In prior blogs from 4/2010 and 9/2010, I bloviated as to the signs and symptoms of colds and respiratory allergies. Recently I have seen patients and coworkers who were not sure if they had a cold or "hay fever".
Colds are upper respiratory tract infections caused by rhinoviruses, coronaviruses and adenoviruses. An adult may average 2-4 colds per year; school aged children up to 12 colds per year. The cold virus enters one's body as an aerosol of viral particle (think sneezes), or by touching a surface that has been contaminated with a cold virus and then touching your eyes or nose. The symptoms of a cold (runny nose, sore throat, cough and low grade fever) lasts 7-10 days but may persist for as long as 3 weeks.
Allergies to plant pollens trigger the misery of seasonal allergic rhinitis. Red, itchy eyes, runny and/or congested nose are the most common symptoms. Post-nasal drip may trigger a cough, especially at night. Sinus pressure and pain may develop as the turbinates (fleshy masses in the nose) swell and block the outflow tracts of the sinuses.
The presence of a fever would indicate that one has a cold. Nasal mucous that is thick and yellow is more common with a cold. Allergic rhinitis usually produces watery, clear drainage. Allergy symptoms come on abruptly after exposure. Brushing the dog may release pollen that has settled on Fido's fur and achoo.
Seasonal allergies occur when the source of pollen or other offending allergen are in the atmosphere. My personal pollen poison is ragweed from August until the first frost. Colds may strike at any time of the year but are more common in the Northern Hemisphere from September to April.
Over the counter cold and allergy preparations are equally effective (ineffective) for colds and allergy symptoms. Allergic rhinitis and conjunctivitis have prescription remedies that are not appropriate and may worsen or prolong a cold. Steroid nasal sprays are very effective in treating allergic rhinitis. They diminish the IgE release of histamine by MAST cells and certain white blood cells.
The use of Neti pots, echinacea, zinc sprays and lozenges, large doses of vitamin C and a steaming bowl of chicken soup have all been recommended as treatments for colds. All are probably harmless and useless. At least the chicken soup tastes good.
The ER sees lots of patients suffering from the annoying symptoms of colds and allergies. The 24/7 availability and the lack of primary care providers contribute to this use of the ER for non urgent problems. The caring ER staff stand ready with boxes of tissues and lots of compassion to help differentiate the cause of your nasal symptoms and prescribe the correct treatment.
Thursday, September 29, 2011
Monday, September 26, 2011
STRESS
Everyone is stressed. The economy tanking, global warming, government failing, spouses, kids, in-laws, bosses UGH!!!
Animals, including we humans, have mechanisms in place to deal with stress. The classic example of an acute stress is the big dog coming at you. Fight or flight response originates in the hypothalamus. This area at the base of the brain releases hormones that start the body's response to stress. The adrenal glands pump out adrenalin, aka epinephrine, and cortisol. Heart rate and respiratory rate increase, blood pressure rises. Glycogen stores in the liver and muscles begin to release glucose into the blood stream. The immune system, digestion, reproduction and growth processes are all suppressed. This is a necessary survival mechanism. The acute stress response was very helpful when our ancestors lived a perilous existence on the plains of Africa or when involved in the innumerable wars humans have fought.
The sympathetic nervous system is responsible to turn on the fight or flight reaction and the parasympathetic system tamps the reaction down.
When the stress response is triggered by a deadline at work, or being stuck in a traffic jam the effects on one's body are deleterious. When stress is chronic because we are always behind at work, stuck in traffic, or in a toxic relationship, the damage to our body is real and potentially lethal. Chronic stress with its waves of stress hormones leads to heart disease, sleep disorders, digestive problems, depression, memory impairment and even worsening of certain skin diseases.
Some people are more vulnerable to stress because of genetic or environmental factors. Anxiety disorder, panic attacks, and depression have genetic components. These mental health conditions prime the pump of the stress response. Children who are neglected and/or abused are also more likely to have severe and persistent stress responses. Events in one's life such as being the victim or witness to trauma may lead to PTSD (post-traumatic stress disorder). High pressure jobs (ER doc, nurse, PA, tech, secretary) often lead to chronic stress. Loneliness, and social isolation also contribute to chronic stress.
There are things one can do to mitigate stress, short of living in a cabin in northern Maine with your family. Eating a healthy diet (skip the fried twinkies), exercising regularly, and getting adequate sleep would be an effective antidote to our modern stressful world. Being in a happy relationship, and having friends and family to share one's life are also helpful. Having a sense of humor and practicing relaxation techniques (such as yoga, meditation, tai chi, or just listening to music) have all been shown to lower blood pressure and heart rate and decrease the levels of stress hormones in the blood.
My stress levels have diminished since I was forced to leave my job at The Hospital. My beloved wife and caring daughter had been encouraging me to leave The Hospital because of the stress. I would arrive for work and find angry, stressed patients who had been waiting up to 6 hours to be seen by a physician. My new job is low volume and low acuity. My patients don't have to wait to be treated. I am mostly stress free. Maybe my hair will change back to black.
Illegitimi non carborundum, don't let the bastards grind you down!
Animals, including we humans, have mechanisms in place to deal with stress. The classic example of an acute stress is the big dog coming at you. Fight or flight response originates in the hypothalamus. This area at the base of the brain releases hormones that start the body's response to stress. The adrenal glands pump out adrenalin, aka epinephrine, and cortisol. Heart rate and respiratory rate increase, blood pressure rises. Glycogen stores in the liver and muscles begin to release glucose into the blood stream. The immune system, digestion, reproduction and growth processes are all suppressed. This is a necessary survival mechanism. The acute stress response was very helpful when our ancestors lived a perilous existence on the plains of Africa or when involved in the innumerable wars humans have fought.
The sympathetic nervous system is responsible to turn on the fight or flight reaction and the parasympathetic system tamps the reaction down.
When the stress response is triggered by a deadline at work, or being stuck in a traffic jam the effects on one's body are deleterious. When stress is chronic because we are always behind at work, stuck in traffic, or in a toxic relationship, the damage to our body is real and potentially lethal. Chronic stress with its waves of stress hormones leads to heart disease, sleep disorders, digestive problems, depression, memory impairment and even worsening of certain skin diseases.
Some people are more vulnerable to stress because of genetic or environmental factors. Anxiety disorder, panic attacks, and depression have genetic components. These mental health conditions prime the pump of the stress response. Children who are neglected and/or abused are also more likely to have severe and persistent stress responses. Events in one's life such as being the victim or witness to trauma may lead to PTSD (post-traumatic stress disorder). High pressure jobs (ER doc, nurse, PA, tech, secretary) often lead to chronic stress. Loneliness, and social isolation also contribute to chronic stress.
There are things one can do to mitigate stress, short of living in a cabin in northern Maine with your family. Eating a healthy diet (skip the fried twinkies), exercising regularly, and getting adequate sleep would be an effective antidote to our modern stressful world. Being in a happy relationship, and having friends and family to share one's life are also helpful. Having a sense of humor and practicing relaxation techniques (such as yoga, meditation, tai chi, or just listening to music) have all been shown to lower blood pressure and heart rate and decrease the levels of stress hormones in the blood.
My stress levels have diminished since I was forced to leave my job at The Hospital. My beloved wife and caring daughter had been encouraging me to leave The Hospital because of the stress. I would arrive for work and find angry, stressed patients who had been waiting up to 6 hours to be seen by a physician. My new job is low volume and low acuity. My patients don't have to wait to be treated. I am mostly stress free. Maybe my hair will change back to black.
Illegitimi non carborundum, don't let the bastards grind you down!
Subscribe to:
Posts (Atom)