Monthly Archives: February 2012

Got a Cold?


We’ve all been there.  We’re stuffed up, nose-dripping all over the place, leaving a trail of Kleenex as we peer through puffy eyes at the Over-the-Counter Aisle that stretches from Portland to Pittsburgh.  “Cough plus Decongestant.”  “cold and flu.”  “Nighttime symptoms.”  “Runny nose and sore throat.” “Headache and ingrown toenail.”  “Stuffy nose and lazy eye.”  “Phlegm and ear wax.”  I mean, it’s so overwhelming it’s ridiculous.  And there’s a good reason why: Common cold is big business!

$2 billion annual over-the-counter sales

$3 billion annually in doctor visits and prescription medications

$16.6 billion in annual lost productivity

189 million lost school days

110,000 visits to the doctor’s office

I’m really seeing those office visits now that I’m in clinics.  Sore throat.  Body aches.  Fever.  No fever.  Muscle pain.  Muscle stiffness.  Swollen lymph nodes.  Sinus pressure.  I look in the ears, may be some swelling and redness.  Look in the nose, maybe some swelling and redness.  Look in the mouth, maybe some swelling and redness.  Feel the lymph nodes,. maybe some swelling and tenderness.  And I know the whole time that the vast majority of the time it’s viral, and antibiotics will not help.  And we will send that person home perhaps feeling like they wasted their time coming in.  But, that’s the reality of it.  Common colds last 7-10 days.  Well in this day and age, we’re only willing to wait a couple days before we swear we have a massive case of strep throat or some kind of horrible bacterial infection and we want drugs pronto.  So far, here’s who’s gotten antibiotics: people who after several days are WORSE.  The fever’s increased.  Their symptoms have advanced.  Or they got better for a few days, and then worse.  People with a family member at home who has an impaired immune system and we can’t afford them getting the cold.  People who have some other under-lying health condition that increases their risks if it is bacterial (like recent asthma exacerbations).  A viral infection can lead to a bacterial infection later, like ear infection (otitis media) sinusitis, or pneumonia, but keep in mind that these three are still more often caused by viruses than bacteria.  The game changes a little bit for infants and toddlers, but still, it’s most often viral.

Here’s another kicker: there are so many different viruses that cause colds that we don’t even know them all.  So why do you keep getting sick?  Well, it’s probably a slightly different virus each time.  And my best advice is to get more sleep and wash your hands more.  Oh and get the flu shot.  Really.  Because colds suck, but the legitimate flu will knock you flat and has more severe symptoms and complications.  It is a virus, but we do have antivirals for that one.  So how to tell whether it’s a cold or the flu?

Flu: comes on very fast- start feeling crappy at 1pm and by 7 pm, you are feeling the whole doozy: your whole body hurts, you have a bad fever, headache, and you feel like crap.  Respiratory symptoms to follow.  Go to the PA now, and see about antivirals.  Or, prepare to weather a nasty storm.

Cold: Scratchy or sore throat, then nasal congestion or runny nose then congestion, watery eyes, lethargy, aches, pains.

Hope that helps.

Since it’s probably a cold, here’s how best to tackle your symptoms:

First of all, rest, hydrate, turn on mom’s humidifier, eat, wash your hands a LOT.

Congestion: topical decongestion like Afrin.  But don’t take it more than 3-5 days or you could experience “rebound congestion” when you stop it.  How to avoid that?  Slowly stop using it one nostril at a time.  Replace it with a nasal saline spray or oral decongestant.  May take 1-2 weeks for your nose to get back to normal.  Oral decongestants are a second-line choice, but run the risk of insomnia, nervousness and headache.  So stick to the Afrin first.

Productive cough: Guaifensin (Mucinex and Humabid), hydration and humidifier.  So look on the label for Guaifensin, it’s the only FDA approved drug for this.

Non-productive cough: look for the drug Dextromethorphan (it’s in Delsum, etc).  You can consider an antihistamine, but try Brompheniramine (Bromfed, Dimetapp, etc) or Chlorpheniramine (Ahist, Aller-Chlor, etc) before Benadryl (diphenhydramine) because they are much less sedating.  Consider adding an NSAID like Naproxen (Alleve, etc) for pain relief.

Runny nose: can try one of the above antihistamines (Brompheniramine, Chlorpheniramine, benadryl at night) because of their drying effects.  Otherwise, Ipratropium is a prescription drug that your PA or doc may consider.

Sore Throat: topical anesthetic Benzocaine (Cepacol Sore Throat and Chloraseptic), NSAID (ibuprofen, alleve, etc).

Fever: acetaminophen or NSAID.

Sneezing: oral non-sedating antihistamine like claritin or zyrtec.  Really!

Conjunctivitis: same as above.

Cough AND cold: evidence shows that a combo of antihistamine WITH decongestant is better than just a cough suppressant.  So look for something with brompheniramine or chlorpheniramine and pseudoephedrine.

A few notes:

Pseudoephedrine alone for congestion: slower onset than nasal decongestant like Afrin, less intense effects.  So,.. try the nasal products first.

If you automatically reach for benadryl to dry up your runny nose and sneezing, try a 2nd generation non-sedating antihistamine instead: Allegra, zyrtec, or claritin.  Really!  Benadryl is too sedating!

Vitamin C is controversial, sorry.  It “MAY” shorten your symtoms by 10-20%.  Which is not much.  And, if you exceed 4,000 mg/day you could get kidney stones.  Ow.

Zinc: May shorten the duration of symptoms if you start it immediately, but by less than half a day.  And you have to take it multiple times per day.  May not be worth it.

PS- people on Benadryl fared worse on a driving test than those who were legally drunk.  So,. only take it at night if you’re going to take it.  Otherwise, use Claritin, Zyrtec, or Allegra.

Here’s a big one with kids: data shows that the use of pediatric cough/cold medications is unsafe at this time for children under 2.  Age 2-6 is a gray area.  So, avoid meds for kids under six.  Instead, keep them hydrated, rested, and use nasal saline to clean out the noses.  Sorry, moms, I realize how much that stinks. But, if your kid is having trouble breathing (flaring nose, skin between ribs/under ribs retracting,) is dramatically less active/alert, or anything that you are overly concerned with, do take them in.

A final few notes: heartburn can lead to asthma and cough.  So if you have a cough that is just NOT going away, consider discussing other causes with your doc besides the cold that won’t quit.

Please don’t ask for antibiotics or storm out if you don’t get them.  I realize that your life is your world, but we have to reduce giving out Z-packs on a massive scale otherwise our drugs simply won’t work anymore when there is a REAL bacterial infection.  If your symptoms and the time-frame really point to bacterial infection, that’s one thing.  Otherwise, please be patient.

Wash your hands, get enough sleep, get your immunizations, immunize your kids according to the REGULAR schedule, and we could massively reduce healthcare costs across the country.