Can't Get Rid of that COUGH?

This time of year especially, coughs seem to stick around forever. Here in Austin, the culprit may be seasonal allergies, but overall the major cause of persistent coughs is viral upper respiratory infections- from both simple "colds" and the big, bad flu. With these infections, after you get past the headaches, and stuffy nose part, you find yourself coughing- often up to SIX WEEKS after the initial illness. Sometimes it's a minor "clear your throat" type of cough, while other times, it's the crazy fits of coughing that keep you from sleeping.

Is there anything that can be done for a cough that wont go away? Yes, but a cough does NOT mean you definitely need an antibiotic- in fact, typically, you do NOT. However, a cough that is not managed with over the counter medicines should be addressed by your physician. Coughing all day long at school or work (or keeping up your spouse with coughing all night) is NOT a good plan!

What can your doctor do? First of all, she does need to rule out any secondary infection such as a pneumonia. If you are a week into your symptoms, and 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. More commonly, though, you may have developed some over-reactive airways and may benefit from some inhalers or other asthma-style of medicines. A prescription cough syrup used at night may help with the nighttime exacerbations, and your doctor can remind you of some traditional home remedies such as cool mist humidifiers that may help. 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 News: 2011 Season

Flu season can be a scary, challenging time for all of us, especially the last two years, thanks to H1N1 (formerly known as the Swine Flu). The BAD news this year is that we're already seeing some cases of the flu, but the GOOD news is that we already have this year's flu vaccine available, and it will provide immunity to several strains of the flu, including the 2009 H1N1. In fact, each year the flu vaccine has three parts, including an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus.

There are two types of vaccines offered- a live vaccine, which is a weakened version of the virus (this is the nasal spray vaccine) and a "killed" vaccine, the traditional injection. I often hear patients say they "got the flu" from the vaccine, but that is impossible from the injection because those viral particles are NOT ALIVE- they can NOT cause disease. It takes about two weeks for your body's immunity to kick in after the shot, so plan ahead, especially if you are traveling.

In the 2010-2011 flu season, which peaked in early February 2011, was less severe than the pandemic flu season the year before, but still had very significant impact on our population. While most people infected have a miserable several days to a week of symptoms, there were over 300 deaths confirmed to be from influenza, including over 100 pediatric deaths (average age around 6 years.) This is not a disease to be ignored.

WHO should get the flu vaccine this year? The CDC recommends that "EVERYONE 6 months of age and older should get a flu vaccine as soon as the 2011-2012 vaccines are available." And that is NOW! Don't worry about the effects wearing off before the end of flu season, by the way, because the effects last throughout the whole season.

When is flu season? Though typically we say October to January, it really starts with September and most likely extend beyond February this year. Let's be proactive and line up early to receive a vaccination, and then follow up with consistent hand-washing and STAYING HOME if we get sick! I LOVE that all our grocery stores, and many other public places now have the anti-bacterial cleansers positioned right as you enter their store- USE IT!

BOTTOM LINE: Don't wait- head to your doctor's office or your pharmacy for a FLU VACCINE now!

Where Did My Favorite Cold Medicine Go?

Today the FDA (US Food & Drug Administration) is removing many allergy, cough and cold products from the shelves of your pharmacy. If you have a favorite that has worked for you, perhaps you should stock up. What's going on? Well, it turns out that there are a ton of drugs out there that lack FDA approval, yet doctors and patients alike are unaware.

Why does it matter? Our FDA actually does a great job of collecting and reacting to adverse events related to medications, acting swiftly to remove products that could cause danger. Though there are not oodles of reports with this group of products, there are enough, especially considering that because most are over-the-counter, adverse events are much less likely to be reported.


Frankly, as I went through the list, I was very surprised that some drugs that I have previously written prescriptions for (like Entex PSE and Bromfed) are NOT FDA approved. The main reason I don't routinely recommend herbal treatments is their lack of FDA regulation, which means there is no guarantee of the amount of ACTIVE product in each tablet or capsule. Turns out, this could be true for any of these allergy, cough & cold remedies as well. Additionally, in the past couple of years, pediatric recommendations have changed greatly, especially for kids younger than two years. Many of these medications do not issue any such precautions.

Here are a few, but go to the FDA website for a full list: Accuhist DM, Aerohist, Allerx, Aquatab, Bromfed, Biotuss, Brovex, Carbodex, Deconamine, Duravent, Entex, Guaifenesin, Histex, Lodrane, Rescon, Ru Tuss, ZCof, etc.

Note that the Triamic brand and Robitussin brand are NOT on the list.

BOTTOM LINE: Go to the FDA WEBSITE and scan the list to be sure YOUR upper respiratory medicine of choice is NOT on the list!

What's in YOUR Medicine Cabinet?

Ever wonder what doctors keep inside their medicine cabinets for their families? Well, my friends (and patients) have definitely asked me, so I thought this week I would share with you my answer. Before I launch into the first ingredient, however, let me encourage you to head directly to YOUR cabinet and THROW AWAY EVERYTHING THAT IS EXPIRED! Just like you should check your smoke detectors a couple times per year, you should also take a look in your stash of medical supplies and toss everything that is expired. Yes, I realize that tiny bottles of prescription medications (especially eye drops, for example) can cost a small fortune, but the only thing worse than "wasting" them by not finishing them is depending on them to work later, when their potency is gone. Don't wait till someone is having a bad allergic reaction to discover your benadryl is long expired!

So, what's the first medication on my list? ASPIRIN- yep, good old-fashioned aspirin. Actually, I keep the enteric coated aspirin, because it's easier on the stomach, but you get the picture. Why do we have aspirin in our cabinet? Not for headaches, though it certainly could be used for that malady. We keep it for several reasons:

1. Heaven forbid a grownup in our home (or neighbors') appears to be having a heart attack- the FIRST response is to have them swallow an aspirin.
2. Studies show that an adult aspirin a couple times per week reduces the incidence of colon polyps (and therefore, hopefully colon cancer, which runs in our family.)
3. Before sitting on a plane or going for a long car ride, a single aspirin can help prevent blood clots from forming in your legs (DVTs- deep vein thromboses.)

BOTTOM LINE: Throw away ALL expired medications, and start your family's medicine cabinet supply list with ASPIRIN.