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  #1  
Old 01-06-2009, 08:00 AM
Phlosphr Phlosphr is offline
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Post viral cough -- why more pronounced when lying down?

I had a nasty cold last week, sinuses running like a river, sore throat and a general sense of malaise - I decided to ask the doc for a Z-pack [antibiotic] and I got one, the cold is basically over, but there is a lingering dry cough. Not productive at all...The problem is I seem to be fine when I am sitting upright, but the minute I lay down I cough like a banshee. I could not get to sleep last night either - it wasn't fun.

Anyone experience the same things? Why do we seem to cough more when we are laying horizontally? Do our lungs somehow constrict and therefore spur a cough?
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  #2  
Old 01-06-2009, 09:15 AM
NinetyWt NinetyWt is offline
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I've always been told that one coughs more when lying down because of aspiration of sinus drainage. When you're sitting up, sinus drainage is more likely to run down the back of your throat and be swallowed. When you're lying down, you stand a chance of breathing it; thus making you cough.
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Old 01-06-2009, 09:25 AM
Phlosphr Phlosphr is offline
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Originally Posted by NinetyWt View Post
I've always been told that one coughs more when lying down because of aspiration of sinus drainage. When you're sitting up, sinus drainage is more likely to run down the back of your throat and be swallowed. When you're lying down, you stand a chance of breathing it; thus making you cough.
Thanks - Yuck! I'll probably prop my head up tonight, last night's coughing episodes were unbearable!
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Old 01-06-2009, 10:33 AM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Post VIRAL cough

Quote:
Originally Posted by Phlosphr View Post
I had a nasty cold last week, sinuses running like a river, sore throat and a general sense of malaise - I decided to ask the doc for a Z-pack [antibiotic] and I got one, the cold is basically over


Can you say "Antibiotic resistance"?

I hold the doctor who gave you the Z-pak ultimately responsible.
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  #5  
Old 01-06-2009, 10:38 AM
Phlosphr Phlosphr is offline
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Originally Posted by Qadgop the Mercotan View Post


Can you say "Antibiotic resistance"?

I hold the doctor who gave you the Z-pak ultimately responsible.
I haven't had a z-pack in a long while...she mentioned that she gave it to me because I am an asthmatic.... Can one develope anti-biotic resistance without having antibiotics on a regular basis? I take benedryl quite a bit but thats an antihistamine...
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Old 01-06-2009, 10:48 AM
robby robby is offline
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Originally Posted by Qadgop the Mercotan View Post


Can you say "Antibiotic resistance"?

I hold the doctor who gave you the Z-pak ultimately responsible.
My thoughts as well.

I am proud of the fact that I have never once asked a doctor for antibiotics. I trust that the doctor will prescribe them if they feel they are necessary, and only then.

Phlosphr, colds are caused by viruses. The Z-pak did nothing for your cold. All that you and your doctor did was to make the Z-pak slightly less effective for people with actual bacterial infections. Note that antibiotic resistance doesn't just affect you--it affects all of us.
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Old 01-06-2009, 10:52 AM
Phlosphr Phlosphr is offline
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Originally Posted by robby View Post
My thoughts as well.

I am proud of the fact that I have never once asked a doctor for antibiotics. I trust that the doctor will prescribe them if they feel they are necessary, and only then.

Phlosphr, colds are caused by viruses. The Z-pak did nothing for your cold. All that you and your doctor did was to make the Z-pak slightly less effective for people with actual bacterial infections. Note that antibiotic resistance doesn't just affect you--it affects all of us.
AH HA! I see. I did not fully understand antibiotic resistance, I'm readnig an article on it now. I wonder why she agreed to put me on one, if I didn;t need one. There is a lot I don't understand about AB resistance...
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Old 01-06-2009, 11:01 AM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Originally Posted by Phlosphr View Post
she mentioned that she gave it to me because I am an asthmatic
Still not a good reason to give antibiotics, absent an active bacterial infection or a very high risk of acquiring a significant bacterial infection. Which is generally not present in uncomplicated asthma.

I'm trying to beat this "let's give antibiotics" reflex out of my staff, with mixed results so far.
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Old 01-06-2009, 11:05 AM
Phlosphr Phlosphr is offline
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Originally Posted by Qadgop the Mercotan View Post
Still not a good reason to give antibiotics, absent an active bacterial infection or a very high risk of acquiring a significant bacterial infection. Which is generally not present in uncomplicated asthma.

I'm trying to beat this "let's give antibiotics" reflex out of my staff, with mixed results so far.
I'll resist the urge to call her and bitch about antibiotic resistance. Thank you for your insights though, I appreciate it. Hopefully this cough will subside soon. non-productive coughs are no fun!
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  #10  
Old 01-06-2009, 12:29 PM
NinetyWt NinetyWt is offline
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Originally Posted by Phlosphr View Post
Thanks - Yuck! I'll probably prop my head up tonight, last night's coughing episodes were unbearable!
I've had moderate success with sleeping in a comfortable recliner.
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  #11  
Old 01-06-2009, 01:26 PM
Chief Pedant Chief Pedant is offline
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Originally Posted by Phlosphr View Post
I had a nasty cold last week, sinuses running like a river, sore throat and a general sense of malaise - I decided to ask the doc for a Z-pack [antibiotic] and I got one, the cold is basically over, but there is a lingering dry cough. Not productive at all...The problem is I seem to be fine when I am sitting upright, but the minute I lay down I cough like a banshee. I could not get to sleep last night either - it wasn't fun.

Anyone experience the same things? Why do we seem to cough more when we are laying horizontally? Do our lungs somehow constrict and therefore spur a cough?
Coughing when you are recumbent can be caused from acid reflux. This is not a diagnosis for you, of course; just an observation offered--and worth what you paid for it just now.

If just one area of lung is inflamed, it's also possible that lying down drains that one area, while standing up does not drain it, since in general the airways drain toward a central point from almost all directions.
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Old 01-06-2009, 02:45 PM
Max Torque Max Torque is offline
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Originally Posted by Qadgop the Mercotan View Post
Still not a good reason to give antibiotics, absent an active bacterial infection or a very high risk of acquiring a significant bacterial infection. Which is generally not present in uncomplicated asthma.

I'm trying to beat this "let's give antibiotics" reflex out of my staff, with mixed results so far.
Giving his doc the benefit of the doubt, maybe he noticed a sinus infection along with the viral cold (happens to me quite a bit) and prescribed the Z-pak for that. Not unheard of, right?
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Old 01-06-2009, 03:00 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Originally Posted by Max Torque View Post
Giving his doc the benefit of the doubt, maybe he noticed a sinus infection along with the viral cold (happens to me quite a bit) and prescribed the Z-pak for that. Not unheard of, right?
Considering most sinus infections are not bacterial in nature anyway, that doesn't fly far with me either. Also, most of what doctors diagnose as sinus infections aren't sinus infections either. Rather they're nasal or sinus congestion, coupled with excessive thickened mucus.

The medical profession has been far, far too willing to give antibiotics at the drop of a hat, even (and sometimes especially) for conditions where there's excellent evidence that it does no good and that it does some harm to do so.

Now, to the actual OP: Change in position has long been associated with cough, both going from sitting to lying down, and vice-versa. I hypothesize that gravity tugging on the cilia of the lung in a new direction is involved somehow. (Note that I do not state this as Fact, only Hypothesis.)
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  #14  
Old 01-06-2009, 03:02 PM
Freudian Slit Freudian Slit is online now
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Originally Posted by Qadgop the Mercotan View Post
The medical profession has been far, far too willing to give antibiotics at the drop of a hat, even (and sometimes especially) for conditions where there's excellent evidence that it does no good and that it does some harm to do so.
Why do they do it, then? If it does no good at all--is it just because people insist on it? My dad, also a doctor, would complain about the overuse of antibios sometimes. When I would bitch about having a cold and wanting to do something about it, he'd say nothing like that would do any good--just rest/fluids, etc.
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  #15  
Old 01-06-2009, 07:07 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Originally Posted by Freudian Slit View Post
Why do they do it, then? If it does no good at all--is it just because people insist on it? My dad, also a doctor, would complain about the overuse of antibios sometimes. When I would bitch about having a cold and wanting to do something about it, he'd say nothing like that would do any good--just rest/fluids, etc.
You're dad is right.

As for why, there are many reasons.

But the most common ones are; because the patient insists, and implies they'll go elsewhere if you don't give them what they want; to get the patient out of your office; to make your patient feel like they got their co-payment's worth; to please the patient so he gives you positive feedback; docs are stuck in outmoded, disproven practice patterns; it's easy.
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Old 01-06-2009, 07:34 PM
Chief Pedant Chief Pedant is offline
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Originally Posted by Freudian Slit View Post
Why do they do it, then? If it does no good at all--is it just because people insist on it? My dad, also a doctor, would complain about the overuse of antibios sometimes. When I would bitch about having a cold and wanting to do something about it, he'd say nothing like that would do any good--just rest/fluids, etc.
There's an old saw every intern learns in our profession: "Don't just do something. Stand there."

It's a great medical proverb but very difficult to implement in practice, for all the reasons Q t M mentions. In my experience, the two commonest are:

1. Patients are more satisfied with antibiotics. In their mind, it elevates their status to one requiring antibiotics. "You just had a virus; mine needed antibiotics." It makes them feel like they did not waste the visit. It makes them feel their money was better spent. No one likes to be told they might just as well have stayed home.

2. It is faster to prescribe antibiotics than it is to teach the patient medicine.

There are two things that perpetuate this overprescribing above all others, in my opinion:

1. The natural history of viral illness lends itself to the patient giving the antibiotic credit for curing him. You get a little sick. You get worse. You feel really terrible. You FINALLY go to the doctor. You get an antibiotic. Your viral illness, which would have resolved over the time course anyway, gets better. Post hoc ergo propter hoc. Next time you are convinced only an antibiotic will knock it out.

2. If you don't give the patient an antibiotic, he'll go to the next doctor over, who will. This comes back to bite us in the ED all the time. It is very irritating to have someone with whom I took a great deal of time talking out of antibiotics casually mention to me at a later date (with gentle patronization) that their regular doctor gave them some antibiotics which "finally knocked it out."

We have another saying: "No good deed goes unpunished." Including trying to fight the larger battle of antibiotic overuse at the cost of irritating the patient at hand.

The overprescribing battle is being won bit by bit, though, I think. I could be wrong. Years ago I tried talking Moms out of antibiotics for bacterial otitis media (they don't do much good even though it's often bacterial). Pretty much a lost cause then. Now you'll see the occasional article in the Mom's magazines supporting that view, so it's nice to have the occasional parent say, "Hey doc, are you sure antibiotics are a good idea here?" Love that.
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Old 01-06-2009, 07:39 PM
Freudian Slit Freudian Slit is online now
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I've never understood why people go to the doctor for colds, though--okay, for things like strep, yeah, but for viruses? And do people really not realize that anti bios aren't finally going to knock out a virus?
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Old 01-07-2009, 09:05 AM
DogMom DogMom is offline
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Originally Posted by Freudian Slit View Post
I've never understood why people go to the doctor for colds, though--okay, for things like strep, yeah, but for viruses? And do people really not realize that anti bios aren't finally going to knock out a virus?
Because Doctors are magic, that's why. The patients feel like crap, so they go to Doctor, who listens to their chest with his Magic Stethoscope, takes their blood pressure with his Magic Sphygmomanometer, and looks in their ears with his Magic....um....EarOScope.
All of these things combined are supposed to make them feel Much Better Now. When that doesn't happen, because of course even the hospitals have to cut back and evidently don't hand out as much Pixie FixIt Dust to the docs as they used to, then people want Magic Pills (since the Magic Doctor Tools didn't work).
And those Magic Pills are Antibiotics (insert sparkly text and angel choruses).

And yes, they really do not realize that antibiotics don't do crap to get rid of a viral infection, and many times don't significantly impact the length of a bacterial infection, either. I don't bother going to the doctor for any kind of infection unless it's obviously not going to get better on its own, or is accompanied by massive pain (such as an ear infection that just keeps getting worse, and increases my vertigo problems to the point of "Shouting Groceries", for example.)

I've had that conversation with people several times, and each time they just moo at me and say something stupid like "well, it might help, so I told him I needed them and if he didn't prescribe them for me I was gonna go somewhere else until I got what I want. Moo."
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Old 01-07-2009, 01:37 PM
lorene lorene is offline
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This is going to seem like a weird fact to insert here, but even in the children's book The Berenstain Bears go to the Doctor, Papa Bear is denying that he's sick but he ends up having a nasty cold...for which the Dr gives him "goopy, pink medicine". After reading the book, I end up reminding my kids that cold don't require or benefit from medicine. Like they care. But I think it's pretty careless to have a misrepresentation like that in a kids' book.
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Old 01-07-2009, 03:05 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Objectively speaking, enemas do just as much for a viral infection as antibiotics. I'll start ordering those for my patients who insist on getting 'something' for their colds instead.
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  #21  
Old 01-07-2009, 03:09 PM
Phlosphr Phlosphr is offline
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Originally Posted by Qadgop the Mercotan View Post
Objectively speaking, enemas do just as much for a viral infection as antibiotics. I'll start ordering those for my patients who insist on getting 'something' for their colds instead.
Good God I'm glad your not my Doc today.

p.s. Mrs. P and I discussed my decision to seek the anti-biotics last night over dinner. She read this thread and said very candidly - should have straightdoped it first huh honey...

I feel alot better, but that is probably the simple natural progression of the virus. I did sleep last night though!
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Old 01-07-2009, 03:24 PM
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Originally Posted by Freudian Slit View Post
Why do they do it, then?...
Look again at the OP. He requested the meds. Not to criticize an individual Doper, but out here in the non-clinical world, the language of health conversations often include what medicines people are going to ask their docs for. As to why? How many ads by pharmaceutical companies have you seen in the last, say, three days, that said, "Ask your doctor if ___ is right for you." Enough of these ads and people get the idea that it's a patient's obligation to suggest medications for conditions that they may not have even had diagnosed!
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Old 01-07-2009, 03:34 PM
WhyNot WhyNot is offline
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Because Doctors are magic, that's why. The patients feel like crap, so they go to Doctor, who listens to their chest with his Magic Stethoscope, takes their blood pressure with his Magic Sphygmomanometer, and looks in their ears with his Magic....um....EarOScope.
All of these things combined are supposed to make them feel Much Better Now. When that doesn't happen, because of course even the hospitals have to cut back and evidently don't hand out as much Pixie FixIt Dust to the docs as they used to, then people want Magic Pills (since the Magic Doctor Tools didn't work).
And those Magic Pills are Antibiotics (insert sparkly text and angel choruses).
I know you meant this in jest, but there's a pretty strong argument to be made that our doctors (at least at the general practitioner level) are not all that different from the Medicine Men *ahem* and Shamans of other cultures. We even have our Magical White Labcoats and Magical Titles and Rituals (undressing, donning the Magical Blue Paper Supplicant's Robe), Cleansing Rites we go through to be Healed and Initiation and Hazing Rituals for new doctors.

(Yeah, my husband writes about this sort of thing for a living. It's contagious.)

Last edited by WhyNot; 01-07-2009 at 03:35 PM..
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Old 01-07-2009, 03:43 PM
Freudian Slit Freudian Slit is online now
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This is going to seem like a weird fact to insert here, but even in the children's book The Berenstain Bears go to the Doctor, Papa Bear is denying that he's sick but he ends up having a nasty cold...for which the Dr gives him "goopy, pink medicine". After reading the book, I end up reminding my kids that cold don't require or benefit from medicine. Like they care. But I think it's pretty careless to have a misrepresentation like that in a kids' book.
This also reminds me of "Peter Pan," there's that scene where Mr. Darling is telling Michael he needs to take his medicine. And then Mr. Darling wusses out and doesn't take his. Some kind of tonic, I guess--but none of them were sick. And then in Never Never Land, Wendy is playing at being mother and part of being mother is making her little babies take medicine every night, like it or not. Medicine=good?
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Old 01-07-2009, 03:44 PM
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Along these lines, Terra Ziporyn has written a book called Nameless Diseases, in which she points out how comforting it is to know "what we have." A person who presents a series of unnatural conditions, i.e. they feel or look different from normal, is greatly comforted by having a medical doctor pronounce a name for the condition. And conversely, that person may be very upset by a doctor who cannot name their situation. I'm happy to invest an MD with the trust that s/he has the knowledge to diagnose and treat me, even knowing that some of that trust and confidence is illusory.
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Old 01-07-2009, 05:15 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Originally Posted by Phlosphr View Post
Good God I'm glad your not my Doc today.
OK, Neti pots then. They've been shown to effectively relieve symptoms.

When used in the nose, anyway.

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Old 01-08-2009, 03:44 AM
dtilque dtilque is offline
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Originally Posted by Qadgop the Mercotan View Post
OK, Neti pots then. They've been shown to effectively relieve symptoms.

When used in the nose, anyway.

Had to google to find out what those were: Nasal irrigation

I do wonder how nasal irrigation differs from waterboarding...


As to the OP, when I have a cold, I try to lay down so that my nose and mouth are lower than my throat. That way the stuff coming out of the sinuses ends up going out the nose rather than down the throat.
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Old 01-08-2009, 07:29 AM
Qadgop the Mercotan Qadgop the Mercotan is offline
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I do wonder how nasal irrigation differs from waterboarding...
You'll take my Neti pot from me when you pry it from my cold, dead hands: http://boards.straightdope.com/sdmb/...d.php?t=496152
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Old 01-08-2009, 08:57 AM
rainy rainy is offline
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I do wonder how nasal irrigation differs from waterboarding...


If you had asked me when I was eight years old, I would have said one is a horrific torture method, the other, water boarding. Gawd how I hated it when Mom made me "sniff warm salty water."

But yeah, as you are gasping for air / choking on phlem, it does seem to relocate a lot of mucus.
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  #30  
Old 12-25-2012, 11:01 AM
alfabettezoupe alfabettezoupe is offline
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just my two cents, i go to the doctor when i have a cold... for antivirals. i do this because i have a huge amounts of problems with my respiratory system and a cold that's untreated in me usually goes to bronchitis and/or pneumonia.

not everyone who goes to a doctor for a cold is a total idiot.
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Old 12-25-2012, 11:22 AM
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Originally Posted by Qadgop the Mercotan View Post
Objectively speaking, enemas do just as much for a viral infection as antibiotics. I'll start ordering those for my patients who insist on getting 'something' for their colds instead.
But decongestants and Tylenol may make a person feel better, not just because of having something to take, but because it may relieve some of the symptoms. Hell, I wouldn't mind having a cold if I didn't feel like shit. I don't think - and I don't want to experiment - that enemas would make me feel any better, so I wouldn't take that. If something could relieve my symptoms, however, I'd be up for that. Maybe docs can start moving people in that direction.
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  #32  
Old 12-25-2012, 12:18 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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Originally Posted by alfabettezoupe View Post
just my two cents, i go to the doctor when i have a cold... for antivirals. i do this because i have a huge amounts of problems with my respiratory system and a cold that's untreated in me usually goes to bronchitis and/or pneumonia.

not everyone who goes to a doctor for a cold is a total idiot.
People with chronic lung disease and/or immunosupression (like CF, severe emphysema, AIDS, and other diseases) may need early intervention for viral infections, of course.

What antivirals are you getting? I'm unaware of any that are actually helpful for the common cold viruses.
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  #33  
Old 12-25-2012, 01:07 PM
alfabettezoupe alfabettezoupe is offline
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i get mavirex aka coldmaris.

i don't have any immunosuppression (i rarely actually get colds, never had the flu, never had any form of herpes including cold sores or chicken pox. i'm somehow still cmv negative at almost 40.) and i don't have chronic lung disease. i just have a susceptibility for colds to go straight from my head into my chest and stay there. every single time they do, i end up with pneumonia or bronchitis and get a trip to the doctor for ventolin and cipro (i'm allergic to all forms of penicillins and sulfa drugs, as well as erythromycin).
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  #34  
Old 12-25-2012, 01:35 PM
Qadgop the Mercotan Qadgop the Mercotan is offline
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i get mavirex aka coldmaris.
Having reviewed the literature on that drug, I think I'll wait for more evidence to accumulate before I decide as to whether it's both safe and effective as an antiviral agent.

Hope it works well for you.
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  #35  
Old 12-25-2012, 01:41 PM
Skypist Skypist is online now
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I tend to have a lingering cough after every cold. It can last for a month or more. Just a dry, non-productive, persistent tickle in my throat that WILL. NOT. GO. AWAY. Hate.

Sometimes I go to the doc with a cold because my cough is so bad that I'm hoping s/he can give me something for relief. Also, my nose gets extremely congested during the worst of the cold and I'm always hoping there'll be some magic new and effective decongestant available (there never is).
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  #36  
Old 12-25-2012, 06:05 PM
alfabettezoupe alfabettezoupe is offline
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Originally Posted by Qadgop the Mercotan View Post
Having reviewed the literature on that drug, I think I'll wait for more evidence to accumulate before I decide as to whether it's both safe and effective as an antiviral agent.

Hope it works well for you.
works great for me. knocks my colds out in days and they don't travel to my lungs.
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  #37  
Old 12-25-2012, 09:49 PM
Senegoid Senegoid is offline
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People go to doctors, even for viral colds and sniffles, because they feel crappy and want some relief. Demanding antibiotics is one response to the problem that doctors commonly don't have much else to offer, or don't seem interested in offering much else.

Dammit, maybe all we really want is some serious symptomatic relief here!

My sad story: When I get a cold, it often "gets down into my lungs" and becomes a lingering cough that lasts for weeks.

Okay, so far, so bad. My problem is, that on more than one occasion, these "lingering cough" have become so severe that I seriously needed some massive symptomatic relief, and doctors have never seemed to take that very seriously. Even more to the point: On at least two occasions, I believed that the cough and bronchial congestion were severe enough to be life threatening. One episode, in particular, led to repeated instances where I literally could not breathe for brief periods of time (like 30 seconds or so) because the tubes were completely blocked and I was unable to cough the crud out. (Each time I did manage to cough the crud out after a while, but not before having a beet-red-face, sweat-streaming, bug-eyed experience.)

Dammit, when I have a cold, I want at least for the doc to offer some industrial-strength anti-congestant or something before I actually need it so that won't happen again. Instead, all I can get from most docs is the proverbial advice "take two aspirin, and if you're still alive in the morning, you don't need to call again."

Fuck doctors on HMO plans.
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