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18 February 2009 @ 05:25 pm
Vile viruses  
After a week of a nasty, nasty cold, I am finally starting to be human again. However, in the misery of my illness, it occurred to me that we have not had a lecture from Drug Doctor Jean in awhile, so this is a great opportunity.

Some information and advice regarding colds and the flu in, I think, my longest post evar! Just to be utterly clear, the products I recommend appear in BOLD CAPS


The “flu” vaccine

Let’s start with the big one. The “flu shot” you get every year (you did get it, didn’t you?) does not protect against the winter puking nastiness. The “flu shot” is actually an immunization that protects against influenza – a respiratory disease that can be very serious, particularly in the very young, elderly, or otherwise infirm. The flu, as people generally use the term, refers to an illness that is usually characterized by gastrointestinal distress (i.e.; puking your guts out). Therefore, if you got the “flu shot” and then shortly thereafter got a sick with the puke-y flu, the immunization did not cause the illness or fail to protect you from that crud - you have a completely different disgusting illness. Even if it WERE the same disease, however, the viruses in the flu shot are inactivated and unable to cause active disease. They ARE, however, able to cause an immune response and you can have things like soreness in the injected muscle or a bit of a fever or tiredness as your body works to identify and destroy the invaders. This short period of malaise is rewarded with immunity against those viruses when you encounter them out in the world, saving you from a long and potentially dangerous illness. However, the influenza bug is a crafty creature and it mutates readily, which means that the viruses chosen to be represented in the vaccine are not always the ones that actually make the rounds. It’s sort of roulette, but some protection is better than none.More information about the flu shot and influenza is available from the FDA here.



 

Alternative medicine preventatives and cures

With the influenza vaccine being less than 100% effective and providing no coverage for the common cold or the stomach flu, there have been some products developed to prevent or treat those common illnesses. Unfortunately, they are generally snake oil remedies and do little or nothing to treat these viral illnesses.

 

One of the most common of the “preventative” treatments is Airborne – a vitamin and herb coctail readily available at most grocery and drug stores. The problem is that there is no evidence that it works. Yes, some of the ingredients have been studied in the treatment or prevention of colds, but Airborne does not necessarily include those ingredients in the same formulations or amounts as were used in the studies. Also, anytime a product lists a “proprietary herbal blend” I consider it cause for concern. Herbals are so poorly regulated that even when a product DOES list the ingredients, there is no safeguard to ensure that the company is actually including those ingredients nor any requirement that they prove that it is free of pesticides, contaminants, or heavy metals. A product that does not even disclose which herbs are included also opens up the possibility of unintended side effects or interactions simply because you don’t know what you are taking. To top it off, while the rules around “dietary supplements” are very lax, Airborne has managed to violate them, being brought to court by the FTC for fraudulent advertising practices and fined millions of dollars (they just lost another big lawsuit at the end of 2008). With no proof of efficacy and big questions about its ingredients, I would not recommend this product.

 

Zicam and similar nasal zinc products may be effective in shortening the length of the common cold, based on the limited studies available. However, there are also studies showing that there are no benefits to it and a growing number of reports that the treatment can temporarily or permanently interfere with the senses of taste and smell. For the somewhat questionable benefit in shortening a self-limiting disease, I don’t really think it is worth the risk and I’d recommend avoiding the product altogether.

 

ZINC LOZENGES, on the other hand, have a better track record. While there still are conflicting studies, many studies do show a benefit to starting zinc therapy within 48 hours of the onset of symptoms and using one lozenge every two hours while awake. The taste of zinc and the unpleasant dry mouth feeling are significant down sides to the therapy since the lozenges need to be absorbed in the mouth, not chewed and swallowed. Also, if you are taking vitamin C or other vitamins, they should be separated from the zinc, since the ionization of zinc seems to be an important component in its efficacy.

 

Speaking of Vitamin C, there is also some evidence that high-dose vitamin C may reduce the severity and duration of colds. Taking it prophylactically however, does not seem to prevent one from acquiring a cold. Also, because vitamin C is ascorbic acid and can mess with you body's pH, there are some risks, especially with very high dose or long term high dose therapy, so limit your intake to 2 grams per day and only while you are ill. Consider skipping vitamin C therapy altogether if you have a history of kidney stones or other conditions that could be impacted by lowering your body’s pH.

 

 

Over-the-Counter Medications and Treatments

When miserable with the common cold or stomach flu, many people reach for over-the-counter medications. While many of these are indeed effective, there are some things to keep in mind.

 

GUAIFENESIN (Mucinex) – This is, in my opinion, one of the best cough/cold medications out there. It is an expectorant, which means that it loosens up the gunk in your lungs and helps you cough it out. You need to increase your fluid intake to promote this process and it doesn’t really do anything for non-productive coughs, but for those wet, phlegmy coughs, it is an excellent choice. One caveat – you often see guaifenesin combined with dextromethorphan, a cough suppressant. Why take an expectorant to help cough out the gunk and a cough suppressent to keep you from coughing out the gunk? Avoid these combination products because they just don’t make sense! Also, there is a significant cost difference between immediate release guaifenesin (taken every four hours) and extended-release guaifenesin (taken every 12 hours), so if you can’t afford the Mucinex, look for the generic, more frequently dosed stuff.

 

Dextromethorphan (Robitussin) – As mentioned above this is a cough suppressant. I would recommend avoiding its use unless you have a dry, unproductive, bothersome cough. It can have significant side effects and if you have lungs full of gunk, you don’t want to trap it there! If you do take it, be careful of the drowsiness side effects in particular.

 

VICKS VAPORUB - VapoRub or similar topical menthol/camphor/eucalyptus ointments are a good option for both cough suppression and aching muscles - symptoms that often go hand-in-hand with colds and the flu. Rub a generous amount onto your chest or achey bits and soon you’ll smell like Gramma, but feel much better. However, do be careful – applying heat or wrapping tightly to the skin can cause chemical burns and you can’t put the Vick’s ointment in a humidifier because it is oil based.

 

Pseudoephedrine (Sudafed) – This is a nasal decongestant that is generally fairly effective, but can increase blood pressure and long term use can lead to rebound congestion. Many people also get a nervous or jittery feeling on it. If you do decide to take it, use as little as possible for as short a time as possible, and try not to take it before bedtime when it may keep you awake. In Wisconsin and many other places, you now must buy this from behind a pharmacy counter as it is a main ingredient in making meth and so has been a favorite target of shoplifters. The “replacement” product (like Sudafed PE) is phenylephrine, which many people find to be less effective, but is less attractive to meth cookers, and so is still available out on the floor of grocery stores, department stores and pharmacies.

 

Nasal decongestant sprays – Avoid, avoid, avoid! They can cause additional irritation and very quickly put you at risk for rebound congestion. Just don’t use them.

 

NETI POTS – Now here is a product I can really recommend! Neti pots are disgusting, vile, horrid things… but wonderfully effective and it is just hard to argue with that. They provide immediate, effective sinus congestion relief with no side effects other than the ick factor. The initial cost is a little steep – about $10-15 for the starter kit – but then you can mix your own replacement salt from recipes online or available from the manufacturer and get years of use for pennies. In addition to treating cold symptoms, neti pots can be effective for other, non-viral sinus conditions, such as allergies, frequent sinus infections, and post-nasal drip as well. As a special geek factor – the doctor behind the SinuCleanse system works at the UW Hospital and has done a lot of the research to support the use of neti pots right here in Madison.

Now… how do you use one of these buggers? Essentially, you use a little watering can to pour water up one nostril and into your sinuses and out the nostril. Then you blow, blow, blow and out comes all the gunk that was up there making you miserable. Gross, yes, I know. I always swore I would not do it, but since the time I got desperate enough to do it, I have been a believer.

Some hints to prevent it from feeling like you are being waterboarded or snorting pool water:

  • Use only one half of the salt packet to start. Many people find that the full packet is too much.
  • Use water a little hotter than you would imagine, but not hot enough to burn. Think a baby’s bottle warm. If the water is cold, it can be a disturbing feeling and the warm water seems to dislodge more yuck.
  • Lean forward over the sink. The more upright you are, the more likely it is that the water will dribble down your throat and make you feel like you are drowning.
  • Take it slow – you don’t need to use the whole potful in one direction or even the whole thing in one session if you don’t want to. Pour some through, then blow. Pour some the other way, then blow. Repeat as needed or desired.
  • Rinse the sink and spray it down with a bleach product immediately after to avoid infecting others.

 

Now, you will note that I said Neti POTS, not just nasal irrigation. Some people foolishly use those little suckers that moms use on babies’ noses or the squeeze-bottle type rinses to force water up their noses. DON’T. It’s like using a sandblaster to clean out a scrape. Using a neti pot uses gentle gravity and water pressure to clear blockages. Forcing water through with positive pressure can cause nasal damage. Even mild damage can lead to irritation and additional congestion. Forcing snot filled goo into your ears can predispose you to an ear infection. Trying to push too much water up there too fast can increase the amount backing up in your throat and making you sputter and choke. I don’t know why the squeeze bottle option is considered more acceptable by some folks and it certainly is on the market, but avoid, avoid, avoid…
 

YES:

  

No:

 

Breathe Right Strips – these are another simple mechanical way to help relieve congestion. The idea is simple and beautiful – pull open your nose from the outside. Imagine a little bandaid with reinforcements – when it is stuck across your nose, it pulls the nose open and makes it easier to breathe. I’ve only used them at night to improve bedtime breathing/reduce snoring, so I don’t know how well they work if worn for more than a few hours and the adhesive might be a bit much for sensitive skin, but if you’re really congested, it’s worth a shot. (Moderate recommendation - jsh)

Combination products – products like NyQuil and the 6,000 varieties of Robitussin abound, but I generally think they are a bad idea. They are a coctail of many different drugs, some of which may be meant to treat symptoms you do not have. It is usually cheaper, more effective, and safer to buy generics of the individual drugs and take only the ones you need to treat your symptoms. If you do choose to use a combination product – be sure to read the ingredients carefully. Many include acetaminophen (Tylenol) or other common medications that can be dangerous if you take too much, so be sure you are not accidentally doubling up doses.

Of course, as with any medications or devices, also read the directions on the bottle or box and keep in mind your own personal health situation, the above is just some additional or non-obvious info about these common meds.
 

 

Prescription drugs - Antibiotics and Antivirals

Sadly, there really isn't too much much to be done about a cold or the stomach flu than treat it with the over-the-counter items to manage the symptoms. If you think you have the respiratory influenza, there are some antivirals on the market that can reduce the severity and length of the illness, but some strains of influenza are becoming resistant so they may not be effective if one of those strains is predominant in your area. If you have the puke-y flu or the common cold, you are out of luck all together with the antivirals.

If you have a cold and you are a mucus-y mess, keep an eye on the goo. If the yuck coming out of your various orifices is clear, white, or light tan, you probably have a viral illness and just need to ride it out. However, if your goo goes bright yellow, green, or brown or does not clear up after a few days, you may want to think about heading into the doctor and ruling out a bacterial illness. A persistant sore throat may also be an indication that your cold has moved on to strep throat, so monitor your symptoms and temperature if you can't seem to shake the sore throat. Antibiotics will only benefit you if you have a bacterial infection - they do nothing for viral illnesses.


General advice

Sadly, in many ways, mom is still right  - clear fluids, lots of sleep, soup and a good book are often the best treatments for a viral illness.

Good luck with the rest of the winter virus season!

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Current Mood: busybusy
 
 
 
JinglyMushroomjinglymushroom on February 19th, 2009 02:13 am (UTC)
*applause*
Mark Gordonmtgordon on February 19th, 2009 03:32 am (UTC)
OK, you have recommendations for acute URI, but nothing for gastroenteritis. Any thoughts there? Most of the antiemetics I know of are more focused to motion sickness (since you won't be able to keep them down if you have acute viral gastritis), but your advice on antidiarrheals might be useful, given that many cases of "stomach flu" don't end at the stomach.

On the subject of URI, though, you might want to address analgesics/antipyretics, beyond "don't overdose on APAP."
eithni: PharmDeithni on February 19th, 2009 08:24 am (UTC)
but nothing for gastroenteritis.

Pretty much because there is little to be done. Antiemetics and antidiarrheals are sort of like the dextromethorphan - if your body really wants to get rid of its contents, you probably should let it. Whether it is food poisoning or viral illness, generally your best bet is to purge, purge, purge and replace the fluids and electrolytes as best as possible.

I did think about including info on antipyretics/analgesics, but decided that was a full rant for another time as this was already getting lengthy. I want people to actually READ these things. :P
ego_id_non_feciego_id_non_feci on February 19th, 2009 04:21 am (UTC)
You're helpful. Thanks!
dread_exdread_ex on February 19th, 2009 05:37 pm (UTC)
In Wisconsin and many other places, you now must buy this from behind a pharmacy counter as it is a main ingredient in making meth and so has been a favorite target of shoplifters. The “replacement” product (like Sudafed PE) is phenylephrine, which many people find to be less effective, but is less attractive to meth cookers, and so is still available out on the floor of grocery stores, department stores and pharmacies.

Couldn't I just do meth and to forget about being sick for a liitle while?
Hey, what about Head-On?
eithni: do I need to kill you?eithni on February 20th, 2009 02:33 am (UTC)
You are an evil woman. :P
dread_exdread_ex on February 20th, 2009 05:41 pm (UTC)
Which is why you love me.
eithnieithni on February 20th, 2009 05:49 pm (UTC)
Pretty much. :)
JinglyMushroomjinglymushroom on March 6th, 2009 11:11 pm (UTC)
Thank you again. I can just feel there's something gooey and yellow stuck to my throat and I don't think inducing myself to cough until my lungs pop out is the best way to solve this problem. Then I remembered Eithni mentioned something about this! And how convenient! Here it is! Thankses!
eithni: PharmDeithni on March 6th, 2009 11:13 pm (UTC)
Pharmageek at your service!