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Posts Tagged ‘cold’

BaseballInjury

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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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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Over-the-counter cough and cold medications to alleviate cold symptoms in young children are being largely withdrawn from pharmacy shelves. This is because of unintentional misuse or overdose of these medications causing harm and, rarely, death, especially in children younger than 2.

These medications are frequently used in good faith, even though there is no scientific proof that these drugs are actually effective. This is a case in which the risks outweigh the benefits.

Health care providers are now asked not to advise the use of such drugs for children younger than 6. Some of the most common are PediaCare, Triaminic and Dimetapp.

I know this may sound discouraging when caring for a sick child, but there are useful non-drug treatments for cold and cough symptoms. Try the following, for example:

• Encourage the drinking of fluids to prevent dehydration and to help thin out mucus. Contrary to popular opinion, milk has not been proven to increase mucus formation.

• Control high fever or pain with either acetaminophen (Tylenol) or ibuprofen (Advil), giving doses once every six hours.

• Saline irrigation can be helpful for a congested or drippy nose. For infants, use rubber bulb suction to remove nasal secretions after applying saline nose drops or spray, or try sinus rinsing for older children.

• Use a cool-mist humidifier or vaporizer in the child’s room. To prevent contamination, the water inside should be replaced daily and the machine should be cleansed regularly according to the manufacturer’s recommendations. If possible, maintain indoor relative humidity between 40 percent and 50 percent.

• If a medication such as Tylenol or Advil is given, I do not advise the use of household kitchen spoons to measure doses of medication. Measuring devices that use units of milliliters (mLs,) usually are packaged with the medicine or can be obtained from a pharmacist.

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

Sometimes, a visit to a doctor is called for. See your health care provider immediately for the following cases:

• A child younger than 2 months of age with any fever

• A child younger than 2 years of age with a fever lasting more than two or three days

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

• Thick green nasal discharge that continues for more than seven to 10 days

• Mild symptoms that do not improve after 10 to 14 days

• A child who seems very ill to you

By the way, for children who have appropriately been prescribed antibiotics, I am frequently asked whether the drug needs to be refrigerated.

The two most commonly prescribed antibiotics — amoxicillin, which tastes like bubble gum or occasionally is fruit-flavored, and azithromycin (Zithromax), which has a cherry/vanilla/banana taste — can be kept at room temperature for up to 10 days. Refrigeration may improve the taste, but it isn’t needed to maintain potency.

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Doctors are seeing an increased number of patients with symptoms of respiratory infections such as common colds, bronchitis, sinusitis, ear infections and sore throats. I would like to review some important points regarding these common infections, along with their recommended treatments.

Everyone has, at one time or another, experienced a common cold that carried symptoms such as nasal and sinus congestion, a runny nose, a 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 — therefore patience, 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 viral infection, and antibiotics are not necessary. If a cough lasts 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 can turn into a bacterial infection.

One of the key factors in determining the proper treatment for a sinus infection is the duration of the symptoms. If you’ve had a cold for one to two weeks and are experiencing pain or pressure in your 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 with a fever and a past history of 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. Many people go through life without a single strep infection.

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 ease 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 might 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 flush out the sinuses, helping clear out mucus. 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 three or four days, or if your fever is 103 degrees Fahrenheit or higher. Your doctor will determine whether antibiotics are necessary to treat you. At the very least, your doctor may prescribe medication that will help treat your symptoms and make you feel more comfortable.

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