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 almost here — not because of the calendar or the first Clemson football game — but because I hear the barking cough of my first 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 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, 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 and wait. My professors used to say, “He needs a little tincture of time.” Often it’s the best therapy.
The important thing to remember as you take the kids to the pediatrician, is most of them don’t need antibiotics.
Frequently, I 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.
Influenza, for instance, often leaves patients wheezing, as do many viral respiratory infections that we often call bronchitis, or, more descriptively, “reactive airways disease.” And coughing is simply your body’s way of opening up those bronchial tubes that are in spasm or clogged with mucous.
Absent a pneumonia, I treat these patients 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.
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 5 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 percent mortality!
So, this fall, remember that painful cough with fever, shortness of breath and brown, green or bloody sputum is a reason for an immediate doctor visit — in contrast with simple earaches, sore throats and runny noses.
Have a very Merry Christmas and a Happy New Year! And stay healthy!
(A good resource: cdc.gov/pneumococcal/about/symptoms-complications.html.)
— Read more at EdwinLeap.com. Edwin Leap’s latest book, “Holidays & Holy Days,” is available now at BaptistCourier.com/publishing.