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!!

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 NEGATIVE...you 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!

Got RED? WEAR IT FRIDAY, 2/5/16

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!

New Years' Resolutions: Take 2

Greek Salad at the Stash

Well, here we are at the end of January already...and how are you doing with your New Year's Resolutions? From the number of FitBits and step counts that I am seeing and hearing, I believe many people are enjoying being more active (or at least enjoying "competing" with themselves or friends over their numbers.) Perhaps the two most common health related resolutions are to increase exercise and to eat "better". What does that really mean?

First let's tackle "increase exercise". Please, focus on the INCREASE. If you are honestly doing nothing, start with walking. Consider a "FitBit" or a smart phone or a simple $10 pedometer, and start charting how many steps you take each day. Next, challenge yourself to up that number each day by 100 steps. We as a society seem to be very motivated by video-game-like challenges, so we know what it takes to "pass" each level, right? Let's apply that to our daily steps. For years, we have been pushing the "10,000" steps per day, which is approximately equal to 4 miles. My encouragement today is simply to see YOUR personal baseline, and push it up by SMALL increments each day.

Eating "better". Okay, I have blogged before about the "unhealthy vegetarian", but for those who have not yet heard my rant...here it goes. "Vegetarian" does NOT equal "HEALTHY". It certainly CAN, and even SHOULD- if that person is concentrating their food choices on- wait for it- VEGETABLES. However, especially in my current patient population of college students, "vegetarian" can mean diets of granola bars, chips, nachos, and cheese pizza. Hmm...let's count the fruits and veggies there- anyone have a calculator? LOL.

BOTTOM LINE: My 2016 Gift to you is that the last day of EVERY month, I wish for you a clean slate- a "do-over" for your NYE Resolutions. On this January 31st, why not pick a simple FEBRUARY healthy resolution? And feel free to share with us your success!

Is TEAL the New PINK?

January is Cervical Cancer Awareness month, and the color is TEAL. Did you know there are still over 12,000 women in the United States who are diagnosed with this cancer every year? And although our treatments have greatly improved, there are still over 4000 deaths from this cancer every year. The good news is that we have PREVENTION, and with this prevention, we hope to eliminate cervical cancer within our lifetime! Take this CDC Cervical Cancer QUIZ to test your knowledge.

The HPV vaccine is approved and strongly recommended for all adolescents- girls and boys- as part of their routine vaccinations at age 11-12 years. The second generation of Gardasil vaccine (Gardasil 9) now covers not the HPV strains that cause 90% of cervical cancers (as well as the two strains that cause 90% of genital warts.) If your child has started the series with the original Gardasil, they may finish out the series with the Gardasil 9 to increase the spectrum of their immunity.

YES, the vaccine is safe. YES, the vaccine is effective- extremely effective! YES, my daughters are immunized, and they are the two people my husband and I love and care about the most on this planet! Enough said.

Pap tests- are they still necessary? Yes, but NOT EVERY YEAR (and the crowd cheers)! Our current guidelines recommend Pap testing starting at age 21 years, and then every 3 years till age 65. There is also an option for 30-65 year olds to test only every 5 years when they do combined Pap and HPV testing.

Does the Pap check for all sexually transmitted infections? NO. The Pap test checks for early cervical cancer. To check for STI's such as HIV, gonorrhea, chlamydia, syphilis, and herpes, you will need additional testing (of blood, urine, and possibly a swab test performed during a pelvic exam.)

Are there support groups for women diagnosed with cervical cancer? Absolutely! For example, I'm honored to be in the picture above with Tamika Felder, the founder of a wonderful support group CERVIVOR- check out her website!

BOTTOM LINE: That magical "cure for cancer" has not yet been discovered for all cancers, but CERVICAL CANCER is preventable- let's end this disease for our children by vaccinating them now!

Out with the OLD, In with the NEW (AKA Healthy New Year's Resolution #1)

Happy 2016! Hard to believe we are nearly half way through January as I look at my home STILL filled with Christmas decorations. Many of us tackle the new year with a cleaning or de-cluttering frenzy after we pack up the holiday decor. In fact, it can be overwhelming as we survey overflowing closets, desks and kids rooms...wishing for that magic wand to neatly organize our lives. I once read an organization plan that suggested a better chance of success if you tackled ONE specific area and thoroughly completed it before you moved on- whether that was one drawer of your dresser, a single shelf of books, or even cleaning the kitchen sink itself. So...instead of the sink or coat rack, may I suggest starting with your MEDICINE CABINET? Whether this means a simple first aid kit or an entire bathroom or kitchen cabinet, let's get rid of the old and bring in a few selected new supplies.

Expired medications, in my experience, are rarely harmful in and of themselves, but they often have lost effectiveness. There is no point in saving the last few drops of prescription cough syrup from 2007...it's not going to help you any more. If you are having an allergic reaction and your diphenhydramine (Benadryl) or worse, your Epi-Pen, has expired...this is not a good time to find out how much their effectiveness has decreased! Ditto with anti-nausea medications. In general, solid tablets have extended shelf lives more than liquids. Additionally, with liquids such as eye drops, the preservatives break down, allowing potential bacterial growth (and the obvious possibility of causing rather than treating an eye infection.)

However, taking leftover "spare" single or several antibiotic pills actually MAY be harmful- because as you partially treat an infection, you make the bugs effectively only weak and dizzy, not dead...and now you have a strain of bacteria that is resistant to new antibiotics. Just say NO and toss these.

Expired bandaids? Okay, you can keep those. But compression wraps (ACE wraps)? If you have washed them a dozen times- unlikely they have enough spring left in them to do their job. High quality splints from old injuries (wrist or ankle)? I keep those as long as they can be cleaned.

Once opened, over-the-counter acne medications with benzoyl peroxide (hello, high school and college students!) TOTALLY lose effectiveness after only a couple months- explains more than a few breakouts. Toss 'em.

Bottom Line: Make a HEALTHY START in 2016 by cleaning out your MEDICINE CABINET this weekend!

Rocky Mountain HIGH...Altitude Sickness

Going skiing for winter break? Mountains are my favorite destination, but...please remember that the high altitude can come with 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- there is a wide variation.

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 & 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 it start?

Symptoms usually 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 will alleviate most mild symptoms. For persistent or worsening symptoms, head to a clinic for possible oxygen and medications. For mild 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!