The Doctor (or Nurse Practitioner) is in (actually online)!

There is an exciting growing trend in healthcare that is economical and convenient for the provider and patient.  I am referring to online healthcare visits.  There are many choices but I am most familiar with the Maven app (https://www.mavenclinic.com).  Please download it and explore.

You can have a confidential quick sick visit, or have a long term medication refilled to name a few options.  You will speak with a licensed provider as if you were in their office but you are in the comfort of your own home. Maven not only has nurse practitioners and physicians but psychotherapists, nutritionists, and physical therapists to name a few.  The fees are reasonable and you can even make an anonymous appointment if you prefer.  Of course not everything can be done online there is still a need for hands on care but the virtual options are great for unburdening the overtaxed healthcare system.

Toxic people

Do you have that one friend, or that relative that does nothing but create chaos in your life?  If you do then you know how disruptive and hurtful they can be. It puts everyone involved in a bad position. Do you choose sides or remain neutral? To the “offended ” person there may not feel like neutrality is possible. If you associate with the one with a grudge you have actually chosen a side. 

Now the one who has been shunned by the toxic person is utterly alone because others choose not to choose which in reality is a choice. 

Invisible disabilities 

A whole army of suffering patients that often go under treated. The Invisible Disabilities Association [https://invisibledisabilities.org] defines an invisible disability as follows:

“symptoms such as debilitating pain, fatigue, dizziness, cognitive dysfunctions, brain injuries, learning differences and mental health disorders, as well as hearing and vision impairments.  These are not always obvious to the onlooker, but can sometimes or always limit daily activities, range from mild challenges to severe limitations and vary from person to person.”

Patients who suffer with these impairments often hear the cringeworthy statement “but you look good” which can add to the anxiety or depression because others offer no empathy or understanding.  An individual with a visible challenge  may be offered special accommodation by employers where a sufferer of an invisible disability will be judged as lazy or a whiner

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Imagine telling a paralyzed individual to stop being lazy and get up and walk!!  This is essentially what some who suffer with invisible disabilities are subjected to when their limitations are considered fake or “all in their head”.  So before we judge try to imagine what life is like for those whose suffering is called into question on a daily basis.  Statements like “your pain is way out of proportion for your injury” or ” you shouldn’t be having those symptoms” are not useful & do not contribute to a trusting relationship between patient and provider.  The patient is thinking “then please tell my body that”!!!  Treating patients this way is  not compassionate and shouldn’t be used by empathetic providers.

A herd of zebras?

We all know the saying when you hear hoof beats think horses not zebras. 

Patients are all special individuals. Each member of the human family is of value. A gem with unique qualities. Now for the big BUT…  

  • your body temperature of 98.9 degrees Fahrenheit is not a raging fever because you “run low”. 
  • Your 24 hour long viral sinus infection will NOT respond to a Z-pak. There is no “nipping it in the bud”
  • I understand you don’t have time to be sick but sadly those are the breaks sometimes 
  • Your sore throats that tested negative for strep is not a rare negative-testing strain
  • I will recheck your blood pressure because 125/78 is “high for you” but I’m not treating a normal result
  • No you will not convince me that the flu shot gave you the flu
  • I’m sorry your pain pills were stolen,fell in the dogs water bowl, flew into the toilet, got thrown away by a family member but I can refill you early 
  • I understand that medicine XYZ made you nauseated but that’s not a true allergy
  • No I cannot agree that taking your blood pressure medicine when you “feel off” instead of every day
  • No I can’t in good conscience prescribe soma for your over-active bladder 

Please know dear patient that I will care for you as if you were a member of my own family but I can’t believe that I have the only all-zebra practice in the world. 

Let’s talk about your sore throat…

Sore throats are no fun.  When we get them the can interfere with  our ability to speak, eat, and if bad enough, drinking enough fluids to stay hydrated. We may look in a mirror, ask a friend to look or take a throat ‘selfie’ with our phone to look for those infamous white patches.  If present we are sure we have “strep” (a pharyngitis or throat irritation caused by Streptococcus pyogenes).  Before you run off to see you healthcare provider armed with you whisper-voice and your throat selfie let’s talk about it.

Most sore throats are viral (85% in children and 95% in adults) which means that antibiotics will do you no good.  Yes even if you have white spots on your tonsils!  The symptoms that are present with strep throat include the following:

  • sudden onset
  • absence of a cough
  • headache
  • nausea and vomiting
  • fever
  • skin rash
  • tiny red spots (petechial rash)  on the top of the mouth (palate)
  • body aches.
  • This infection is more common in late Autumn and early Spring.

If you have a family member with strep throat you will not necessarily catch it but it is pretty contagious.  Strep can spread through airborne droplets when someone with the infection coughs or sneezes, or through shared food or drinks. You can also pick up the bacteria from a doorknob or other surface and transfer them to your nose, mouth or eyes. So if a loved one is infected EVERYONE in the home should WASH his or her HANDS like it is their JOB!

So now you know that more often than not, your sore throat is probably viral and time is the only cure.

For more information  ….

http://www.mayoclinic.org/diseases-conditions/strep-throat/symptoms-causes/dxc-20165964

http://emedicine.medscape.com/article/764304-overview

http://www.webmd.com/oral-health/guide/sore-throat-cold-strep-throat-tonsillitis#1

 

 

Do I have the flu?

Flu-Symptoms-vs-Cold-Symptoms-1.jpg

If you are sitting upright and still have the will to live…. probably not. Kidding aside I see so many patients that believe they have the flu when it is actually a common cold or sometimes even allergies.

Common cold virus symptoms include the following: mild to moderate hacking cough, sore throat, sneezing, runny and or stuffy nose, NO fever, mild aches and less often a mild headache. You can typically perform your daily functions.

Influenza (flu) symptoms: very sudden onset of symptoms, moderate to severe headache, fever (102-104 degrees Fahrenheit), severe body aches, exhaustion, severe cough, chest tightness or discomfort. You are unable to work or do much more than rest.

Allergic rhinitis symptoms: mild cough, some fatigue is possible, NO fever, itchy watery eyes, possible rash, runny nose and sneezing.

Treatment:  In 2016 there is still no cure for the cold.  There are antiviral medications that are often used to shorten the course and decrease the severity of the flu. But why not arm your immune system with a Flu vaccine to hopefully avoid it all together!  Allergies are best managed with antihistamines or topical nasal steroids (Flonase, Nasacort).

 

The manufacturers of Flonase made this easy chart to help explain what I’ve covered above.know-your-enemy.jpg

Not all sinus infections need antibiotics.

It is very important that if you suspect you have that good old sinus infection you communicate carefully with your provider. If you have been sick for less than a week your sinus infection is viral and does not require antibiotics.  To qualify as bacterial rhino sinusitis several key symptoms should be present.  1)duration longer than 10 days, 2)purulent (pus) nasal drainage,  and 3) re-sickening meaning that you began to get better and then were pretty sick once again.

Sinus infections are usually (9 out of 10 cases in adults; 5-7 out of 10 cases in children) caused by a virus. They are less commonly (1 out of 10 cases in adults; 3-5 out of 10 cases in children) caused by bacteria.[CDC website]

I’ll be honest.  Often we will give you a z-pak to get you out of the office faster instead of trying to convince you that you don’t really need antibiotics.  There is no such thing a “nipping it in the bud”.  We are sorry you don’t have time to be sick but taking an antibiotic when you have a viral illness will simply contribute to the every growing number of antibiotic resistant bugs.

sinusitis-lg

So, what do you do to manage the symptoms of a viral sinus infection?

  • Get some extra rest, and stay hydrated
  • oral zinc can decrease the length of a viral illness
  • Put a warm compress over the nose and forehead to help relieve sinus pressure
  • Use a decongestant or saline nasal spray
  • Breathe in steam from a bowl of hot water or shower
  • Take acetaminophen, ibuprofen or naproxen to relieve pain or fever
  • flush out the area with a neti pot or sinus rinse

So now you are armed with information to be a responsible  citizen when it comes to antibiotic overuse.