It is never a good time to get sick but unfortunately the cold and flu season is once again squarely upon us. The common cold lasts an average of seven to ten days and usually starts with a sore throat and possibly low grade fever, then progresses to nasal and sinus congestion. Finally, a cough, sometimes productive of mucus, is usually the last symptom to develop and the last to resolve. There is not yet a cure for the common cold and antibiotics not only won’t help but increase the risk of allergic reactions, side effects, and development of resistant bacteria. Plenty of rest and fluids is a mainstay of treatment but there are also many medicines available over-the-counter that can help make things a little more manageable – the key is picking the right medicines for the symptoms you are having.

Over-the-counter cold preparations are confusing with endless combinations of medicines and claims to alleviate certain symptoms. The best approach to selecting the most helpful one is to understand what active ingredients are in each pill and what they are expected to treat. This can help you tailor what you are taking to your current symptoms and limit side effects.

Dextromethorphan, also termed as “DM”, is a cough suppressant that acts directly on the cough center in the brain. It comes as a liquid cough medicine or as a pill. In some studies two teaspoons of honey were shown to be just as effective for reducing nighttime coughing.

Guaifenesin works by thinning mucus or phlegm. This can be helpful if you are having a lot of post-nasal drip (mucus down the back of your throat, clearing your throat a lot), or are coughing up mucus. It should be taken with plenty of water.

Oxymetolazone is a nasal spray also sold under the brand name Afrin. It can give you quick relief from nasal congestion but it cannot be used for more than 72 hours or 3 days in a row. If used longer than that it can actually cause worsening congestion. I like to use Afrin for those nights when you simply cannot breathe out of your nose and the misery of that keeps you from sleeping. It also can be helpful if you are congested before plane trips to help your ears equilibrate to pressure changes.

Pseudoephedrine is a very effective decongestant that is sold behind the pharmacist’s counter though you do not need a prescription for it. You will need to show identification to purchase it and are limited to the quantity you can buy at one time. It is the “D” component in Mucinex –D, Allegra – D, etc. Decongestants relieve nasal stuffiness by narrowing blood vessels and reducing swelling in the nose. This narrowing can affect other blood vessels as well, which can increase blood pressure. This medicine is not a good choice for people with heart disease or poorly controlled high blood pressure. Some people cannot take pseudoephedrine because it makes them feel jittery, spacey, or gives them palpitations. It comes in a 4-6 hour preparation or a 12-hour preparation. Until you know how it affects you I recommend the shorter lasting form.

Pharmacies tend to be sold out of it often during the height of cold season so I like to make sure I always keep some on hand.

Phenylephrine is the decongestant that is sold in the pharmacy shelves and can be a good choice for people who do not like the way pseudoephedrine makes them feel. Some feel it is a less effective decongestant.

Drowsy antihistamines include Benadryl (diphenhydramine) and doxylamine which is found in NyQuil, Alka-Seltzer Night, and other night time preparations.

Many combination pills will also include acetaminophen as a pain reliever and fever reducer. Be mindful of how much you are taking. It is best not to take additional acetaminophen, or Tylenol, with these as too much can be toxic to your liver.

If you have any questions or concerns about the use of over-the-counter medications please do not hesitate to contact us. If your symptoms are lasting longer than usual, you have a persistent high fever, shortness of breath, or just don’t feel right it may be more than the common cold. Please come in and see us in the office.

As we embark on Breast Cancer Awareness month, it is worthwhile to review the statistics, risk factors, and preventive strategies of this globally devastating disease. Breast cancer is the most frequently diagnosed malignancy worldwide. It is the most common female cancer in the U.S., and it is the second leading cause of cancer death in women in the U.S., with over 40,000 deaths annually.

Non-modifiable factors that are associated with an increased risk of breast cancer are female gender, white race, increasing age, postmenopausal status, and prolonged exposure to estrogen, such as early onset of periods or late menopause. Family history of breast or certain other cancers may also increase your risk–this should be discussed with your doctor. Other factors that may increase the risk of breast cancer include obesity in postmenopausal (but not premenopausal) women, and hormone replacement therapy. Lifestyle factors have also been implicated in the diagnosis of breast cancer. For example, there is a significant dose-dependent relationship between alcohol intake and breast cancer, even with as little as three drinks a week. Smoking also appears to increase the risk of breast cancer.

There are also some protective factors that appear to decrease breast cancer risk. Breastfeeding is one example. Physical activity appears to be another protective factor–yet another good reason to get out and exercise! Finally, there is some evidence that soy products, and other phytoestrogens like legumes, flaxseeds, and sesame seeds may be protective.

So aside from awareness of negative/positive risk factors, how can we reduce our risk of developing breast cancer? Cancers are most easily treated if they are detected early; therefore, the first line of attack against breast cancer begins at home, by developing “breast self-awareness”. Each woman should be familiar with her breast/axillary (armpit) exam–including skin and texture changes, as well as lumps. Any change from your baseline should be brought to the attention of your doctor immediately. Clinical breast exams, performed by your doctor during your annual gynecological appointment, are another important factor in screening for breast cancer. And mammograms are advised by most professional organizations starting at age 40; the specific interval for these can again be discussed with your doctor, depending on your age. Finally, women with family history may be advised to consider testing for one of the known breast cancer genes. Breast cancer takes a terrible toll on the women and families whom it has affected; awareness of risks and preventive tools is the best defense we have in containing, and hopefully one day, curing, this disease.

One of most frequent reasons that women come to see their primary care physician is to discuss abdominal pain and bloating. I don’t think a day in the office goes by that I do not hear those words. Most frequently these patients have what is known as Irritable Bowel Syndrome (IBS). Not surprisingly, it is the most commonly diagnosed gastrointestinal condition, affecting 10-15% of the population.

The true definition of IBS is: a gastrointestinal syndrome of chronic abdominal pain and altered bowel habits (without other organic cause) at least 3 days per month in the last 3 months. Commonly, the abdominal pain is intermittent and described as “crampy”. Exacerbations can occur frequently and are associated with eating and times of increased stress. The abdominal pain associated with IBS can vary in intensity and location, but is often relieved with bowel movements. Other common symptoms include: bloating, gas, nausea, diarrhea and/or constipation, and feeling full quickly. “Red flag” symptoms such as anorexia, weight loss, persistent rectal bleeding, pain awakening a patient from sleep or certain lab findings (i.e. anemia) are rarely associated with IBS and should prompt a further workup for an alternative diagnosis.

Unfortunately there are no tests specific to the diagnosis of IBS. Frequently, a physician will run blood or stool tests and maybe order additional procedures such as a colonoscopy to rule out other potential causes of symptoms. If no other source is found and no “red flag” symptoms are present, a diagnosis of Irritable Bowel Syndrome is made.

There are 4 different subtypes of IBS:

1. Diarrhea predominant
2. Constipation predominant
3. Mixed type
4. Unsubtyped

Treatment options vary between the different types.

As any patient who suffers from IBS knows, making the diagnosis is only half of the battle. Treatment for this ailment takes time, patience and diligence to improve symptoms. IBS is a chronic disease, which means most patients will likely have it for life. That being said, the majority of patients will be able to control their symptoms with one or more of the treatment modalities available.

Upon diagnosis, a patient should take time to keep a log of symptoms and what the circumstances were at that time (what she ate, what she did, etc). This will help to elucidate any specific pattern or specific food that may be contributing to a patient’s pain. It has long been thought that certain foods in certain individuals can be a source of IBS symptoms. If a patient has been diagnosed with Irritable Bowel Syndrome, her first step should be to eliminate foods known for high gas production such as: beans, onions, celery, carrots, raisins, bananas, apricots, prunes, Brussels sprouts, pretzels, bagels, alcohol and caffeine. In many patients, reduction in these foods can bring around a significant improvement in abdominal pain and bloating.

If still with significant symptoms despite reduction of high gas forming foods, a patient may decide to follow a stricter approach with the low FODMAP (fermentable, oligo-, di-, and monosaccharides and polyols) diet. High FODMAP foods are poorly absorbed and are rapidly fermented in the gut causing gas and bloating. Such foods are listed below.

Oligosachharides: wheat, barley, rye, onion, leek, garlic, shallots, artichokes, beets, fennel, peas, pistachio, cashews, legumes, lentil and chick peas..

Disaccharides: lactose (milk, ice cream, yogurt)

Monosaccharides: apples, pears, mangoes, cherries, watermelon, asparagus, sugar snap peas, honey and high fructose corn syrup.

Polyols: nectarines, peaches, plums, mushrooms, cauliflower, artificially sweetened chewing gum and other sweets

Obviously this can be a very restrictive diet. If taking on a low FODMAP diet it is recommended that you do this under the guidance of a trained dietician in order to avoid over- restriction and malnutrition. Ideally a patient would be on a low FODMAP diet for 6-8 weeks at which time she would gradually re-introduce the above foods one at a time to determine which specific foods are tolerated and which are not.

Though it is thought that food allergy could possibly play a role in Irritable Bowel Syndrome, at this time there is insufficient evidence to recommend food allergy testing in patients with IBS. This is largely due to the fact that current modes of allergy testing have not been reliable in identifying affected patients.

In addition to dietary management, 20-60 minutes of moderate to vigorous exercise 5 days a week has been shown to significantly decrease symptoms of IBS. It is also important to address daily stressors through counseling and stress-reduction techniques (meditation, yoga, etc) as increased stress often leads to increased IBS symptoms.

If lifestyle interventions still fail to control symptoms, your doctor can prescribe medications specific to the patient’s symptoms. For example, anti-diarrheals in diarrhea predominant IBS, laxatives in constipation predominant IBS, antispasmodic agents, and antidepressants.

In summary, Irritable Bowel Syndrome is a very common disease affecting a large number of women. Symptoms generally consist of abdominal pain, bloating, and a change in bowel habits. In order to diagnose IBS, doctors must rule out other organic causes of gastrointestinal disease. Though it is not curable, most patients are able to control their symptoms with lifestyle changes or medications.