There hasn't been a whole lot going on over the past few weeks except work which is why there has been a lack of updates on the site. After several months of paperwork I finally started my moonlighting gig which is both exciting and a little stressful. I now work Tuesday and Thursday evenings at a medical clinic seeing overflow patients with acute problems who couldn't be fit in during the day. It is the first time I've done my job without a supervising physician directly overseeing what I'm doing or without there being someone else around I can ask for some advice. Like I said, it can be a little stressful but overall I think it is going pretty well and I'm enjoying the extra experience (and money).
By far the most frequent ailment I've seen while moonlighting is the dreaded sinus infection. We all know the symptoms: sinus congestion, runny nose, ear pressure, sore throat, and in general just not feeling well. I wanted to quickly go through my treatment regimen for a sinus infection, as backed by evidence-based medicine.
- The overwhelming percentage of sinus infections are caused by virus infections (>90%). This has been shown in studies using CT imaging and sinus cultures. Unfortunately, this isn't practical in an every day clinical setting so practice guidelines state to assume the infection is viral unless it lingers more than 7-10 days. Since viral infections don't respond to antibiotics, that means no antibiotics unless you've had symptoms for over a week.
- Intranasal steroids have the best evidence supporting them to relieve sinus pressure and head congestion
- If there is a cough from post-nasal drip, I'll use a codeine-containing antitussive, especially if they've failed over the counter cough medicine.
- I suggest Tylenol for throat pain and plenty of fluids.
Does the intranasal steriods actually treat the virus or just help the symptoms? Glad to hear that you are getting to get out on your own. Good luck or happy practicing.
ReplyDeleteJoe
The steroids just cut down on inflammation to help with symptoms. They don't kill the virus. Unfortunately, our anti-viral medicines aren't very good. For the most part I just try to maximize symptom relief while your body fights off the virus on it's own.
ReplyDeleteDo netti pots help sinus infections?
ReplyDeleteYes they do. In fact, I think there is a fair amount of evidence supporting their use. However, I don't recommend them much in clinic because by the time they come to see me they've either already tried the netti pot or I feel like they want some kind of prescription, which is where the flonase comes in. Again, most of this is symptom treatment, not actually treating the cause. Your body will treat the cause (in most cases). But anything to help open up the nasal passages helps, and the netti pot does this.
ReplyDeleteSometimes the antibiotics have unexpected effects so is best to keep them to the minimum. Several years back I ended up with lung problems due to excessive smoke. I got antibiotics and they messed up my bowls. Ended up with hemorrhoids.
ReplyDeleteYes, every treatment has risks and benefits. Most of these infections are viral so giving out antibiotics only provide risks and no benefits. People think that they get better with the antibiotics but the truth of the matter is that they would've improved without the antibiotics and they just happened to be taking them when they improved. Of course some of these infections are bacterial and they require antibiotics but it's pretty tough to tell when this is necessary and knowing this is part of the art of medicine.
ReplyDelete