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Enoch Choi, MD  
Male, 39
Palo Alto, CA

Specialties: Family Medicine

Interests: sinusitis, Migraine, Low back pain
Palo Alto Medical Foundation
Urgent Care
Palo Alto, CA
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Tips on telling a cold from a bacterial infection: sinusitis, pharyngitis, bronchitis

Jan 30, 2008 - 108 comments
Tags:

bacterial

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sinusitis

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pharyngitis

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cough

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sore throat

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Bronchitis

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Infection

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Cold



The flu has passed epidemic rates in much of the country, and if you don't have a cold, I'm sure you have a friend who has the sniffles, fever, chills, aches and pains of a viral upper respiratory infection.  This is different from a bacterial infection such as sinusitis, bronchitis, or pneumonia.  A viral infection doesn't improve with antibiotics as these infections do.  A virus hijacks your own body's healthy cells and uses it to reproduce and spread.  A bacteria is its own living cell and multiplies and spreads on its own and is easier to destroy in that process.  

Speaking of outbreaks, influenza is finally reaching Palo Alto right around now. If your doctor knows that your own area is experiencing an outbreak of influenza, it may be reasonable to treat with antiviral drugs, especially if your temperature is more than 100 degrees and your symptoms have lasted less than 48 hours, and you don't have pneumonia. This is because antivirals won't help if given after 2 days of symptoms. They work by stopping the spread of the virus and if you take the antiviral too late, it's too late to stop the spread, it's already happened.

Here are some guidelines on helping differentiate between run of the mill colds and more serious bacterial infections:




When do I need antibiotics for a cold, as an adult?

Never.

Are you sick with a runny nose, sore throat, cough, possibly even goey green and brown stuff coming out? Well, you're not alone, you've got a cold like millions of other adults right now around the world. Colds are upper respiratory infections that are almost always caused by viruses in adults. They typically get better after a week to ten days.

Viruses can even cause colored mucous, that thick discharge you can't see through, which many people believe only can come from a bacterial infection. Colds can even cause pressure in sinuses, when viruses affect the sinuses .
Antibiotics don't help in these viral infections. Treatments aimed at reducing symptoms can help. A recent review in the American Family Physician journal on Feb 15, 2007 highlights some of the treatments that are helpful in the common cold and how to tell if you're getting worse than just a viral infection:

http://www.aafp.org/afp/20070215/515.html

http://www.aafp.org/afp/20070215/522ph.html

symptoms that are worse than those of a normal cold or that haven't gotten better in 10 days

• a high fever

• an earache that gets worse

• a pain in your face, especially on one side

• shortness of breath

• a health problem that makes it more likely that you will have problems with a cold (for example: asthma and other lung diseases or a disease that affects how your body fights infection)

These are general guidelines, meant to be taken in the whole context of your health history by your doctor.

Conditions that increase the risk of bacterial infection including the complication of pneumonia include the elderly or those with heart and lung disease. Another helpful reference includes the American College of Physicians, Annals of Internal Medicine, 20 March 2001, Volume 134, Number 6. http://www.annals.org/cgi/content/abstract/134/6/479





When do I need antibiotics for sinusitis, as an adult?

Doc! My face hurts on one side and colored mucous is coming out! These are common complaints from adult patients who think they have acute bacterial sinusitis. What people don't know is that it's not common before 7 days of illness, and it's usually best to hold off on antibiotics until symptoms have stuck around for more than a week. Sinusitis is different from the first few days of stuffiness and pressure from viral illness. Clues that you may have a bacterial infection include

- pus coming out of your nose,

- upper tooth pain or pain in your face,

- sinus pain on one side,

- new or worse symptoms after initially improving after a cold

Instead of antibiotics, reach for over the counter painkillers, fever reducers, and decongestants. When it's more clear to your doctor that you do in fact have a bacterial sinusitis, your symptoms will be more moderate to severe, and can be treated with antibiotics that are more narrow-spectrum such as amoxicillin as a first choice. Later generation antibiotics that have broader coverage across more kinds of bacteria should be reserved for complicated infections.

These are general guidelines, meant to be taken in the whole context of your health history by your doctor. Another helpful reference includes the American College of Physicians, Annals of Internal Medicine, 20 March 2001, Volume 134, Number 6.

http://www.annals.org/cgi/content/abstract/134/6/479






When do I need antibiotics for sore throat?

Rarely.

Doc, I'm sure I have strep throat, it's killing me! Well, you may have it but it's pretty unlikely. Only 5 to 15 per cent of people with sore throat have Group A beta-hemolytic Strepococcus bacterial infections. Most cases are viral. Your doctor may consider treating for strep if you have at least 3 of the 4 following signs: fever, pus on tonsils (exudate), tender lymph nodes in front of your neck (anterior cervical lymphadenopathy), and lack of cough (no coughing). If so, treat with antibiotics that are more narrow-spectrum such as penicillin since there's virtually no resistance to penicillin by strep in the community. If less than 3 of 4 of these signs are positive, then wait for your strep test or throat culture to show a bacterial infection before taking antibiotics.

These are general guidelines, meant to be taken in the whole context of your health history by your doctor. Another helpful reference includes the American College of Physicians, Annals of Internal Medicine, 20 March 2001, Volume 134, Number 6.

http://www.annals.org/cgi/content/abstract/134/6/479



When do I need antibiotics for bronchitis?

Almost never.

Doc, I can't stop coughing and am bringing up pus. Well, you're not alone. Millions of other people are in your shoes right now, and over 90 per cent of them have viral infections with coughs productive of colored phlegm.

You should watch out for symptoms of pneumonia but if you have a fever under 100 degrees, pulse rate less than 100, less than 24 breaths per minute, and your doctor doesn't hear anything in your lungs, you can be reassured that pneumonia is unlikely. If your doctor is worried that you might have pneumonia, a chest x-ray can look to see if there's an infection, especially for those who have coughed for more than 3 weeks.

With a viral bronchitis, you should avoid antibiotics especially zpacks (Zithromax / azithromycin) which are overprescribed for these symptoms , and can lead to side effects and adverse drug reaction such as rash, antibiotic drug resistance and yeast infections. Instead, helpful treatments include cough suppressants, bronchodilators (albuterol inhalers), and antihistamine-decongestants.

One possible exception is that you might need antibiotics in an exacerbation of COPD (emphysema or chronic obstructive bronchitis) expecially if you have worse shortness of breath and productive cough of pus.

Another possible exception is that you might need antibiotics in case of an infection with pertussis, where you cough for more than 2 weeks AND have an uncontrollable cough which can cause vomiting, or a whoop sound when you breathe in. In this case, your doctor may swab to look for pertussis, and may choose to start treating you with erythromycin or azithromycin (zithromax) especially if there's an outbreak of it locally in your community, just as we've had here locall in Santa Clara County.

These are general guidelines, meant to be taken in the whole context of your health history by your doctor. Another helpful reference includes the American College of Physicians, Annals of Internal Medicine, 20 March 2001, Volume 134, Number 6.

http://www.annals.org/cgi/content/abstract/134/6/479





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by chigirl29, Jan 30, 2008
Great post, Dr. Choi.  Our dr. just prescribed antibiotics for a viral illness--with no secondary infection present or one detectable.  I think more doctors should read this.  Antibiotics are way over-prescribed.

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by Enoch Choi, MDBlank, Jan 30, 2008
thanks for the kudos!  they sure are over-prescribed!

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by lksa, Jan 30, 2008
Doctor Choi,
It is so refreshing to have a web page like yours that just gives us some good common sense information . I get so annoyed when I receive emails claiming cures for all sorts of ailments, and then after scrolling through ten or fifteen testimonals, they say "Just sent $49 and I'll disclose these three simple ingredients for you." They are usually titled, "Things your doctor doesn't want You to Know." I never fall for this junk, because I know that any doctor who stumbles on a cure for cancer will not ask money for his "secret." There was one advertisement on your page, doctor, that tauts a cure for chronic bronchitis. He states that this miraculous cure was "given" to him by an elderly lady that lived across the street from him. I wonder why, if it was given to him , he can charge for it.
What do you think of these practices, doctor Choi, and why are they allowed to scam people like this?
also, do you know that they are advertising on your site?

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by itsallwaves, Jan 30, 2008
At what points during a cold are you considered contagious?

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by kimber54, Jan 30, 2008
I agree with what you are writing especially being a nurse.  I use homeopathics and herbals to help which do most times.  But this time, after getting the respiratory flu, I had terrible pain in my chest, a high pitched inhalation when having paroxysms of coughing, and a cough not responding well to OTC stuff.  Using tessalon perles helped the cough abate but I had awful tasting mucus, was unable to bring it up and horrible shortness of breath with what is normally unchallenging activity.  Being the weekend, I went to a "minute clinic" and was seen and although I was not super congested in my lungs, based on symptoms I was given azithromycin.  Within 48 hours, I was a new person and the chest pain, shortness of breath, etc. lifted.  The awful taste is also gone.  This was less than a week of being ill but I feel I really benefited from the antibiotics even though based on your criteria above I should have waited or avoided altogether this medication.

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by Jody515, Jan 30, 2008
Thank you so much for your insight.  I also just went thru a similar issue with sinus issues, headaches, & upset tummy.  I thought it best to just ride it out.  I did & feel much better & glad I did so without running to the doctor or pharmacy. I do not want to take antibiotics unless absolutely necessary.

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by itsallwaves, Jan 30, 2008
In addition to my question above, I forgot to ask if it's ok to get a flu shot when you are just getting over a cold.

Thanks for this great article!

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by gracem, Jan 30, 2008
Ok.... But here is the question......   My Daughter seems to have cold symptoms since before Christmas....  Hacking cough.... sore throat.... tired....   I thought she must have strep or mono.... It has been going on for over 1 month.... She has gone to the dr. for codine syrup... now has some anti biotics.... But NO ONE ELSE in the house is getting these symptoms??????   Years ago my cousin had a persistent tickle in her throat and as time passed she finally saw a country Dr... who identified it as Hogkins.... So I'm worried about my daughter not imroving and Not Spreading this to the rest of us... she is 18 and in college.

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by tkuo, Jan 30, 2008
Dr. Choi,

Helpful article indeed. are there any recommendations for those who has already been infected by bacteria? For example unexplained chest pain for months? How to prevent cells from being hijack by bacteria? Cheers.

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by jlk1947, Jan 30, 2008
Dr. Choi
I understand and agree that antibiotics can do nothing for the common cold. I am a 61 year old healthy woman, I do have asthma but not severe.  Since September I have had 6 colds, runny nose, cough (sometimes very severe), facial pain around my sinuses, achy - no temp. I seem to recover for about 10-12 days when I get another cold. I do not see the doctor because I know there is nothing to be done for them. I did see the doctor for another reason with my last cold 3 weeks ago and he did prescribe antibiotics not for the cold but because my ashtma. In about 2 weeks I was feeling better, yesterday I came down with another cold. My question is if there is a reason I'm getting back to back colds that I should be concerned about?  
Thank you.

JanK

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by amishra, Jan 30, 2008
THANKS DOC!

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by Maengo, Jan 30, 2008
Thank you Dr. for this valuble information.

In response to the question above:
I am often wondering as well, exactly when one is contagious with the cold...is it true we are only contagious before the actual symptoms begin? Thank you.

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by MJIthewriter, Jan 30, 2008
I must be one of the rare people who do occasionally get bacterial secondary infections as a complication of getting a cold.  My hypothesis is that my chronic sinus allergies keep my sinuses inflamed, so when I get sick, I'm especially weak there. It seems the sinus infections would most often occur at the peak of allergy season, being fall (ragweed) and spring (tree pollen).

Thankfully *knock on wood* it hasn't happened in about three years, but in the past I would get terribly sick with sinus problems. I would wait it out for about 5 days to a week and see if my symptoms got better.
Eventually it'd get to the point where every time I exhale I'm blowing out thick gunk and feeling terribly sore.  Those times it would not clear up on its own but it did get better after taking antibiotics. I can't take Penn. so my choices are usually limited to zythromax (sp?)



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by Enoch Choi, MDBlank, Jan 31, 2008
to itsallwaves:  ironically, one is most contagious the week up to the point of starting to show symptoms since the viruses are most active spreading at that time.  One continues to be contagious as they are coughing/sneezing.

OK to get flu shot, but best to wait until any fevers subside for 24 hours so you don't get that illness mixed up with thinking that it's from the flu shot.

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by Enoch Choi, MDBlank, Jan 31, 2008
to tkuo:  best way to avoid getting hijacked is to use universal precautions: wash hands often, stay away from those who cough/sneeze

if you do haev a bacterial infection, antibiotics can help

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by Enoch Choi, MDBlank, Jan 31, 2008
to MJIthewriter:

I would question if you really had bacterial infections, and could possibly get better with nasal saline rinse and nasal steroids.

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by babahjoseph, Jan 31, 2008
I am feeling pain on my chest and i feel the cold on my throat when talking trying to come but it does not and i did not cough.Is it a sign of cold and i am feeling pain on the back of my neck.
Please help.
Joseph Babah
Freetown Sierra Leone.

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by rworell, Jan 31, 2008
Dr. Choi, I too thought that I had an Sinus infection and its been about 15 days but my symptoms are not that severe. my Colds almost always run 10 - 14 days long. Severe at first and then just take forever to leave my body. Is that uncommon??

My symptomos were  Slight pain between the eyes and thick green mucas in the nose.  My doctor prescribed Afrin for twice a day for 5 days and if I don't get better then to call and he'll prescribe an antibiotic.

sounds like you were dead on.  I appreciate the explanation.

Rich from Maine

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by watchjack, Jan 31, 2008
Good input Dr.
limit drug intervention, and 'beef-up" the imune system; at the same time short circuit distilling a super-strain of  bacteria.
This is a usefull first step, now we need to look at prophalactic use of antibiotics in animal feed. USA is one of the last remaining few countries that have not outlawed this practice.  Granted cattle gain 10% more weight per unit of cattle feed consumed, but at what cost. Cattle breed resistant  bacterial strains with their gut that people are eventually exposed to, due to inefficiencies in the slaughtering procedure. When experts suggest that cattle should be put on a grass diet; off the corn based diet; for  two weeks before slaughter in order to 'clean out the gut' prior to slaughter; the industry complains of lost profit due to the weight loss in the cattle. We only hear about occurences of food poisoning on the grand scale when many perple are affected. We never hear of the individual cases where people lose one or two days  at work, or possibly more that 'catch' colds' due to the  (sub-clinical) depleted condition of the immune system fighting diet related conditions.
Poultry; in confined pens, display agressive scratching behavior when their  'personal space' (or chicken equivalent)  is violated. This leads to infection and reduction in profits, hence pre-emptive antibiotic administration in the feed.
Maybe these industries should be linked to the health care industry, by tax, based on the number  of occurances of  'industrial practices'  based diseases. We  should pay more attention to this as people are generally  "inoculated" with antibiotics 2 or 3 times a day this way and not only during the flu season. There is another area of study, just beginning, investigating the effect of these  pharmacuticals after entering the 'receiving stream' in out  streams and rivers. The possible impact of  constant low level exposure of  antibiotica on the  environment with possible devestating results. Colera, and other water born diseases that do not respond to  treatment!!!!
By the way none of this is new, I did a term paper on this in college 18 years ago. Way to go media!!! Lets keep pushing a socialized medical system!!!

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by friggy, Jan 31, 2008
Dr. Choi, thanks for the bronchitis information.  I think my kid's getting it right now.
Here's an interesting study on how the flu virus spreads, to add to your already impressive knowledge.

http://www.nytimes.com/2007/12/05/health/05flu.html?_r=1&scp=1&sq=flu+likes+winter&st=nyt&oref=slogin

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by lmusique, Jan 31, 2008
I agree with you that Antibiotics should not be taken unless really necessary.  I always thought that if you have a high fever for several days, that was a vital sign that your body is fighting infection!  That used to be what the Doctors would say ... but now they say it's a virus and time will heal the pain and suffering.

So, what I am wondering is if you let your child run a fever for 10 days and then you discover that there is an infection ... that means that your child missed 10 days of school + another few days before antibiotics start working.  My 17 year old child was recently checked for Strep Throat (3 times) and Mono (twice) and all the tests were negative.  He was in a LOT OF PAIN, high fever, for 4 days but because the tests were negative, the Doctors would not give him any medication, until finally, we brought him again to a Doctor (3rd time) and she finally gave him Penicillin.  As soon as he started taking Penicillin, his fever went away and he began to feel better.

My child took Antibiotics only a few times when he was a small child for ear infections.  For the last 13 years of his life, I don't ever remember him taking Antibiotics or ever being that sick.  He is very active, plays hockey and soccer, loves to go to school and he sometimes gets a minor cold here and there but for the most part, he is in good health.

Now, I can't imagine why anyone (Parent or Doctor) would want to let a child or an adult hang around on a couch, in A LOT OF PAIN, for 10 full days.  That is just cruel to me ...  I think that after 3 days of having a high fever, that is a sign that there is infection somewhere.  His symptoms were:  sore throat, swollen tonsils, blisters in his mouth, high fever, gums were bleeding, gums were white and sore, very tired and weak  - he had no runny nose, no sneezing.

My son could not even eat because he was in such pain and after 4 days, he couldn't even drink water, he was in such pain ... he lost approx. 10 lbs in only 7 days, imagine if he would have gone another 5 days.  He had three Strep Throat Tests and two Mono Tests and everything came out negative so according to the Doctors, there was no reason to give him antibiotics.  But I did not give up, I kept bringing him to a Doctor until I finally got Penicillin for him.  Now maybe I was wrong in giving him Penicillin, but my son is back to school (he missed 6 days of school) and he is almost back to his old self again.  This will remain a mystery for us ... did he only have a virus or did he actually have an infection somewhere in his body.  I would like to think that the FEVER was a vital sign that there was an infection somewhere??~!!!



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by djkyosti, Jan 31, 2008
Dr. Choi:
What you have explained here is consistent with what my doctor told me yesterday.  I had a cold for a few days that seemed to be getting worse.  By the fourth day I had a low grade fever, sinus drainage, sinus pressure, sneezing and felt unwell so I went to see my doctor since I am prone to sinusitis and have asthma.  The doctor told me that he thought I just had a cold and that it should clear up on its own.  He did not think it was bacterial and said I did not need antibiotics.  I asked how one knows if sinusitis is bacterial or viral and he said that the indicators are duration and fever of 101 or higher.  Since I already feel better although do still have some drainage (including a small amount of blood after blowing my nose which I thought was a sign of bacteria), I think that this conservative approach of not prescribing antibiotics right away is the best course of action.  It also seems to me that some doctors would have prescribed me antibiotics and I would have felt better and would have assumed it was from the antibiotics even though I would have made the same recovery without them.  

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by Joeboo, Feb 01, 2008
Hi Dr. Choi,
I goto your El Camino place on El Camino Real All the time. In fact I think Dr. Markovitz is pretty much done seeing me...

Well, I will come say hi next time I am in Urget care, where I catch most of my infections.



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by looloo1122, Feb 01, 2008
I agree how the use/abuse of antibiotics can happen. Your article was very informative. I am just getting over a cold. Never even considered going to a doctor even though I was out of work for 2 days. I used a Neti Pot on my sinuses and think it helped a lot. It has been one week and I feel great now. Some people just don't understand that abusing antibiotics is bad for them.  Thanks Doctor!

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by harmonytx, Feb 01, 2008
Hello Dr. Choi,
Just want to say "Thank You' for taking the time to share this helpful information, I appreciate it very much!

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by MJIthewriter, Feb 02, 2008
Thanks. This last year I've been put on Fluticasone for my sinus discomfort. I wonder if that could be one reason I've been doing better this last year than other years?

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by Enoch Choi, MDBlank, Feb 03, 2008
to everyone who's so sweet, You're Welcome!

to rworell: afrin is fine for folks without hypertension, but watch out.  Your doctor asked you to stop after 5 days, because it's potentially habit forming after just 3-5 days of regular use.  My ex-roomate from college was addicted and took many months to wean off of afrin

to MJIthewriter:  Fluticasone (flonase) is very helpful as a nasal steroid to reduce inflammation, swelling, mucous production.  it's most useful after clearing your nose with saline (salt water, such as Ocean)

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by slelle, Feb 17, 2008
Dr. Choi,

My husband was on a business trip to California last week and came back to Chicago very sick on Tuesday.  We had to take him in to the emergency room on Thursday (we just moved to Chicago and don't have a physician yet) because his fever was 104.5 and I was really worried.  They told him that he did not have pneumonia but rather Bacterial Bronchitis and gave him Z-pak and an inhaler.  I can't remember the name of the inhaler prescription.  He is finally starting to feel better this afternoon after 5 days of pure hell but he is worried that he may still be contagious.  We have a 7 month old daughter.  Should he still be worried about holding her?  I assumed that as long as he practiced good hand washing that it would be ok.  What are your thoughts?


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by Enoch Choi, MDBlank, Feb 17, 2008
hand washing is great, very helpful to keep the large respiratory particles that are being coughed onto them from spreading to your child.  Wearing a mask is hepful as well, for he same reason.

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by bikermomma, Feb 17, 2008
Loved this post. It helped me in so many ways.
Thanks,
Jen

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by Maryjaine, Feb 25, 2008
Dear Dr. Choi, My 15 year old son has been battling a severe sore throat for six monthe now that I have been really keeping track. Everytime His pcp has been perscribing antibiotics. They have helped him within two days . This time he would not saying it was viral. The antibiotis were just a bandaide. First of all why did he need a bandaide in the begining. Next for the sake of him being in severe pain, why cant we put the bandaide on again and run further test to see why we needed it in the first place? My frustation is for my son. He has endured this pain for too long and missed too much school. What should be my next step.. He already has an appointment with Ear nose throat Doctor .Should I take him there or am I overreacting?  I was told by the ER doctor that STREP and Mono were the only two bacterial infection affecting the throat.

Thank You,
Dawn

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by cautious69, Mar 14, 2008
Thanks for the insight.  I was just diagnosed with acute bronchitis and was given a prescription for anitbiotics.  I have a question.  My 13mo old has had a cough for about 10 days.  He is not constantly coughing just 2-3 times a day but when he does cough it sounds like he is trying to cough something up.  Since he cant take medicine what is the best way to get that stuff loose and out of his chest?  

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by Enoch Choi, MDBlank, Mar 14, 2008
Maryjaine, yes, an ENT would be a good doctor for your son to see

Cautious69, the best idea is to have your 13 mo old to be examined by his pediatrician since a viral cold often gets better in a week or so.  You're right that those under 2 are reccomended NOT to take over the counter remedies since they don't work.  A humidifier sometimes helps.

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by PlateletGal, Mar 14, 2008
Dr. Choi,

Thank you for being responsible and not over prescribing antibiotics. I used to get sinus infections all of the time (I have CFIDS) and frequent URI's. With the help of some naturopathic physicians, I now know how to get rid of these infections without taking antibiotics.

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by PlateletGal, Mar 14, 2008

Tricks I've learned through Naturopathic physicians and/or homeopathic practitioners on how to beat a sinus infection and an URI (upper respiratory infection) --- WITHOUT antibiotics.

Sinus Infections:

J's NOSE DROPS --- a Naturopathic physician gave me these once and these drops actually worked for me. I always tried the saline drops, but that wasn't enough. The nose drops can be purchased online and they are easy to use. The ingredients in the drops (in case you may be allergic) are organic borates, sea water, alcohol, irish moss extract, echidnae, calendula, golden seal, marigold, iodine, methylene blue and flavored with pine oils.

BI YAN PIAN --- These are herbal supplements that have not only gotten rid of my sinus infections (just like the drops), but also help with my allergies as well. My mom is taking these now and she's amazed.... she's already beat two sinus infections using this product alone. This product helps with the inflammation and also dries up mucus, so that your nasal passages will open. You can purchase this product online, but I would highly recommend purchasing a brand that is made in America. Since this is an herbal remedy, you may want to consider talking to your physician before using them and/or try taking one tablet first to make sure that you aren't allergic to any of the ingredients.

URI:

CAYENNE PEPPER (liquid drops) --- A Naturopathic physician taught me this trick. You can purchase the drops either online or at a local health food store. OK... they don't taste great in your water, but they have killed every URI or bronchitis infection that I've had. After years of being on antibiotics, I was so happy to find out that I had another option. I just add a few drops to my water when I have either one of these illnesses and drink tons of water throughout the day. I told a physician that I used to work with about this trick and she told me that it makes since since cayenne pepper is a natural dilator. Cayenne pepper also works on sinus infections.


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by lmil, Mar 27, 2008
Thank you very much, you post is extremely helpful. I wish that there would be more doctors as you. I live in Columbia, MD and every doctor that I've visited seems to be a complete moron. I want to believe that they are not idiots; after all they made it through med school. So it’s probably lack of care.

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by Enoch Choi, MDBlank, Mar 29, 2008
Imil, not often a lack of care (i hope), it's also due to risk aversion, it's less risky to prescribe an antibiotic so patients can't claim you've undertreated them

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by Bogdan82ro, Mar 31, 2008
Hi! How do I know if a have a virus, bacteria, or fungi in the sinuses. In the morning I discharge little secretions that are clear sometimes and sometimes yellowish. Most of the time I don't discharge anynthing and I feel a pressure around the eyes, which have become more sensitive. I' ve tried multiple courses of antibiotics with no result. It remains to be seen if it is a virus or a fungi. How do i detect that?

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by peanut1988, Apr 01, 2008
Dr. Choi –

I had a raw throat (not soar) for close to a month then it sort of went away (saw my Doctor, she said it was viral) and bam I got this chest (sore feeling) after seeing her where I was coughing and felt like **** for almost another month.  I didn’t see my DR. again because why waste her time or mine to say “get lots of rest, drink lots of liquids”…..I would think I was getting better then BAM it affected my voice a bit (talked froggy like) and I was coughing, almost like a smoker’s cough (I’m NOT a smoker).  I worked during the week, went straight home and rested and didn’t go out too much on the weekends.  Now it’s finally a month to 6 weeks later going away but I still feel soreness in my chest and whenever dust or anything is near me I tend to cough but NOT coughing up flem and its not out of control. I cough a bit at work too, not a lot – its like this smokers cough that stays with you forever.  I live in Los Angeles.  What do you think I have/had?  I’m not 100% but more like 90%


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by myrasol_2004, Apr 03, 2008


Hi, My daughter she is 3 yrs and 4 mos., she started schooling from last September, and from that time onwards she keeps on getting sick. But from December to this day we noticed that her throat and ear infection keeps on coming back, within only two to three days interval of feeling better from one or two weeks of infections, her throat had fuss and her fever is so high, lately her pediatrician prescribe her Ospexin and three consecutive days of injecting her gentamycin. She felt better but in next three days she again got the same infection, and her pedia prescribed Augmentin, and for five days again, gentamycin injection which lasted yesterday. She suffered a lot already, she lost 1 and a half kg., because of poor sleep and less food intake during the period of throat pains. She has to continue her augmentin for ten days, today is day 6. She had cough and colds initially then now it's gone, but I am afraid her case will come back again, and afraid antibiotics will be prescibe again. The side effects are what I'm worried with, and of course the pain she'll go through, I am actually freak clean than before since these incident but next week she has to go to school and I am real scared of what will happen to her..This gave a very negative thoughts and feel drain and helpless, please advice...

May

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by Enoch Choi, MDBlank, Apr 03, 2008
Bogdan82ro,  after multiple courses of antibiotics, less likely to be bacterial and more likely viral.  Fungal infections can been appreciated by looking up in your nose.

Peanut1988, a sore chest is not uncommon after coughing from straining the rib muscles, cough can also make you hoarse, and a cough can last for weeks to months after a cold so it's not uncommon to have a cough now and then like you're having.

myrasol_2004, i've got a similarly aged child, and since sending to preschool, same thing -- always getting sick.  If after multiple courses of oral and injectable antibiotics i would worry about the side effects too.  ask your doctor if she really needs them or if it's just to be extra careful, because sometimes these are viral infections which go away on their own.  Don't despair, try to fight those negative thoughts, and overcome the draining helplessness by asking for more help from both your doctor and your friends.  Don't give up!  It's hard but totally worth it when your child is feeling better!

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by Kristina7, Apr 05, 2008
Dr. Choi,
  I was having some sinus pressure and swelling that went into my ear and caused some dizziness maybe allergies. Then I made a big mistake and went on our planned trip up to Mt. Rose elevation 10,000. It became terrible worse when I got back. The doctor said I had fluid and pressure in my ear. She put me on prednisone for 5 days, seemed to help. But earache continued for a total of 2-3 weeks I went to another doctor and she also said there is no infection. I thought it was getting better but now 5 weeks later the right ear started a very light ring and pain again. I am concerned with if there is an inner ear infection that they can't see? I am taking high doses of Aleve or Advil and it is helping keep down the inflamation, but it also reduced fever. I have had a fever of 99.8  with fever reducers. It is just taking so long I am worried what if there is an infection?
Kristina

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by sky72, Apr 05, 2008
Good advice doctor.  I woke up with a very sore throat yesterday, with some nasal stuffiness, colored phlegm a mild cough.  I had the flu shots but i knew that would not prevent me from getting the flu.  I'm just wondering though, I saw some white stuff on the left side of my throat.  Now, that gets me worried.  Should I get a consult for that?

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by myrasol_2004, Apr 12, 2008
Thank you doc for your good advice, but after my daughter I would like to ask you about my health. I forgot to mentioned last time that I was also getting the throat and ear infection infection from time to time. But I believed she could be getting the infection from me.
  Three years ago I suffered from UTI after giving birth to my daughter, I was constantly having it, that every month I visited the doctor at least twice and everytime I was on antibiotic for last two years. It was really hard for me, mid of last year it slowly disappeared, doctor visit is gone. But around November last year I started having this earache and sore throat, that I again started going back to the doctor and everytime I was prescribed antibiotic again. It was hard to notice how everything had happen, since I have two kids and it was winter I thought it is because of flu season or changing weather, now my kids are ok, esp the little one, the climate had change now, too warm where I am but from last Nov. till now my infection didn't go even my doctor keep changing my antibiotic, I researched about it, Could it be that I am having MRSA? I wanted to go back to my doctor but I know I will go for another course of antibiotic, so should I tell him about this, in fact I changed from one doctor to another, cause it seems nobody could give me the right medicine, please help me again...

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by JJKVI, Apr 30, 2008
Not sure if this is till open but....I have a history of mild asthma. 31 days ago I came down with a cold that aggrevated my asthma & gave me ear infections in both ears, sinus infection, bronchitis & some pneumonia and on & off fever. I was originally prescribed a Zpak (by Urgent Care before pneumonia set in) and then a 7 day course of Levaquin (by my Allergy & Asthma doc) and also was on a 20 day course of Prednisone. We thought I was pretty much better last week…although some coughing it was pretty benign & sinuses a little stuffy & some colored mucus..but I didn’t push for any more antibiotics or any further care. Well, within a day or two all the symptoms (stuffiness, constant production of yellow/green mucus from both nose & lungs) returned along with fever & chills. This happened at another point earlier on where I had one or two days of feeling better but then the symptoms returned. Anyway, I am now on a 20 day course of Ceftin. The asthma is being controlled by various inhalers but re: my sinuses & lungs I am wondering if it is possible that I’ve just had a nasty virus..or maybe caught two back to back.. this whole time & all of these antibiotics are maybe useless? I’ve been on the Ceftin for 4 days now & haven’t had much improvement. Should I push for a culture? I haven’t been able to smell or taste for over a month. Every time I talk to clients on the phone they ask if I have a cold because I’m so nasally and can’t talk for more than a couple of minutes without coughing. This really needs to stop. Any suggestions would be appreciated.



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by Mollsker, May 16, 2008
Dr. Choi,

I've scoured the internet for years for this type of information as I am always getting URI - last year I was very sick and my Kaiser doctor told me it was likely the "100 day cough" that was going around.  After spending a month in bed, I demanded antibiotics as I have a history with URI and felt quite sure it was bronchitis and quite possibly turning into pneumonia.  She prescribed the anitbiotic and I was better in 5 days.

Thanks for not only providing details on the symptoms and treatments but also responding to folks' questions. I wasn't expecting that at all when I began reading the thread.  What a great service you are providing to the general public.  Thanks so much!

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by cheekymamac, Jun 02, 2008
Virus worse than a bacterial infection?    How fast for a viral infection to pass from person to person?

I and my family have experienced a viral infection that has spread to three family members all in 3-4 days first noticing a burning heavyness in the chest, slight coughing and shortness of breath, then within 2-3 days later coughing up phlem, increased shortness of breath, loss of voice-difficultly talking, not wanting to eat, fatigue, dizzyness when walking, raw buring throat, lozengers are a must-can't breath without them due to coughing fits and extreme pain burning when coughing. This viral infection started from a freind with this viral cold and the coughing had passed on this infection that had started as viral, told by her doctor then turned into a bacterial infection.I and my family had only been around this person for a 3-4 days before all 3 of us coming down with this. Now 2 of us have a bacterial infection, bronchial pneumonia.I have been to the doctor 2x for this and have not been prescribed anything. I have been told both times it is viral.So do I wait and see if it goes away? I have missed 3 days of work and have been on days off for the week. it is just over a week and I am still couhging up phlem and it now is into my sinuses, chest pain is bearable now and the burning throat ...whew gone.still fatigued, shopping, washing floors and day to day activities. My head is clearer and able to think of more than beyond myself.This viral thing has completely taken us by surprise and with we couldhave been more prepared. I am doing everything to protect my family from getting this, hand washing, sanitizing spray in the bathroom after each use, disinfecting jel when I can't wash my hands, spraying the phones,remotes, and staying away from the public including work, as there are may other co-workers that  I share the phone with and in close contact, With families who have sick parents going thru chemo and have other health issues this is very important. My parents are the other 2 who have come down with this so called viral infection and it has nocked them both off their feet. It has taken another 2-4 weeks of their health away from them.So I have decided to put up a sign for friends and family if you are sick with viral or bacterial infections-Please Stay Away until you are better :) /these viral infections seem to be more severe and harder to get rid of especially if there are complications.

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by cheekymamac, Jun 02, 2008
Hi Dr Choi :)

Lots of great advice in the previous posts.
This has been very useful information I have sent the link to my family and hope that they could use some of the advice in these posts.As far as my symptoms I think I'm feeling better, in some ways and then something else comes up,like an ear ache that isnt going away with motrin.I have had pain in both my ears that run down the sides of my neck and travels behind my ears..Also the pressure and pain in my throat :( nose congestion and (coughing which is less)still painful to cough.It seemed to get worse when I had gone grocery shopping and picking kids up from school where I was talking more than I had been all weekend.
I deal with migraines and kidney stones and this virus is really putting a damper on my work and family life. hhhmmmnn need a get better pill :) I have been taking multi-vitamins, vit-c that you swallow (chewable vit-c burns the throat),vit-d,echnachia cough candies (must have),over the counter cough syrup(burns throat) no buckleys please.least not now,vics vapor rub(good anytime when sick)    Usually I try to avoid taking antibiotics if I have a choice and when I do I am adamant on finishing. The 2x i have seen a doctor I have requested an antibiotic,but to no avail. With the new symptoms ear ache becoming more and more painful I may have to see a dr. I have had my tonsils out over 6 yrs ago and find when I have a sore throat it affects my ears and pain travels down the sides of my neck.
Viral or Bacterial ? How do we protect ourselves? Whats the best way to build up our immune systems when one has been on antibiotics?  


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by cheekymamac, Jun 03, 2008
Hi Dr choi :)

I dont usually post and rarely spend time on the computer.And I havent given a cold virus this much attention.Even if it is for my own way of coping with this, writing it down keeps me busy.It has caused me and my family to take viruses a little more seriously.It is now day 9-10 and I still  feel no relief. Between painful ear aches and bleeding nose in the middle of the night and puss in both my eyes along with the uncontrollable coughing, chest pain and stuffy runny nose I have found very little relief. I have not had a virus quite like this... I have rebooked yet another Dr appointment and will insist on an antibiotic. This will be 3x going to see a dr. One of my parents have also had a bleeding nose, puss in the eyes and major earache. We live in diferent communities and have been exposed for the first 3 -4 days.
If you were in contact   with someone who has a bacterial infection would't you more likey to have a bacterial infection of some sort.

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by PoorBaby, Jun 21, 2008
Dr. Choi,

Thank you for this site.  I got a cold 10-12 days ago and seemed to be over 5 days later.  Two days later, I felt like I was getting another cold without the fever/chills.  It progressed over 5 days to sinus/head pressure with yellowish mucous (sorry).  Should I do anything else than what has been recommended for cold treatment?

Thank you,
Poor Baby

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by girlvet, Jul 28, 2008
Dr. Choi you are my new hero.  As a recent survivor of Clostridium Difficile, I applaud your over-use of antibiotics  stance - as that is what contributed directly to my illness.  My neti-pot is my new best friend..lol.  Thank you for spreading the word.

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by LMFrance, Sep 29, 2008
Hi Dr. Choi! I just read your article...and i have a question for you. I had a "sinus infection" a couple of weeks ago, i had an ear infection too, a really bad ear infection. Then....about a week after i finished the antibiotic (i took it for 10 days) i started feeling sick again. i went back to the doctor and they said that the "sinus infection" hadn't gone away..and they prescirbed me a zpack...now im on the zpack..then i developed a cold...so i have a sinus infection and a cold...but now i have this horrible cough...i dont cough persistinelty..but when i do cough all the mucus is in my chest..so it wont come up..and when i cough i always feel like i have to puke. i've had a fever for the past 4 days now...it's been to 104. i've kept it down with tylenol...but i still feel horrible...i also have this horrible stomach ache...i think it hurts bc i haven't eaten, but when i eat it doesnt go away...my heart is racing and when i breath its very deep...im dizzy and i've just had the worst past couple of weeks..please let me know what to do.

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by helscha, Oct 07, 2008
Dear Dr. Choi,
last winter I had the worst cold ever, it lasted 4 weeks.  I rode it out because for some reason I did have some energy left and no sinus headaches.  Mostly cough all the time with lots of pus.  For maybe a week I had red eyes and pus coming out of them which I noted when waking up in the morning.  My eyes were nearly shut.  I didn't think I would die because I heard that it was going around.  My question, was it bacterial?  I live in the Peninsula also.
I am asking because now I have another cold (day 14) with lots of light to medium yellow pus from the chest (yellow and sweet tasting) and the nose, some sinus headache with it.  No fever for 12 days but now suddenly 102/103, not above yet, I am watching it.    I have absolutely NO energy this time, aches over all my body also.  It is like the other cold last winter except I have no red eyes. When I exhale there is this gurgling sound which makes me cough up the pus, no shortness of breath.  


Could it be bacterial and I should take antibiotics?  This mornign I canceled a flight.  Didn't want to take this to the people I was going to visit.  Took some Advil, feel a bit better after it.

Only very positive thing is that I have no appetite and finally lost the 5 pounds.  I'm thirsty and drinking LOTS of fluids.

Thanks, Olga



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by parlance, Oct 08, 2008
Dr Choi, thanks for this extremely helpful post.
Like other readers, I searched because I have a viral cold and my doctor said that even the yellow gunk coming out of my nose wasn't a sign of bacteria. Thanks for reassuring me about that.

My question is this: I have (bravely) been chewing and swallowing two whole cloves of garlic mixed with a big spoonful of honey - I can only bear to do it once a day. I made up this idea myself. It seemed to clear my head. Do you think this is a useful thing to do?
Thanks, Catherine

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by helscha, Oct 09, 2008
I posted two days ago.  Dr. Choi has not responded since.
My advise to all, don't wait too long if you have that fever for around 100-103, have lots of mucus and have no energy because yesterday I finally went to emergency (my regular doctor was not in and the otheres in the office were too busy to see me), and the result was that I have pneumonia.  Now taking antibiotics!!!
Olga

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by fayecunanan, Nov 07, 2008
Hello Doc!!

I have a similar problem with one post i read about coughing up pus... (is that phlegm that's yellowish green?)  I have had exactly that for three to four weeks now... (i never got fevers and doctor said she could hear rals but no pneumonia)  first doctor gave me anit biotics and next doctor put me on Flumicil and broad spectrum anti bacterial medicine and am still coughing up pghlegm after I was done with the seven day meds.

Should tests be done?  What should I do first?  I am so worried my two little kids will get it...

FayeC

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by ASK52, Feb 07, 2009
I just got on this site and it's sad to hear of so many people suffering. The good news is there's many, simple alternatives to fighting these problems. First and foremost, ALL cold and flu viruses are ph sensitive. Meaning they need an acidic environment to get established and then multiply. That's why most people get sick and the guy next to you doesn't. Your blood is acidic and his is alkaline. So, once you get a cold or flu the goal is to alkalize as quickly as possible. Take a tsp. of baking soda in a glass of warm water very 2 hrs. This will also increase eliminations, which is what you want when your white blood cells are fighting virus cells.  There will be a lot of dead cells that need to be cleaned out. Drink plenty of water and natural fruit juices.  Lay off the proteins, starches and sweets, they're acid reacting.  Vegetable broths and soups are best.  Don't over eat. Get rest. Take echinicea tea to strengthen the immune system.  For a sore throat gargle regularly with warm, salt water, for the iodine, or gargle with a concentrated iodine solution such as Lugos Solution or Atomidine. Nothing works better than iodine for killing the infection.  If you don't have iodine hydrogen peroxide works well also.  For coughs, get an herbal cough syrup(with cherry bark and horehound) that is an expectorant, not a suppresant, to cough up the phlem.  Boil fresh eucalyptus leaves over your stove or hot plate and inhale the fumes.  This is the best thing in the world for lung infections.  And finally, some of Grandma's remedies still work better than any drug.  Chest packs can work wonders. Use camphor, or mustard, or Vicks or even onion packs.  A hot mustard foot bath can clear a head cold very quickly. Which seems odd that a foot treatment would help a problem in our heads.  But we've all gotten our feet wet and come down with a head cold.  Modern science is still scratching their head over that one.  But simply put, wet feet disturbs our circulation which also effects our blood's ph.  Now most western doctors will disagree with this theory, even though that's one of the first things they're taught in medical school. You can't reproduce a virus in an alkaline environment. Yet they're also taught that the body makes every attempt to maintain blood ph at a certain level, which is also true.  What they aren't taught is the lower limit of those levels is acidic enough for a virus to get established and the upper levels are alkaline enough to kill the virus.  That's it try this and I'm sure you'll be amazed with the results, no drugs and up on your feet much sooner.

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by Tillyest, Mar 06, 2009
Thank you Dr Choi, I've been sick with the common cold for 5 days now. And used to run to my Doc right away. Now that I'm older, I'm trying a more holistic approach. In the past the over the counter stuff would often lead me to a sinus infection. But now that I've been diagnosed with hypertension and cannot take decongestants I bought myself a neti pot. It's been wonderful at keeping my nasal passages open and moist, and clearing away the nasty mucus. (but don't use it if you can't get any air through your nose) I would recomend this to anyone who can't take decongestants any longer.Your Idea to ride it out and skip the meds is great advice! I'm sure I've taken tons of antibiodics that weren't necessary. Just wondering why you wouldn't recomed Mucinex for theose people with chest congestion though? I've been using it with great sucess when my chest became heavy. Anyway like your philosophy about antibiodics. Thanks again!

Tilly H.

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by pthakur99, Aug 01, 2009
Dr. Choi
I am suffering from a dry cough for about 5 months, which started with viral which turned into pnemonia and pharangitis and now coughing day and night after my life is misurable.

I have taken about 3 antibiotics . omnicef, levaquine, armangtom no relief just side effects..

One of the doctor is suspecting a tumor or parasite I have no idea how can this happen I have never been sick in my entire life and here my body is giving up on this cough..

I keep drinking hot water which gives me dry feeling inside and if I sit then and not open my mouth it helps for a while
but I cannot breathe much.

I am going to see the pulmonologist on monday but don't know what to expect.

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by MommyMusic, Nov 04, 2009
I am a mom of two young very active little boys...almost 4 and 2 year old...(16 months apart).   Every since my second baby my body has gone on a wako mode.  I developed an allergy to milk...so bad that I cannot even take certain medications anymore with lactose in it.  I get nasty migraines for 24 hours if I accidently get milk in my body and if I eat cheese or cooked milk I get this horrible lower back pains that keep me up most of the night with a guaranteed yeast infection the next day or two.  Also I get this darn cold every 26 days for the past six months or so.  Basically 3 days before my menstrual cycle and then the cold resolves on the 4th or 5th day into my cycle. Of course my work schedule picked up and my little guy just started preschool, which involves a lot of running around….so I am saying this because my exercise decreased as a result of all the parenting activities.  Help!  I want to be a healthy Mom.  One last symptom…my most important symptom….ENERGY LEVEL is down.  Help me get that back for my two boys who crave tickles 24(7).    

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by CherylOmaha, Nov 30, 2009
Dr. Choi,
Have you heard of people losing their voice after using a Z pack?  My doctor prescribed it for a sinus infection on Nov. 18th, by the evening of the 19th I had begun losing my voice.  On the morning of the 20th I had hives.  It is Nov. 30th and I still don't have my normal voice back.  I feel fine except that my voice just squeaks out.  I think I may be allergic to Zithromax because I have lost my voice at least 2 other times after using it but not as long as this.  Another time I developed symptoms similar to pneumonia that lasted for several months.  My doctor could never diagnose what it was.

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by Trobin1920, Dec 26, 2009
Dr Choi,

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by Trobin1920, Dec 26, 2009
Dr Choi,

I have been dealing with a fever for the last 5 days, It only goes up during the evening, I have a mild running nose, i'm not really coughing, I really don't have cold symptoms just chills from the fever, When I take Motrin after an hour or so I'm fine. I feel a little tired, but otherwise I feel fine. I have a light headache in the morning and a sore back, but i'm not sure it it's because I can't get comfortable when I sleep. What could this be, It's the weekend so I can't go to my doctor, I'm starting to get worried!!

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by megs30, Jan 01, 2010
I am sometimes confused over these issues and my symptoms. I will start out, always without exception, with a sore throat, which is almost always indicative of a cold. By the second day, in the mornings, I am already coughing up hard, green mucous. I use my OB as my primary. He presribed a Z-pac which gave me relief in about a day. This has happened before. I thought I was getting a cold, but a Z-pac gave me relief within a day. I know that antibiotics only work on bacterial infections, and I get a lot of respiratory cold-type sickness in the winter (like everyone else). Why do antiobiotics help me about 90% of the time. Is it possible that there are that many bacterial infections that mimic a cold?

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by myra2009, Jan 08, 2010
thank you dr. for any info.after a very ,very bad cold with congestion i am haveing a nasal sounding voice and sometimes its gritty sounding forr a few seconds.i do have drainage in the back of my throat that is very bitter and sometimes foul smelling.could you give your insight to my voice problem please?

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by gschloff, Jan 10, 2010
I started out with the flu, laid flat on my back for two days trying not to vomit.  Then it turned into a head/sinus cold.  After about a week to two weeks I started feeling better, then got a chest cold.  It's been about 7 weeks since all this began and I'm still sick.  Coughing up mucus, and mucus is green (sometimes) when I blow my nose, constantly coughing.  Have had sore throat for 3 days also, and tender lymph nodes.  When I would swallow, it felt like I had a rock in my throat and would hurt up into my ears.  Today I feel somewhat better, sore throat is better, "rock" is not there today.
Night before last I couldn't even get one hours sleep at a time because I was coughing so much.  Last night was much much better, actually slept for 4 hours at a time.

I've had this so long though why am I not getting better?  I've been taking Tylenol cold medicine every 4 hours for the last couple of days, it seems to help, but after taking it for 3 or 4 days then quitting, I get sick all over again.  

Should I be taking antibiotics?  I am a 60 year old female.



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by sissy6569, Jan 17, 2010
I have had both flu shots.. I am 70 years of age and I have diabetes, I control it with diet and Pills. I have high blood pressure that I keep under control .. I am in very good health ..  My home is being remolded and I have come down with the same thing I had before when work was being done in my home.. I have mucus that is yellow a terrible cough and my fever is 99..  I am taking Mucinex 600 MG... And drinking plenty of water and diet green tea.. I feel so bad I can't do anything I just want to lay around I try and set up so as the phlegm does not stay on my chest.. I did see some very small amount of blood when I was coughing.. My mouth is sore my lips are chapped .. In my days the doctors gave antibiotics for about everything.. I have had this now for 5 days now .. I would like for this to clear up by itself and what I am doing .. Any help on why when my home is being remodeling this has happened to me again.. Or maybe it is just a coincidence.




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by Goslynmaxx, Feb 04, 2010
Thank you so much for the post! I was gonna run to the University Health Center for some antibiotics for my sinusitis...but I'll just wait it out for awhile. Thank you so much, Doc!!

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by Isabelle543, Feb 27, 2010
Great post, but unfortunately some doctors seem to think a negative Strep test means a throat infection cannot be bacterial. I visited one of those doctors awhile back and it was one of the worst experiences of my life. Even though I had exudate on my tonsils, slight fever, elevated heartrate and was getting worse, not better, after 4 days, she refused to treat me with antibiotics when my strep test was negative.

Fast forward two days when my husband insisted that I see another doctor: That physician took one look at me and offered me a shot of penicillan. Thank goodness for her. I was feeling better within 24 hours, the exudate was clear within 36 hours of starting the antibiotic and my appetite started coming back. It took several more days before I was really feeling back to normal, but that first doctor was just wrong. There are more bacteria in the world than strep and while it might be a low chance that it's bacterial, that shouldn't be ruled out.

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by SpennyJ, Mar 25, 2010
Does lower back pain/kidney pain tell you which is more likely?  virus or bacteria?

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by Klibier, Nov 06, 2010
Thank you Doctor!!

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by DalyaE, Jan 04, 2011
Dear Doctor Choi,

I had a terrible sore throat right after Christmas and saw the doctor as soon as i could. He prescribed an anti biotic which i began immediately. Some 24 hours later, i developed a fever. I used cold compresses and brought it down. It only lasted 24 hours. My sore throat felt better three days later and although i don't have a cold, i did notice some bright green discharge whenever i blew my nose or coughed. This is no problem. What i am concerned about is that i now feel like i am developing a cough! I have a dry cough that is triggered every time i take a deep breath. I am taking anti biotics so why should i be developing new symptoms? Is this normal? I really don't want to go back to the doctor so can you suggest any over the counter medicines or cough syrup?

Thank you!
Dalya

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by eardele, Jan 13, 2011
One simple reason for over-medication of the people of this country is - yes you might know it - $$ interest in anything and everything, including people's health. The advice posted by some of you about natural remedies is really good and does work but the problem is that none of the doctors will give it to you here in the US (copay collected=job done), while in other countries it is common knowledge and every doc will provide you with his/her expertise. Have you ever visited a naturopathic doctor? Do you know how much one visit costs in the US? A lot. Well, in other countries (Western & Eastern Europe) any general doctor will give you information and advice on both natural and antibiotic treatment options because they are sincerely interested in patients' well being and giving them choices, while also educating them.

Another sad side to this story is that, for example, when you go to the pharmacy to look at the OTC nose drops, all you see is major big pharma's chemical stuff while natural drops, like the ones mentioned in PlateletGal's post above (consisiting of organic borates, sea water, alcohol, irish moss extract, echidnae, calendula, golden seal, marigold, iodine, methylene blue and flavored with pine oils) are considered to be an exotic novelty here, while in other countries you can get those over the counter... Strange, huh? Well, may be not - we are all forced to contribute to Big Pharma's, Big Bucks in this country so why not prescribe antibiotics left and right, especially the newest ones that need to make the sales numbers;(

I do give you all credit for researching and looking into this - you can't afford to be in the dark in this new information age, thanks to the Internet.

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by healycar, Jan 16, 2011
Hi Dr Choi. I am a very worried Mom. I have an 18 year old son who does not smoke ( he hates it ) nobody in our family smokes either. I talk about smoking becasue for a long time I thought that this was the answer to his constant coughing. He coughs all day long, all night everyday for about 2 years now only it has become so much worse he has told me recently that it really hurts his chest when he breathes. It keeps him awake all night and he is sitting crucial exams this year that decide what college he will go to after high school so he really needs his sleep. He just wont come to the doc with me or when I make appointment for him he doesnt take them because the cost of Doctors fee's here in Ireland is so high that most of the time you have to try & get over illnesses by yourself. So he is worrying about me having to take out a lone just to pay the doc. & if he needs an xray that will be hundred of euro's too & then medication, well I wont even go there ( I am sure these are the reasons why he will not go). His cough is no stop & he has absolutely no mucus at all whatsoever. Please help. I would really appreciate some advice.

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by angelwinggallery, Feb 14, 2011
We visited our grandkids last Sunday week and our granddaughter had a terrible runny nose and cough. She sneezed and coughed right in our faces on numerous occasions while we were there as a one year old would do while holding them.  On Wednesday I had my monthly doctor's visit and since I had been having sinus issues anyway they went ahead and did a test for the flu that came back negative. The next day my daughter-in-law let me know that our granddaughter was diagnosed with the flu after all. My question is could it be possible that I could have still gotten the flu from her and it takes awhile before it shows up?  It has been one week now since we were exposed to it.  I still have a sore throat and congestion but that could be just sinus. How long does it have to be in your system before it would show up on the test they do?  I just don't want to get around anyone if it's possible that I have it, especially my 82 year old father.

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by ChitChatNine, Feb 18, 2011
How widespread is the flu this year versus last year?

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by mAnDaleigh1990, Sep 12, 2011
I have had a scab/sore in my nose for a month now. i get staph infections offen in my nose and didnt think twice to do what my doc. told me and clean it every day with poroxicde and neosporin. but its gottin worse. and im not sure what could have caused it. now my throat is hot and i have a nasil drip that is blood tinged and has an oder. and gives me an upset tummy. i dont have health insureance and only like to go to the dr. when need. is there anything i can do at home or should i go see a dr?


                     Amanda 21,kentucky

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by bevenus, Sep 17, 2011
Dr. Choi, can you PLEASE HELP ME, I keep smelling smoke but no one is smoking.  I did invite a friend over about 4 days ago and he is a smoker.  He sat at my living room window and smokes a few cigarettes while he was here but he had the window open.  Around 24 hours later i started smelling cigarette smoke constantly but no one is smoking.  My nose is stuffy and my eyes burn.  It feels as if someone is sitting next to me constantly smoking.  This scary because i did not sleep for almost 48 hrs.  I have researched this on the next and a lot of people are and have experienced this same thing.  When i'm in the car it's bad and even at work.  I have to constantly go outside to get relief, this is really getting to be too much.  I read where this one guy said that he experienced this for months and turned out that he had a bacteria  sinus infection and he said that his neighbors smoke had settled and stayed in his sinus due to the infection.  Have you ever heard of this and can you PLEASE HELP ME with some answers on what to do? I can't imagine going on another week with this.

Bev

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by chinth, Oct 10, 2011
Dear Dr.Choi,


That piece of info was actually breathtaking.

Just would like to let you know my condition.

I am a person diagnosed for sinusitis it comes to a point where I totally cannot breathe and also I usually get this condition togeher with a throught infection and flue..I heard there is a permanant cure via HOMEOPATHY.

Mately the last infection I built i got a deadly sinus infection with flue.well my docs gve my Enhansin 625 (dose for 5 days)and also another command antibiotic which the name I cannot remember together with Allegra 120mg (dose for a month)..I toll the medicine with 1005 compliance and now the sinus condition went off but I still have the throught infection+cough and severe back pain..these conditions I achived lets say 3 weeks back when I first got the infection..yesterday went to doc and he was concered that my cough and throught infection was still present and gave me ZETRO 250mg..what do think ..Do I need to take a biopsy or something..this thrught infection and lower back pain is kiing me..pls advice.

thanks
Chinth

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by sadia628, Oct 18, 2011
HI

I want to clear something for myself.
I have
>soar throat (pain while swallowing)
>brownish green discharge from nose
>NO sneezing
>very little cough
>itching in the throat and the ear

Its been more than 1 week probably 10 days now

I have taken aspro and paracetamol, pain finishes but then next morning its there again when i wake up

What is this and what should I do?
please reply and help


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by sadia628, Oct 18, 2011
I have post nasal drip as well and it hurt when i try to clear it up by swallowing...so i try to take is out of my nose and its brownish green in color

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by EstherC56, Oct 25, 2011
i was diagnosed with MRSA a week after my dr. diagnosed me with sinusitis. After amoxicillin 10 days and prednizone for 5 days I called to tell her the swelling went away but I had thick nasal passage on the right side. She sent me to an ENT. He looked at it there was a sore insdie by nose but had no puss, he poked and got a culture and that is when I was diagnosed with MRSA. He put me on an antibiotic that clears MRSA for 10s and I go back Friday after 5 days on this antibiotic. My question is after being on antibiotic and no fever am I still contagious? It is much better and he will do antoher swab test Friday. Just need to know if I am contagious

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by Terry2476, Nov 20, 2011
I have had bronchitis for a month now, and have been to the doctors twice already. The first time they prescribed me to meds, and nothing. Then, they prescribed me to something stronger and took an x ray. I'm almost done, but not much of a change. The doctor said my lungs looked actually really good, but why am I still coughing? My husband and 2 kids (6 and 2 yrs. old) have been coughing, too. They have been going through the same thing. I'm tired as well as my family.
Please help!! I have done research and thought about it maybe it being something in the house, but I am just in a complete loss.
Thank you.


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by Hacking_phlegm_45times_aday, Apr 16, 2012
Dr Choi,
I'm certainly hoping you are still online; last post was 6 months ago. You seem to have a excellent handle on issue like this and can see you've been very helpful. So....I'll take my chances. I have learned the difficulty of an accutae diagnosis as I had seen maybe 10 Dr.s over 25 for this hacking up phlegm cough.This  was never a 365 day per year issue; some irritant might set it off maybe every few years. I enjoyed years without it,also.

HISTORY: I have had (diagnosis) 'sinusitis' for years, but this also changes  depending on where I live. Maybe 6-7 mornings per month, I will have nighttime sinus drainage (unaware this is in my stomach)  that will produce a cough to bring up the phlegm. During most of these episodes, I will throw up my first few sips of coffee...AM coffee is on the backyard porch. I moved from that particular place (in with a GF and had ZERO) episodes for 6 months. I moved back to the same place and immediately, had these return. I believe elm trees were in the back yard. This was my first clue..solid evidence.

CURRENT: Male /56
I had a gall bladder attack 7 weeks ago. The pain was so severe  I finally went to an emergency room later that morning. I have some small stones and apparently the bottom of gall bladder has 'sludge' in in. Yes, I would have it removed.. I have balls in motion re: acquiring health insurance

The next day I developed a wicked cough.Deep, dry...producing phlegm. The same sinus drainage as the isolated incidents before and ONLY in the morning, turned to a 35-45 deep coughs per day. Good God, they hurt after a few days. --My roomate was diagnosed with Pheumonia about 4 weeks ago.---

I have carefully watched my food and have been symptom free since, but made a mistake 5 nights ago. I took a few healthy bites of a gyro sandwich...and believe I could feel the repercussions in a matter of seconds. They have changed the recipe; a ton of feta cheese was added. I removed all the cheese , but had another attack upon waking up.

This one was maybe half as painful as the first and lasted 8-10 hours.

MAIN CONCERN: This cough has returned with a vengeance, once again on day two. It's no less than 30 and may exceed 40+. It will occur while shifting at night. I can't swallow the stuff, so I have a 12 Oz. cup half full of the phlegm in my room. For 4 days, my energy has been totally sapped. My roommate gave me some of his Amoxicillan tonight, (I belive this was his pneumonia antibiotic)  which is likely why I even have the concentration  to write this...last few days I could barely get out of bed and internet research might last 30 minutes...just totally void of energy.

1. Never have I had such a wicked cough in my lifetime always producing phlegm.
2.  I also never have had a fever that would start with shivering and then turn to a sweat.
3. It just seems to me that there are numerous things going on at the same time. Any Gall Bladder research is completely void of a hacking cough as a symptom  

Can you offer some hypothesis, so I can be armed with information once I am assigned to a doctor with this health insurance? Finding a good one is tough these days...and most lose interest/don't hear you should you talk over two minutes. I really need to 'get it right' this time.

Thanks so much. I'm hoping you can assist in cracking this multi issue case

All the best to you and family, .
Kelsey
Ft Worth TX    

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by Hacking_phlegm_45times_aday, Apr 16, 2012
PS...The phlegm is 100% clear in color but twice in 4 days what I coughed up was obviously bile; dark brown in color with that nasty taste.
I've experienced the taste maybe 5 times ...but never from  coughing. Don't  recall what the issue was; perhaps a heartburn scenario, which I've had maybe once every 2.5 years..rare for me

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by Worldsavior, Jul 14, 2012
Colds, Flus, AIDS, Cancers, Symptoms... Relax! For sure very soon H1N1, H5N1 flu viruses and any other viruses known on Earth will die the moment they touch you...

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by SRBCK, Sep 04, 2012
I agree totally 100%.  Can't seem to make some people understand this....no matter how much research you show them and no matter how many times I get better with the same illness they have without the antibiotics.  Then they just say that I apparently had something different...even when I caught it from them coughing without covering their mouth.

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by precious455, Oct 04, 2012
Hi my doctor said it was pharyngitis and prescribed me with amoxxicilin and cetirizine but i still have bumps on the third portion of my tongue..its been five days.

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by brucer526, Nov 02, 2012
What are your thoughts about using Colostrum which is an anti-body made from Cows milk that gave birth within 48 hours that helps strengthen immune response??? Is it bad or dangerous to use just like an antibiotics?  It seems to lessen effects once you have it. I have had some luck with it defending getting a cold but once you get a cold there seems to be no way to get rid of it except waiting it out and living with it's duration. How about Echinacea root, Vitamin C or D3 to assist in prevention or shortening duration?

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by smischke, Nov 29, 2012
Thank you!  I just had an argument with my secretary, who insists I should see a doctor and get antibiotics for the cold I've had for 3 days.  I told her it was viral and antibiotics wouldn't help.  She asked how I knew the difference (since I'm one of those "fake" doctors who just does research and teaches health professionals in college, and not a "real" doctor).  I told her I just knew -- I'm old enough to have plenty of viruses and plenty of bacterial infections -- and I've never been wrong yet according to my family doctor.  I was looking on the web for a succinct list to discriminate, and ran across your nice explanation.  Now I can explain the difference -- not that I'll ever convince her.  Maybe when we are completely out of effective antibiotics, the world will start to listen.

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by caregiver222, Nov 30, 2012
This is a worthwhile, albeit dated, post.

One of the most significant issues in an infection is whether or not to lower the fever.

Fever is part-and-parcel on the immune system. Essentially, mother nature has determined that certain universes of organisms can only successfully replicate within a narrow range of temperatures. A "fever" is a natural  way of preventing replication of harmful organisms. Any medication, whether it be an NSAID or aspirin that interferes with this process destroys an important layer of protection.

Decades ago, the drill was to sit with the patient, provide them with plenty of fluids and wait until the fever "broke".

Nowadays, at the smallest rise in temperature, mom reaches for the pill to make the child "feel better".

The decision as whether or not to interfere with a fever is a judgemental call. It is true that an uncontrolled prolonged fever can sometimes cause cellular damage, but this is usually not the case.

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by nl2040, Dec 22, 2012
Hi! Your perspective is really great...and I kept looking at your picture, and then realized, wait, I know you from college!

You seem to be doing well, and thank god you're in family medicine.

regards,
NTanya Lee ('91)


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by aditya_968, Jan 19, 2013
sir .
in my throught fill with rashes and no cough is in my chest pain in my neck nerves. i take brutacef az 250 and one pain reliver tablet and betadin gargel please help me for good medicine i am taking last 2days but 20% relif plese send me more antibiotics.

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by ryanito, Feb 19, 2013
Hello, I have a very bad cold what could i drink?

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by lolobug, Feb 23, 2013
Hi there Doctor.. Just a quick question. About three weeks ago i went to the ER and was diagnosed with a bad case of bronchitis. I was coughing horribly bringing up green mucus as well as producing it in my sinuses... I was given the z pack and an inhaler. I took all antibiotics as prescribed except for the inhaler because i have SVT and they thoughtt it would be best if i used it as least as possible.. Its been three weeks now i was getting better now im waking up with a nose clogged full of green mucus a slight sore throat and my ears are bothering me.. Im a 42 yr old female with high blood pressure and SVT. My regular physician did take blood from me last week and said my iron was pretty low and gave me iron pills but should i go see him again about the ear nose and throat thing? Just frustrated! Please help...

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by nevaeh05, Feb 25, 2013
Help ive been in so much pain legs , feet , arms evey were hurts so bad ive been like this for 3 days today ive got pus comeing of my cest and feel so ill my wole boad is killing and on the 1st day i couldnt keep still as legs hurt so much ive been hot and cold and felt sick but havnt been i sweat and feel ruff whats rong with me never felt this b4 i am 28 yrs old and female just in case u need to no plz help x

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by Kassie59, Mar 22, 2013
Hi Dr. Today I got my lab tests back, and they said my Mycoplasma IGM is a low positive, and my Mycoplasma IGG is a high positive 370. I was told on Dec.1, I had Bronchitis and given a weeks worth of antibiotics. Was better for 3-4 days and relapsed horribly. Given another week of antibiotics. A week later, I started intense allover body itching, and a horrible rash broke out all over my back, shoulders and neck. I still have this going on and my life is beyond miserable. Given many creams, pills for the itching, and nothing gives me relief. I have since learned that this is directly connected to Mycoplasma Pneumoniae. My Dr. called and told me that all my tests came back normal. I picked copies of these labs up from the hospital to see them for myself, and I had a couple of other abnormalities as well. One being Anemic. My husband and I have decided I will be seeking a new Physician since I no longer trust her with my care. I hadn't seen a Dr. in 9 yrs., so not a hypochondriac, but was a healthy person. I also, with the rash and itching, have had ear infections, horrible joint pain, random chills, and lumps on my neck that come and go. Sure my immune system has to do with that. Can you tell me about any treatment you are aware of for this Mycoplasma infection? Need help, please!!!!  Thank you!!  I'm looking for a new Dr. and this could take a little time, so, anything you can tell me in the meantime would be greatly appreciated!!!

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by malisse, Jun 23, 2013
I have a question and if possible need it answered soon. I have pain in my chest . it hurts when I breath in and when I put my hand on my chest . I went to the er the other night because I have major surgery coming up this Tuesday the 25th of june 2013 . . they put me on a ekg that was normal . then they took blood work all was normal. then they did a xray of my chest and a ct scan and every thing came back normal. he said I could be having heartburn. but that is not the pain I am getting this is more of a sore pain. im not sure if it is a muscle or what . but with all of my test coming back normal and still having this pain I don't know what to do . surgery is on Tuesday and I have waited forever to get to this date. I have had anxiety due to knowing this surgery is right around the corner. but I am sure it can leave a sore feeling in ur chest making you feel like you have been broused .. please if any one can get back to me with a answer soon I would so appreciate it .

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by Nelcat, Oct 14, 2013
My daughter is 9 years old and has cold symptoms such as a sore throat, some occasional cough and bad headache as well as tiredness and yellowish phlegm, but no high fever, other and 99 or maybe a 100 F. Her doctor is out for the entire week and I am worried that she won’t get better. The urgent care does not prescribe antibiotics, because they want the primary care doctor to do so. Nevertheless, I have a refill from her last doctor visit for amoxicillin that I could call at the pharmacy. Should I start her on this antibiotic? I am wondering if she does not have a strep, if the antibiotic could present any other problem. Because otherwise I can then help her and not have her waiting feeling so bad for an entire week 

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by Ria171, Jan 10, 2014
Hi Dr.!
I have a question. I have tendency to get inflamed sinuses and infections. I was over in Asia and came back to the states for a week before going back. For the past five days I've suffered with sinus pain and teeth aches and having been blowing out so much green mucus. My ears are plugged as well. I went to the dr and he put me on a z-pack. I'm now on the last dose and while I've continued to blow out crap and the pressure has lessened a bit I still have pain and do not think the medicine has really done that much. What else could this be? Do I have a viral infection? If so what's the best way to get rid of this? I'm flying again on Tuesday and would like to feel better by then (that will be the 10th day of feeling like this).
Thanks!
-Maria  

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by walkeekee, Mar 18, 2014
Hello Doctor.  I am a 49 year old male who had sinus polyp surgery three months ago.  The surgery went well and I've been able to breathe a lot better.  A few days ago when I bent my head down to pick up something on the ground a strange dull yellow liquid (thin, not thick like mucus) started dripping out my nose.  I wiped it and thought nothing of it.  This happened again yesterday and today.  Someone told me to taste it to see if it was metallic, salty or sweet.  It is definitely sweet tasting.  It has the consistency of blood, except it's yellow.  Could this be spinal fluid or a bacterial infection?  Should I go into my physician right away or wait to see if it goes away?  Thank you!

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by Cinderella1969, May 21, 2014
Hello Dr. Choi,
Am a 44 Yr. Female.am not sure if I have a cold or something more like bronchitis.
My symptoms are coughing with phlegm, headaches, some facial pressure, chest pain front and back. Wheezing, tired. Sweating at times. Have not taking anything for it. And its been 3-4 days I have felt this way. I just thought it would go away to ride it out. But the chest pain came back today. Can you help and identify what's going on? Thank you.
     All my best
        Cindi . C.

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by Txporters, Jul 06, 2014
Dr. Choi:
I have had an upper respiratory infection for 12 days.  I was feeling better at day 7 or so, but now my symptoms have worsened.  I have soreness in my upper left molars, and it hurts when I blow my nose now...specifically on the left side.  But, I have a great deal of pressure and pain on both sides.  I have been taking Cipro twice a day for over a week now, but still feel miserable.  Mucinex provides temporary relief, but I've gone through a whole pack almost.  Any suggestions??

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by Chris718, Jul 09, 2014
If you do not have a secondary health problem such as asthma/COPD, etc. I would say first line is to not treat your URI with antibiotics. If you DO have asthma, you are almost always treated with antibiotics. I went thru a phase in my late teens early to late 20's and 'didn't want to take antibiotics'. I've seen pulmonary doctors for my asthma as well. When you have asthma, you may be asymptomatic, meaning not have any symptoms, but you still DO have asthma. My asthma is mild to moderate. I also had open heart surgery when I was 4 and a half years old, a VSD repair. Immediately after that surgery, I developed pneumonia. If you have ever had pneumonia, you are more likely to get it again. So, moral of my story is, when I get sick, sometimes it does not start as a cold, I just start feeling 'funny' and a bit unwell, I may develop a dry cough, with no phelm. Then a day or so later, I get a bit more of a persistant dry cough, with a very bad taste, I used to say it tasted like poison. It's not from my stomach, as someone had suggested above. My lungs usually have a burning sensation, can feel like there is a fire in the center of my chest. I have difficulty breathing, because the chest cold exacerbates my asthma, and I then have asthma symptoms, which I didn't prior to getting this 'chest cold' I developed an allergy to penicillin years ago, because I had to be premeditated prior to dental work and my dentist was prescribing me about 5 to 6 thousand milligrams or was it 600? I forget, but taking that much at once, several times that I saw him made me develop a reaction in his dentist chair. So now, I"m allergic, and have to take Zpack.  Within 2  to 3 days of taking the z pack the poison tasting cough goes away. If that's not a bacterial infection, I don't know what is. : / Once I start to get this kind of chest illness, I must begin using my rescue (asthma) inhaler and doubling down on the steroid inhalers for my lungs to help keep them open. Sometimes a steroid shot or a week of steroid pills by mouth, not  a very high dosage helps to take down the swelling in the lungs so the Zpack can do its job. My general doctor, and my pulmonary doctor have said that allowing chest infections to linger a long time, in people with asthma or other lung conditions, damages lung tissue. He said it scars lung tissue, and leads to having worse lungs. I know this to be true as I have experienced it for my whole life, and I'm 49 now. Times I have waited, or didn't get to the doc fast enough or had this see the doctor and come back again, has allowed my chest cold/acute bronchitis to become 'a touch of pneumonia' which I imagine is a bit of pneumonia in certain areas of the lungs. The more parts of your lungs infected with pneumonia, the sicker you are. So unfortunately zpacksll are pretty much in my future. When I do get these URI, chest colds I absolutely cannot be in a smoking environment, bars, night clubs, etc. Even being around a few ppl smoking, hurts my lungs, and makes it harder for me to breathe. I have also found if I spend two or three nights in night clubs for many hours, I will develop a chest cold, bronchitis which requires antibiotics. I really wish public smoking of any burning matter would end indoors anywhere. Thanks for your kind and helpful advice Dr. Choi. :)

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by jacksongirl2012, Oct 03, 2014
My cold started with a cough then went into my head pounding having hot and cold sweats nose being plugged up body feeling drained now its back to a cough and nose being half way stuffed and I'm coughing up green stuff sometimes its not green especially when I wake up and I have been fighting this for two weeks now I have taken a multi vitamin everyday a nasal decongestant every four hours mucinex every four hours and nighttime cold medicine every night even a couple antibiotics I had left for a infection last time I was sick I can't seem to knock this cough and sniffles what should I do? Please help I'm tired of being sick its embarrassing I can't be anywhere without people wanting to not be around me cause I'm sick

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by courtsbee1, Oct 16, 2014
I have an illness that just wont quit....I have been off and on sick constantly for 2 months now. I have been on antibiotic, penicillin and a puffer and every time my meds run out the illness returns.....i get slight stuffy nose, slight cough, chest pains, sverely swollen throat inside and out, fever, body pain, and migrains....I am wits end....what is wrong with me?

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by mmil, Nov 06, 2014
Dr.
I am hoping you can help. June of 2014I had strep throat and was given a z-pack about two weeks later I had not got any better and went to the hospital to find out I had pneumonia in my three lobes of my right lung. I was hospitalized and given levaquin in the hospital and when I left.two months later September I then had an upper respiratory infection where the right side of my neck was swollen and sore to the touch. I was given two weeks of ciprofloxacin. Three weeks later the end of October my throat was burning so bad with a sinus type drain I was told at that point that I had again a respiratory infection and given a z-pack.the right side of my neck has now to P sizelumps that are not sore to the touch any longer they just never seem to go away after the first respiratory inflammation. I finished the medic the Z packnot even 1 week ago and now I feel a sinus drip and slight burning in the back of my throat the two lumps are still there and every time I was in the hospital I was asked if I had lymphoma? They performed a MRI on my neck blood work and chest X Way saying that everything looked normal but I do not feel normal and the infection seemed to continue to come back. Can you please help?

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by mmil, Nov 06, 2014
No cough during these times also have the most extreme dry scalp only tar shampoo will work

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