A Doctor's Travel First Aid Kit

Packing up for your summer vacation? If you are driving and have the luxury of a bit of extra space, you may want to consider packing a first aid kit to take with your family. If you already keep one in your car (hello, fellow soccer/dance/volleyball moms!) then let this be your reminder to pull that kit out of your car, CHECK EXPIRATION DATES, and replenish all your used up supplies.

What's in my kit? A handful of medicines have earned their way into my ever-ready first aid kit.  Here is my top 10 list:

1. Ibuprofen- for headaches, muscle aches, fevers or menstrual cramps.
2. Tylenol- to supplement the ibuprofen if the ache or fever is severe.
3. Antacid tablets (TUMS or Rolaids)- still the fastest relief from heartburn/stomach acid.
4. Hydrocortisone cream (steroid such as Cortaid)- for anything that itches (bug bites, allergic skin reactions.)
5. Triple antibiotic cream- for cuts/scrapes (after washing with water.)
6. Bandaids- the GOOD kind that really stick, with specifics for knuckles, knees, and most commonly, HEELS (for those blisters!)
7. Benadryl tablets- for an intense allergic reaction to food, stings, etc; also may be used to help nausea.
8. ACE wrap- handy to limit swelling of a sprained ankle, knee or wrist.
9. Aspirin- honestly, I only keep this in case an adult has symptoms of a possible heart attack.
10. Imodium- I do NOT recommend this to stop infectious diarrhea (so do not take if you have a fever), but if you get a "nervous stomach" with the thought of flying, driving, or simply being cooped up in a car with your relatives, consider this medication to calm down your bowels.

BOTTOM LINE: These few basic first aid supplies should get you through 99% of the illnesses and injuries that crop up on your trips. Remember the creams may count as "liquids" so slip them into your airline-specified ziplock baggie if you are flying!

Relief for Allergies!

Rainy days in May mean high mold counts on the Austin allergy scale.  A nonstop sneezing reaction of my own has prompted me to blog about some belated good news for allergy suffers. Late last fall (October 2013), the FDA approved the first OTC nasal steroid for seasonal allergies- Nasocort AQ...and there was much rejoicing! I have maintained for years that I wished the nasal steroid sprays would have gone over the counter before the non-sedating antihistamines (like Zyrtec, Claritin & Allegra) primarily because the nose sprays have far fewer side effects.

People frequently initially cringe when I suggest a nasal steroid spray for their seasonal drippy nose, sneezing and congestion- for a couple reasons. One reason is that many of us hate even the thought up shooting something up our noses. Rest assured, using a fine mist from these sprays is NOTHING like getting water forced up your nose from jumping into water! If that is your (or your teenager's) primary concern, try a sample before you rule out this treatment option. The second main issue is a global distrust or fear of STEROIDS. Again, relax- you will not be morphing into Arnold from THESE steroids. Nasal steroids are not muscle-building anabolic steroids, but a separate class of drugs called glucocorticoids, which decrease inflammation. Additionally, these nasal sprays are very minimally absorbed into your body, but instead work more locally in the nasal membranes.

BOTTOM LINE: If you have been prescribed nasal steroids for your seasonal allergies, know that there is now a full-strength over the counter option. 

(Disclaimer- I have no financial ties nor investments in Nasocort or any other medications, but like all practicing clinicians, I have my own clinical preferences...and this is one of them.)

Can Healthy Lungs "Collapse"?

My last blog entry talked about costochondritis, a common frustrating but benign cause of chest pain in young people. Today I would like to talk about a much less common but potentially far more serious cause of chest pain in young adults- pneumothorax, more commonly known as a "collapsed lung".  If images of television's Dr. McDreamy dramatically inserting a chest tube into an ER patient pop up in your head, please keep in mind that this medical issue only occurs in just over 1 in 100,000 people in the United States per year. In my private clinical practice, I saw less than an average of one per year, despite seeing innumerable patients with chest pain. Now working in an urgent care setting, I definitely see this more often but it is still relatively infrequent (I diagnosed three in the last six months, only one of which required surgical intervention.)

Wouldn't you know if you had a collapsed lung? Shouldn't you be gasping for breath? Well, not necessarily. Most of what we see outside of hospitals is much more subtle, and typically involves a very small portion of the lung. (I should clarify that I am talking about primary spontaneous pneumothorax here, where the person has no known underlying lung diseases such as pneumonias, tuberculosis or cystic fibrosis.)

Who gets this? The classic body type we think of as a risk factor is a very tall, thin, frequently athletic person. Smoking is also a risk factor, but is not necessary. 

What does it feel like? The pain is typically very sudden, sharp, and one sided, often near the shoulders or neck (not towards the heart or breast bone). Pain is worse with a deep breath or cough. Often patients think they "pulled something" in their back/chest/neck. 

How can the doctor know if the lung is collapsed? When the doctor listens to your heart and lungs with her stethoscope, she may be able to hear a discrepancy in your breath sounds- the side with a partially collapsed lung may have softer (or absent) breath movement than the other side. However, when the portion collapsed is very small, there may be no obvious findings on the physical exam.  In the schematic above, my balloons are demonstrating a fully inflated lung on the image right hand side, with a partially deflated "lung" on the left. On regular chest x-rays, the outline of the shrunken lung can be identified as an opaque shadow, leaving the remaining "empty" part of the chest cavity that an inflated lung would normally fill looking darker black than the other side. Chest X-rays are typically the only imaging necessary, though occasionally a CT scan is needed to identify additional lung pathology.

What is the treatment?  The treatment for pneumothorax is highly dependent upon the size of the collapse as well as physical symptoms. Larger or recurrent collapses may require chest tube placement to re-inflate the lung, and/or surgical intervention to prevent additional lung collapses.

BOTTOM LINE: Most sharp chest pains in otherwise healthy young adults are NOT from the lungs, but partially collapsed lungs do occur and are not always dramatic. See your doctor if you have any concerns about your chest pains, even if you are not short of breath (and even if you are otherwise young and healthy.)

Chest Pain in a Teen or Twenty-Something?

In otherwise healthy young adults, chest pain is rarely a serious medical problem. The vast majority of the time, chest pain is coming from the chest WALL, not the heart- which is typically the concern of the patient or his/her family. This chest wall pain is medically labeled as "costochondritis." We see this more in young females than males, most often between the ages of 20 and 40 years, though younger teenagers may have this as well.

What causes costochondritis?
Sometimes the cause is obvious, such as a new weight lifting regimen or workout routine, or perhaps after a lingering upper respiratory infection that left you coughing for a month. Often, however, we cannot identify a trigger or likely cause.

What does it feel like?
As opposed to the squeezing or pressure sensation that we associate with cardiac pain, chest wall pain tends to be more achy and actually tender to touch. Although the pain may be in multiple locations, it is typically one-sided and often right along the junction of the ribs with the sternum (your breast bone).

Do you need a chest x-ray to diagnose costochondritis?
While chest x-rays may be ordered to rule out other causes of chest pain, there is no specific clinical finding that you can see on a chest X-ray film to "show" costochondritis. Along the same lines, there is no blood test to prove or disprove this diagnosis.

How do we treat costochondritis?
Topical ice massage, stretching and anti-inflammatory medications such as ibuprofen, or straight pain-relievers such as acetaminophen (tylenol) may all be tried to see if they offer improvement. Often people with this complaint are less concerned about making the discomfort go away, but are seeking reassurance there is not something wrong with their heart. The symptoms of costochondritis have an annoying tendency to wax and wane over weeks to months, regardless of what intervention is  attempted. Changing behaviors is also critical if there is a concern of an overuse injury as a cause.
The good news is that this is not a medically dangerous condition that leads to scarier diagnoses, and while the symptoms seem to hang on "forever", the vast majority of the time the symptoms seem to fully resolve by the end of a year.

BOTTOM LINE: Chest pain that is actually tender to touch in an otherwise healthy young person is often "costochondritis", a benign but annoying chest wall problem that tends to last for weeks to months, then spontaneously resolve.