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Thursday, May 26, 2011

The Cold That Won't Quit

A VIEW FROM THE OFFICE




THE COLD THAT WON'T QUIT

     
     We all get colds once in a while. Usually we suffer a couple of days of runny nose, sneezing, the feeling of congestion, and the feeling of being a little run down. Most (but not all) colds are done in 72 hours, and we're used to dealing with them. Colds are caused by viruses and do not require antibiotics. The problem is that many colds lead to secondary complications, what we call a bacterial superinfection. Examples of such superinfection include ear infections (otitis media), strep throat, sinus infection (sinusitis), goopy eyes (conjunctivitis), chest cough (bronchitis), or even pneumonia. These infections happen because the preceding viral infection reduced our immunity and gave these germs a better chance to set up shop in one of our cranial cavities or airway passages. These infections are the reason most patients come to see a doctor after a cold. Most of these will respond to an antibiotic. The usual practice is for a doctor to prescribe an antibiotic for 7 days--usually something like amoxicillin, sulfa, or azithromycin. We are now increasingly realizing that most of these infections do not even require a full 7-days of antibiotics. For most symptoms will resolve in 2-3 days. 


     The problem I want to talk about today are the exceptional cases--the ones where symptoms have not resolved even after a full 7-days. What do you do then? 


     There are 3 main patterns to these exceptional cases:

  1. An ear infection that does not resolve. Most often this is caused by retained fluid in the ear. Occasionally, it is a problem because the initial antibiotic used does not cover whatever particular germ was in the ear fluid. The standard approach to this problem is to undertake another round of antibiotics with a different, stronger antibiotic. Occasionally, if the problem is clearly due to fluid in the ear, we will prescribe some form of cortisone, either as a nasal spray like Flonase, or as cortisone pills (prednisone) for 7 to 14 days. Ultimately, failure of symptoms to resolve with this treatment will lead to a referral to an Ear-Nose-Throat (ENT) specialist. Usually, they will repeat this same kind of therapy for another round, and, if that doesn't work, they will offer a surgical option like placing tubes in the ears. It is quite rare that an adult would need this kind of surgery, but occasionally, especially among persons with severe allergies, it is appropriate.
  2. Sinus infections that do not resolve. Sinuses can be notoriously difficult to clear up. In fact, many patients, especially those with allergies, will have repeated bouts of sinus infections during a year. Each episode of infection tends to make it more difficult to clear up the next one. In recent years, the experts have generally recommended delaying antibiotic therapy for at least a week to give it a chance to resolve on its own. If symptoms of face pressure or pain or severe congestion persist for over a week, then amoxicillin is the most often prescribed antibiotic. The exception is when you have previously been treated with amoxicillin for some other infection within the last 2-3 months. In this case, the high-strength form of amoxicillin is used--i.e., Augmentin, which is significantly more potent, but also more likely to cause intestinal upset and diarrhea. For persons with chronic, frequently recurring sinusitis, treatment needs to be for longer periods of time--for 14-21 days. Failure of symptoms of sinusitis to resolve is the most common good reason for using one course of antibiotics right after another and perhaps even for a third time. Failure to resolve with a third course of antibiotics will result in a referral to an Ear Nose Throat specialist and x-rays of the sinuses or a CT scan.
  3. Chest infections that do not resolve. Here the primary symptom is cough, often associated with a sensation of chest tightness, and occasionally even by frank wheezing.  One practical tip to remember is that there are basically two kinds of cough: (1) the cough due to a tickle in the throat or drainage in the back of your throat from your nose or sinuses. This usually feels like a scratchy throat and is accompanied by a constant upper airway cough to clear the throat; (2) the second type of cough is the deep in the chest cough. It will be very obvious that the cough is coming from deep in the chest, often with production of yellow-greenish phlegm. This combination of symptoms (cough and yellow-green sputum) is indicative of the common diagnosis of acute bronchitis     The experts are still arguing about what is the best treatment for acute bronchitis, and the majority trend is to believe that antibiotics are usually not necessary for simple, acute sinusitis where symptoms have only been present for 1-7 days. Experts differ on whether you should wait for 7 or 14 days to start antibiotic treatment. I have reviewed all the major bronchitis studies myself and I reach a slightly different conclusion. Basically there are about a dozen major studies (and several studies studying these studies), and the truth is that they split right down the middle on whether antibiotics help the resolution of acute bronchitis symptoms or not. So it's a toss up. It is perfectly reasonable to treat these symptoms with antibiotics, and it is also perfectly reasonable not to treat them. I usually let patients make this decision. My personal rule of thumb is to consider antibiotics if symptoms have persisted for more than 3 days, and definitely to recommend them if they last for 5 days or more. I usually prescribe either amoxicillin or azithromycin for these infections. Usually 5 days of antibiotics is enough.
               When cough is associated with more symptoms than just purulent sputum and chest tightness, the other diagnosis that must be consider is pneumonia. Pneumonia is basically just an extension of bronchitis as the germs move all the way down the airways and actually begin to enter into the lung tissue (alveoli) itself. Pneumonia is accompanied by much more severe symptoms--usually including high fever, shaking chills, and shortness of breath, often severe fatigue of just a feeling of being really sick. In fact, just the combination of acute cough, high fever, and shortness of breath (rapid breathing) is enough to make a diagnosis of pneumonia; you don't even need a chest x-ray. There is a variation of pneumonia, however, that is more subtle; in these cases it can present with just a cough, but no fever, and usually with a sense of malaise. This kind of pneumonia is often referred to as "walking pneumonia" or an atypical pneumonia. Pneumonia, of all types, is treated with amoxicillin, azithromycin, or Levaquin (or their equivalents) for at least 7 days. Symptoms usually improve dramatically after 48 hours.

    So the real issue for today's article is what do you do if your cold is still causing severe chest cough, tightness, and/or wheezing one to two weeks after onset? I am assuming that you have already made one visit to the doctor and that appropriate treatment with antibiotics was undertaken if there were any signs of bacterial infection. There are basically two courses to follow here:
  1. If the doctor told you that initially all you had was a viral infection and did not prescribe antibiotics, then you may in the mean time have acquired a secondary bacterial infection (otitis media, sinusitis, or bronchitis). The appropriate plan for this is antibiotic treatment for 5 to 7 days with a common antibiotic like amoxicillin and treatment for the most severe symptoms--like a decongestant for severe runny nose or nasal obstruction, a cough syrup for severe cough, and/or asthma medications (an inhaler usually) for wheezing or tightness. In this scenario, symptoms usually resolve quickly and you're done.
  2. The other scenario is the classic prototype of the cold that just won't quit. After your previous treatments, your cough is improving some, you're no longer coughing up as much yellow or green phlegm, you don't have any fever or chills, but you still feel tight in your chest, may have occasionally whistling or wheezing sounds in your chest, and tend to have bad spasms of coughing that make you really breathless and leave you feeling weak with aching ribs. The first thing to do in this scenario is to take a chest x-ray to make sure than no atypical lung infection (pneumonia) has been overlooked, and to make sure there is nothing else there that could cause such symptoms (like a lung mass in smokers). If the chest x-ray is negative, then the most common cause of this scenario is asthma. In many cases there may be a past history of asthma in childhood. For many, there is no history of asthma, but severe viral infections (and bacterial infections) can trigger new asthma (usually short-lived) even in a patient who has never had it before. In others there is a history of smoking. Smokers are the one group of patients who should expect to have recurrent episodes of the "cold that won't quit" since smoking so damages the airways. The treatments for asthma are an inhaler (albuterol, 2 puffs every 4 to 6 hours for coughing spells, chest tightness, and/or wheezing). If this is tried and does not bring enough relief, the next step is cortisone, usually by pills, usually in a dose of 40 mg of prednisone (or equivalent) for 7 to 14 days. This should take care of the asthmatic part of any infection that won't quit. For the rare patient, who is not better even after this, I will prescribe Advair; this is a dry-powder inhaler that combines a long-acting form of albuterol with a long-acting cortisone. It is probably the most effective medication on the market right now for persistent symptoms due to bronchospasm and asthma. Note that once you have had one course of antibiotics for a chest cough and the x-ray is negative, there is no real point in taking any more antibiotics.
     Sometimes there is still a nagging cough and a general feeling of fatigue and just not feeling well. This is very distressing to patients, and they generally want the doctor to do something and to do it quickly. If we have already run through the steps described above, there is not much else to do. For some infections, and certainly at this stage of the cold that won't quit, you just have to wait it out. It will go away. About once in every 5 years most adults will get a severe infection like this that seemed to start as an ordinary cold, but it keeps them feeling sick and miserable for as long as one to two months. If you have run through the protocol above, there is nothing else to do. You just wait. After a while, simple time will cure most everything. While you're waiting to feel better, just ask yourself if you've had any other cold this bad in recent years. If you haven't had one like this in the last 5 years, then you can tell yourself that everything is normal, and you've paid your dues for another 5 years.

27 comments:

  1. Might I suggest that if the cold does not go away that a simple CBC be done? If those results come back fine then waiting it out would be ok. Sometimes a cold that does not go away can be indicative of something that can be treated following the results of a CBC.

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    Replies
    1. Hi Karen, I see that two years later nobody has replied to your question. CBC is Complete Blood Count, or in UK (where I am) it's Full Blood Count or FBC. Hope that helps. The symptoms described above I've experienced to varying degrees since I was 13; I'm now 52. It's not getting easier and the wall faced every time I approach a GP (general Practitioner/family doctor) is getting higher; I have to explain my symptoms each time and then not believed.....terrible. Shaun, Warrington, UK

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    2. Good evening to you all I want to write a shortly message to the world how doctor ehiaguna help with his great herbal medicine to cured me from this horrible virus HSV 1 and 2 I get his email from someone name Olivia mason how she was also cured by doctor ehiaguna I never believe there was cure until I meet her testimony, I contacted doctor ehiaguna I don’t believe there was cure well I am so happy to write this testimony to the world, this man immediately when I sent him email and this man response within 20 minus and give me the necessary process and the herbal was sent to within 4 day I took it according to the instruction so with 2 week I was completely cured and I get my test done I was confirm negative I am so happy if you want to get his contact you can message him with this email drehiaguna@gmail.com or you can also WhatsApp him +2348073908953 he can fix this.HIV.HEPATITIS.ANTHRAX.HPV.CANCER.ALSAND ALSO SOLVE YOUR RELATIONSHIP PROBLEM

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  3. Thanks for sharing this extremely informative article on wheezing causes. I recently read about wheezing on website called breathefree.com. I found it extremely helpful.

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  4. I am sharing my story in an excited mood. It all started when I woke up with a bad cough. I felt it was because of the cold, maybe, I didn't put on enough warm clothing to sleep. I coughed all through that day. I waited a few days to see if it got worse and it did. I was coughing to the extent of dry heaves and I was vomiting. The cough hurt my throat severely. I finally ended up in the ER. They sent me home with antibiotics, an inhaler, and some pills to stop the coughing.
    After 7 days, of worsening cough, I went back to the hospital where I was diagnosed of chronic asthmatic bronchitis. My wheezing became so loud that I found it difficult to sleep. When I went to the doctor I was given a Z-Pak, albuterol inhaler, oral steroids, cough pills which didn't do any good, and was told to take Mucinex. The more I take these medications, the worse my condition became.
    I went in search for a cure without complications. I read stories of people who had worst cases of bronchitis and asthma. I was happy that people had gone through what I was going through and were cured.
    I contacted the email address shared by someone who suffered bronchitis and was cured by Herbal Medication without complications. I received tremendous improvement after its use. The wheezing stopped totally and my sputum was no longer greenish. In case you have the same issue or you wish to help someone who has, you may contact Dr. Scott for his medication via drevanscott@gmail.com

    ReplyDelete
    Replies
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  5. Coughing And Wheezing, A Remedy That May Work For The Common Chest Cold And Bronchitis
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    ReplyDelete
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  12. Good evening to you all I want to write a shortly message to the world how doctor ehiaguna help with his great herbal medicine to cured me from this horrible virus HSV 1 and 2 I get his email from someone name Olivia mason how she was also cured by doctor ehiaguna I never believe there was cure until I meet her testimony, I contacted doctor ehiaguna I don’t believe there was cure well I am so happy to write this testimony to the world, this man immediately when I sent him email and this man response within 20 minus and give me the necessary process and the herbal was sent to within 4 day I took it according to the instruction so with 2 week I was completely cured and I get my test done I was confirm negative I am so happy if you want to get his contact you can message him with this email drehiaguna@gmail.com or you can also WhatsApp him +2348073908953 he can fix this.HIV.HEPATITIS.ANTHRAX.HPV.CANCER.ALSAND ALSO SOLVE YOUR RELATIONSHIP PROBLEM

    ReplyDelete
  13. I’m here to testify about what Dr godwin did for me. I have been suffering from (GENITAL HERPES VIRUS) disease for the past 4 years and had constant pain and inching, especially in my private part. During the first year, I had faith in God that i would be cured someday.This disease started circulating all over my body and I have been taking treatment from my doctor, few weeks ago I came across a testimony of Rose Smith on the internet testifying about a Man called Dr Godwin on how he cured her from 7 years HSV 2. And she also gave the email address of this man, advise anybody to contact him for help on any kind of diseases that he would be of help, so I emailed him telling him about my (HSV 2) he told me not to worry that I was going to be cured!! Well, I never doubted him I have faith he can cure me too,, Dr Godwin prepared and sent me Healing Oil, Soap, roots and herbs which I took. In the first one week, I started experiencing changes all over me, after four weeks of using his Roots/ Herbs, Oil and Soap, I was totally cured. no more inching , pain on me anymore as Dr godwin assured me. After some time I went to my doctor to do another test behold the result came out negative. So friends my advise is if you have such disease or know anyone who suffers from it or any other disease like HPV, HBV, HIV, ALS, HBP, CANCER etc. you can contact Dr.godwin for help via drgodwin52@gmail or whatsapp +2348158184060

    ReplyDelete
  14. God bless Dr okosun for his marvelous work in my life,my name is robin 
    nicole I was diagnosed of HERPES since 2015 and I was taking my 
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    ReplyDelete
  15. I GOT CURED FROM HERPES VIRUS I was diagnosed of HERPES virus and i have tried all I can to get cured but all to no avail,,until I saw a post in a health forum about a herbalist man who prepare herbal medications to cure all kind of diseases including #HERPES virus,at first I doubted if it was real but decided to give it a try,when I contacted this herbalist via his email and he prepared a #HERPES herbal cure and sent it to me via DHL delivery company service, when I received this herbal medicine, he gave me step by direction on how to apply it,after applying the way I was instructed,I was totally cured of this deadly disease called HERPES, all thanks to Dr OGODO Email this great herbal doctor via his email Ogodoherbalhomesolution@gmail.com
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    ReplyDelete
  16. I was in severe ribs and stomach pain at about this time last year. And I went to the hospital for treatment and was diagnosed for CHRONIC HEPATITIS B I was told it has no cure and i was so devastated because all hope seems to be lost, some drugs was given me to slowdown the viral load, and it got worse after sometime. I came across Dr. Iyabiye’s recommendation online while studying about the disease, and then I reach out to him just to try but I was taken by surprise. I got completely cured, all the pains were gone and I went back to the hospital for another test and I was tested negative to the disease. Here is the doctor’s contact if interested: iyabiyehealinghome@gmail.com (+234-815-857-7300)

    ReplyDelete
  17. Herbal treatment is 100% guaranteed for Herpes cure, the reason why most people are finding it difficult to cure Herpes is because they believe on medical report, drugs and medical treatment which is not helpful to cure Herpes. Natural roots/herbs are the best remedy which can easily eradicate herpes forever for more information about Herpes cure Pls share this. I was so happy to see that my result showed up negative after taking Dr.Sandy herbal medication for my Herpes contact him via Email    dr.sandyspelltemple@gmail.com     call Whatsapp Number +2349154145362
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    ReplyDelete
  18. HERPES INFECTION CURE IS 100% AVAILABLE WITH THE HELP OF DR OGBERAESE HERBAL MEDICINE.Joy and happiness is all i can see around ever since i came in contact with this great man Called Dr Ogberaese. i complained bitterly to him about me having herpes only for him to tell me it’s a minor stuff. He told me he has cured thousands of people but i did not believe until he sent me the herbal medicine and i took it as instructed by this great man, only to go to the hospital after two weeks for another test and i was confirmed negative. For the first time in four years i was getting that result. i want to use this medium to thank this great man. His name is Dr Ogberaese , i came in with his email through a friend in USA called Edith Rose and ever since then my live has been full with laughter and great peace of mind. i urge you all with herpes or HSV1&2 to contact him if you are willing to give him a chance. you can contact him through his email drogberaese54@gmail.com or you can also WhatsApp him +2348073818653

    ReplyDelete

  19. My dad was diagnosed with early onset Parkinson's disease at 56.his symptoms were shuffling of feet,slurred speech, low volume speech, degradation of hand writing, horrible driving skills, right arm held at 45 degree angle, but now he finally free from the disease with the help of total cure from ULTIMATE LIFE CLINIC, he now walks properly and all symptoms has reversed, he was having trouble with balance especially at night, getting into the shower and exiting it is difficult,getting into bed is also another thing he finds impossible.we had to find a better solution for his condition which has really helped him a lot,the biggest helped we had was ultimate life clinic they walked us through the proper steps,am highly recommended this www.ultimatelifeclinic.com to anyone who needs help.

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  20. months ago I felt some pains and I went to the hospital my doc told me I had Herpes about 1 year ago and I need to start the treatment early, he gave me some medicine to be taking and I told him no I’ll not, because I hated taking medicine when I won’t not see cure for the purpose. After I got home I started getting worried searching for strong advice and I found valid natural treatment online a lot of people says they got herpes cure from DR ODUDU and I contacted DR ODUDU that same day I purchase his cure online, after three weeks of taking the herbal treatment i got cured totally. i tested negative all thank to DR ODUDU you can reach out to him through his email: [dr.oduduherbalhome@gmail.com ] or message him on WhatsApp +2348101571054 stay safe and bless you

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  21. Good news this is to everyone out there with different health challenges, as I know there are still a lot of people suffering from different health issues and are therefore looking for solutions. I bring you Good news. There is a man called Dr Ehimare a herbal practitioner who helped cured me from HSV (2). I have suffered from this disease for the past 5 years and I have spent so much money trying to survive from it. I got my healing by taking the herbal medicine Dr Ehimare sent to me to drink for about 14 days . 3 days after completion of the dosage, I went for a medical checkup and I was tested free from HSV. All thanks to God for leading me to Dr Ehimare who was able to cure me completely from this deadly disease. I’m sharing this so that other people can know of this great healer called Dr Ehimare because I got to know him through Elizabeth who he cured from HIV. I was made to understand that he can cure several other deadly diseases and infections. Don’t die in ignorance or silence and don’t let that illness take your life. Contact Dr Ehimare through his email drehimare3@gmail.com or whatsapp on +1 (267) 691-1087 He cure all forms of disease {1}HIV/AIDS {2}DIABETES {3}EPILEPSY {4} BLOOD CANCER {5} HPV {6} BRAIN TUMOR {7} HEPATITIS {8}COPD{9} SICKLE AND ANAEMIA.etc Be kind enough to share as you received.

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  22. For any kind of disease or virus you should contact Dr Aboda for natural healing treatment i am a living weakness thank you so much Dr for helping me get rid of this HSV completely via email: drabodasolution@gmail.com

    call/WhatsApp +2349012479806

    https://dr-aboda-solution-home.jimdosite.com/

    Facebook Page: https://www.facebook.com/Drabodasolutionhome

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  23. FINALLY FREE FROM HERPES VIRUS. what a miracle i never believe there is cure because my doctor tested me herpes positive and she told me there is no cure, i’m very happy today that i’m having a free life without this herpes virus, i can remember some months ago when i was crying all through the night and day that i can’t get cured from this herpes, i found this herbal man called Dr Ehizele on internet when i was doing research on cure for shingle i contacted him to found out if i can get help from this herpes virus, i was so surprise when he told me that he have the herbs cure to it and he sent me the herbal in less down 5 days i was so happy when i get someone giving me hope that he can cured me i took the herbal for just 2 weeks, when i went for test after taking the herbal i found out that i am cured i was so happy and surprise, i want to use this opportunity to inform you that there is cured to herpes virus you can also contact him for his help as soon as possible so that you can get rid of this herpes once and for all you can reach him through this email: ehizeleherbalhome@gmail.com or whatsApp him on +2347089384319

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