Is This Strep Throat?

Are you worried you might have "strep throat"? How can you tell when it is time to head to your family doctor for a sore throat? Certainly the majority of sore throats are not caused by the streptococcus bacteria, and do not require antibiotics. In fact, seasonal allergies often cause extremely painful throats, but do not involve bacterial infection at all. While there is very little in medicine that is completely black and white, there are several clues to clinicians that a particular sore throat may be caused by strep (and therefore, respond quickly to antibiotics.)

Typically with strep infections, we see a combination of fever, a sore throat (that looks beefy red, with or without white pus on the tonsils and often with the red spots on the top part of the mouth), with tender, swollen glands (lymph nodes) in the front part of the neck, and LACK of a cough. The presence of a cough almost always excludes the possibility of strep, so if you are coughing, chances are greater that you may have a viral or other cause of your sore throat.

Other symptoms that are common with strep throat infections are headache and stomach ache, with or without nausea and vomiting.

How helpful are the rapid strep tests? Very- if they are positive. A positive test has a 95% chance that you do, indeed, have strep. However, not all types of strep are identified with the rapid test, only Group A (which is the classic "strep throat" that can lead to scarlet fever). Other types of strep (Groups B, C, D, and G) can also cause throat infections, but will not be identified with the rapid strep test. A false negative test may also be the result of a suboptimal swab, which can happen if the patient has an overactive gag reflex (which raises the tongue and blocks the tonsils). There is a 3-10% false negative rate (meaning you test negative, but you do have strep.)

A throat culture- where that same swab is placed on agar to actually see what bacteria grows- takes a couple days to yield an answer, but it is 99% specific.

What can you do to feel better? Happily, strep is a bacteria, so antibiotics due indeed cure this problem. In addition to taking the antibiotic that your doctor prescribes, taking ibuprofen or acetominophen typically helps with the pain and fever. I am a big advocate of salt water gargles (for the first day or two) to ease pain. For this, my advice is to put a couple tablespoons of salt into a standard 8 oz glass of warm water- it won't all even dissolve, but the point is to make the gargle solution extremely hypertonic (very salty), which appears to aid both in numbing the throat as well as helping to fight the bacteria.

BOTTOM LINE: Signs of strep throat that should signal a diagnostic trip to your family doctor include fever, sore throat, painful & swollen lymph nodes (glands) in the front of your neck, and NO COUGH.

Can't Swallow That?

Difficulty swallowing, known medically as "dysphagia", is a very common complaint. In fact, up to nearly a quarter of patients seen in primary care settings will suffer from this problem. Dysphagia is definitely more common in the older population, whether they are in nursing homes or living independently.

What causes dysphagia? The most common cause depends on the age. In small kids, there may be structural problems present from birth that may need surgical correction. In adults, however, the cause is often something that can be fixed more simply, with medications and/or behavior changes.

Smoking, excess alcohol, and obesity all tend to increase stomach acid refluxing back up into the esophagus, which can cause pain or difficulty in swallowing. Reflux, also known as GERD (Gastro Esophageal Reflux Disease) is a very common cause of dysphagia that is seen in otherwise healthy people. Quitting smoking, stopping excess alcohol and weight loss can all improve symptoms, as well as taking medications that reduce acid production.

Medications such as NSAIDS (like ibuprofen), potassium supplements, antibiotics and osteoporosis medications can all cause problems with swallowing, so both diagnosis and treatment of dysphagia in this case may involve stopping prescription medications.

• Let me take this opportunity to caution against "DRY SWALLOWING" pills. I cringe when I see people grab an ibuprofen and swallow it without a drink. Every time you take a pill or capsule, swallow it along with at least a half glass of liquid. Dry swallowing can essentially "scrape" or chemically irritate the lining of your esophagus. And please, let gravity help you get that pill all the way to your stomach- don't lie down for at least five or ten minutes after you take medications.

Less commonly, the more serious causes of dysphagia are to blame, including cancers, strokes, neurologic disorders such as Parkinson's Disease, advanced infections, or scarring from prior trauma or radiation.

BOTTOM LINE: Don't ignore trouble swallowing, especially if it persists or is getting worse. Schedule an appointment with your family doctor!