Month: November 2019

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Immune Support Supplements

I did not take these photos. I am not endorsing these particular products–but I do use 3/4 of them.

Elderberry

The most commonly studied are the supplements from the flowers and berries from the plant Sambucus nigra, commonly known as European elder.

I think I first heard about this supplement from my dentist. I bought some of the syrup to try for myself, thinking I was going to take it daily to prevent getting sick. Well I bought the syrup, instead of the gummies, and instead of mixing it in water, I take it to the head. It tastes like really concentrated prune juice—so daily dosing is a no for me.

I decided to take it at first sign of cold symptoms, when I could tell I was feeling run down, and I noticed, I didn’t really progress to the severe symptoms of day 3-4 if I was able to catch it early. I didn’t want to tell my patients about it yet—I mean, I try to only really speak on things as “Dr. Sims” that I can put some evidence behind. But this was AMAZING!

I did a few colds without it and—nope, it definitely worked—cuz those colds without it were awful.

And finally, I had had enough colds prevented that I felt comfortable giving the “Dr. Sims” subjective stamp of approval. But then, I looked it up. And turns out, there’s some evidence showing that my subjective findings, may not be subjective after all (YAY!!!).

This article from Cleveland Clinic highlights some studies that show that it may just boost our immunity.

This article showed that it shortened cold duration in air travelers, and this one further supports findings that it may have anti-flu activity (NOT a good reason to skip the vaccine though!).

Considerations: If buying elderberry syrup from your neighbor or friend who makes it, please be aware that consuming undercooked or under-ripe berries can result in cyanide toxicity if done in excess. This is also true for the other parts of the plant. Please consume supplements responsibly, and under the counsel of your physician.

Vitamin C and Zinc

Vitamin C and Zinc are well established for immune support. Important points to make:

  1. They are best used to shorten the course of a viral illness, and not in prevention. The best prevention is hand hygiene and a healthy lifestyle (fruits, veggies, whole grains in diet, exercise, good sleep). The evidence for zinc is stronger than that for Vitamin C.
  2. Zinc is best in lozenge form and slowly sucked. This allows it to have prolonged contact with the oropharynx, which is where the virus is multiplying.
  3. Zinc can cause nausea—you will want to have had something to eat prior to having your zinc supplement.
  4. The dosing and delivery of these is unclear. I generally dose a zinc lozenge at least twice daily and up to 3 times daily with meals, and double the supplemental dose of Vitamin C. You should discuss recommendations with your physician.

References for Vitamin C and Zinc:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273967/pdf/JFP-60-669.pdf

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418896/pdf/10.1177_2054270417694291.pdf

https://www.mayoclinic.org/diseases-conditions/common-cold/expert-answers/zinc-for-colds/faq-20057769

https://www.ncbi.nlm.nih.gov/m/pubmed/23440782/?i=5&from=/19432914/related

https://www.ncbi.nlm.nih.gov/m/pubmed/19432914/

Garlic

This article highlighting the benefits of garlic shows that garlic not only may help shorten the life of your viral illness, but also may be useful in helping prevent it. Main downside here is that many people find the quantities needed for efficacy very difficult to tolerate.

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It’s Likely A Virus…Or is it?

Its that season…

Pumpkin spice everything. Soup. Chili. Beans.

And, yep, germs EVERYWHERE!

In honor of my first evil toddler cold of the season (for the record it’s currently 2-1 in favor of my regimen—Daylight savings threw off my Spidey-sense), I figured I’d share some insight on how to tell when you may be dealing with influenza vs common cold, common cold vs bacterial complication—meaning now you need to see a doctor and get some of the double-edged sword that is an antibiotic, or it may be strep…which generally, adults aren’t dealing with unless they’re around germy children. Yes, children are little incubators, and I never got sick before I had them. They’re lucky they’re cute!

INFLUENZA AND STREP

COMMON COLD

SYMPTOMATIC THERAPY

VITAMINS AND HERBALS?

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Rainbows

Soulful Sundays: Once a week I will have an installment that speaks to my spirituality, because, as I’ve said, to me, spiritual wellness, is essential to complete wellness. Because I am Christian, my spirituality is heavily based on my relationship with the Trinity and the Christian Bible. If reading about God, Jesus, or the Spirit will offend your sensibilities, these posts aren’t for you–be advised

13 I do set my bow in the cloud, and it shall be for a token of a covenant between me and the earth.

Gen 9:13 KJV

I was riding in the car, thinking about a particularly difficult situation. In fact, many would call it impossible, or hopeless. I had my eyes closed, and I was talking to God, asking Him to make this situation better, and to strengthen me and prepare me if He decided not to, and I opened my eyes and saw the picture I’ve loaded to today’s blog…a rainbow. Not taking up the sky—not overwhelming. If I wasn’t looking, I would have missed it. If I had kept my eyes closed longer, I would have missed it. At first, the parallel to the scripture lost on me, I tried to snap a picture, thinking that my oldest would really want to see this partial rainbow. And then, the significance of what I was seeing hit me. The symbol of a covenant. A promise. What the rainbow can represent to those who believe. God’s first promise, and His every promise. For me in that moment, that tiny rainbow, in that great big sky–that almost invisible hope, in all that impossibility—it gave me so much peace.

You see guys, I didn’t get to write last week. There’s a reason. A great one. I took a trip to see a physical therapist who has changed the course of my headaches. I’m about 70% better. I may have to take my abortive therapy tomorrow, because I’ve simply overdone it the past few days, but where I’d been taking this medication every day to every other day, I have gone 11 days without taking it. For the first time in over 6 months, I went 11 days migraine free. I am so amazingly and abundantly grateful to God! It’s amazing!

And that’s just the beginning of what He’s been doing for me in the past 3-4 months. He is simply AWESOME. AMAZING. So I’m sitting in the car, talking to Him about this situation, and there is this tiny symbol of his covenant with Noah, in the great big sky, and if I had waited just 2-3 more seconds, I’d have missed it, and I’m so moved, because I’m almost certain He’s just told me to be quiet and trust Him more. To hush, and stop thinking so hard, and do what He says, and that even if He’s got to destroy some things I think I need, He’s got me. Peace, be still.  

But Jesus looked at them and said, “With man this is impossible, but with God all things are possible.”

~ Matthew 19:26 ESV

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Splinters and Planks

Soulful Sundays: Once a week I will have an installment that speaks to my spirituality, because, as I’ve said, to me, spiritual wellness, is essential to complete wellness. Because I am Christian, my spirituality is heavily based on my relationship with the Trinity and the Christian Bible. If reading about God, Jesus, or the Spirit will offend your sensibilities, these posts aren’t for you–be advised.

Do not judge, or you too will be judged. 2For in the same way you judge others, you will be judged, and with the measure you use, it will be measured to you. 3“Why do you look at the speck of sawdust in your brother’s eye and pay no attention to the plank in your own eye? 4How can you say to your brother, ‘Let me take the speck out of your eye,’ when all the time there is a plank in your own eye? 5You hypocrite, first take the plank out of your own eye, and then you will see clearly to remove the speck from your brother’s eye.

Matt 7:1-5 NIV

This verse is resonating with me this week. So often we see what others need to change, how others have wronged us, how others should grow. I have praised God in these migraines—one thing He has shown me is who is in my corner, and who is not. He has helped me walk away from situations that were not for me. He has helped me grow in ways I didn’t know possible. I praise Him in that. However, in all that, I am constantly praying that I am not guilty of the above—that I do not find myself flawed in someway that I am blind to due to a plank in my eye.

It’s very much like how at the beginning of all this, I sat and told my patients to take care of themselves, take time for self-care, while literally running myself into the ground and ignoring my own advice. In fact, my taking the time off work, at my physician’s and admin’s advice, was because I wanted to be able to look my patients in the eye, and know that I had done the very thing I encouraged them to do, day in and day out. And today, it’s with a different conviction, but zero judgment, that I encourage my patients to self-care when necessary.

So this week, I am challenging us all, me first, make sure you are appropriately reflecting on yourself. Make sure you are leading growth by example. Make sure you are being the Christ you want to see in others before you ask it of them. Let’s not be so arrogant that we think we have it all figured out—that’s the beginning of the end.

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Houston Fall

Houston fall and spring is some of my favorite weather. Last week, we had one of those perfect days where it was 70 degrees and almost no humidity. So after arguing my older son outside, we finally spent some time as a family, riding very underused bikes, enjoying the perfect weather, and each other.

The little one was on the red tricycle my best friend bought for my older one when almost 5 years ago (I really need to Marie Kondo my life, but it worked out this time), and he took great joy in calling attention to the difference between his red and his brother’s orange.

I love this view!!!

It was one of those afternoons you hope will live on forever. In fact, after arguing about how he didn’t want to go outside, the older one didn’t want to come back inside…so I didn’t make him. I let him ride to his heart’s content…because how many days do we get like this in Houston?

Then we did something we don’t normally do. We came inside, and watched Planet Earth II on Netflix and ate microwaved popcorn from a great big bowl. It was a wonderful day.

Sooooo many calories!! At least we had already burned some off outside.

More importantly, I took the time to enjoy my family. To slow down and savor the moments with them. To soak them in. In this fast-paced world, we’ve got to do that more often.

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Symptomatic Therapy for Upper Respiratory Tract Infections

The most important therapy right now is symptomatic. I am not a fan of combined formulations, because I prefer to target my specific symptom set, and I generally will just deal with the achiness and omit the Tylenol/acetaminophen or Advil/Motrin/ibuprofen that’s typically always a part of the combo meds. Also, the antihistamine in combination medications are typically short acting, and wear off in the middle of the night, resulting in waking halfway through the night feeling miserably, or having to dose every 4 hours. It’s just a lot. I prefer things that can be dosed once or twice a day. However, you can also use this as a way to make sure your combo med is treating all your symptoms.

For runny nose:

Antihistamines: Claritin/loratadine, Allegra/fexofenadine, Zyrtec/cetirizine, Xyzal, Benedyl/dyphenhydramine (short acting, but dries better)

Pseudophedrine/Sudafed (decongestant, but dries—shouldn’t be used if you have high blood pressure)

For post nasal drip and congestion:

Fluticasone/Flonase

Nasonex/mometasone

Pseudophedrine/Sudafed (decongestant, but dries—shouldn’t be used if you have high blood pressure)

Saline irrigation with something like Nettipot, Arm & Hammer Simply Saline or a store brand irrigation

Chest congestion:

Mucinex/guaifenasin

(Will not help dry up, but will help it come up, which is very important! You do not want that mucus blocking the airways and growing bacteria)

Vick’s VapoRub

Cough:

Generally, during the acute phase of illness, cough is protective. You want to cough mucus up, and I don’t like to suppress cough until I know the cough is residual. The goal is to decrease the mucus and decrease the need for the body to cough. Also, Vick’s VapoRub, cough drops, and lots of warm fluids.

Muscle aches/ Headache:

Ibuprofen/Advil/Motrin

Tylenol/acetaminophen

Sore throat:

Ibuprofen/Advil/Motrin

Tylenol/acetaminophen

Salt Water Gargles

Lozenges

Other Notes

Vitamin C, Zinc, and Elderberry may all have roles in shortening viral illness. I recommend my patients add them to their regimen if they have no metabolic (liver, bone, or kidney) issues.

REST is so important in healing. Try to get as much rest as possible to prevent developing a secondary bacterial infection. When I give the above instructions it’s my goal to prevent the need for an antibiotic prescription.

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Common cold

The overwhelming majority of calls I get, wanting to be seen for waking up “sick,” or “coming down with something” are some variation of a normal viral illness This is the typical time frame:

Day 1-2: feeling a little off. You may be more tired than normal. Maybe your throat is more scratchy, nose is more itchy, but it’s really easy to miss if you’re busy, or there is some other explanation.

Day 3: I’m normally called on this day. Today you feel pretty bad and you have known you haven’t felt like yourself for a couple of days. You are starting to really have the common symptoms, may be feeling a little achy, but less so than the flu, and you have some more intense fatigue today. Now is when you definitely have some sort of runny nose or congestion or sore throat or cough–something to let you know you’re sick.

Day 4: Today is definitely worse. Honestly, no matter what I do on day 3, it’s going to be worse. You feel like crap. There’s mucus everywhere. Sorry.

Day 5: If we do everything right, this is the day the systemic symptoms should start to improve (meaning if you ran a fever, it should stop, you should have fewer body aches, be a little less tired, etc), but if it’s going to move into your chest, it will start to do so today if it hasn’t already.

Day 6 and beyond: you will be coughing but you should be improving overall. If you get worse systemically at this point, it’s time to call your doctor. You likely need an antibiotic. However, remember, the cough can hang around for a while and be QUITE annoying.

Prevention:

How do we prevent the common cold? Wash your hands. Wipe down your surfaces. Eat a healthy diet. Get plenty of rest. Pay attention to your body. What I have found is that if I can catch myself in day 1 or 2 when I’m just feeling more run down, I can keep myself from really hitting the sick of day 3 if I 1. Rest, 2. High dose C, 3. Zinc lozenges, 4. Elderberry Syrup. I can’t find any evidence to say that this works for everyone. It works for me.

Treatment:

You missed your window of prevention and you’re in day 3? Ride it out. There is no medicine that’s going to kill a virus. That being said, vitamin c, zinc, and elderberry are very promising for shortening the duration of a viral illness, again assuming no kidney, liver, or metabolism issues (so make sure you check with your personal doctor before use). I also tend strongly advocate for treating your symptoms, because untreated mucus symptoms are the biggest cause of bacterial infections in my completely subjective opinion. I like to be able to prevent the need for antibiotics, so I give my patients the run-down on what to use to dry it up and keep what’s in there rinsed out or flowing out. See the post here. Mainly with a virus, you gotta just suck it up, and ride it out. Get some REST!! As a society, we highly undervalue it, and it’s so important to our recovery. And remember, the annoying cough can last for up to 1 month, but it shouldn’t be associated with fever, chills, night sweats, or shortness of breath. And generally, your docs may have a prescription up their sleeves for this annoying cough if you ask.

Secondary Bacterial Infections

Understand that it will normally take 10-14 days for a bacterial infection to develop after a common cold if it’s going to happen. ENT studies have shown it takes at least 14 days for bacterial sinus infections to develop, so even if you’re have classic sinus infection symptoms, it’s likely from a non-bacterial cause if it’s prior to 14 days. It just takes that long for enough bacteria to grow to be causing an infection. Before this, you likely don’t need antibiotics unless you have some kind of special risk factor.

At this point, I normally want to see my patients. I want to make sure you aren’t more sick than you think, and I want to localize the infection to make sure I pick the best antibiotic for your infection. All antibiotics are not created equal, so please don’t use the last antibiotics you had for the infection you might have right now unless you’ve received the okay from your physician.

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Flu and Strep

With both of these, you generally are much sicker than with the common cold. You may be running fevers, but you definitely feel like you should be in bed, and generally, aren’t going to be able to ignore your body for long. They are typically accompanied with severe body aches and headache. If you think you have one of the above, it’s normally best to contact your doctor.

Influenza

In most cases, influenza is fast and severe (although if you’re vaccinated, it can really change the way it presents if you still catch it). You think you may be getting sick, and by the end of the day, you think you’re maybe dying…lol. There are typically body aches, runny nose or post nasal drip, sinus congestion, cough, and chest congestion. There’s also frequently gastrointestinal symptoms like nausea, vomiting or diarrhea. Fever is typical, but the absence of fever doesn’t mean you don’t have the flu.

Normally, you get sick within 2-3 days of exposure to flu.

For the best way to prevent the flu, and for loads more information, see this blog post.

Treatment: For certain populations, not all, antiviral medications are recommended. These medications are recommended within a certain timeframe (usually within 48-72 hours of symptom onset) so contact your doctor as soon as possible if you’re suspecting flu.

In my research on my favorite advice for common cold therapies, I found out that elderberry may just have activity against influenza. If you have a healthy liver and kidneys, it may be worth adding to your treatment regimen if you’re recovering from flu.

Strep

Strep throat can accompany other infections, but generally, pure strep throat is not associated with the other symptoms of an upper respiratory illness. Fever, sore throat, headache are the mainstays of this illness. Having cervical lymphadenopathy (swollen glands in the neck) makes it more likely, but this can happen with the other illnesses as well.

Generally, you feel as bad with strep as you do with the flu…one of the main times that i figured out I had the flu was when I said to myself “I haven’t felt this bad since I had strep.” So yeah, you feel horribly.

However, it’s not common in adults. Typically you will have been exposed to younger children in order to be at risk. You will need to be swabbed, but also, make sure that whoever is swabbing looks at your throat. I will normally treat if the throat looks like classic strep, (it does have a very classic appearance) or if there is known exposure and the symptoms are super classic, since the rapid test is not 100% accurate.

Treatment is generally with amoxicillin of some sort. If you’re allergic, a cephalosporin, clindamycin or azithromycin will do.

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