(9 pm. – promoted by ek hornbeck)
First, please join with me in wishing Youngest Son a very happy 22nd birthday!
Now to the topic at hand, which is timely for me since it seems that I am getting one. I had a scratchy throat at bedtime last night, but with the change in the weather here in the Bluegrass beginning yesterday, I just sort of did not pay attention to it. When I awakened this morning, it was a different story.
I had fever. I am extremely sensitive to changes in body temperature, because my normal is around 97.7 degrees. Thus, when I hit 99, I am SICK! I also had the scratchy eyes and the runny nose. As the day wore on, and I did not get better, I decided it was time to act. I took aspirin for the fever, a gram of ascorbic acid and 50 mg of zinc to boost my immune system.
The Mom Cat reminds me to add this statement: This is just a survey of some remedies for the common cold, along with what I do personally. If anyone suffers from any chronic medical condition and are under the care of a physician, consult your medical professional BEFORE you take anything that he or she is unaware.
Do these things work? There is no doubt that aspirin lowers fever and reduces aches and pains. As for the Vitamin C and zinc, the evidence is less clear. There is some evidence that C will reduce the incidence of colds in test subjects who do heavy exercise in cold environments, but not a lot that it really helps to reduce the severity or duration in the general population. However, one of my heroes is Linus Pauling, and he was an advocate of high doses of C to prevent and treat colds, and how can I argue with the only person in history to win TWO Nobel Prizes that were not shared with anyone else? I also an a strong believer in the placebo effect.
The zinc is a little more complicated. It is known that zinc is essential for the immune system to operate optimally, but the difference betwixt a zinc deficiency and a zinc excess is large. Fifty mg is likely a very safe dose, so I will stay with that daily until symptoms resolve. There is some pretty good evidence that, taken within 24 hours of symptoms, it does reduce both the severity and the duration. One zinc preparation that has conclusively shown to cause harm was the old nasal gel formulation of Zicam, now taken off the market by FDA because it was linked to permanent loss of scent of smell in some people.
Other actions that I take are to be sure to drink plenty of fluids, especially water. I also have increased my intake of vegetable juice from eight to 16 ounces per day. Later this evening I may add a different liquid, just for pain relief and to assure a good night of sleep! Other than increased handwashing (for the benefit of others, since studies show that person to person transmission of the virus by touch is a major route), the only thing that I do is to try to rest a little more.
This got me thinking about other cold remedies. One of the most ancient is chicken soup, and there may be something to it. Some studies show that chicken soup components may affect some disease components favorably in vitro, but the affect in vivo is much less clear. Likewise, garlic, often a component of chicken soup, has shown the same. Whether or not chicken soup has a positive effect directly, people who are ill tend to go off of their food, and something easy to digest and very nourishing can not help but to be of benefit at least indirectly. It helps the most when a loved one prepares it fresh and brings it to the patient in bed, along with some crisp crackers and a glass of juice. The hot vapors coming off of the bowl of soup also help to soothe irritated nasal passages, and oddly enough, the hot soup often soothes a sore throat.
Lots of people swear by Echinacea, but scientific results for a benefit are weak. For most people it probably does no harm, but some people should avoid it, including those with tuberculosis, multiple sclerosis, HIV infection, and several other conditions. Besides, some species these plants have been gathered to the point of becoming scarce. I would rather look at the extremely attractive flowers and have my spirits lifted by it than to destroy the plant for its roots. Although difficult to quantitate, it is known that people in good spirits tend to recover more quickly from many medical conditions than those in poor spirits. I am almost certain that the reason that I got ill was the bout of really low spirits that I had earlier this week.
A very old folk remedy for the common cold is to “sweat it out”. In this procedure, the patient gets into bed and wraps up in warm bedclothes and then drinks hot liquids (chicken soup being one of them). This will often induce sweating, and when some of the covers are removed evaporation of the sweat can cool the patient, thus reducing fever for a while. This is basically telling the brain to reset the thermostat, but it only works for a little while. However, it can make the patient feel better for a time and probably has few adverse effects. It neither reduces the severity nor the duration of the cold.
Another folk remedy for fever was to drink a tea made from willow bark. This actually works! It turns out that willow bark contains a glycoside, salicin, that is metabolized to salicylic acid, the actual active ingredient in aspirin. We can not take salicylic acid directly because it is very irritating to the GI tract, but once the aspirin or salicin is in the bloodstream, the salicylic acid is diluted so that it is no longer an irritant.
One semi traditional remedy for a cold was the Vicks VapoRub treatment. In older children and adults this can help to soothe airways and reduce the tendency to cough, but it is not particularly effective. In addition, some recent studies indicate that in infants and very small children the product may do more harm than good, because the product can actually irritate and cause more mucus production. This 106 year old product probably is best used with extreme care.
Leeches are right out for this! However, they have been used for centuries to relieve conditions like fever because of the mistaken belief that the redness and hotness of a fever was caused by having too much blood in you! Thus, they have been used to treat colds. Interestingly, leeches have once again been introduced into modern medicine but for much different reasons. Perhaps we shall have a Pique the Geek on that sometime.
There are no approved medications for “curing” the common cold on the market yet, although several drugs are being developed to combat rhinoviruses, the cause of most colds. If these pass clinical trial muster they might be available by prescription in the next few years. Cost for these drugs at present is not known.
If there is no cure and the best treatments are just iffy insofar as shortening the duration or reducing the severity of a cold, then what can we do? Actually, there are several things that will reduce the symptoms of a cold, but not really treat the underlying disease. The first is to use something like aspirin or ibuprofen to reduce fever and aches and pains. Those of you who read my scientific pieces know that I do not recommend acetaminophen for anyone unless they are unable to take anything else, but that is another story. A cool bath or shower, or even a spongebath, can make a feverish patient feel better, as can a cool, damp washcloth on the forehead.
There is a school of thought that says reducing fever interferes with one of the body’s mechanisms for shortening the course of the disease on the hypothesis that a feverish body is less hospitable to the virus. I am aware of no study that supports this idea, and I would rather have a cold a day longer with little fever than a day shorter being miserable with fever. But that is just me.
If coughing is a problem, there are several treatments for it. Now, remember, that some coughing is necessary to clear out mucus from the airway, so as long as the cough is productive, that is, bringing out infected mucus, it is best to cough. If the cough is unproductive, just a dry one from irritation, then a cough suppressant is in order. There are dozens of them on the market, and most of them suffer from a very bad defect: they contain the largely ineffective and potentially dangerous drug dextromethorphan. Authoritative studies sanctioned by the American Academy of Pediatrics show that this drug is not any more effective in children than placebo, and since children are often more sensitive to drug effects than adults, presumably it is also not effective in adult, either.
So what do you do for a cough? Honey has been shown to be a feeble cough suppressant, but should never be given to children under one year for any reason old because of the possibility of infant botulism. Infant’s stomachs do not have a high enough acid concentration to prevent spores of the bacterium that cause botulism to develop, so never give honey to infants. My preference is a prescription cough syrup containing codeine of hydrocodone and no dextromethorphan. In some states these products are available without prescription but you have to sign for them. Interestingly, heroin was developed originally as a nonaddictive substitute for codeine in cough remedies.
The menthol cough drops work pretty well as long as you are sucking on them, but are not long lasting. They are dangerous for small children as they are a choking hazard. Besides, you do not want to overdose them on the menthol. But for older children and adults they are fine, and due to the local cooling effect of the menthol have a minor effect on a sore throat.
If your coughing is trying to be productive but the mucus is too thick to dislodge, products containing guiafenesin help a little. There is a well known brand name with the offensive TeeVee adverts of a family of mucus moving in, but store brands can be had that are just as effective at a fraction of the cost of the name brands. This drug works by thinning the mucus so that you can cough it out more easily.
There are a couple of things that can be done for sore throat. One of the most effective, and certainly the least expensive, as a very warm (as warm as you can stand, but certainly cool enough not to be a burn risk) is to gargle plain table salt dissolved in that warm water. The relief does not last very long, but you can repeat is as often as you wish. With the common cold, sore throat is most often caused by post nasal drip of mucus from the airway, but some is also due to the virus attacking throat cells. However, sore throat caused by a cold alone NEVER involves blisters. If you have blisters, there is a good chance that you also have a bacterial infection, and some of these can be serious (or even life threatening). If you have blisters in your sore throat, get to a medical professional fast.
I already mentioned the menthol drops, and they work OK for a while. There are lozenges that contain local anesthetics like benzocaine (or at least there used to be, I have not checked on availability for a while) that also work, but I am not a fan of ingesting these agents. My favorite sore throat remedy is Chloroseptic, or store brand equivalents, that use phenol as the local anesthetic. At a concentration of 1.4%, the phenol is not strong enough to be caustic or toxic, and it is an extremely effective agent. While I rarely get a sore throat, when I do I rely on the warm salt water and the phenol numbing agent. The kind that I like is a liquid that can be sprayed right onto the affected area, and the relief is almost immediate.
I mentioned that I push fluids when I have a cold. No study has shown that this has any effect on shorting the duration or reducing the severity of a cold, but there is some logic in it. As I said earlier, most folks with a cold go sort of off their food, and much of the water that we normally consume is actually in food rather than drink. Thus, drinking extra water or juice (I prefer vegetable juice) helps to offset the lack of intake of water that you get from food. It is also important to eat a nutritious diet, even if reduced in quantity.
As for OTC cold remedies, I am extremely dubious about most of them. Most of them are combination products, meaning that you get several drugs at once, whether or not you need them. Almost all of them contain the following ingredients:
A pain reliever/fever reducer, usually acetaminophen
A cough remedy, usually dextromethophan
An antihistamine, often chlorphenerimine, and
A nasal decongestant, usually phenylephrine
I have already told you that I think that acetaminophen and dextromethophan are either dangerous, ineffective, or both. Chlorphenererimine is a good drug, but can be quite sedating in some individuals. Besides, many people do not derive any benefit from it for a cold. Phenylephrine is just about useless as a decongestant, scoring barely above placebo in most studies. READ THE INGREDIENT STATEMENT! Run away from anything with acetaminophen and/or dextromethorphan! Do not pay for phenylephrine, because it does little if any good. Here is a much better strategy, in my opinion.
Buy separate drugs. Most of the effective ones are quite cheap, and making your own cocktail is usually cheaper and more effective than the combinations available OTC. Here is what I use when I have a really, really bad cold.
Generic aspirin or ibuprofen for fever and aches and pains. Sometimes I use generic Alka-Seltzer for this because it is FAST acting. If you simply can not tolerate these, or naproxin, then I very reluctantly recommend acetaminophen. If you can handle the fever, just avoid the acetaminophen.
If you have a cough, get a cough syrup without dextromethorphan but with codeine or hydrocodone as the active ingredient. One bottle, if used correctly, should still have some material left even after the expiration date.
If you feel better if you take an antihistamine, buy generic chlorpheneramine of dyphenhydramine (Benedryl).
If you have bad nasal congestion, buy some generic pseudoephedrine, which actually works. In most states you will have to go to the pharmacy counter and sign for it, but you would already be there to get the effective cough remedy. Alternately, you can buy one of those squeeze bottles of a local decongestant. Be careful with any of them if you have high blood pressure, please! Here is the beauty in this:
You only take the drugs that you need. Let me repeat, you only take the drugs that you need. With the combination products, you take everything. Even you are not coughing, you are taking a (ineffective, in most cases) cough remedy. At least in my personal experience, I need fever reducers much more often than I need cough remedies, antihistamines, or decongestants. By using this approach, not only do you save money, you also avoid unneeded drugs for your unique set of symptoms.
Well, that is about it for now. I know that this reads more like Pique the Geek than Popular Culture, but if one looks at the adverts on TeeVee, one sees that there are a plethora of cold remedies, and about the only disclaimer is the “Use only as directed” one, and those are on each of the individual products that you can buy on the cheap. Besides, Sunday’s Pique the Geek will be devoted to the report about matter traveling faster than light released by CERN yesterday. I have a hypothesis (which I already posted earlier today and to which I shall link Sunday) that sort of makes the messy stuff go away, but I want to get more information about the announcement before I say anything else.
By the way, next week we shall return to music. Specifically, we shall start the first of a two part series about the wonderful album by The Who, Odds and Sods.
Doc, aka Dr. David W. Smith