Posted by: drrozkaplan | July 15, 2010

The Common Cold

I have a bad summer cold.  Coughing, congested, headache, body aches.  In fact, I’m even wheezing, which I never do, and my head feels kind of like it’s going to explode.  I dragged myself to work with the start of this yesterday, but fortunately I have today off. I am praying that I get better before the weekend, because this weekend is the WXPN singer-songwriter weekend, and I don’t want to miss it.  But the only thing worse than wheezing and feeling like your head is going to explode is sitting in the sun in blazing heat, listening to loud music while you are wheezing and feeling like your head is going to explode.

I caught this from my husband.  He started out with these same symptoms.  He usually bounces back from viral illnesses very quickly, but this time, he started getting better, then got worse:  terrible coughing, shortness of breath, weakness and fatigue.  He had developed pneumonia.  After some antibiotics and inhaler treatments, he is still coughing a bit, but feels much better over all.

I’m not expecting this to happen to me, though. You might ask how I know this.  In fact, I don’t know for sure, and it’s possible that I, too, will develop a secondary bacterial infection and need antibiotics.  But right now I don’t.  I know this is a virus, and viruses don’t get treated with antibiotics.  Patients often will ask for antibiotics for such symptoms, and it is part of my job to explain to them why antibiotics are not indicated, and why, in fact, it is not in their best interest to take them.

Again, how do I know?  The key indicator here is that I have multiple systemic symptoms: headache, body aches, congestion, cough, fatigue and malaise.  No fever, so this is the common cold.  A bad case, because I feel really bad.  If I had a fever, I guess I could say it is a flu-like illness.  But I have no specific indicator of a bacterial infection.  No isolated sinus pain or drainage, indicating sinusitus, no fever. shortness of breath, productive cough, or chest pain, indicating possible pneumonia.  And I’ve only been sick for a couple days.  So, I get symptomatic treatment:  tylenol for body aches and headache (I could use ibuprofen but it bothers my stomach), over the counter cough medicine and decongestant (I like Mucinex products).  I am using a prescription inhaler because of the wheezing.

I’m going to try to rest and drink fluids and stay out of the heat.  That’s what my body is telling me to do.  Body wisdom.  I think it will help me get better faster, although there are doctors who will tell you that it will run its course no matter what you do.  But really, I think my husband got sicker partly because he didn’t slow down.  He was in a bad situation because he was ‘on service’, covering a hospital service, teaching the residents and students and there was nobody to cover for him.  He had to work 7 days a week and had no time to pay attention to his symptoms.  He had to go out in horrible heat and humidity last weekend.  And even when he was starting to feel really bad, because he is the comsummate purist, he resisted the antibiotics until he was ABSOLUTELY sure there was no choice.

There really is no point in taking antibiotics if you don’t have a bacterial infection.  It makes no sense to take them to prevent the onset of bacterial infection.  And in fact, taking antibiotics when you don’t need them is harmful.  It can cause resistant strains of bacteria to develop, which is bad for individuals, but also for the general population, making our armamentarium of antibiotics less effective.  In fact, this has already occurred because of over-prescribing of powerful antibiotics such as Zithromax, Cipro, and Levaquin.  We hear about bad strains of bacteria, like MRSA, on the news:  a result of overprescribing of penicillin and its derivatives.  And antibiotic use can cause overgrowth of yeast and alternative bacteria in the individual: a small price to pay if the patient REALLY needed the antibiotic, but an unacceptable outcome if the antibiotic prescription was unnecessary in the first place.

Of course, I wish I had the magic bullet for the common cold.  If I had true influenza (I know I don’t, it’s not flu season and anyway, I’m not sick enough) I might be able to shorten the course or make it a little less severe with medications such as Tamiflu- but still I couldn’t cure it. ( We do have some antivirals for flu, herpes, some hepatitis viruses and HIV, but these are complicated drugs, which more hold viruses at bay than ‘cure’ them. )  But luckily, what I have now is just a cold.  It feels lousy, but it will pass.  So I have to be patient, and use what is available for symptoms. From my 20 years of medical experience,  I can say with pretty good confidence that my head really will not explode.

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Responses

  1. Ick… feel better!

  2. wait- quick question- you said that it makes no sense to use antibiotics as a preventative– but I am one of those odd people who is asymptomatic for strep throat– my first symptom is rheumatic fever. As a result, I’ve been put on prophylactic antibiotics. There’s no evidence that it works, but I haven’t gotten rheumatic fever or strep since. Thoughts?

    • I didn’t mean that all antibiotics to prevent all infections make no sense. In certain situations, a person may be at a particular risk, and an exposure to a particular bacteria is anticipated. Then prophylaxis is appropriate. Another such situation is a person with an artificial heart valve who is about to have a dental cleaning: mouth bacteria is expected to enter the bloodstream and ould infect the artificial valve, which would be disastrous, so antibiotics aimed at the mouth bacteria are given prophylactically. But when someone has a viral infection and a normal immune system, there is no reason to suspect that they will become super-infected with any particular bacteria , and no way to predict what antibiotic treatment might be appropriate. There is more harm to good of trying to ‘prophylax’ that person against bacterial superinfection.


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