What symptoms and medicine are real?

Factual Questions
1

I’ll leave it open to other ailments with interesting answers but I’m thinking of the typical seasonally cold/flu type thing.

  1. Which symptoms are just annoyances and can be safely dealt with (suppressed) by medicines versus those which are a healthy bodily defense? For example, I can imagine various typical excessive mucus excretions as either a way to expel foreign bodies naturally, or else a pathogen’s method of hijacking the body into being more contagious. Which is it?

  2. Antibiotics don’t work against viruses, and over proscribing can lead to resistant strains. Is there any way for doctors to tell other than expensive complicated genetic blood testing if you have a bug or a virus? If not, what protocol is used to determine whether antibiotics are prudent?

2

It’s generally accepted that symptom suppression is fine for a basic cold, with a couple of caveats. First, it shouldn’t replace taking it easy, getting lots of rest and drinking lots of fluids. You may FEEL better, but you’re still sick and you’re still communicable. Stay home anyway, or your office mates will hate you when you get them sick.

Fever is hotly (ha!) debated. Some people treat any elevated temp with NSAIDS. Some people think that a mild to moderate fever is useful for denaturing the proteins in a cold virus, and may kill them sooner than your white blood cells can, or help the white blood cells to be more effective by weakening the viruses. So unless it’s making you miserable, most docs I know suggest not treating an elevated temperature that’s under 102, except in very small babies and the elderly or immunocompromised.

Neti pots are great, and oft’ recommended, for helping clear out the gunk in your nose/superficial sinuses and you can make a hypertonic solution when there’s a lot of mucus. The hypertonic solution (double the salt and bicarbonate) may also “dry up” the nasal passages temporarily. This does not lengthen the duration of a cold; mucus production at this stage of an illness is not useful. It’s an inflammatory reaction created by histamine and other chemicals in your body which are released whenever your body notices there’s an infection. If you recall, most viruses have a 2 week incubation period - it may have been useful to sneeze or blow your nose 2 weeks ago when the virus was just inside your nose, but by the time you have symptoms, it’s well inside your body.

OTC decongestants are fine for older children and adults, but they haven’t been researched much or found useful in infants. Poor babies are stuck with saline nose drops (the infant version of a neti pot) or the dreaded Nose Sucker (bulb syringe). I’ll be honest, though - most OTC decongestants are useless. All the stuff that works has been taken off the market for safety and/or abuse concerns.

My very favorite nasal congestion thing: Afrin nasal spray. LOVE the stuff. Unfortunately, it is highly, highly *physically *addictive. I’ve gotten hooked on it before, and it’s just hell. It can cause rebound congestion - not actually mucus production, but inflammation of the sinuses that makes nose breathing impossible. But when it works, it works REALLY WELL. I tend to save it for really important days, because one really should not use it for more than three days. So if it’s your kid’s graduation day and you’re snorky, go for it, but don’t plan on using it long. Again, mucus production is not helpful to the healing process.

Cough suppressants for older children and adults are okay, but many docs suggest you save them for nighttime, when you’re sleeping. Especially if there’s a “gunky” cough with sputum production, you really do want that stuff up and out. Bacteria just looooooove to breed in gunky lungs, and if that gunk stays down there, you may find yourself with a bacteria pneumonia on top of your cold. Unfortunately, just like decongestants, if it works, they take it off the market. A tablespoon of honey works better than OTC cough medicines, IME. (Honey should never be given to babies under the age of 2.)

If you feel like you’ve got gunky lungs with a cough that’s just not satisfyingly productive, Guaifenesin, brand name Mucinex, is pretty good stuff. It’s an expectorant, not a cough suppressant, so it won’t stop your cough, but it will help thin secretions and make your cough count. Again, getting the gunk out is a good thing; gunk does not help the healing process.
I eagerly await someone else’s answer for number 2, because it’s something I’ve wondered as well. I know that if there’s doubt, they can do a culture - literally swab your nose or sputum and send it to a lab to grow it into a petrie dish and then test the resulting colonies for characteristics (like we did back in Microbiology class). But I also know most doctors have decided long before they get the results back whether an infection is bacterial or viral, and I have no idea how. Someone once told me (and it *was *a doctor, but I’ve not been able to verify it elsewhere) that if you have a fever, it’s probably a virus, not a bacteria. He said this was why so many schools and hospitals have “if you have a fever, you’re not admitted” policies - that fever = virus and viruses are harder to treat than bacteria. If you spread your virus around, that’s a big problem for the hospital. There are only a few antiviral medications and they’re pretty hard on your body and have a lot of side effects. If you spread a bacteria around, they have more tools (more antibiotics) which may fight it.

3

Well, right. The Flu has more fever, more aches & pains, more fatigue. A mild fever sometimes occurs with a cold, but the rest are very rare with a cold, and common with the flu.

see this chart:

If you have Strep along with your cold, it’s pretty obvious to a MD, and that’s one thing that is often treated with antibiotics. You can often see Strep yourself in a mirror with a flashlite.

For those that don’t like the waterboarding feeling of a neti pot, I suggest a saline nasal spray. NOT Aftrin & it’s clones, like WhyNot said, they can be very addictive after too many uses. Sure, no problem for the 1st couple of nites of a cold or flu, however.

4

Oh and for many purposes, it’s almost impossible for a layperson to tell a cold from allergies, which is why I almost always suspect allergies and not a cold during allergy season, even tho the person will say “I have a cold”.

5

Do you get fever from allergies?

6

Rarely a slight fever. But you don;t get a fever from a cold, usually.

7

It’s not a physical illness, but I’ve heard it said that phobias are unusual in that they are usually all symptom; there’s no deeper issue (beyond the design flaw of the human brain that makes us prone to developing them in the first place). Eliminate the phobia, problem fixed.

8

Fever, increased mucus production, coughing, sneezing - all defensive mechanisms that either help kill the offending micro-organism or aid in physically removing it from the body. They are still annoying symptoms, but they serve a purpose. Aching muscles, sore throat, sinus pain - not so helpful, except perhaps indirectly by forcing you to rest. Relieving the symptoms of cold and flu doesn’t mean your body can’t still fight the virus, though.

As for the second question, assuming we’re still talking about cold/flu type illness, bacterial infections are usually secondary to the initial viral infection, and localised to a specific part of your respiratory tract - throat, bronchi, lungs, sinuses etc. Doctors generally diagnose them based on history (severity, duration, and type of symptoms) and clinical examination. If needed, diagnostic testing would just be a swab for bacterial culture.

9

Excellent post!

A side note on the guaifenesin: It’s the same thing that’s in plain Robitussin (and store brand) syrup, in a more portable / palatable form. I don’t know why it took so long to have it OTC in pill form (I used to get prescriptions for that medication, back before Mucinex was available).

While I understand the rationale behind not suppressing coughs unless they interfere with sleep, I thought I’d mention the nonproductive coughing that can sometimes develop as an illness progresses. Nothing getting brought up, nothing TO bring up, just godawful nonstop eyeball-popping coughing. That is misery-making and should be stopped. As you noted, nothing OTC does a damn thing for that!!

10

We are conflating signs and symptoms. A “sign” is something objectively observable from outside the patient, such as a fever or excess mucus. A “symptom” is something that can only be reported by the patient, such as aches.

11

Do you sincerely believe that the OP was making a distinction? Or is it more likely he was using the perfectly understandable layperson’s use of the term?

12

I wasn’t aware of the distinction. That’s interesting. Change “symptom” to “symptoms and/or signs” if you feel the need.

Please tell me more about the bacteria vs virus issue. I’ve been to doctors who throw antibiotics at anything, and ones who are very hesitant to prescribe them. But I’ve never been to a doctor who has actually seemed to make an actual decision based on diagnosing me. I’m always left with the impression it’s based more on a general policy than an actual diagnosis. Is that a fair assessment, or is there more to it? For example, is there a general correlation with fever? I thought a lack of fever was indicative of a bacterial infection, but the doctor still thought “it’s probably the virus that’s going around”. But he said I could come back for an antibiotic if I was still sick after another week.

13

I am not a (human) doctor, so I don’t have any first-hand diagnostic experience. That being said, I doubt that there is any difference in the ability of viruses and bacteria to cause fever.

Scarlet fever is a well-known example of a bacterial infection that leads to high fever.

Lipopolysaccharide (LPS), a common structural component of many gram-negative bacteria (such as E. coli oder pseudomonas), also causes high fever when it gets into the bloodstream.