Ask the Doctor

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ALLERGIES Here are more points from the Riverside County report:

Lesbian, Gay, Bisexual, Transgender Health and Wellness Profile

  • Asthma is more common in lesbians (24.1%) and bisexuals (24.8%) than all other groups. Is this related to increased smoking, stress?
  • More Bs report being disabled compared to heteros; this is true statewide.
  • Even though more Ls, Gs, and Bs are insured, they tend to postpone medical care or emergency care more than heteros.
  • Bs use community clinics or emergency departments more than heteros or LGTs
  • LGBs report having less people who love them than heteros.
  • On the other hand. Ls have more support they can call on when ill, while straight women and Gs have the lowest chance of support.
  • Psychological distress reported is more than triple for Bs and double for LGs compared with heteros.
  • Two to four times as many LGBs think about suicide compared to heteros in Callifornia.
  • 9%          of girls and 11% of boys in 7th to 9th grade reported being harassed or bullied for being thought of as gay.
  • Nearly a quarter of reported hate crimes in California are motivated by an anti-LGBT bias.
  • B women and men report at least twice as many incidences of intimate partner violence than heteros in their lifetime.
  • Again, there is much less data on Transgenders so you don’t see many comments on them.

ALLERGIES

This is the time of year where we experience allergic eye, ear, nose, throat, and lung problems. Dust and pollen are kicked up by winds and we suffer. It is amazing that some suffer from one kind of pollen while others do not. You may look on different weather web pages that show the pollen counts and what pollen is the main culprit when you are suffering, but this is not helpful unless you can jet off to an area where your pollen is lower until it passes where you live.

The symptoms are itchy, dry eyes, itchy noses, congestion, more mucus/snot, plugged ears, itchy or sore throat, asthma, dry or wet cough, shortness of breath (asthma).  I think you noticed that  ITCHY was mentioned several times; it is the hallmark of allergies.  If you have many itchy areas or the creams don’t work, consider an antihistamine. Loratidine is an example of the antihistamine family that causes drowsiness in very few people. Chlorpheniramine causes it in a few more, and diphenhydramine causes it in many.  We can’t tell which antihistamine you will respond to so we usually start in the order mentioned here.

For itchy eyes and noses there are over the counter drops that are quite helpful. There are also drops containing decongestants, antihistamines, and steroids (anti-inflamatories) like hydrocortisone.  For nasal congestion with thick mucus, try normal saline spray or put a pinch of salt in some warm water in a jar and snort it (the liquid, not the jar) up your nose. Keep it inside for about 5 minutes and blow it out. Repeat the process till no thick mucus comes out. If you still can’t breathe then your membranes are swollen and only a spray or pill will help you.  A netipot for more thorough irrigation can be purchased off the web but there was a case or two of a parasite that was in the tap water and it went into a person’s brain.  This was in the South. So it may be risky to put unflitered water up your nose.

At night or when I play professional football (what?) I may use a plastic nasal strip to keep my nostrils wide open to breathe better and not snore loudly.

Paying attention to the plants outside your windows that are blooming when you become congested gives you a clue as to what plants to avoid and maybe replace with plants you tolerate.

It is important to determine why you cough. There are different treatments for different causes of cough: from an irritation or a tickle in the throat or from post nasal drip (clearing your throat to move mucus into your mouth to swallow it) or from your lungs (you just cough when you exhale). Many providers are not in favor of the shotgun treatment (many small bullets in some medications which have 4 or more medications in them) approach and prefer a more targeted approach. A popular cough medicine among providers for cough is an antihistamine combined with a cough suppressant. Dextromethorphan (DM) is very popular among providers.  Some OTCs have this ingredient. Benzonatate is a good pill for suppressing coughs which is available by prescription. Occasionally we must use narcotics which have their own problems.

A cough can last for a few weeks since the infection is gone but the inflammation hasn’t gone away.  Think of a wound or pimple. After it starts to get better it does take many days for it to disappear. The patient feels fine otherwise, but this is quite a hassle.  So cough syrup may be needed for a long time.

WHEN TO SEEK ATTENTION

Shaking chills (not just feeling tingles or chilly), fever over 100.4, change in sweats for no reason, shortness of breath when not coughing are reasons to seek medical attention. Now some  people sweat when they put too many blankets on at night or if the weather is hot.  Many times these signs may be the result of a virus, and viral infections are more common than bacterial. What is important is to noe a change from your normal sweating or chills pattern.

Antibiotics are correctly not OTC. In fact, they are overprescribed by providers due to not understanding the rules for when to prescribe them or they feel pressured by the patient against their better judgement.  There is more and more bacterial resistance to antibiotics and some patients in the hospital have to take more dangerous antibiotics since their bacteria are very resistant to the strong antibiotics (against the bacteria) which are less dangerous to the patient.  This cold and flu season, I handed out a paper explaining these facts and the paper was well received; the patients did not demand antibiotics. A couple visited me later and did need antibiotics since their viral infection or allergy had complications of bacterial infections. Later, on the next appointment, the patients reported that they had improved.

The meat industry is beginning to discontinue giving antibiotics to animals used for meat. This practice causes resistant bacteria to move through the human population also.

Ear symptoms can be a part of allergies or colds.  There are two tubes connecting the back of the throat to the back of the two eardrums. This lets air in to let the eardrum move with sound better. When a virus or bacteria or allergy causes swelling of the throat behind the nose, that opening can shut causing no air to enter. The air in the tube is absorbed into the mucus and blood and that loss of pressure pulls the eardrum in, tightening it.  You may hear or sense popping, bubble sounds, or a sensation that you have water in your ears.  The best treatment is pseudoephedrine. I also have found success in some with decongestant nose drops, paying attention to sniff the liquid to behind the nose and lying face up to get the medicine right at the tube openings.

Since there are bacteria in the air, they can grow to become pus in the blocked tubes; this is a middle ear infection needing the decongestant because drainage is the main treatment. Sometimes they need antibiotics

It is a challenge to diagnose eye irritations. Make sure your eyes are not infected or don’t have a speck of dust in them.  Bacteria, viruses, and allergies can have yellow or green secretions. There are other serious diseases of the eye that can confuse the patient. Seeing a provider can help sort this out. Simple itching, though, is almost always allergies and eye drops for this OTC are quite helpful.

Clear discharge from the eyes nose, sinuses, lungs  usually indicates a process that is not from an infection. Nasal, throat, or sputum that is dark in the morning and clears later just means you had some dust trapped when you were sleeping earlier.  Blood from the sinuses or lungs can be concerning. It is good to discuss this with your provider.

Keep those questions coming. Be Safe!

Daniel Pearce, D.O., FACOI, AAHIVS
Clinical Associate Professor of Medicine, Loma Linda University School of Medicine|
Adjunct Professor of Internal Medicine and HIV, Touro University California College of Osteopathic Medicine and Midwestern University Arizona College of Osteopathic Medicine
Researcher, Veterans Administration Hospital, Loma Linda
HIV Specialist, Riverside County Public Health Department
Hepatitis C Specialist and Researcher, Southern California Liver Centers, Riverside

 

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