Shs podcast: Upper Respiratory Infections – Student Health Services



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SHS Podcast: Upper Respiratory Infections – Student Health Services

[Narrator Voice #1]: Howdy and welcome to the TAMU health podcast. Conversations about health as it relates to the Texas A&M student. Brought to you by Student Health Services. You can find us on social media (Facebook, Twitter, Instagram), our handle is @TAMUhealth, and visit our website at shs.tamu.edu. Thanks for tuning in.

[Male Voice]: Howdy! I’m Dr. Garry Gore. I’m one of the physicians here at the Beutel student clinic.

[Female Voice]: Hi, I’m Kim Patton. I’m one of the Nurse Practitioners here at the clinic.

[Male Voice]: And we are here today to talk a little bit about colds, flu, sore throat, cough, all of the upper respiratory problems that come when students come back to school in the fall. So Kim, let’s talk about the average cold symptoms and compare that to influenza symptoms. Be aware we are already seeing a couple of isolated influenza cases both locally and from international travelers. So, it’s important to understand the difference between cold symptoms and flu symptoms.
It’s important to understand the difference between cold symptoms and flu symptoms. So, the common cold is going to be a viral infection. You are going to have a lot of the usual runny, stuffy nose, you may have some sore throat, a little non-productive coughing, sneezing, and you can also feel tired, fatigued, you might have some mild muscle aches and pain. A little bit of headache and maybe some watery eyes. Now watery eyes and sneezing are also signs of allergy problems, so sometimes we need to see you to differentiate between the two.

Now to compare, influenza will usually have a fever that is high, like over 101 or 102, you may have shaking chills, you may have more significant muscle pains, and you may have a harsher cough, loss of appetite, and even some nausea or diarrhea. Now both of these are viral illnesses and some new information that is coming out that has affected my practice is I’m not prescribing Tamiflu, which many of you may be familiar with, any longer. Some research studies that were not completely disclosed showed that the Tamiflu was not as effective as it was originally marketed to be, and so Tamiflu only reduces the severity of your flu symptoms by about half a day, and it doesn’t do much to decrease the severity of your symptoms. So duration is really only minimally effected, severity not at all, and without insurance it’s about $120 a prescription. So what we are finding is that we were actually prescribing something that was not as good as we were told it was, it was expensive, and so I personally will no longer be prescribing Tamiflu, and I do not recommend that you ask for it necessarily. In special situations, your doctor may recommend it. For example, if you are very close, living very closely with someone who has a problem fighting infections, or if you’re in the hospital, your doctor may give it to you. So, there are certain instances where it may be used. In general, a healthy young adult probably doesn’t need to have TAMIFLU for the flu.

Now for cold symptoms, there is not good medicine to make it go away. Once you have a cold, antibiotics will not be effective. We typically treat the symptoms and try to help you feel better until you get well by yourself. We will talk in a little bit about preventing colds before they start, but right now I want to talk about some strategies for when you get a cold and how you treat your symptoms. Kim, feel free to jump in as well. Now, when you have nasal congestion and runny nose, you need two medicines. For the congestion, you need a decongestant. Now Dr. Gore’s favorite is pseudoephedrine, or what

many of us call, Sudafed. This is commonly sold behind the pharmacy counter but without a prescription, and it’s very inexpensive. If you have runny nose, then you also need an antihistamine. Again, not very expensive at all and you can buy that without a prescription. There are sedating and non-sedating antihistamines. We usually recommend those that many people know as Claritin, Zyrtec, Allegra and a new one called Xyzal. These are less sedating and are often sold in combination with the Pseudoephedrine. You will notice those names as Claritin D, Zyrtec D or Allegra D. The “D” means decongestant, so know that the “D” means it has Sudafed in it.

[Female Voice]: Those are also behind the counter. You’ll need an ID.

[Male Voice]: Yes, anything that has a “D” in it, that’s the good stuff, and it’s going to be sold from behind the counter. Now the reason it’s sold behind the counter, is because apparently someone can make methamphetamines out of pseudoephedrine. So, be sure to ask for your pharmacist’s help in getting the right medicine. I don’t personally like most of the preparations that are sold over the counter without a prescription and without talking to a pharmacist because the decongestant in those is not as effective, in my opinion. So, you’ll see a product on the shelf that’s called Sudafed PE. That “PE” refers to a different type of decongestant, so don’t be misled. It’s not exactly the same thing as you can get behind the counter. Always follow label directions. Those medicine that we’ve talked about are usually once a day, very convenient to take. Now if you have high blood pressure, we don’t recommend taking a decongestant. Please talk to one of us or your pharmacist about which antihistamine would be best for you. Now if the oral decongestant doesn’t seem to help enough, I recommend using nasal spray. The most common one is called Afrin and you can always buy generics with confidence with these medicines. But if the oral medication is not enough, then go to a spray for the nose. Use that as directed, and be aware that some of the decongestants require you take a break after about three days use. If you use it for longer periods of time without stopping, when you do stop, your nose will become very congested because it was happy on the decongestant.

[Female Voice]: And then sometimes we will transition you to a nasal steroid, like Flonase or Nasonex or something, that is safer to use long term.

[Male Voice]: Yes, and we do like the nasal steroids for allergy-related nasal congestion and runny nose. So if you’re not sure, talk to us if you’re in the clinic, and we can help guide you on which spray may be better for you. Now I’m also a big fan of Vick’s Vapor Rub. Grandma was right. This stuff works and is most commonly used at nighttime when you’re going to bed. We typically rub it on the chest and put on a t-shirt so it doesn’t rub off onto the sheets. But it will help to keep your nasal passages open through the night. One of my favorite decongestants is chicken tortilla soup, or hot and sour soup from the Asian restaurants. So anything that is hot and spicy, hot in terms of spice, can also help to temporarily decongest your nose as well.

If you’re having sinus pain and pressure, you can make a warm pack or you can purchase either microwavable packs that are gel-filled or that may have rice in them, that you can heat up in the microwave and put over your forehead and nasal area to help increase the blood flow and reduce sinus congestion as well. If you’re interested in making your own, you can look on the internet about making one out of a clean cotton sock and some rice, and we have those instructions in our clinic as well. So Kim, let’s talk a little bit about coughing.

Coughing is one of those irritating symptoms. It bothers you as well as everyone around you while you’re in class. And there are a couple of good medicines that are not sedating that you can try first.

[Female Voice]: So some of the over the counter products will have Guaifenesin and Dextromethorphan in them. You might hear Mucinex or Mucinex DM. Guaifenesin is what’s in Mucinex and you can also get it in the form of Robitussin. Dextromethorphan is in Mucinex DM. That’s what the “DM” stands for. Robitussin makes a DM I believe as well. And then Delsym, which is just Dextromethorphan by itself, is a longer-acting cough medicine that can be particularly helpful. It’s important when you take anything like Mucinex to drink a lot of water, that way the secretions, they’ll tend to become more loose and you’ll be able to get rid of the phlegm and keep it thin. Honey can also be pretty helpful. Putting honey in hot tea or hot water, like 1-2 tablespoons, you can do that every other hour, and that can be a good, natural cough suppressant. Good while studying or lounging around at home. But, if you’re a diabetic or have issues with high blood sugar, obviously we wouldn’t recommend honey in that case.

[Male Voice]: And I’d also add, don’t forget just your regular cough drops, peppermints, hard candies, things that you can take with you to class and suck on to help reduce the irritation while you’re attending class or taking a test.

[Female Voice]: Of course if you have a severe cough, or you’ve tried over the counter things and those aren’t helping, then definitely we’d want to see you in the clinic. We do make some a little bit stronger options. Of course they can be sedating so we will obviously discuss that with you at an appointment if you need to be seen.

[Male Voice]: Another option that is less sedating but is available by prescription is a medicine called Tessalon, and they are little golden pearls, and we often recommend these because they are not sedating and it is the next best thing to try before using something that may make you too sleepy to attend class. Now sore throats are common. We have seen a couple of cases of strep already, even before classes have started this year with some of the students who have returned for early activities. It is not possible for us to look at you and tell you whether you have a strep throat or not. We use a scoring criteria to help us determine the probability of whether you have strep, and this helps guide us in whether to recommend testing for strep throat. In general, it is not recommended to give antibiotics for a possible strep throat without first testing and proving that it is strep throat. There are a couple of different kinds of strep bacteria that cause strep throat. The one we are most concerned about is called Strep A. Strep A can cause other problems if it’s not treated, but this is not the case with Strep G or Strep C, which are some of the other common ones that we see. So when we do the rapid strep test, we don’t necessarily need to do a throat culture to see what else might be growing there, because we don’t typically treat if it’s not Strep A. Now be aware that we are also on the lookout for mononucleosis. If you strep test is negative, we might recommend that we check for that as well. But in general, if your strep test is negative, you don’t have a fever, and it doesn’t seem that you have strep, we are going to recommend supportive care by treating the pain using saltwater gargles, maybe some throat lozenges, to help you feel better until you get better on your own. Now the sore throat salt water gargles should be made a particular way. Many people just put salt in a glass of water without really understanding what they are doing. You’re not trying to put in a lot of salt and burn the problem out of your throat. We want you to use about ½ teaspoon of salt to one cup of warm water. You’ll use this solution to gargle three to four times, spitting it out after each gargle, and then you can make a new solution about every

two hours and gargle again. My favorite sore throat lozenges has an ingredient called Benzocaine. Benzocaine is a topical anesthetic and this will actually numb your mouth and numb your throat. It’s not just a sugary candy that feels good. So, I recommend getting Benzocaine lozenges if you’re having significant sore throat pain.

[Female Voice]: Something else that we need to just mention would be if you have a sore throat and there’s a concern for possibly an oral STI, that it would be important to let us know because we would need to swab your throat and check for that. That would be a totally different sore throat issue.

[Male Voice]: That’s a good point, Kim. We do see sexually transmitted sore throats. It is not nearly as common. If you think this might be a concern for you, we do need to see you in the clinic.

Now it kind of goes without saying that when you’re sick, you need to rest. That doesn’t mean that you can stay home from all your classes, but it does mean that you don’t go to the Rec and workout really hard. We want you to give your body time to heal, we do want you to drink extra water, and get as much sleep as you can.

We understand limitations to that sometimes, but when you can, you need to rest and put any activities that are not absolutely essential on hold.

[Female Voice]: So another little bit about sore throat issue would be when you can return to school or work. Of course if you strep throat, we would like for you to be on the antibiotics we prescribe for at least 24 hours, usually within 48-72 hours we recommend you change out your toothbrush because after that point, you are considered less contagious. Now that doesn’t necessarily apply for the non-strep throat cases of sore throat.

[Male Voice]: Right, but good point to reinforce, if you have strep throat and start antibiotics, you can return to class within about 24 hours, so you’re not contagious to others once you’ve been on antibiotics for that time.

[Female Voice]: Some of the things that we would like for you to watch for or would want you to be seen or be seen in the ER if it’s on the weekend or after hours would be things like difficulty breathing, if you have a skin rash with your sore throat as well, if you’re drooling, unable to swallow, you have a significant amount of swelling to your neck or to your tongue, if you have difficulty opening your mouth, stiff neck, and also if you have an underlying chronic illness or some type of medication that may weaken your immune system. Those are all reasons why you would need to be seen in the clinic or in the ER if it’s on the weekend or after hours.

Definitely a way that you can prevent sore throat or some of these viral illness in the fall or when classes starts are to make sure that you are washing your hands, especially after coughing, or blowing your nose, or sneezing. Alcohol-based hand rubs are a good alternative for disinfecting your hands if there’s not a sink readily available. It may not always be possible for you to avoid being near a person who is sick, often people will get roommates sick or have several people living in the same area. So it’s important to avoid touching your eyes, nose, or mouth that way you can prevent the spread of an infection throughout the house or if you’re sharing a bathroom. Disinfecting wipes can be particularly helpful if you’re wiping everything down really well.

[Male Voice]: Let me jump in. The most effective way to reduce the spread of cold symptoms and the cold virus is to wash your hands. It’s more effective than not sneezing or coughing on someone. So when you’re seeing an alcohol-based hand sanitizer as you’re entering or leaving a building for example, take advantage of it. If you see it, use it. Wash your hands often. That’s the best way to stay germ free.

Now another thing to talk about in terms of preventing cold symptoms is Vitamin C and Zinc. There has been some kind of back and forth talk in the literature whether these are effective and how much they are effective. The first thing to say is once you have the cold, Vitamin C and Zinc will not help. Now some caveats to that, because it’s a little bit fuzzy on the edges: Vitamin C has been proven to be helpful to prevent you from getting the cold. So if you are going to travel, especially by air, you might start taking Vitamin C a day or two before your trip and take it during your trip until you’ve returned home. But once you get the cold and you’re having coughing, sneezing, runny nose and so forth, you can stop the Vitamin C because it’s not going to really do anything for those symptoms. There is some evidence that oral zinc lozenges are effective in reducing the duration and the severity of cold symptoms if they are taken immediately on first sign on cold. Now I don’t have specific recommendations for a particular product, but in general, you have to take these lozenges about every two or three hours for the first day, and then multiple times each day for the duration of your illness. So oral zinc lozenges are certainly something to think about if you want a more homeopathic, non-prescription way to treat a cold. But again, once you have it, it’s going to be much more difficult to treat. We recommend that you never use a zinc nasal spray. I believe most of these have been taken off of the market. But loss of smell, permanent loss of smell, has been associated with zinc nasal sprays, so do not use zinc nasal sprays. Echinacea is another product that has been used by some, there really is mixed evidence on this depending on which Echinacea you’re using. In general, when we did the cost analysis, it was about $48 to use Echinacea to treat cold symptoms, which that $48 might be better used on some other medications. But those are available locally at our natural food store and other areas around town. I don’t personally recommend Echinacea but if you like homeopathic remedies, then there are some that will work. Use Echinacea purpurea, not Echinacea angustifolia. I know those are funny names for people that aren’t used to plant names, but Echinacea purpurea, is the product that you want to look for.

[Female Voice]: Another thing we needed to touch on would be pain medication. Of course over-the-counter pain relievers, Acetaminophen (which is Tylenol), or Ibuprofen or Naproxen (which Ibuprofen is Motrin, Naproxen is also known by the brand name, Aleve), those are definitely some of our go-to medications that can provide fast and effective relief of sore throat pain. Now if you have cold and flu symptoms, and you’re having body aches, fever, headache, those medications can be extremely helpful and just help you feel better. Now these medications can be taken every six to eight hours. Of course, there are extra strength versions of Tylenol, which would be 500mg tablets. Regular Tylenol is 325mg tablets, so you would do one or two of those. Motrin and Ibuprofen come in 200 mg tablets, and you take anywhere from 400mg to 600 to 800mg, depending on weight. We usually use that to help determine dosing. Those can be taken every 6-8 hours. Aleve is a little bit different as far as dosing, and that’s usually a twice a day type medication as it’s a little bit longer acting. So these medications are kind of our go-to in treating headaches, body aches, sore throat, some of the swelling that you get related to, swollen tonsils. Ibuprofen which is NSAID can be particularly helpful for that.

And then ear pain is definitely something that we see a lot for cold and flu symptoms. If you’re having a lot of muffled hearing or your ears are feeling plugged up or kind of full, decongestants like Dr. Gore talked about, Sudafed in particular, can be particularly helpful in helping relieve some of that discomfort. Of course, we are always happy to look at your ears to make sure you don’t have any type of secondary ear infection but it’s not uncommon to get a red tympanic membrane, which is your eardrum, when you do have a viral infection and not necessarily need antibiotics unless it continues for several days or gets worse.

In addition to a decongestant, some of the tricks you use to relieve ear pressure when you’re flying are also effective. Many of us chew gum when we get on a plane to help our ears pop when we change altitude. What you’re actually doing there is just creating a lot of saliva and swallowing more frequently. It’s the swallowing part that actually helps to open up the tubes and equalize the pressure between your middle ear and the back of your nose and mouth. So, if you have problems with your ear feeling muffled or full, in addition to a decongestant, we also recommend chewing gum as well. And everybody likes that. Everybody likes the doctor to say “chew more gum.”

[Female Voice]: And then Mononucleosis, Dr. Gore briefly mentioned that as well, something that we definitely see a lot of in the college population. Mono is a viral infection that’s caused by the Epstein - Barr virus, and it is something that looks a lot like strep. It causes the tonsils often to get swollen, you’ll get exudate, which are kind of what we call white patches on the back of your throat, your lymph nodes particularly get swollen and you’ll often have fever and fatigue. So this is something that we see a lot of. It’s transmitted by saliva, so kissing and sharing drinks, but often students are not going to know how they got the virus. So that is something that we can check for in a blood test and there are, as far as treatment wise, it’s just a lot of different options that are similar to what we’ve already talked about, but in particular we want you to rest a considerable amount and avoid contact sports, exercise or strenuous activities. We often will kind of see you back several times when you have mono to really monitor you pretty closely because it can make you sick for a week to two weeks, and fatigued for up to several months at times.

[Male Voice]: Right. You know, in general, most of the item, simple colds, coughs and so forth can be managed at home with some guidance, and that’s why we do the podcast. But if you ever have a question, you’re not sure if you have something more serious, certainly if you have fever, we’d like to see you in the clinic so that we can reassure you it’s not something that needs antibiotics or further evaluation with lab testing, or something like that.


[Narrator Voice]: This is a production of TAMU health. Please note that these conversations are never meant to replace your home primary care physician. For any specific health questions, and prior to making a change with your medical care, please discuss with your provider, or come see us at Student Health Services. If you have specific topics for the podcast, you can reach us through social media (TAMUhealth) on Facebook, Instagram, and Twitter, or send us an email at tamushs.marketing@gmail.com. More information about the clinic can be found at http://shs.tamu.edu. Thanks and Gig ‘Em!

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