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.

 

 

Turning Bad News Into Good

A glum eleven year-old sat on the bed. His glum parents and two glum adolescents sat nearby. The eleven year-old had developed a sore throat, casting a pall over their vacation. They hoped I would make it go away.

Doctors love making things go away, and this would happen if the child had strep, the only throat infection (diphtheria aside) that medical science can cure.

Parents assume that a child with pus-covered tonsils has strep, but many viruses do this. Researchers have determined that a doctor can diagnose strep by observing four signs.  (1) pus-covered tonsils, (2) swollen neck glands, (3) fever, and (4) absence of cough. Since it’s strictly a throat infection, other respiratory symptoms such as cough or congestion make strep unlikely.

This patient had zero out of four. His throat and neck glands were normal; he had no fever; he was coughing.

Working hard to turn this into good news, I explained that the child had an ordinary virus. He would feel under the weather for a few days before getting better. I handed over some remedies, assuring them that these would help. Staying in bed wasn’t necessary. They should try to enjoy themselves.

When the father politely asked if something might speed things along, I explained why it wouldn’t. Never forgetting their manners, the parents expressed gratitude. I left them my cell phone number and urged them to phone if any problem developed. 

We parted on good terms, but I could sense their disappointment. No matter what the doctor said, everyone knows that sick children must rest. So they would wait.  

Isn't Science Wonderful!

“He has pus on his tonsils, so it’s probably strep,” said a guest, calling about her teenage son. I hear this phrase regularly. It causes me some stress because I know that later I might find myself delivering a why-antibiotics-won’t-help explanation to a sullen audience. 

One popular (i.e. wrong) medical belief is that pus on tonsils is a sign of strep throat. In fact, this is true only about ten percent of the time. Viral infections produce identical exudates.

Arriving in the room, I discovered that the boy had pus on his tonsils but also a fever, swollen, painful glands in his neck, and no cough. Good scientific studies show that the presence of these four signs: pus on tonsils, fever, swollen neck glands, and NO cough raise the odds of strep to over fifty percent, so prescribing an antibiotic is appropriate. I prescribed an antibiotic. The family made it clear they were in the presence of a doctor who knew his business.

Isn’t science wonderful? It is. But it’s wonderful in ways that are often not satisfying. More in my next post.