Fall and winter can be daunting for physicians. These are the times when many infectious illnesses are more common. I can usually tell that Autumn is close— not because of the calendar or the first college football game — but because I hear the barking cough a child with croup.
Since this is the time of year for respiratory infections, let me share a couple of points. First of all, many of your children will have stuffy noses, earaches and sore throats. This is par for the course, as most children will have several upper respiratory viruses each year during cold and flu season.
The important thing to remember as you take the kids to the pediatrician, urgent care, E.R. or Minute Clinic, is this: most of them don’t need antibiotics.
The majority of ear infections and sore throats are viral. It’s a reflex in our society to want antibiotics, but usually they don’t help. In addition they can cause allergic reactions, vomiting and diarrhea. Finally, they contribute to antibiotic resistance. So ask your healthcare provider, “Is this really necessary?” And if it isn’t, treat the symptoms with Tylenol, Motrin, fluids, chicken soup and cuddles. And wait. One of my professors used to say, “He needs a little tincture of time.” Often it’s the best therapy.
It can be very frustrating, I know. In fact, I often see folks this time of year who are coughing for days or weeks. They have been to doctor after doctor and have had multiple rounds of antibiotics. Frustrated, they show up in the E.R. at 2 a.m., short of breath and miserable. If they still have a fever, I’ll often get a chest X-ray to check for pneumonia. But when it’s not there, I go with plan B. You see, I find that many such patients are actually wheezing. They may or may not have asthma or emphysema, but other things can cause wheezing. Coughing is simply your body’s way of opening up those bronchial tubes that are in spasm or clogged with mucous, and moving out the debris.
If those wheezing, coughing patients don’t have a pneumonia, I often treat them with prescription broncho-dilators like albuterol. When taken with a “spacer,” which is a tube attached to allow for deeper breathing, the cough is dramatically improved. Then I throw in a steroid for a few days, and what weeks of antibiotics failed to accomplish is done. Again, sometimes antibiotics just aren’t the answer.
Next, a word about influenza. This year’s vaccine was not very effective…in Australia. But apparently it’s working better here. If you aren’t vaccinated, you should be. As for Tamiflu, many physicians (myself included) are not very impressed with its effectiveness. It’s a discussion you can have with your physician if you have the flu.
Finally, beware of pneumonia. The very young and elderly, in particular, are terribly susceptible to pneumonia. Pneumococcal pneumonia, for which a good vaccine exists, can be a devastating illness with a five percent mortality rate when treated. It sometimes leaves patients exhausted for weeks, even when treated effectively. It’s also a disease which, in the pre-antibiotic era, may have had up to 30% mortality.
So, with Winter upon us, remember that a painful cough with fever, shortness of breath and brown, green or bloody sputum is a reason for an immediate doctor visit. As is severe vomiting, diarrhea or abdominal pain, or fever, headache and confusion. But most adults and kids with the average fever, sore throat and runny nose can simply wait it out.
However, as always, if you’re uncertain remember to contact your physician or come to the ER.
Have Happy New Year! And stay healthy!
Edwin Leap, MD, is the associate director of the Newberry Emergency Department.