Just dealing with the common cold and sinus infections is actually pretty hard! First, it’s hard to know just why folks come in, but usually there’s some additional agenda: a fear, a trip, missing work, a sick loved one we should not infect, etc. And, there’s almost NO good education about the many remedies out there. Just advertising! And there is little about best practices and side effects, just marketing and technical data on chemicals and dosing, not about function and effect.
Currently, the only good oral decongestant on the market is pseudoephedrine. Federal law was passed to restrict access at the request of law enforcement to get rid of methamphetamine labs, which were widespread and dangerous to law enforcement and to the drug cookers. They were buying over the counter pseudoephedrine and making methamphetamine out of it. When the law was passed, in our state one had now to sign for it with a pharmacist and show identification. No more over the counter! The drug manufacturers used their privilege of changing ingredients while keeping the brand. What a deal! They could bait and switch chemicals and never inform the doctors or the customers! Widely, phenylephrine was substituted for the pseudoephedrine. All of my peers thought that was a poor, weak substitute. Later the FDA required it to be studied: it was no better than placebo. So there it was: the public buying completely ineffective product and not knowing the only “good stuff” was behind the counter accessible only with the pharmacist, identification, and a signature, only for those over 18, and only 60 12 hour tablets.
I realized my special knowledge should be widely shared, but without a forum outside of my practice, I just built a quick text to share by printing, that told my patients how I personally treat my own common colds: 12 hour pseudoephedrine in the am, oxymetazoline 0.5% nasal spray at night, since the former disturbs my sleep, and that of most adults. 12 hour dextromethorphan liquid for cough, and naproxen sodium 220mg for pain, if needed. That’s all! Zinc lozenges are the only other proven value: sucked on all day they shorten a cold by ONE day and taste like, well, zinc. No thanks, but if you like sucking on metal, they do work.
What I didn’t anticipate at all was how positive this would be for patients! Instead of a prescription for codeine, or an unnecessary antibiotic, they were more than happy to try what I use myself, and furthermore to learn HOW to buy over the counter products that their doctor recommended, to have a written list to show to the pharmacist and keep at home, and perhaps to avoid the next unnecessary trip to the doctor for a self-treatable illness like a bad cold. And perhaps to avoid a sinus infection. For the sinus infection prone I add fluticasone nasal spray at night sometimes, and also advise nasal hypertonic saline irrigation using a neti pot, or homemade methods.
Sharing how we have also been sick, and what we have learned about how to take care of ourselves is a special gift to patients. Thank God I have had few ailments, but those that are common that I can share with folks makes a better connection, a stronger relationship, and better outcomes. It also results in less use of antibiotics, which is good stewardship of the public health, helping to prevent those nasty resistant organisms, and reducing waste.