Thursday, January 19, 2017

The Layman's Guide to Winter Diseases

This time of year my time at work is spent almost exclusively with patients suffering some upper respiratory ailment or another.

This is a basic guide to what I've learned and some of the guidelines that direct my care.

The bottom line? You probably don't need an antibiotic. (See my previous post on antibiotics). BUT if you're miserable it might also be worth coming in to the doctor's office.

Sinus Infections

These are almost always viral. More than 90%. Some small percentage will turn bacterial, and of these, new research is showing that most people will get better on their own even if it's bacterial. What can you do if you feel like your head will explode from the pressure?

-Try a steroid nasal spray (Nasonex or Flonase). These are available over the counter and decrease the inflammation in your nasal passages. They are not a cure-all but do help with the symptoms.

-Try a good decongestant. By "good" I mean pseudoephedrine, or Sudafed. If you don't have to show your ID to buy it, you're probably wasting your time. DON'T take sudafed if you are pregnant, breastfeeding, or have any problems with high blood pressure.

-Try a sinus rinse, such as the NeilMed Sinus Rinse or the Neti pot. They are weird and a little gross, but some people find them very helpful.

-Drink a lot of fluids, humidify your air (put a pot of water on the stove to boil all day and put a humidifier in your room at night), eat healthy foods and rest.

-Come to the doctor's office if you are no better after 10 days or if your symptoms are progressively getting worse.

Ear Infections

For adults or kids, take some tylenol or ibuprofen for the pain. There are also over-the-count ear pain relief drops (such as Hyland's earache drops or Equate homeopathic earache drops at Walmart) you can use for the pain.

For adults and kids over 3, 75% of ear infections will clear up on their own within a week without antibiotics. I generally like to see my patients wait at least 48-72 hours before starting an antibiotic if they're a little older, unless symptoms are severe.

Sore Throats

Everyone thinks their sore throat is strep throat. The vast majority of the time, they are wrong. 90% of sore throats are actually viral. If your sore throat comes with a fever AND you don't have other symptoms like a cough or runny rose, then the chance that it is strep is much higher. 

When in doubt, I personally never mind running a strep test to provide a patient peace of mind, and sometimes I really can't tell just by looking. Mono can also look a lot like strep.

In the meantime, salt water gargles (about 1/2 tsp salt to 1 cup of warm water), throat lozenges, warm liquids, and tylenol can all be helpful.


Your cough is probably caused by a...wait for it...VIRUS. People love to talk about getting bronchitis like they were two steps from the grave, but antibiotics are rarely indicated for bronchitis (like sore throats, 90% of bronchitis is viral).

That said, a bad cough can be life-threatening in some situations--pneumonia, severe croup, RSV in infants, etc. And even if your cough is caused by virus, it certainly may still be worth a trip to the doctor's office.

Some guidelines: 
-If your cough came on suddenly and came with fever and body aches, that smells a lot like influenza. We can test for that in the office and in some cases give antiviral medications for influenza. Another thing to consider is pneumonia, which I will sometimes check for with a chest x-ray. I always take pneumonia very seriously.

-If you have a cough that is so bad it's keeping you up at night or causing shortness of breath or wheezing, come on in. Often coughs will cause inflammation in the lungs that can make breathing a little more difficult. Sometimes inhalers or breathing treatments can be helpful, and in some cases I'll give some cough syrup to help with sleep.

-If your child has a cough that is causing them ANY degree of respiratory distress, don't hesitate to come in. If they are not eating or drinking, seem to have a hard time breathing, are wheezing audibly, or can't sleep because they're coughing so much, they may need treatment.

-If you have had your cough for more than 3 weeks with no improvement, or if it has been getting worse, in some cases I may consider antibiotics. Some coughs that persist may also be caused by other treatable problems like reflux.

Self care for coughs:
-For adults and children over 6, you can try over-the-counter medications like guaifenesin (Mucinex or Robitussin) or things like Dayquil, Delsym, Theraflu, Alka-Seltzer plus, etc. Children under 6 should avoid most cold and cough medications--current evidence suggests that they don't help much anyway and also can have risky side effects. There is some mild evidence in favor of honey, however, so it doesn't hurt to give them some of that if they're over 1 year.
-Humidify your air if you live in a dry climate like I do. Put a humidifier in your room at night while you sleep. Put a pot of water on the stove to boil during the day. Take a steamy shower or bath. Humidified air soothes your respiratory tract and loosens secretions and mucous so it's easier to cough up.
-Kids with croup will often benefit from cold air. Sometimes taking them outside at night during a coughing fit will calm it down quite a bit.
-Drink a lot of fluids (preferably water). For kids, I care less about their appetite than I do about their willingness to drink fluids. Eat healthy foods (7-9 fruits and vegetables a day). Get a lot of rest.

Last but not least, I really do recommend getting a flu shot. Flu shots WILL NOT give you the flu and are for influenza, not the stomach flu. Influenza is miserable and very dangerous for babies, pregnant women, elderly, and anyone with respiratory problems. Even if you're not worried about getting the flu, you could give it to someone else.

Stay healthy, my friends.


  1. I look forward to your next post. I love this.

  2. Love it! Do you make house calls (to Kentucky!)? :)

  3. I need to bookmark this page, and use it as a referrence for next time the winter illnesses decide to visit out home (which I don't know why they visit because they are never welcomed). ;)