What's the BUZZ? Caffeine vs. Alcohol

We all know that caffeine is a stimulant, and most of us have a daily dose to fight fatigue and pep us up. So why create caffeinated ALCOHOLIC drinks? Doesn't that seem counter intuitive to put a stimulant (caffeine) with a sedative (alcohol)? A recent interesting high quality study, Acute impact of caffeinated alcoholic beverages on cognition: A systematic review points out a few facts you might want to share with your favorite college student...

• Energy drinks combined with alcohol DO decrease fatigue and "PERCEPTION of intoxication"
• However, despite FEELING unimpaired, complex tasks such as driving definitely ARE impaired.
• Additionally, caffeinated alcoholic beverages INCREASE impulsivity- which can obviously lead to drinking too much (further decreasing judgment and increasing impulsive choices).
• Finally, with this cycle of feeling less buzz and drinking more, ALCOHOL ADDICTION may increase.

I find this study particularly interesting in light of the "pre-gaming" with Attention Deficit Disorder (ADD) meds and alcohol that has become increasingly common on college campuses. Same concept- the ADD med stimulant taken before drinking alcohol blunts the "buzz" response from alcohol...at least for the first few drinks. Unfortunately, these stimulants do not blunt the other effects of alcohol toxicity such as decreased gag reflex, poor muscle coordination, feeling off-balance, nausea, vomiting, and ultimately impaired breathing. So what happens is you feel "fine" till suddenly you are unpleasantly drunk, then you risk vomiting with impaired consciousness and/or gag reflex...allowing you to choke and aspirate your own vomit-which, by the way, can be lethal. Or worse, you feel "fine" and choose to drive because you have no idea that your judgment and motor skills are significantly decreased, leading to a wreck that hurts not only you but potentially others...because you are driving a one ton weapon. 

BOTTOM LINE: Combining caffeinated energy drinks (or ADD meds) with alcohol is a potentially very dangerous choice because you blunt the "buzz" of alcohol without decreasing the other negative effects of rising blood alcohol levels. Just say NO.

Can't (cough) Stop (cough) COUGHING?

COUGHS often seem to hang around FOREVER, and this year's flu season has been a prime culprit.
Allergies certainly can cause coughs as well, but typically allergy coughs are more the dry, annoying, clear-your-throat variety, rather than the wet sounding coughing fits (that worsen every evening and prevent sleep) which come from viral respiratory infections. Typically there are a few days of headaches, fever, body aches, sore throats and stuffy nose,  but then the cough itself may persist for up to SIX WEEKS after the initial illness.

Is there anything that can be done for a cough that wont go away? Yes, absolutely.

Will an antibiotic fix a cough? Especially is there is green mucus? Probably NOT, because the vast majority of respiratory infections are viral. Green mucus does not equal bacterial infection.

So you NEVER need an antibiotic for a cough? No, that is not true- sometimes a cough IS being caused by a bacterial infection (possibly a pneumonia), but this is the exception, not the rule.  If you are a week into your symptoms, slowly getting better, and then suddenly you feel a ton worse and develop a fever, this might be a bacterial infection setting up shop AFTER the virus cleared the way past your body's defenses. For this scenario, yes, you need an antibiotic.

If antibiotics don't help, why see your doctor for a cough? 
Certainly not every cough NEEDS to be evaluated by a physician. Over-the-counter cough products include DM (dextromethorphan) (which works at the brain level, decreasing the drive to cough) plus expectorants like guaifenisen (ex. trade name Mucinex) to thin up the mucus. Combinations of these ingredients (along with decongestants to help stuffy noses) make up the cough/cold/flu products like Dayquil/Nyquil/Robitussin/etc. and may be helpful in alleviating cough and cold symptoms in adults.

Cool mist humidifiers next to the bed often bring relief, and honey (either taken as a straight teaspoon or in a hot tea) has been objectively shown to help improve coughs (though never for children younger than one year).

However, often after a viral respiratory infection, the lungs' defenses become overly reactive, creating too much mucus and then subsequent spasm of the airways- we call this "reactive airway disease" and this is the same process we see with asthma. Subsequently, persistent coughs often resolve more quickly when treated with prescription asthma inhalers or other oral medications (possibly anti-inflammatory steroids).

Additionally, there are other prescription cough medications that might help.
Benzonatate (trade name Tessalon) is a non-addictive, non-sedating medication that works in the lungs to decrease the cough reflex by numbing the stretch receptors in the respiratory tract. (In my clinical experience, this drug either works like a dream or has little impact, but its low side effect profile makes it an attractive choice.)

Finally, a cough that is keeping you (and/or your bed partner) up all night despite OTC medications may require a sedating prescription cough syrup. With our current opioid crisis, know that conscientious physicians are appropriately limiting the quantities of these potentially addictive medications, and this is not a long term solution.

Finally,  a cough may come from other sources, such as acid reflux or sinus drainage or a medication side effect (such as from one class of blood pressure medications), which require different treatments.

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

Ever been skiing and noticed your toenail had turned black and incredibly painful at the end of the day? Was the entire nail black or only the base?  "Skier's toe" is a common and often very frustrating injury from skiing.

The medical term is a subungual hematoma, which simply means bleeding under the nail. This can occur from a single instance of trauma like dropping something on your toe, or from small, repetitive trauma like a too-small or too-big ski boot (which allows your foot to slip back and forth, slamming your toes repeatedly).

If YOUR toenail is black and painful at the end of your ski day- do NOT wait to go in to a clinic, because the sooner you get treatment, the higher the success rate. The treatment procedure involves burning a tiny hole through the nail, which allows the trapped blood to drain. There is typically only a few drops of blood, but the pain that small amount of blood causes underneath the nail (if NOT removed) is fairly intense.

As with so many medical problems, PREVENTION is key! Make sure your ski boots fit properly- do NOT cram your foot into a friend's boots- and be sure your socks are not bunched up. Using the newer thin ski socks, rather than old school super thick ones, also helps. (Don't worry, the new fabrics keep your toes warmer, despite what it might appear.) This painful injury should NOT occur if your shoes/boots fit correctly.

BOTTOM LINE: Make sure your ski boots and socks fit properly to avoid getting skier's toe!

PS. While in experienced hands, the red-hot tip of a flame-sterilized paperclip may be used to swiftly burn a tiny hole through the nail, I would definitely NOT recommend trying this on your own after watching a youtube video for training. Among other challenges, people have been known to pass out from simply watching this procedure done...and dealing with the head injury (or other trauma) that results from someone passing out (often in a bathroom with sharp or hard counter edges) is worse than the original problem.

Spring Break 2018: Know Your Limit

Spring Break is here, and students everywhere are gearing up for a week-long party. ALCOHOL is typically a focus of these festivities, so let's review some facts about alcohol dangers. In recent years, studies show that about a third of college students admit to binge drinking (consuming 5 or more drinks in a row.) The good news is that this number is down over 15% from over the last two decades, and actually, drinking trends in ALL categories are decreasing- whether the measurement is annual consumption, monthly, weekly or number of binging episodes. A great tool to educate yourself (or your favorite college student) is this VIRTUAL BAR  where you can enter in your gender, age and weight, and then "pour" yourself drinks and watch your blood alcohol levels rise...

Another wonderfully informative program/website is Aware Awake Alive. Check out their table with drinks/blood alcohol concentrations, and SHARE THIS WITH YOUR FRIENDS. Ultimately, know that if you have a THIRD drink, you are most likely legally drunk. AND, please note, this is a third drink measured by the book (not a "college pour" of alcohol into a plastic red cup- those cups hold several servings in just one glass). The biggest mistake friends make is leaving their intoxicated friends alone to "sleep it off".  If someone has "passed out," they NEED supervision. The alcohol level in their bloodstream will continue to rise, which can cause them to either vomit (and potentially choke, because their gag reflex is dulled by the alcohol) or to stop breathing. If their breathing is less than 8 breaths/minute, CALL 911 immediately.

Pain killers often find their way to spring break as well, whether that is courtesy of a knee injury skiing, or simply part of someone's personal medicine cabinet. Please take note:

Pain Killers (narcotics- think codeine or vicodin) + ALCOHOL= DEATH.

This combination accounts for far too many accidental suicides per year- NEVER MIX THESE.

BOTTOM LINE: Enjoy spring break, but if your festivities include alcohol, make sure you know your limit AND know exactly what to do if one of your friends drinks too much. 

Altitude Matters!

Skiing for spring break? Whether you prefer downhill or cross country skiing, remember that the high altitude might add in a few medical challenges. Be aware of signs and symptoms of "mountain sickness" (aka. altitude sickness) and if you are susceptible to this issue, look closely at ski resort ALTITUDES. Full disclosure, my destination of choice is Crested Butte, CO, which is one of the higher resorts...no pun intended.

HOW HIGH do you have to be for altitude sickness?
There is not a set elevation for typical mountain vacations that affects everyone. Symptoms are uncommon at altitudes below 5000 feet above sea level, and fairly common above 8000 feet. If you fly to a higher elevation (such as above 8000 feet), wait a day to acclimate before you start hiking the high peaks nearby. This is very common- an estimated 75% of people visiting mountains with altitudes higher than 10,000 feet will get some degree of altitude sickness. Note that many people have a significant difference in degree of symptoms between altitudes of 9000-13,000 feet- which may explain why they "felt fine" skiing last year at a different resort.

For Colorado skiers: 
The highest ski mountains are in Arapahoe Basin and Loveland (13K), with Breckenridge barely under at 12,993'. Snowmass/Aspen, Keystone and Copper Mtns peak at roughly 12,300-12,500', with Crested Butte and Winter Park closer to 12K. Vail is 11,500 while Durango and Steamboat are around 10, 500. To get below 10K, consider Buttermilk at Aspen (max 9900) or Steamboat Springs Howelsen Ski Area at only 7,136. Obviously the ski towns themselves are not at these peak mountain summit heights, and many resorts offer lodging at a variety of elevations- consider this factor when deciding about the convenience of ski in, ski out, as sometimes you are better off further down the mountain.

When does altitude sickness begin?

Symptoms usually start within the first 24 hours, and often as early as the first few hours after arrival.

What are the common signs?

• Mild to moderate: HEADACHE, decreased appetite or nausea, insomnia, and lightheadedness
• Severe:  All of the above plus vomiting and shortness of breath
• Note that in severe forms, there can be brain swelling (High Altitude Cerebral Edema) and/or fluid collecting in the lungs (High Altitude Pulmonary Edema)- these are medical emergencies.

Treatment?

Ultimately, GOING TO A LOWER ELEVATION will relieve symptoms, but rest and hydration usually alleviate most mild symptoms at your current elevation. For persistent or worsening symptoms, head to a clinic for possible oxygen and medications. In Colorado, there are oxygen bars and even over-the-counter oxygen cans that can help relieve mild symptoms. For insomnia, try over the counter melatonin.

PREVENTION:

• Increased hydration with water or sports drinks, and avoidance of diuretics like CAFFEINE and ALCOHOL, especially the first few days.
• SLOW ASCENT if possible (driving up to the mountains is lower risk than flying).
• If you have had altitude sickness previously, especially if it has occurred on multiple trips to the same elevation, see your doctor and consider prophylactic medications (acetazolamide or steroids).

BOTTOM LINE: Don't let the mountains literally take your breath away- plan ahead to prevent altitude sickness!