Sickness Makes You Sick

“Normally I wouldn’t bother with this cough, but when I started to bring up green mucus I knew I had to do something…..”    

Hotel guests tell me this regularly, and it’s wrong. Everyone’s respiratory tract makes a quart of mucus a day. When the respiratory tract is irritated, it makes more, and the mucus may turn yellow or green. In an otherwise healthy person, this has no ominous significance.

No one stares at their throat when they feel fine, and a sore throat always looks suspicious. Everyone knows that white spots on your tonsils are a sign of Strep that requires urgent attention. In fact, plenty of ordinary viral infections make tonsils look bad.

 “The fever came back,” guests tell me as if this were a serious development. But Tylenol or aspirin only work for a few hours, and then you must take more. When patients tell me that they worry about a fever, my advice is “then don’t take your temperature.” They treat this as a joke, but the truth is that fever is just another symptom.

 All bets are off if you suffer a chronic illness or serious immune deficiency or are extremely old or extremely young, but this is not the case with almost everyone I see. When people in good health get sick, they feel sick.

 

 

Green Is Not a Big Deal

One mystery I’ve never solved is why patients worry about green bodily fluids.

Guests with a cough tell me that they wouldn’t have called if their mucus hadn’t turned green. In fact, in an otherwise healthy person, green mucus is rarely a serious sign. Ditto for yellow. Everyone’s respiratory tract produces a quart of mucus a day. When it’s irritated, it produces more, and it can change color.

If you vomit on an empty stomach you might see bile which is green. This has no great significance. Many patients believe that they shouldn’t vomit if their stomach is empty, so something ominous is happening. This is not so. The signal to vomit comes from your brain, not your stomach.

Patients with diarrhea often save it in the toilet for my examination. I consider it bad manners to refuse to look, but normal stool can turn green.

There are exceptions. Blood from these orifices is never normal, so it’s OK to show me. If your stool or vomitus is black – pitch black, never dark brown – that’s usually bleeding.

A good rule (although my lawyer insists that I add that plenty of exceptions exist) is that you should see a doctor if you feel bad. If you don’t feel bad, it’s probably not necessary. Don’t pay too much attention to green stuff.