Tuesday, December 22, 2009

Do you have sinus congestion?

Arizona is known for many things besides the beautiful scenery. Medically speaking, Arizona is known for seasonal, strike that, year round allergies. Many people have post-nasal drip, runny nose, sinus congestion, sore throat and cough. None of these symptoms is associated with a fever usually and patients typically complain that this has been going on for weeks. I personally grew up in Northern California and never had allergies until I settled in Arizona. The relative lack of humidity, year round, is a huge factor.

I have a lot of patients who present with 2-3 days of sinus headache, nasal congestion and post-nasal drip. They always want antibiotics. Do they need them? Officially, no, but do I prescribe them anyway, yes. These reason, I prescribe them when I think this is allergic or viral is because, the patient was concerned enough to come in and be seen. They have to go back to work or take care of the kids and it's not for me to say "No, you can't have that medicine, you'll be fine." Some of you might be think, isn't that the job of a physician, to tell you what medicines you can have and which are unnecessary? Yes, that is the job of a physician but it's also my job to provide care in the best interest of patients. That's why if you want narcotics and don't need them you won't get them here, for example.

There have been many studies on the placebo effect (taking a sugar pill that you think will heal you because you have been told so by your doctor) and how well it works and the ethical questions surrounding it. If I have an antibiotic that you have taken before, and you have attached a value to that therapy ("Doc, every time I get this I take a Z-pak and it goes right away") such that it works and it's all you need, If I deny you that medication, am I doing more harm than good? Don't know. Don't even know how that could be studied. I do know that patients all the time think their illnesses are cause and effect when very little but death and taxes are cause and effect. As a physician, I see them as coincidences or completely unrelated but to challenge a patient to an academic argument when they are ill is the antithesis of care. So, If a patient says "Doc, every time I get a running nose, I take chemotherapy and it goes right away," well that patient needs to be educated and they won't get chemotherapy. Azithro (z-pak) is relatively safe medicine, yes antibiotics resistance is possible but I just wonder if the placebo effect may be the real medicine in this situation.

In an effort to be avoid antibiotic Resistance and possible side effects from unnecessary medications, let me give you a head start on what you can do if you start having either allergic or viral sinusitis.

Initially, you should start with pseudophed OTC 30-60mg every 4-6 hours which will help shrink the sinuses. Don't take it in the evening as it could keep you awake.

Next, you can take ibuprofen at the same time for pain relief but sometimes this isn't necessary because the shrinking of the sinuses allows for drainage which relieves the pressure and takes the pain away. If you are going to take it, make sure it's with some food.

If you feel that your eyes, ears and nose are itchy, this may be a allergic issue and you might want to take plain benadryl 25mg at bedtime as an antihistamine. This will make you drowsy and will help prevent all that mucous production.

A cool mist humidifier will increase the humidity in your bedroom and prevent your nasal passages from drying out while you sleep.

If you feel achy and run down, this may be an viral process and you may want to take one of the many OTC viral remedies. The one I like is Umcka Cold Care.

When do you need antibiotics, you ask?
We reserve antibiotic therapy for patients given pseudophed and ibuprofen for 7 days who have the following:
Facial pain, green nasal discharge, tooth pain, or antibiotics in that last month for another illness.

Using the above treatment regime will not only provide you relief sooner and cheaper but will also aid the doctor in understanding how bad your sinuses are and help you get antibiotics when you need them rather than when you want them.

Bryan Glick, DO