Sinus infection? Allergy? Cold?

One of the most often seen complaints in primary care is the basket of nasal stuffing/dripping with headache.  Some patients come in, absolutely certain it’s “another sinus infection because I get them all the time.”  Others are sure it’s “the same allergies I get all the time.”  And yet the final category are those who are certain the cold will kill them, likely before the end of the day.  Each of these unfortunate souls can find it hard to keep up with the mad-paced electronic-super charged society we live in. Many wait until they can no longer take it.  Others rush in after just a mere few hours of symptoms.

So how do I figure out what is really wrong with the patient?  Above all else, listening to the patient’s story as to what their symptoms are and how it unfolded offers much guidance.  For instance, a patient who felt fine and then “suddenly” felt like they were “hit by a Mack truck” are more likely to be suffering from a viral illness of some sort.  Colds, you know, the ones which make you look like Rudolf the red-nosed reindeer and cause a sharp spike in Kleenex stock, are viral.  They don’t need antibiotics to cure.  In fact, so sorry all of you who want an antibiotic for every sniffle, antibiotics will do no good for a cold or viral illness.  None.  Zero. However, if a patient pushes, sometimes I will give in after I tell them they will still get better in about 7-10 days because that is about how long most viral illnesses last.

Other markers of the cold/allergies/infection are ones I see when I examine you.  I really do like to check your ears, nose, and throat.  Your ears could have wax build up or fluid behind your eardrum.  Both can be painful.  Both can seem rather abrupt. But the treatment is very different.  Your nose is a wonderful clue box as I call it.  Oh the things the inside of your nose tell me!  And your throat is a lovely indicator of allergy (the back of your throat looks kind of like a cobblestone street) or some other nasty things I may need to address.  I’ve found strep throat  by sight and I’ve also found folks who have just eaten something bready like a bagel of which remnants can look remarkably like white pustules back there.  (You might want to brush your teeth and don’t eat anything before you come in to see me).

While you’re there, I like to see how your blood pressure is doing.  Today’s American diet has led to blood pressure problems at very young age.  It’s no longer just for those over 40.

And very often, folks like to tell me about what’s going on in their life.  Most of all, they need to vent to someone who won’t tell others.  And who will listen.  And who will care.  Because I truly do care about my patients.  I care about their families.  And I like patients to show me a quick snapshot of their pets.  It’s something to bond over.

The next time you get sick, remember to tell your practitioner about how quickly or slowly you fell ill.  Tell us about how long you’ve been sick.  And know your symptoms.  If the answer to every question is “yes”, I’m often suspect the patient wants a quick antibiotic because a lot of the questions I ask do not apply to every cold/viral/allergy illness across the board.

And by the way, I like patients who look things up on Google.  Why not?  Sometimes when I am incredibly busy, they often have an idea as to what is going on and will be sure to tell me about those symptoms so I can verify with a few more questions and a good physical exam.

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