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?
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.
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…
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…
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!
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.
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.)
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.
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.
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:
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.
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:
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.
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.
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.”
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.
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.
Rather they’re nasal or sinus congestion, coupled with excessive thickened mucus.