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Archive for the ‘Colds’ Category

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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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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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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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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Every parent of a sick child wants to do whatever possible to make the child feel better. But most cold- and flu-like illnesses in children are caused by viruses, which will be cured by the child’s own immune system.

Many over-the-counter cold medications for children have been withdrawn for safety reasons. The Federal Drug Administration now warns against giving children younger than 4 years any over-the-counter medications, other than pain and fever relievers.

Here are my suggestions for symptomatic relief of your child’s cold- or flu-like illness:

Encourage the child to drink plenty of fluids to prevent dehydration and to help thin out mucus. Contrary to popular opinion, milk has not been proven to increase mucus.

Fever or pain can be controlled using either acetaminophen (Tylenol) or ibuprofen (Advil). Accurate, consistent doses should be given every six hours.

Saline irrigations can help with drippy noses. For infants, use rubber bulb suction with saline nose drops to remove mucus. Older children can use a saline nose spray.

Place a cool-mist humidifier or vaporizer in the child’s room. To prevent contamination, the water should be replaced daily and the machine cleansed regularly according to the manufacturer’s recommendations. Keep indoor relative humidity at about 40 to 50 percent.

If a medication such as Tylenol or Advil is given, I do not advise the use of household silverware spoons for dose measurement. Teaspoons found in our kitchens can vary in size and should be used only for eating, not for measuring liquid medication. Proper measuring devices using units of milliliters usually come with the medicine or can be obtained from a pharmacist.

Honey can relieve a cough by increasing saliva, which coats the throat and relieves irritation. Suggested doses are half a teaspoon for children between 1 and 5 years, 1 teaspoon for children 6 through 11 years and 2 teaspoons for children age 12 and older. Do not give honey to a child younger than 1 year of age.

See your health care provider immediately for:

** An infant not yet two months of age with any fever

** A child younger than 2 years with a fever that lasts longer than two to three days

** A child who complains of an earache or a severe sore throat

** A child who has thick green nasal discharge for more than one week

** Mild symptoms that do not improve in 10 to 14 days

** Any child who seems very ill to you

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