When Your Cold Is Not A Cold
January 14, 2009
It’s cold and flu season again, and for many of you, drinking lots of liquids, getting enough sleep and eating chicken soup will be enough to bring you back to health. But for some others, you’ll have persistent or lingering problems that may make you wonder, could it be something else?
Whether it’s a chronic cough, a lump in your throat, headaches, or post-nasal drip, there are a variety of symptoms that can mimic routine colds or flu symptoms. The challenge is in determining what exactly is causing your problem so that you can address it properly.
Cold Versus A Flu: What’s the Difference?
Most routine colds are self-limited, and go away within 4-7 days. Common symptoms of colds are a low-grade fever, a runny or stuffy nose, mild cough, and a mild sore throat.
A flu infection, however, is caused by a different virus, and tends to be more severe, with higher fevers, chills, muscle aches, worse headaches, slightly longer course, and increased generalized fatigue. If you’re otherwise healthy and you follow the typical precautions (rest, fluids, sleep, etc.), both the common cold and the flu will eventually go away. But if you have an underlying medical problem, are more stressed than usual, or run yourself ragged despite your infection, then either the infection may not go away, or slowly turn into something else, or be left with one major symptom that just won’t go away for weeks to months. This is when the real problem begins.
When Colds Never End
There are a number of different conditions that can aggravate your cold and flu symptoms. For example, if you have any degree of underlying allergies, this can make your symptoms even worse, with continued nasal congestion, post-nasal drip or ear and sinus congestions and fullness. If you have a history of allergies, either removing yourself from whatever you’re allergic to or taking an over-the-counter allergy medication may help.
One of the more common situations that cause chronic or persistent symptoms is if you have sinusitis. Persistent nasal congestion can back up your very narrow sinus passageways (or the Eustachian tube for the ears) and after an initial negative pressure sensation, fluid can build up and get infected with normal bacteria that live inside your nose.
However, it’s been shown in recent studies that what most people describe as a "sinus infection" is not truly a bacterial infection, but mostly due to pressure or clear fluid. In this case, opening up the sinuses or ears, starting with conservative methods such as vigorous nasal saline irrigation may help. More aggressive decongestants such as over-the-counter (OTC) decongestant pills or sprays (only for a few days at most) are other options. Antibiotics are rarely needed, since most cases are not really due to bacterial infections. If you can open up your sinuses, your body is able to do the rest. Click here for a FREE brochure on which OTC medications are best for your cold symptoms.
Another interesting fact about sinus pain and headaches is that the pain itself in most cases is not caused by an infection, but by a migraine attack of the nerve endings in your sinuses. In contrast to your classic migraine headache (pounding one sided headaches with sensitivity to bright lights and noised, nausea and vomiting), irritation and inflammation of the nerves in your sinuses can cause pain, pressure, post-nasal drip, and sometimes nausea. In some cases these sinus "headaches" may respond to anti-migraine medications, such as Excedrin Migraine or Imitrex. In this situation, avoidance of certain foods that can trigger migraines is also recommended (such as caffeine, alcohol, MSG, aged cheeses, red wine).
Colds and Acids Don’t Mix
Acid reflux can’t cause colds or flus, but colds and flus can definitely cause acid reflux. For some people, the inflammation from the infection causes narrowing in the nose and throat, leading to stronger than usual vacuum forces in the throat via the following mechanism:
Due to modern human’s unique oral cavity anatomy, our tongues can easily fall back, especially if on our backs (due to gravity) and when in deep sleep (due to muscle relaxation). Many people with this condition naturally like to sleep on their sides or stomachs, but any degree of even mild narrowing due to inflammation can trigger a vicious cycle, where the tongue falls back, leading to partial or total obstruction. (I talk about the reasons why some people are more susceptible to this in my newly released book, Sleep, Interrupted: A physician reveals the #1 reason why so many of us are sick and tired. For more information or to download sample chapters click here.
Once the tongue falls back and obstructs, as you try to take in a few breaths, tremendous vacuum forces are created in the throat, literally sucking up normal stomach juices into your throat. Your stomach juices include not only acid, but bile, digestive enzymes, and bacteria. Even small amounts of these substances can irritate not only your throat but studies have shown that these can even go into your ears, sinuses and lungs. This causes more inflammation, which narrows the airway even more, causing more tongue collapse. If your nose is stuffier, then vacuum forces are created downstream and the tongue falls back easier. Notice the multiple vicious cycles.
Acid irritation in the throat will produce the classic throat acid reflux symptoms, such as chronic throat clearing, lump sensation, difficulty swallowing, hoarseness, chronic cough, post-nasal drip, and tightness in the throat. This condition frequently coexists with a variety of other upper respiratory conditions.
Not too surprisingly, sinus headaches, post-nasal drip, and throat acid reflux frequently go hand in hand. It’s also been shown that people who are prone to these issues also have what’s called chronic rhinitis or non-allergic rhinitis. This is where your nose’s nervous system is hypersensitive to weather changes such as temperature, humidity, and pressure changes, and other irritants such as chemicals, fumes, scents or odors. This is thought to be due to an imbalance in the involuntary nervous system of your nose.
Sometimes, a patient will come in extremely stressed and concerned about the possibility of cancer, as they’ve smoked in the past, or a parent died of throat or lung cancer. In almost all cases, after a thorough history and examination of the throat structures, patients are reassured that their symptoms are most likely due to the conditions that’s causing inflammation, such as acid reflux, or allergies.
Why Antibiotics Aren’t The Cure
So now that you know what may be causing your chronic problems, what can you do about it? In most cases oral antibiotics are not the answer (although this is too often prescribed by most doctors). In certain cases patients swear that within a day or two of being given a certain class of antibiotics (macrolides, which include azithromycin or clarithromycin), they felt significantly better, which proves that it was a bacterial infection. One possible explanation is that the macrolide antibiotics have a unique property where it stimulates the smooth muscles of the stomach, causing more contractions and thereby pushes the stomach juices and contents down faster into the intestines. So the less acid is lingering in the stomach, the less it can come up into the throat to cause problems. This is probably why many patients feel better after being given a Z-Pak for throat pain. General surgeons use these medications intravenously to stimulate bowel function after major abdominal surgery.
So now that you know the improper way to treat a cold or flu, what should you do to feel better? The first thing to address is to make sure you are able to breathe well through your nose. Try nasal saline sprays or any of the other various ways of getting saline into your nose. Saline acts as a mild natural decongestant, helping to open up nasal passageways and sinuses. The only downside is that it has to be repeated frequently. If you have any allergies, try to find out what you’re allergic to and get it under control. You can start with over-the-counter allergy medications and if that doesn’t work, you may need to see your doctor about your allergies. Worst case scenario, you may need to see an allergist. If your nose is still stuffy, you may want to consider seeing an ear, nose, throat specialist to figure out if you have an internal structural problem that needs to be addressed.
Some people have naturally flimsy nostrils. Sometimes, this occurs years after rhinoplasty, since narrowing the tip of the nose also weakens the sidewall cartilages that support the nostrils. In this case, Breathe-rite nasal dilator strips may help. If this is not strong enough, or if it won’t stay on, there are various internal nasal springs or clips that can be used (Nozovent, Breathewitheez). Having a stuffy nose internally can also aggravate this nostril collapse problem.
One of the most important habits to avoid is eating close to bedtime. If you have stomach juices lingering from a recent meal and you lay down to sleep, if you have even mild partial to total obstructions, you’ll vacuum up these juices into your throat, which can then go into your nose. This causes more inflammation and more obstruction with arousals. You should try to avoid eating about 3-4 hours before you go to bed.
Alcohol is another substance that should be avoided close to bedtime. It may make you drowsy and fall asleep better, but because it relaxes your muscles, you’ll stop breathing and wake up more often. Again, use the same 3-4 hour rule. What this means is that you can still have a glass or wine or beer with an early dinner.
Many of you will naturally want to sleep on your side or stomach, but if you normally like to sleep on your back, try sleeping on your side or stomach, whichever is more comfortable. This will lessen the degree of tongue collapse due to gravity.
I alluded to sinus pain and pressure being like migraine. Even if you’ve never had a migraine, try to avoid certain foods that can trigger migraines (already mentioned above).
Lastly, it’s not too surprising how often people push themselves while sick. It’s just common sense that you should rest, take it easy, and care of yourself. This involves regular exercise, eating healthy, and taking part in activities that is calming and relaxing. If all these conservative options don’t help, then it’s time to see your doctor.