Saturday, February 27, 2016

STILL Coughing? Will Anything Help?

Is your cough driving you (and everyone around you) nuts? If your purse, coat or pant pockets are overflowing with empty cough drop wrappers and tissues, than you've dealt with that cough on your own long enough. Whether the original culprit was a common cold, the flu, or "just" seasonal allergies, coughs can take on a life of their own as our lungs gear up mucus production and airway spasm. My rule of thumb is that lingering coughs should be on a clear decrescendo- getting slowly but steadily better each day. If your cough is getting worse by increasing in frequency, intensity (like those fits of coughing hard enough to make you leak urine), or preventing sleep, then it's time to let a doctor listen to your lungs and take a full look at you.

But what can be done for a cough that wont go away? Do I need antibiotics?
The vast majority of persistent coughs do NOT need an antibiotic, because they are typically a left over reaction from a respiratory virus.  However, if you are a week or more into your symptoms and things seem to be improving, but then suddenly you feel a ton worse and develop chills, sweats and fever as your cough worsens, this might be a bacterial infection setting up shop AFTER the virus cleared the way past your body's defenses.- possibly even pneumonia. For this scenario, yes, you often do need an antibiotic. More commonly, though, frustrating coughs are the result of developing  some over-reactive airways and therefore, you may benefit from inhalers or other asthma-style medications. Not uncommonly we prescribe a very brief course of oral steroids (prednisone) for someone who develops wheezing and airway spasm after a viral respiratory infections.

But I don't HAVE asthma- so why am I coughing? People who did not grow up with the diagnosis of asthma can still have an asthma response to a respiratory tract infection or seasonal allergies- we call this "reactive airways disease". Your lungs make extra mucus and have more inflammation,  together causes airway spasm- audible to the examiner and sometimes to the patient themselves as a "wheeze". The asthma inhalers or breathing treatments through a nebulizer (machines that deliver the asthma medication as a fine mist that is inhaled through a mask or mouthpiece) work to pop open those airways, stopping the wheeze that was caused from the airway spasming shut in areas. That relief is temporary, however, because it fixes the problem and not the cause. The steroids are the real "fix" because they decrease the inflammatory response that started the whole cycle.

What else might my doctor give me?
There are a variety of cough suppressant combinations that include dextromethorphan, which is in most over the counter cough and cold products. Some persistent coughs without the reactive airway component will respond to a prescription cough suppressant called benzoate (brand name tessalon perles.) Additionally, a prescription narcotic cough syrup may help you sleep at night and reduce the nighttime exacerbations. Finally, your doctor can remind you of some traditional home remedies such as cool mist humidifiers and topical menthol products that may help your symptoms. Finally, sometimes a cough comes from other sources, such as acid reflux or sinus drainage, which require different treatments.

BOTTOM LINE: See your doctor to evaluate coughs that get worse after a respiratory illness, or that wont go away- don't expect antibiotics, but know there are other treatment options!!

Thursday, February 25, 2016

Flu Vaccine- NOT TOO LATE!

* The "C" in the flu tests pictured above is for "control"

Friends, family, colleagues and everyone else- FLU SEASON was mild to begin with, but now we are really gearing up. Pictured above are two positive flu tests from one morning this week (two of many). The extra good news is that so far I have not seen anyone with the flu who was vaccinated, though certainly that can happen. Remember that seasonal influenza causes thousands of hospitalizations and deaths every year in the United States, and the flu vaccine is our best method to prevent or at least reduce the severity of the flu.

This year, we hit a home run on the strains in the vaccine, as we have a very good match between the vaccine and the current strains. Yesterday's CDC press release notes that the overall effectiveness of this years vaccine is 60%. While that number might not sound super impressive, reducing the total healthcare burden of people needing to seek care for flu symptoms by 60% is huge in our total population! Also, keep in mind that if you receive the vaccine but in your case it is not fully effective so you still get the flu, your symptoms should be less severe, and your infection is likely to resolve more quickly. I'm posting this today, though, not for adamant anti-flu vaccine holdouts, but for the well-intentioned stragglers that simply never got around to getting the vaccine. Please, it's not too late- GO GET VACCINATED!

CDC data shows happily that only two states- Arizona and Oklahoma- are having HIGH levels of flu-like illnesses right now. Texas, along with Arkansas, Connecticut, Florida, Hawaii, Illinois, Maryland, Nevada, New Jersey and New Mexico are close behind with "moderate" levels, which is no surprise with what I am seeing in my patients.

Remember- not all flu looks the same. Fevers can be high or minimal. Headaches, sore throats, muscle aches, cough, runny nose and fatigue are common. Stomach symptoms with nausea, vomiting or diarrhea can occur independently or with the other symptoms.

When should you go to the doctor? If you are MISERABLE- feeling like a truck hit you, rather than a common cold or allergies causing upper respiratory symptoms, then go sooner rather than later, because if you do have the flu, the anti-flu medications are maximally effective when started within 2 days of symptoms beginning.

Does everyone need medication if they have the flu? No. Most otherwise healthy young people can manage without anti-viral medications, but they may certainly benefit from a cough suppressant or decongestant.

Why bother testing for flu? There are several reasons, partly for you, the patient, and partly for public health/your family. If a college student living in close quarters in a dorm has the flu, for example, we would rather they not infect their roommate and classmates. Knowing they have the flu helps us advise them on when to return to class, or perhaps help parents who live nearby to decide to whisk them home for a few days of chicken soup and true rest. Remember, if a flu test is POSITIVE- you've got the flu. If it is still might have the flu. (For more explanation, see Was My Rapid Flu Test Accurate?)

BOTTOM LINE: Flu season is still here and it is NOT too late to get vaccinated!

Thursday, February 4, 2016


Don't wait for Valentine's Day next week to wear RED- pull it out tonight to wear on Friday, February 5, 2016. The American Heart Association has set aside the first Friday in February to call attention to cardiovascular disease in WOMEN. Did you know that one in three deaths in women are caused by heart attacks and strokes? This is not to minimize the deaths and struggles from cancers, but to create awareness about the incredibly high frequency of these diseases in women, and therefore encourage more women to take positive steps to improve their health. The best news is that the  vast majority heart attacks and strokes can be PREVENTED when people recognize, modify and treat their risk factors. So...let's start with basics:

What is a "heart attack"? The heart is ultimately just a muscle, and like every other muscle, it needs a unique blood supply to provide the nourishment it needs to work. Although the heart muscle's  job is to move blood by pumping it, that blood being moved to the body is not the same blood that feeds the heart muscle itself. Instead, there are smaller blood vessels (called coronary arteries) that carry the specific blood that supplies the heart muscle. If one of these small arteries gets a clot or blockage that obstructs the blood flow, then the area of heart muscle that requires that blood supply will have the "attack" because it is not getting the fuel it needs, so that portion of the muscle can be hurt or destroyed. If the fuel line in your car were clogged, then your engine would have an "attack" because it wasn't getting fuel. Similarly, a stroke is when an area of the brain has it's blood supply cut off by a clot. 

What can you do to decrease your risk of a heart attack or stroke?
1. Quit smoking (always number one on my wish list for patients to improve their health!)
2. Know your numbers- what is your BLOOD PRESSURE? your CHOLESTEROL? your BMI?
3. Move MORE- whatever your baseline activity is, kick it up a notch!

Rather than focusing on losing twenty pounds,  running a marathon, or getting off all your blood pressure medications in one month, pick a few small changes that you can easily incorporate into your life as a permanent change.  

1. Consider starting these changes by scheduling a physical with your family doctor to learn your "numbers" to help prioritize your lifestyle changes.

2. Commit to one vegetarian meal per week (if that is not already part of your standard food rotation). If you are vegetarian, look at what you eat and add in new fruits or vegetables in different colors than you typically consume.

3. If you are inactive, start walking 10-15 minutes per day. If you walk a mile per day, kick it up to a mile and a half. If you walk or jog a couple miles per day already, alternate with an exercise bike or swimming. The point here is that WHATEVER you are doing, take it up ONE notch.

BOTTOM LINE: Wear RED this Friday, 2/5/16, serving as a reminder to you and the people you love to prioritize learning your own personal risk for heart attacks and strokes- then start making changes to prevent these diseases!