family practice issues and general life events

Posts tagged ‘cough’

Allergies and Asthma

When you come in complaining of runny nose and congestion, I do feel bad for you.  Really I do.  I can sympathize.  Well up to a point.  If you tell me you just sneezed twice and it was intolerable, well I will try to help you, but that won’t equate to an emergency to me.  Heck it isn’t even a minor emergency.  And if you tell me taking an antihistamine is just too much trouble, well I may even become irritated.  I will try to hide it, but it will be there.  Why?  Because I probably have more severe allergies than most.  

I spent my childhood wearing long sleeve shirts when my eczema was so severe it looked to the untrained eye that I was attempting to shoot up.  Never mind that I was 8 or that I apparently had no regard for where the vein was when I was attempting to “shoot up”  In fact now my skin is tough in my antecubital fossa (crease of the elbow) that while my veins are close to the skin, you have to work to get to the vein when I have to get blood work done.  Additionally, I have spots that are now lacking any pigment at all do to damage that I have done. 

So please believe me when I discuss the importance of proper hydration of the skin, both topical and by mouth.  If I tell you that it will come back unless we can identify the trigger and avoid it.  And if you don’t want to avoid it, well that is fine, but the rash may come back and probably will.  Mine did throughout childhood, because well Pizza Hut pizza was worth it to me.  It is a trade off.

As for your runny nose, well you might have to take an antihistimine, Claritin, Zyrtec, Allegra, Benedryl, etc.  It may not require a doctor’s visit, they are all over the counter now.  Now if they are severe enough, maybe allergy testing and desensitization are worth it to you.  But if it is just once a year, when the flowers bloom it might not be worth it to you.  Sometimes you have to decide.  I can offer the tests, and can offer treatment, but you have to take it, consistently.

And I do apologize but there is nothing about your particular rash that will let me know what caused it.  (Assuming it is an allergy)  I don’t know if you changed detergents, soaps, or if you used that new lotion you got for Christmas.  I don’t know that you ate something new, and I will continue to ask all of these questions to help to identify the triggers.  And sometimes without allergy testing we may never know.  Sometimes it is obvious with questions, but not always.

And if I suggest checking you for asthma, realize that I am following current recommendations, and that the two processes are very similar.  However, I might not be able to tell you if your 2 year old will grow up with asthma.  First of all she is too young for the test, and secondly she may just have a cold today.  So please don’t try to insist that I do all the testing today.  I can’t. She cannot do the test.  Most kids can somewhere around 6, and even then depending on the asthma type and severity their test could still be normal.

What I can tell you is that you as a parent should stop smoking.  Sorry, but smoking in your bedroom travels through the vents of the house into the child’s room.  Those of you who say but I only smoke outside, well most people in cold weather smoke too close to their house to not be sucked back into the ventilation system, not to mention what is brought back in on your clothes.  And many of you neglect to realize that your car is a small enclosed space, and smoking in it regardless of whether the child is in the car or not harms the child all together.  It stays in the car, why do you think the resale value of cars that people smoke in are so much lower than those of nonsmokers?  It stays in the car.  And those who want to lie to me, well if I get secondhand smoke fumes by walking in the room, well you are probably affecting your child, just like me.

And those asthmatics who smoke?  Why?  You already have a hyper-responsive set of lungs.  Why are your introducing irritants that make your condition worse?  I know nicotine is addictive, and difficult to quit, but in addition to lung disease, it also contributes to heart disease, cancers that include not only lung and oral, but bladder, liver, and colon cancer.  If you are diabetic your risk for amputation increases significantly if you smoke, and healing of wounds is significantly impaired.  So much so I know back surgeons who will not operate unless you quit smoking for at least a week before and a month after surgery, and plastic surgeons who have included in their pre-operative consent that you understand that scarring and healing is worse and if you smoke, you will be responsible if the wound does not heal.

And if you come if sneezing and coughing and complaining if you can’t breath, don’t get offended if I tell you, that you need to quit smoking.  And don’t lie to me and tell me you don’t, when it smells like you have had a whole pack right in the room.  I will do what I can tell help you stop smoking if you want help.  But that is something you have to decide for yourself, or your kids.

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