Ears clogged? Popping? Clicking?

It doesn’t matter what time of year it is, most days bring at least one patient complaining of their ears being clogged, popping, or clicking.  Some folks say they “can’t hear” and it usually comes on rather suddenly versus very slowly over a period of weeks or months.

Sometimes it follows a cold.  Other times it accompanies allergy season.  I like to let the patient tell me their story, as in, “tell me what happened” or “tell me about it” so they know I am listening and tuned in to hear clues about what additional questions I may need to ask.  When I start to ask questions, it’s called a “drill down”.  Think of it as a funnel.  I start by asking broad large questions, like catching everything going through. Then, as I pick up clues, I funnel the questions down and ask more focused questions. Usually by then I have only a few things I think could be going on.  That term is called “differential diagnosis”.  So the funnel goes from a big wide mouth to a tiny, little one with only a few things medically wrong which could fit through the opening.  That’s the drill down.  It guides my physical exam and what differential diagnoses I feel could be in the mix.

So when a patient states they have popping and clicking and feel like they are “hearing under water” or “everything sounds far away” or they “can’t pop their ears”, I am usually pretty sure they have fluid in their ears or their ears are clogged up due to something such as ear wax or allergies.

That’s about time when I take a look.  Let’s say I see fluid or the exam guides me to believe the issue is allergies.  One thing I use is a 4-5 day course of Sudafed (regular is fine) or my favorite is Fluticasone proprionate (Flonase).  It has a light steroid in it which shrinks the area in the ear enough to help open things up.  For allergies, it’s a nice medication.

Now here is the most important thing: it’s how you use it!  I tell my peeps it’s about HOW you use the nasal spray.  When you go to spray it, hold the bottle.  Then CROSS YOUR ARMS.  By doing this, you angle the tip of the bottle so that it points towards your sinus cavity and ears versus going right straight down the back of your throat.  Then you spray and sniff VERY lightly.  Not even enough to sniff a flower.  It should feel as if it is going to run out of your nose for about 10 seconds.  But it won’t.  Your nose is like a sponge.  If you spray and sniff and you can taste it down the back of your throat, you sniffed too hard.  Your throat may feel great but it sure won’t do anything for your sinuses or your ears.  I’m sure there are videos on YouTube by the manufacturer as to how to use this medication the best way.  But that’s how I tell my patients to use it and most of them have reported pretty good relief.  Remember to be patient.  It can take about 2 weeks to get relief.  The ears are tough little buggers and don’t want to drain fast.  They may pop a little more before they heal.  If it lasts longer, then go see your health care provider.  Again, I’m not giving you medical advice, I’m just ruminating about what’s worked for me and my patients.

It sure is helpful to have something to fix your ears.  I’ve had patients return after a course of this nasal spray and tell me they were so sure it wouldn’t work, and, wow, weren’t they surprised when it did.  Sometimes NPs have to work just a bit harder to win over patients.  That’s okay.  I have a lot of time to win them over one at a time.


Allergy season: Which product? When to take?

Oh allergy season is upon us.  If you haven’t already started an allergy pill, hurry on up down to the Piggly Wiggly and pick up a bottle, box, or carton.  Today.  To-day.  I know the ads show allergy sufferers dancing through fields of hay fever and snuggling next to Fluffy the super-furry long-haired white cat.  Apparently, the drug companies want you to believe their allergy medication works “in as little as 30 minutes”.

Okay, people, here’s the truth.  If you want the best allergy coverage, start taking allergy medication about two weeks before your allergy season begins.  Spring allergies?  Then start no later than March 1st.  Late summer?  Start July 1st.  Fall?  Start September 1st.  Now remember my disclaimer, my comments are not meant for everyone and not intended to replace the advice of your health care provider.  However, in general, it takes about two weeks for allergy medication to seat itself in your system and cover most of the symptoms.  You know, the runny nose, watery eyes, itchy ears, and throat.  While you can get relief quickly, full coverage relief is best achieved after two weeks.  That means heavenly 24 hour relief.

Here’s a pearl I’ve learned which may or may not apply to you.  For indoor allergies, I’ve found Claritin works fairly well.  Yes, it will work on outdoor allergies, too.  But it sure does seem to cover indoor pretty well.  And, yes, the store brand is fine for most people although some patients don’t do as well with the binding ingredients.  You will have to decide that for yourself.  For outdoor allergies, Zyrtec covers fairly well.  For most people, taking allergy medication at night is a pretty good idea because it can make you tired.  Relief from allergies and a good night’s rest.  Not bad.  Allegra is also a good alternative.  Patients ask about the stuff behind the counter, for example, Claritin-D.  The D is a decongestant.  In general, most people do not need it.  It is not very often, in fact, that the decongestant is necessary except in short-term periods.

If your ears are feeling “clogged” and popping or clicking, it’s often because they are not clearing properly.  It is often on the heels of a cold or allergy-related.  I’ll talk about that in my next post.  It’s something you can buy at the pharmacy as well.  So stay tuned….

Job Search & Networking

This week I attended a national conference for nurse practitioners (NCNP 2017).  The original intent was to learn the newest guidelines on common ailments I encounter in primary care practice. However, with recent events, I found myself in need of networking to see about locating a new employer.  Here’s what I found…

Being outright honest about why I parted ways with my previous employer was refreshing to both parties.  I did not bash the folks I used to work for.  Instead, I quickly noted our disagreement and stated I enjoyed working for the previous company and would miss them but things did not work out as I had hoped.  It was truthful and heartfelt.  Speaking negatively about a previous employer, even when, by many accounts is could have been justified, would have been poor form.  It is not in my character.  My grandfather used to tell me the only two things people can’t take away from you are your character and your education.  He was right then and that statement continues to hold true today.

Another thing I found was that the nurse practitioners I met from around the country were engaged in refreshing their knowledge. They enjoyed networking with others regardless of geographic origin as much as I did.  I’ve picked up a few words in another language which has been fun, too.  It is apparent the days in which health care providers earn their license and then practice the same way year after year until they retire some decades later are gone. NPs are vested in their patients’ health and wellness.  That entails constant refresher courses as guidelines for every major and minor disease, ailment, and injury change faster than they can be printed.

It’s been the type of week which reinforces why I became a nurse practitioner.  I have met other NPs who also strive to do the best they can to do right by their patients.  I’ve also picked up clinical pearls, those tid bits of information which successfully guide medical decisions to help my patients recover or cope with medical illnesses.

When I return home tomorrow, I will get on the plane as a better NP, have more friends, and maybe, just maybe, a new job in the pipeline.  I sure do hope so.

If no job materializes, I know God will have the right job waiting at the right time just for me.  It’s kind of like a prescription for medication, follow the right  steps and then wait and in time things will work out just fine.


Those who are supposed to care

Sometimes we as health care practitioners (HCPs)are the ones who are ill or injured.  When that occurs, we generally believe the other HCPs around us, and particularly, those whom we work so hard for, will treat us with caring respect. For some HCPs, especially some employers, that is simply not going to happen regardless of the nature of the injury.  Large facility employers have adequate policies in force to protect both the employer from lollygaggers and the employee from heartless owners who purposefully disregard obvious painful, debilitating injuries.  Smaller places of practical care often  have policies which evolve spontaneously, usually to the benefit of the employer.  It is not until times of such disability that employers reveal what type of wizard is truly behind the curtain.

In the course of our employed lives, which accounts for roughly 70% of our time on this earth, realizing that our employer is not the wonderful, caring being we had believed them to be.  The slow realization that the previously beloved employer is focused only on money production can be agonizing.

After much thought, two end products should result when the employees care more about each other than the employer could ever claim in front of the Almighty.  First, the injured practitioner should give swift, adequate, professional notice.  Save yourself.  In order to be the best NP one can be, it is an absolute necessity to care for oneself and about oneself.  Working for any practice that only treats employees well when those employees are, um, well, is like continuing to date someone after they have shown themselves to be untrustworthy.  Save yourself.

The second end result should be to evaluate future employers more carefully.  Weigh smaller versus larger practices.  Ask about written policy handbooks.  And what to expect if policies are overhauled.  Are employees grandfathered?  It is important to know.  Save yourself from jumping too fast. 70% can be a long, long time.

Sadly, finding out how an employer treats injured employees is often something we understand after the process has started.  Worse is that this has to be written about at all.  Our society has become so completely romanticized with the PC of everything that it is difficult to understand how any employer can be so callous as to watch an employee physically suffer day after day and then verbally and policy-driven attack them.

However, if you are genuinely kind, truly and authentically kind to co-workers and patients, rest assured those fine people will be tremendously supportive right through to the last-minute of the last day.  And that, my friends, is why being honest and kind triumphs over hardened money-driven hearts every single time.