Seasonal Allergies

Of course, discuss your symptoms with me or another physician. If you have been diagnosed with seasonal allergies or "allergic rhinitis" then you are probably searching for relief. Here are a few suggestions for the treatment and prevention of seasonal allergies.

The best medication for seasonal allergies is intranasal (in your nose) corticosteroids. This includes Fluticasone (Flonase) and Mometasone (Nasonex).  These medications are the strongest available for treating eye itchiness, nose itching, sneezing and runny nose.  These medications must be taken as directed (often twice a day) and start working within the hour, but may take a few days for maximum effect.  Do not give up on them if they do not work the first 2 days. Give it time!

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Past nose steroids such as Flonase (now over the counter), antihistamines are powerful ways of reducing your allergy symptoms. Everybody reacts differently to allergy pills, and some can cause you to become sleepy.  There are a lot of options. The allergy medications that seem to work the best include fexofenadine (Allegra) and cetirizine (Zyrtec). These are also available over the counter and come in generic and brand name formulations. Of course, I recommend the generic versions to save you money with the same medication!

Interested in an all natural approach to keeping allergies controlled?

Look no further than a NetiPot. This device flushes out your sinus cavities, and whatever irritants (dust, pollen) are wreaking havoc with you.  A few things to remember with the NetiPot.  First, always use fresh, purified bottle water, not from the tap. Second, always use the salt packet that comes with the NetiPot. Lastly, give it some time to get used to the sensation of salt water going through your nose and sinuses. It will feel very odd the first few times. 


Treating Dry Skin

Dry skin can make us feel itchy and uncomfortable. For those who have common skin conditions like eczema good skin can is a must.  Here are my general recommendations for good skin care and some product suggestions.

1) Use mild, non-perfumed, non-dye soap. Harsh soaps do not clean better than gentle ones, and often times our skin can become irritated with perfume and dyes (colors).  One example is Dove Sensitive Skin without perfume or dye. When you buy in bulk, it's about $1.10 per bar.

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2) The most common cause of dry skin is water. Yup. Frequent bathing or water contact removes valuable oils from your skin's surface.  Try to avoid showering more than once a day, and pat yourself off, do not rub and lastly, avoid very hot showers.

3) Perhaps the BEST thing you can do for your skin is to moisturize. This can get confusing. First some terminology.  All moisturizers are made out of water and oil (and any active ingredient like Aloe). . The oil is the good stuff that our skin needs.  Lotions have the least oil an the most oil. Although they are easy to use, they are the least helpful.

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Although easy to use and quick to absorb, these lotions are not going to do much for very dry skin. Instead, try a cream (typically 50% oil) or an ointment (about 80% oil).  Here is an example of a cream that comes highly recommended by the dermatologists I work with.

Remember how I like to recommend generic products as compared to brand names? Skin care is no exception

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Always apply the moisturizer right within about 3 minutes of bath or shower, while your skin still has a little water on it. This will seal in the moisture and help the valuable oils penetrate into the skin. You may apply the moisturizer at other times in addition to this.

Some patients have recommended urea containing products. These tend to be more expensive and I'm not sure they work any better than frequent use of other creams and ointments.  Don't waste your money on expensive options before trying appropriate use of less expensive options.

If your dry skin continues, or if you have been diagnosed with another skin condition such as eczema, you may be prescribed a topic (skin) steroid ointment to use.  Steroid creams work by telling your immune system to CALM DOWN. They can be very powerful in the short term, but longer term use (more than 4 weeks) can thin out the skin.  Follow the prescriptions closely and do not use steroid cream on your face or private parts unless specifically instructed.

Appriach to non-Genital Skin Warts

Everyone you talk to has a home remedy for these buggers. My first question is, are you sure it's just a wart?  Let me know about any skin findings so me or another physician can make sure you do not have something dangerous.

Here's my approach for treating warts:

Most skin warts (again, not on your private parts, if you have those let me know) are from a virus, specifically one called Human Papillomavirus (HPV).  There are many types or "strains" of HPV, some can even cause certain cancers, which is why we vaccinate our pre-teens against the more dangerous strains of HPV.  But those warts on you are not cancerous. They're just annoying.

The first option is to just wait it out.  50% of warts will be gone within a year.

The best home remedy for warts (or verruca vulgaris if we want to sound sophisticated) is Salicylic Acid 17%.  There are many different types of this medication including bandages and creams. Use whichever formulation you prefer, but don't get too aggressive. This liquid is strong stuff!

Let's say the wart does not go away with salicylic acid and you want it treated by a physician? In that case, we will likely use Liquid Nitrogen to try to destroy the wart and the local virus.

In my Practice Information page, I promised to be honest with you as my patient. The truth is, this spray is not comfortable. It stings. A lot.  The best way to use liquid nitrogen is to spray for 10 seconds or more, and it often takes 3 or 4 treatments spaced out every 2 weeks. Success rates are about 50-70% There will be blistering, soreness and redness at the area that will start soon after the treatment and may continue for a few days.

For children who may not tolerate this treatment, ask me about the Wart Clinic where other treatments are available.  What about Duct Tape?!  Some say applying duct tape works, but there is no good data.  So I cannot in good conscious recommend it.  Sorry duct tape fans.

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How to prevent warts?  Avoid touching them on other people and avoid biting your nails, as those are known ways to get them. (Tosti A, Pinoccini BM. Nail disorders. In: Dermatology. London, United Kingdom; Mosby:1061–1078.) 

Cough and Cold Products

It's a drag having a cold. Luckily there are medications available over the counter than can help make you feel better.   When choosing a product, I recommend you use generics (pharmacy brand) as they are often the same chemical and less expensive.  Of course, if you have symptoms you are concerned about, or are not feeling better in a few days let me or another physician know. These recommendations are for adults over the age of 18. 

Click on each product to learn more about the warnings before taking them.  Pictures are from CVS for consistency; choose whichever pharmacy or brand you trust.

Cough: This can be the worst part about being sick. For relief of short term coughs (less than 2 weeks), start with menthol cough drops. These can soothe your throat and provide short term relief.  How about cough syrup? I would skip it. The data is mixed  and the side effects can make you sleepy. If you can't sleep due to your cough, let me or another physician know.

Congestion: Nasal Decongestants have been shown to help with symptoms of cold. Of the products out there, I recommend pseudoephendrine (Sudafed). This is a strong medication that can help you feel better quickly. Do not take if you have high blood pressure.  The stronger version of this medication is the type you need to ask for, kept behind the counter.

Aches and Pains:  As long as you have normally functioning kidneys and liver, ibuprofen (Advil)is a strong medication to help with the body aches associated with a cold. Make sure the drink lots of water so you do not get dehydrated while taking this medication.

 

An alternative is acetaminophen (Tylenol) which can help control fever and body aches. Again, don't take this medication if you have a bad liver or kidney disease.

Be very cautions about combination products. For example, Nyquil Cold and Flu has 3 different medications:

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a) Acetaminophen (Tylenol)

b) Doxylamine (a type of antihistamine, like pseudoephedrine or Sudafed)

c) Dextromethorphan (a cough medicine which has not been shown to work well)

TONS of stuff crammed together in one pill or liquid should make you think twice.

What about Natural Remedies for the common cold?  Unfortunately, not much helps. 

Wait!  Does Vitamin C work for colds? Nope.

What about Zinc? Nope

Ecinacia? Nope

What may help you feel better may be chicken soup (mom was right) and Vapor Rubs.

Let me know if you have could or cold symptoms that are not improving after 7 days or getting worse. And remember to wash your hands to help ensure you don't infect people around you!

 

Nausea and Vomiting During Pregnancy

It's very common to have mild nausea and vomiting during pregnancy. After you have been evaluated by a physician and found to be healthy and safe, there are many options for products available over the counter to help with this common problem.  Doxylamine (Unisom SleepTabs) in addition to vitamin B6 has been used often for the treatment of nausea and vomiting of pregnancy. Some studies suggest this combination reduces symptoms by 70%.  Talk to your physician before taking this or any medication. Hope you feel better!

 

(American College of Obstetrics and Gynecology. ACOG practice bulletin: nausea and vomiting of pregnancy. Obstet Gynecol. 2004;103(4):803–814)

 
 
 

Belly support for back pain during pregnancy

Bringing new life into this world does not come easy.  There are some products to make it more comfortable, however. For a sore belly and back (after being evaluated by your fantastic physician or nurse midwife), consider a belly support strap. These great devices can help redistribute the weight of the baby-to-be and help you be more comfortable.