Chronic cough

Cough is common, and can linger, during the allergy season. But does cough equal allergy? Most commonly it doesn't.

A cough can be an annoying, embarrassing symptom, or an important clue leading to rapid diagnosis and effective treatment. It is one of the most common reasons to see a lung specialist, accounting for more than one third of new patient visits in our practice. There is an abundance of confusing medical literature available, most of it on the internet; a recent search found more than 300 articles related to chronic cough published so far this year, and that's only the tip of the iceberg.


Coughing itself is remarkably effective. Acute cough is our primary defense mechanisms to protect the airways and lungs from unwanted invaders, such as aspirated food or secretions laden with bacteria or acid from the stomach. Receptors line the major airways to trigger an acute cough, which can create flow rates approaching the speed of sound! This rapid air flow creates shearing forces that move secretions up and out, but unwanted effects, such as rib fractures, sprained chest muscles and even syncope (brief loss of consciousness) can result.

What makes a cough chronic? The accepted time scale is three weeks without an obvious precipitating cause. There are many clues to the cause of a cough which your physician can review with you. Generally a carefully taken health history and physical exam will identify many major concerns, such as asthma or allergy, exposure to inhaled toxins, or medicines known to cause cough. Smoking is of course an irritant; it inhibits normal mucus clearance mechanisms, and most long term smokers have a chronic cough, though some are not bothered by it. The timing, nature and history of the cough are important to review, along with associated respiratory symptoms and findings on physical exam, such as abnormal breath sounds. Chest x-ray and tests of lung function are helpful in the detection of unexpected or subtle abnormalities, such as airflow obstruction indicating asthma or COPD. “Post infectious” cough can follow respiratory infections, either minor or major, and can last for months. A state of airway hyper-responsiveness develops even though the infection itself has resolved. Frequently anti-inflammatory medicines, such as those used for asthma, are given to bring the airway back to normal. Acid reflux is another occult cause for chronic cough, as is allergic post-nasal drainage. Frequently these conditions produce minimal symptoms except for the cough. Surprisingly the majority of well established coughs have more than one cause as their basis. All must be treated, or resolution does not occur.

In most cases, rare or life threatening causes are easily ruled out and common causes, such as asthma, allergic drainage and acid reflux, are diagnosed and treated effectively. Resolution and patient satisfaction depend heavily on a systematic evaluation and adequate length of therapy, thus a good working relationship with your Physician is key.

Diagnosis and treatment of chronic cough is an important part of our office specialty. If chronic cough affects you, give us a call.

Get what's important from your doctor visit

Part of my article in EzineArticles.

The most important thing you should get out of your appointment with the doctor is an adequate explanation to the problem which prompted your visit.

Write down your questions in the order that you feel is the most important. Write down, or ask your doctor to write down, the answers to your questions, including instructions for the use of prescription and over the counter medications, medical devices, and lifestyle changes. If there isn't enough time to have all of your questions answered, then you will have had the most important ones addressed, and could save the rest for the next visit.


Carry with you, at all times, a legible, up-to-date list of all the medications you take. Include in it all prescribed and non-prescribed medications by all of your physicians. Also include in the list the dose, reason for use, frequency of use, and the date you started taking the medication. Examples might include:

1) Digoxin.25 mg. every evening, for control of heart rhythm, started 6/2009.
2) Buffered aspirin 650 mg. as needed for mild headache, started 2007, Dr. XYZ.

This list will be useful to you during your visit and in case of an emergency. Don't assume that your physician knows all the medications you are taking!

During your visit, try to be as specific about your symptoms as you can. Telling your doctor "I had a fever last night with shaking chills and a temperature of 101" is much more meaningful and leads to a faster diagnosis than saying "I have been feeling sick since last night." Telling the doctor "I have been taking amoxicillin 500 mg. every eight hours since I became sick" is much more meaningful than "I took those yellow horse pills you gave me two years ago for two days."

Remember: In order to derive benefit and satisfaction from your visit to the doctor, both you and your physician must work together. You are the principal source of information about the way you feel. The more detail your doctor has about your condition, the more will he be able to help you, and you will feel better having accomplished what you started out to do. It takes teamwork!

Be an active partner in your own health care. Let's do it together!

Do you have COPD?

If you develop shortness of breath faster than you should, you cough frequently, and are also a smoker, you may indeed have Chronic Obstructive Pulmonary (Lung) Disease, or COPD. The term COPD refers mainly to chronic bronchitis and pulmonary emphysema. More than 80% of COPD is caused by cigarette smoking, with the remainder caused by genetic factors (alpha 1-antitrypsin deficiency), industrial exposure (e.g., coal mining) and questionably air pollution.

COPD is a progressive disease, responsible for an enormous strain on the national healthcare budget, on the work place, and on one's personal well being. More than 12 million Americans are now known to have COPD, and many more have the "hidden" disease. COPD is the fifth leading cause of mortality in the US, and its economic burden is even higher.

The sooner COPD is diagnosed and treated, the better it is. Lives can be saved, jobs can be spared, and extra medical expenses avoided.

So, if you have shortness of breath, smoker or not, make sure COPD is not a factor. Don't delay, see your doctor, you won't regret it!

Think twice before indulging…

Are you planning to exercise away the extra calories of your next meal? Think again.

A typical McDonald double cheeseburger has approximately 440 calories. Add large French fries at 500 calories and you're at more than 900 calories (we won't count the soda because I know you chose the zero calorie one…).

If you weigh about 155 lbs (what used to be the typical adult male weight in the US), and you like to walk, you'll burn 76 calories for each mile.

So the meal you just had would cost you an 11.8 mile walk. No problem, it's still less than a half-marathon distance.

Incidentally, if you were to stop by the Cheese Factory for a cheese cake portion, that will only cost you an additional 9 miles.

Of course, you could do the un-American thing, and have a good portion of no-skin chicken and salad (you can even have a little oil and balsamic vinegar dressing) plus fruit, at less than 400 calories for the meal. Still hungry? Have an apple plus another fruit later.

Do the right thing, your body will thank you for it.

Control your calorie intake

What you see here is just a small sample of what's now available at our Health Extenders practice as part of our newly designed weight loss program. For more information, you may contact us by email. If you live in our area (Fairfield County, CT) and want to have a comprehensive evaluation of your weight loss needs, contact us by phone at (203) 853-1919.

This will help you lose weight and remain thinner

Many of you have been aware of our weight loss programs at our practice for years. At home, Sandy and I find it helpful to control our breakfast calorie intake by using HMR shakes. We prefer the HMR 70 vanilla mix. Try it if you wish. This is how we use it:

1 packet of HMR 70 vanilla mix
1 glass filled ½ with crushed ice & ½ with water
1 tsp Hershey’s powdered cocoa (sugar-free)
Place HMR packet in bottom of blender.
Then add ice, water and cocoa and blend.

Optional additions:
½ banana or,
½ cup berries
extracts (calorie free)

Add to partially-blended shake and blend again for an additional minute.

Enjoy!

Calories:
HMR 70 110 calories
Banana/berries 50 calories (approx)
Hersheys cocoa 5 calories

Total 165 calories (approx)

You may use 1 ½ to 2 packets of HMR, but remember to count your calories. You may experiment with other fruits and extracts to create a special shake for yourself.

Share your experience with us. Selected recipes will be published with full credits (and 6 free packets of the mix with your next order of HMR shakes).

Weight loss 2011 – How we handle it at our practice

So you decided to lose weight, but you're not sure you're doing it the right way?

Know that you are not alone. More than two thirds of adult Americans need to lose weight. Of these, more than half are severely overweight (BMI, body mass index, greater than 30; normal is 20-25), and are at significant medical risk. A major reason why Americans don't live as long as they should is obesity.

Here is some of what we do to help:

• Evaluate your need for weight loss
• Assess reasons why you're having difficulty in losing weight
• Make sure there is no medical abnormality responsible for your increased weight
• Measure (not guess) your metabolic rate, and calculate your daily calorie requirement
• Design a diet-exercise program that meets your specific requirements, taking into account any medical condition thou may have
• Assess your ability to do exercise and prescribe an exercise/physical activity program (and you don't have to be an athlete to do it…)
• Identify and reduce overeating triggers
• Provide calorie-specific meal replacements and snacks
• Prescribe medication to control appetite, where applicable

Don't try to lose weight too fast. One-to-two pounds a week is good.
Don't wait, just do it!