly children 4-5 years of age with a range of 6 weeks to 17 years of age and often shows minimal or no symptoms.

They are however, more likely than adults to have potentially more serious symptoms, especially those children with asthma who may need hospitalization. Infected adults show minimal or no symptoms.

The virus is found in secretions from saliva, nasal mucus, or sputum (from the lung). It is spread by coughing, sneezing or touching contaminated surfaces such as doorknobs or other inanimate objects.

Mild symptoms include runny nose, sneezing, cough, and generalized aches and pains. More serious symptoms are difficulty breathing, worsening asthma and respiratory distress. Mild symptoms are treated as if one were treating the common cold.

More severe cases are usually treated in the hospital, often in the intensive care unit where respiratory care and treatment of wheezing can be best handled. There are no antiviral treatments or vaccines available at this time.

Some ways of protecting one’s self from getting the EV D-68 infection include:

n Frequent washing of hands for preferably 20 seconds with soap and water, especially after changing diapers as the virus is found in stool. The use of an alcohol-based hand sanitizer is not as effective as is the proper use of soap.

n Avoid touching your nose, mouth and eyes with unwashed hands.

n Avoid close contact such as kissing, hugging, or sharing eating utensils with anyone who appears sick.

n Practice good respiratory hygiene by coughing or sneezing into your elbow or tissue.

n Disinfect frequently touched surfaces.

As with any contagious illnesses such as the common cold, influenza, or EV D-68, STAY HOME! See your doctor if you feel that your symptoms are worsening and/or if your fever is rising.

On a personal note, for those of you who have followed my cancer journey this past year, I’m happy to say that I continue to be in remission, I’m feeling good, and have started back to work.

I’m giving myself a little break and will work half time for the foreseeable future. Your prayers and good thoughts have been greatly appreciated!

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Winter Resp

The winter respiratory, cold and flu season is upon us. I have seen quite a spike in visits to urgent care by people suffering from coughs, nasal and sinus congestion, sore throats and generalized achiness.

I believe that people, now more than ever, realize that there is no cure for the common upper-respiratory infection, also known as URI or head and chest cold.

I am sympathetic to anyone who feels ill, and I understand the desire to feel well as soon as possible, but there just is no quick fix to the common upper-respiratory infections, including bronchitis.

Unless one’s symptoms last longer than expected, as I will describe below, antibiotics will do no good and may even cause unwanted side effects and help create germs that are resistant to antibiotics.

Here are some situations in which someone with upper-respiratory symptoms should be seen by a doctor:

– You have a fever of 103 degrees Fahrenheit or higher.

– You have any fever lasting more than three days.

– Your cough is associated with wheezing, chest pain or shortness of breath.

– You are elderly or have a compromised immune system due to chronic disease or chemotherapy.

– You have vomiting for more than one day and cannot keep down any liquids, or you have profuse diarrhea.

– You are basically well, except that you have a cough for two to three weeks.

– Your sinus congestion with green mucus doesn’t improve after seven to 10 days.

Most coughs, even with yellow or green mucus, are considered bronchitis and are caused by viruses that cannot be cured with antibiotics. A recent large study concluded that bronchitis can last as long as 3 weeks. If your cough lasts longer, you should see a doctor.

Another reason to see a doctor is if you have a cough associated with fever, shortness of breath and feeling as if you’ve been run over by a Mack truck — you might have pneumonia or influenza. Treatment is available for many who have these illnesses.

Regarding sinusitis: Almost all sinus infections, even with green mucus production, begin as a common viral infection and will improve without antibiotics. If symptoms last more than seven to 10 days, then an antibiotic may be indicated.

When you do see your doctor, let him or her evaluate you by listening to what you have to say, examining you and then determining what type of treatment is necessary to make you feel better.

PS: It’s not too late for the flu shot. Influenza cases are just beginning in our area, and as is happening in other parts of the country, this disease may spread among us quickly. Better safe than sorry.

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calling

It’s getting to be the time of year when respiratory illnesses, such as colds, coughs and the flu, begin to make more of us ill.

I’m frequently asked by patients whether they can return to work or school or resume exercising when feeling sick. I’d like to offer some guidelines to help make such decisions.

I know missing work or school can mean falling behind on one’s workload, but going to work or school while ill can not only prolong an illness, but also spread it to others.

It seems employers and educators are becoming more tolerant of excused absences due to illness. They realize that not only will workers or students who are sick be less productive, but they may cause others to become ill and affect the entire office or classroom.

In fact, it has been reported that more than two-thirds of all health-related productivity losses are the result of sick employees who show up and perform poorly — not those who miss work to recover.

As a rule, stay home when ill:

– If you have a fever (100 degrees or higher).

– If you experience frequent coughing or sneezing.

– If you are taking medication that may make you dizzy, lightheaded or unable to concentrate.

– If you have vomiting or diarrhea.

Consider returning to work or school when the above symptoms have cleared up.

Meanwhile, you can take several precautions — whether at home, at work or at school — to help keep from spreading illness to others.

Wash your hands frequently with soap and water or with a hand sanitizer, and keep your hands away from your face.

Cover your face when sneezing or coughing, using tissue paper or the sleeve on your arm.

Try to stay several feet from face-to-face contact with those around you.

I can’t emphasize enough the importance of keeping distance between those who are sick and others who are not. Germs are spread through respiratory droplets from our noses and mouths. In normal conversation and breathing, those droplets from the mouth may extend out one or two feet from you, but a sneeze or cough can spread them an estimated six to eight feet.

Those who are healthy need to act defensively when in the presence of someone who is showing symptoms of an illness.

Mild to moderate physical activity is usually OK if you have a common cold and no fever. Don’t exercise if you have a fever, fatigue or widespread muscle aches.

If you do choose to exercise when you’re sick, reduce the intensity and length of your workout. Exercising at your normal intensity when you have more than a simple cold puts you at risk for a more serious illness.

Let your body be your guide. If you have a cold and feel miserable, take a break. Scaling back or taking a few days off from exercise when you’re sick shouldn’t affect your performance. Resume your normal workout routine gradually as you begin to feel better.

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I would like to make my annual plea for everyone to get a flu shot.

According to the Centers for Disease Control and Prevention, there is a good supply of the vaccine available this year, enough for 135 million doses.

Influenza, commonly called the flu, is unpredictable. During the 2009-10 season the “swine flu” was a pandemic, causing thousands of hospitalizations and many deaths worldwide.

It is estimated that during an average flu season, 250,000 to 500,000 people die worldwide from complications of the flu. Although last year’s flu season was relatively mild, there were still numerous deaths, including 35 children who died of influenza in the U.S.

This year’s vaccine contains two new strains, plus the same H1N1 as last year. Children 6 months and older and almost all adults should be vaccinated, starting now. The vaccine’s effectiveness should last all season. Children 8 years and younger need two doses only in the first year they are vaccinated.

Flu shots are safe at any stage of pregnancy and are especially important for expectant mothers, as they are much more likely to have a serious illness resulting from the flu and could thus be more likely to miscarry or have a premature delivery. A pregnant woman’s flu shot stimulates her immune system, creating antibodies that cross the placenta into the fetus. That protects her baby during the first six months after birth, before the infant is old enough to be vaccinated.

There’s no need to delay receiving the flu shot because of a mild illness, but don’t get a shot if you have a fever. Waiting until the fever is gone or until you’re feeling better after a more moderate or severe illness is the rule.

Many people worry that a flu shot might give them the flu. That is just not true. The viruses found in the flu shots have been inactivated (killed), and dead germs cannot cause illness. They do, however, stimulate the immune system to create antibodies to help prevent the flu.

The only people who should not get a flu shot are those who:

– Are allergic to egg products.

– Have already had a bad reaction to influenza vaccine (extremely rare).

– Have had an episode of a neurological disease called Guillain-Barre syndrome.

A few minor side effects may briefly occur from the flu shot, such as a mild ache and redness at the injection site, a low-grade fever and mild body aches.

I look at it this way: Why not get a vaccination that has minimal side effects and has a good chance at preventing an illness that could make you feel terrible for a week and also make you miss work? It’s a cheap form of health insurance.

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There are many misperceptions about the appropriate use of antibiotics for the treatment of upper-respiratory infections.

As we come to the end of another year and find ourselves in the midst of the cold and flu season, I want to talk about the diagnosis and treatment of the common upper-respiratory infections. These infections include sinus infections (sinusitis), sore throats (pharyngitis), ear infections (otitis) and coughs (bronchitis).

These are the most common illnesses seen in my practice in urgent care, as well as in most acute-care practices. We physicians are constantly receiving information from current medical literature indicating that almost all of these infections are caused by viruses, which are completely unaffected by the use of antibiotics. These viral infections will usually improve with time. The big question here is how much time.

At what point does the simple viral infection become a secondary bacterial infection that can be cured with an antibiotic? That is the critical issue, and one that I’m sorry to say is difficult to determine.

We physicians have various means to confidently diagnosis such problems as appendicitis, heart attacks, ulcer disease, diabetes and others. But we have no easy, fast, or accurate method of determining at what point in time the upper-respiratory infection changes from a viral infection to a bacterial infection.

I want to say emphatically that antibiotics will not shorten the duration of an upper-respiratory infection.

Why not just give an antibiotic and hope for the best?

Simply put, antibiotics can cause problems from annoying to life-threatening allergic reactions, diarrhea and yeast infections. Just recently, overuse of antibiotics has been linked to obesity by Dr. Martin Blaser, a professor of microbiology at New York University Langone Medical Center. Antibiotics are also very costly and drive up the cost of health care when prescribed needlessly.

The most important issue is that the inappropriate use of antibiotics causes the development of “super germs” that resist treatment by almost all antibiotics. Unfortunately, unlike in past years, very few new antibiotics are being developed. The situation worries me.

What I would ask of patients with symptoms of the abovementioned respiratory illnesses is to give as much time as possible for the illness to run its course. If you have a fever or increasing pain, if you feel so sick that you can’t perform your usual routine or if you develop any other symptom that worries you, an immediate trip to your physician is justified.

Once you decide to see your doctor, you should expect the doctor to listen to your explanation of symptoms, examine you, give you a diagnosis and offer an estimate as to when you should feel better. Then let him or her advise you of the proper treatment to help you feel better.

When it comes to the common upper-respiratory infection, let us do for you what will ultimately help you, in the safest and best way, feel better.

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