I'm really not sure why I didn't think of this before.
I am a retired ER physician and father of many. After graduating from Chicago Medical School in 1990, I embarked on a 23-year career in Emergency Medicine. Medical interests include wilderness medicine, addictionology, and trauma psychology. I currently teach health and medicine online. DISCLAIMER: Accept all medical advice with a jaundiced eye. Before following my suggestions, do your own research and consult with your physician first. Enjoy & Learn!
What I Am All About
Sunday, April 14, 2019
Saturday, April 13, 2019
My Quora Answer: Nasal Congestion Relief
I promise I will post my "Adult Upper Respiratory Infection Recommendations" for you soon. It may now be too late for this Cold season but it is amazing advice.
By “clogged” you mean “congestion” which is caused by edema and swelling of your nasal mucous membranes. Many people believe that congestion is due to nasal discharge but that is only partly true as snot may build up behind a congested passage. Therefore, the best medications contain a decongestant. Mucolytics, or chemicals that cause thinning of the discharge help a little bit, mainly by helping liquid snot to sneak past your inflamed mucous membranes. The most common one is Mucinex, mainly because of clever and frequent commercials. Its active ingredient is guaifenesin which is also found in a myriad of other products such as Robitussin.
As an aside, the “DM” in Robitussin-DM stands for dextromethorphan, a highly effective cough suppressant. Because it is derived from opiates, it is often abused by narcotic addicts. They have to drink several bottles to even get a little buzzed. My guess is that they abuse it in order to get out of or prevent withdrawal until they can score the real stuff. I cannot imagine drinking even one bottle of it, much less several.
And now, back to congestion and decongestants. These appear in several forms, including orally and topically. The latter means they are applied directly to the nasal mucous membranes, either via a spray, mist, or gel. They work by constricting the small blood vessels (arterioles) in your nose, which lessens and prevents fluid drainage. In the U.S., these include phenylephrine (which is the “PE” in their names), desoxyephedrine found in Vicks Vapo inhaler, and oxymetazoline, the active ingredient in Afrin. The FDA banned ephedrine, a very good one because people use it to create amphetamines. It is still available worldwide.
My favorite decongestant is oxymetazoline because it is very effective and is active for 12 hours. When it first came out, it cost me $12 per 3 oz bottle. Now that it has gone generic, I pay $1.00 for 1 oz at Family Dollar. Same chemical, way better price. It is also one of the medications that I recommend in my “Adult Upper Respiratory Infection” pamphlet. When I get the chance, or really when I am asked, I will post the whole thing here on Quora for you.
The biggest hazard of using Afrin is that you can become addicted to it. This isn’t what we usually think of that word, but rather that you need to keep using it in order to breathe. It has a rebound effect too, meaning that the congestion is worse when it wears off. To prevent this, I use it alternating nostrils because hey, you only need one open in order to breathe through it. Even if it becomes more edematous, you are giving it a 24-hour rest to return to baseline.
Since several symptoms appear early in the course of a URI which are mediated by the release of histamine, antihistamines such as diphenhydramine (Benadryl), work wonders. But only in the first 3 days. After that, histamine release lessens and using an antihistamine is worthless, if not outright negative. The main side-effect is dryness and you don’t want that. The early fluid discharge is so significant that this shouldn't occur.
One final recommendation and it’s a good one. Nasal congestion is also caused by inflammation. Therefore, the Non-Steroidal Noninflammatory Drugs (NSAID’s) work wonders throughout the course of the illness. They are also pain meds and antipyretics (bring down fevers). These include ibuprofen, naproxen (Aleve), and even aspirin. I prefer naproxen since dosing is only once-a-day and doesn’t upset my stomach like ibuprofen. Even better, is that there is Aleve-D, which contains a decongestant.
When naproxen was available only by prescription, we often wrote prescriptions for up to 750 mg BID (twice a day). The usual for an adult was 500 mg BID. However, when it went over-the-counter (OTC), the pharmaceutical company cut the dose to only 220 mg every 8 hours. I facetiously call this a “homeopathic dose.” So for really amazing relief, I recommend one regular Aleve tablet or capsule plus one Aleve-D 2–3 times per day. Once again, take with food and avoid if you have a history of asthma, peptic ulcers, or kidney disease, or are allergic to any NSAID.
By “clogged” you mean “congestion” which is caused by edema and swelling of your nasal mucous membranes. Many people believe that congestion is due to nasal discharge but that is only partly true as snot may build up behind a congested passage. Therefore, the best medications contain a decongestant. Mucolytics, or chemicals that cause thinning of the discharge help a little bit, mainly by helping liquid snot to sneak past your inflamed mucous membranes. The most common one is Mucinex, mainly because of clever and frequent commercials. Its active ingredient is guaifenesin which is also found in a myriad of other products such as Robitussin.
As an aside, the “DM” in Robitussin-DM stands for dextromethorphan, a highly effective cough suppressant. Because it is derived from opiates, it is often abused by narcotic addicts. They have to drink several bottles to even get a little buzzed. My guess is that they abuse it in order to get out of or prevent withdrawal until they can score the real stuff. I cannot imagine drinking even one bottle of it, much less several.
And now, back to congestion and decongestants. These appear in several forms, including orally and topically. The latter means they are applied directly to the nasal mucous membranes, either via a spray, mist, or gel. They work by constricting the small blood vessels (arterioles) in your nose, which lessens and prevents fluid drainage. In the U.S., these include phenylephrine (which is the “PE” in their names), desoxyephedrine found in Vicks Vapo inhaler, and oxymetazoline, the active ingredient in Afrin. The FDA banned ephedrine, a very good one because people use it to create amphetamines. It is still available worldwide.
My favorite decongestant is oxymetazoline because it is very effective and is active for 12 hours. When it first came out, it cost me $12 per 3 oz bottle. Now that it has gone generic, I pay $1.00 for 1 oz at Family Dollar. Same chemical, way better price. It is also one of the medications that I recommend in my “Adult Upper Respiratory Infection” pamphlet. When I get the chance, or really when I am asked, I will post the whole thing here on Quora for you.
The biggest hazard of using Afrin is that you can become addicted to it. This isn’t what we usually think of that word, but rather that you need to keep using it in order to breathe. It has a rebound effect too, meaning that the congestion is worse when it wears off. To prevent this, I use it alternating nostrils because hey, you only need one open in order to breathe through it. Even if it becomes more edematous, you are giving it a 24-hour rest to return to baseline.
Since several symptoms appear early in the course of a URI which are mediated by the release of histamine, antihistamines such as diphenhydramine (Benadryl), work wonders. But only in the first 3 days. After that, histamine release lessens and using an antihistamine is worthless, if not outright negative. The main side-effect is dryness and you don’t want that. The early fluid discharge is so significant that this shouldn't occur.
One final recommendation and it’s a good one. Nasal congestion is also caused by inflammation. Therefore, the Non-Steroidal Noninflammatory Drugs (NSAID’s) work wonders throughout the course of the illness. They are also pain meds and antipyretics (bring down fevers). These include ibuprofen, naproxen (Aleve), and even aspirin. I prefer naproxen since dosing is only once-a-day and doesn’t upset my stomach like ibuprofen. Even better, is that there is Aleve-D, which contains a decongestant.
When naproxen was available only by prescription, we often wrote prescriptions for up to 750 mg BID (twice a day). The usual for an adult was 500 mg BID. However, when it went over-the-counter (OTC), the pharmaceutical company cut the dose to only 220 mg every 8 hours. I facetiously call this a “homeopathic dose.” So for really amazing relief, I recommend one regular Aleve tablet or capsule plus one Aleve-D 2–3 times per day. Once again, take with food and avoid if you have a history of asthma, peptic ulcers, or kidney disease, or are allergic to any NSAID.
Wednesday, April 10, 2019
No Till Gardening
Ruth Stout's book Gardening Without Work For the Aging, the Busy, and the Indolent was the first gardening book I read. I remember finding it the basement of my maternal grandmother's house and just devouring it. The gardening advice still stands firm & strong.
Friday, April 5, 2019
The Doctor From Hell
This is my Quora Answer to the question "What is the Coldest Thing a Doctor Has Ever Said to You?" This updated answer now contains the quote originally found in my ex-wife Angie's book A White Rose for Jonathon. It is a great read and is available through Amazon.
“Don’t give me that ‘Oh my God’ business. This is nothing but data. Now you go home and conjugate it. That’s what you do with data.”
We entered the office waiting room and
registered with the receptionist. As soon as she saw our name, she got the
nurse. We were ushered back immediately. The nurse put us in a room and stood
in the corner, The secondary obstetrician walked in with our chart in his hand.
He was a thin, short man. He stood as far away from us as he possibly could,
his back against the wall, the chart closed in his hand. The entire world stood
still for this moment in time. I could feel my heart racing. My only comfort in
all of this was my God and my Mike. I could feel Mike standing tall and strong,
nestled closely against my back. He was trying to protect me already from what
he knew would be unbearable news.
The doctor began, "Everybody wants to be
happy. Everybody wants a live baby. Well, that is not the news I have for you.
You are going to have a dead baby. Your baby will not make it. Everybody always
want everything to be okay but that's not for you. This raises many questions.
Sometimes the more questions ask, the more questions you get. Sometimes there
are no answers…” On and on he droned. I wanted to see what was in the chart. He
had yet to give us any reasons why this was all happening. It was all vague
generalities. We sat very still and completely silent.
There came a point when I could no longer bear
to hear him go on and on without really telling us anything. I leaned and
forward and grabbed the chart out of his hands. Mike leaned over my shoulder to
read with me. At the bottom of the page it read:
Significant Findings
1. Two-chambered heart.
Unable to visualize remaining chambers.
2. Malformed abdomen of
unknown origin
3. Nuchal translucency
well beyond normal limits.
I didn't understand what "nuchal
translucency" meant. Up until this time both Mike and I had not said a
word. We were just trying to take it all in.
I looked at Mike and asked, “What is nuchal…?” I
didn’t get to finish my sentence. The doctor said, “This is highly significant
of a chromosomal abnormality."
"Oh, my God." It came out softly and
was all I could say. My mind was flooded with the possibilities of what this
could mean. I knew that some chromosomal abnormalities were fatal and some were not. My mind was overcome -- would
my baby be disfigured or permanently disabled, would he suffer endless
surgeries, would he even live?
The obstetrician moved from the wall and knelt
in front of me. Thank God, finally this cold man was going to show some
kindness. He put his fingers just inches from my nose.
“Don’t give me that ‘Oh my God’ business. This is nothing but data. Now you go home and conjugate it. That’s what you do with data.”
http://bit.ly/2CXfbEE
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