#colds

Hi Guys. I have a cold.

Unrelated, but some of you have asked how to take care of yourselves when you're sick. Unfortunately, "how to take care of yourself when you're sick" is more of a book than a tumblr post, so I've been struggling with how to tackle it.

But in light of my stuffy nose, I felt a good start would be focusing on something that everyone experiences at some point- the common cold.

The common cold is a viral upper respiratory infection. That means a virus, usually a rhinovirus (but can also be a coronavirus, an influenza virus, or an adenovirus), infects the upper part of the respiratory tract. Adults get colds on average about 2-4 times per year. Young children get them like 3-8 times per year (not kidding). It usually takes between 8-16 hours between being exposed to a cold and showing the first symptoms, but it can be as long as 72 hours. Symptoms typically peak around day 2-3 and last 6-10 days.

Colds usually start with a sore throat and a dry-feeling nose, and progress to nasal congestion (stuffy nose), nasal discharge (snot), headache, sneezing and cough. The discharge is usually clear and watery at first, but can progress to being yellow or green. The color is just the dead white blood cells that are fighting the infection. It does not necessarily mean it's a bacterial infection, contrary to popular belief. Systemic symptoms like fever and body aches are rare.

Because it's a virus, antibiotics (which only treat bacterial infections) won't work. We also don't have any antivirals that work against the common cold. Very high doses of zinc (75mg elemental zinc per day, or about 100mg zinc oxide) have been shown to shorten colds and improve symptoms. Lower doses of zinc do nothing on their own, but combined with vitamin C they may improve the runny nose symptom of colds. Vitamin C alone, regardless of dose, does not appear to do anything to prevent or treat colds. We have done many placebo controlled trials on this.

Your main strategy with colds is to rest, control symptoms and wait them out. So this post is going to tell you how to do that.

Hydration: It's probably the last thing you want to do with a stuffy nose, but you're going to want to drink a lot of fluids. Not only are you losing a substantial amount of water through snot and breathing through your mouth (up to a liter a day, and you lose a lot more on top of that just existing, so it needs replaced), but extra water helps loosen secretions and if you decide to take an expectorant like guaifenesin, it won't work well if you're dehydrated.

Warm, sweet or salty liquids are sometimes easier to drink a lot of when you're sick than plain water. Honey as a sweetener can help soothe sore throats and is nice in tea. Bullion broth is convenient if you like broth. The important part is to drink a lot more than you normally do. Set a timer to remind yourself to drink if you need to.

Sleep: Get enough of this. Pay special attention to getting into bed on time. Raising the head of your bed can make it easier to breathe through your nose at night. If you don't have a wedge pillow, you can do this by taking a straight-backed chair, laying it on it's front on the bed with the legs pointed towards the head of the bed, covering it with pillows, and laying on it.

Humidity: Steam and humidification can soothe irritated mucosa in the nasal passages and help loosen secretions. Use a humidifier if you have one, or boil water on the stove and breathe in the steam. Sometimes a hot shower also helps a lot.

Meds: There are a lot of over the counter medications available to you to manage symptoms. It is important to note that you should never give these to a child under two, and never give these to a child under 6 without a doctor's recommendation.

Painkillers: Can help with headaches and sore throat. Your options generally are acetaminophen (tylenol/paracetamol) or an NSAID like ibuprofen or naproxen. NSAIDs are generally more effective and can help some with nasal congestion. Acetaminophen is better for headaches. If needed, you can take acetaminphen and an NSAID at the same time.

First Generation Antihistamines: Help with excess mucous production/runny nose, watering eyes, and cough. Also helpful to give you a better night's sleep if you're struggling. Options typically include diphenhydramine (Benadryl), chlorpheniramine, or doxylamine (Unisom). There isn't a lot of evidence that second-generation antihistamines like loratadine (Claritin) or fexofenadine (Allegra) do much for cold symptoms.

Decongestants: These help with nasal congestion. The only oral one that works is pseudoephedrine (there is oral phenylephrine too but it doesn't do a great job for most people), but there are a number of topical (nasal sprays) that work very well. These include phenylephrine and oxymetazoline. If you haven't tried the nasal sprays, definitely give them a shot. But generally you don't want to use them for more than about 3 days or they will cause rebound congestion when you stop. Also the nasal steroids for allergies don't do much for cold symptoms. And they're expensive.

Expectorants: Expectorants loosen mucous, so they're helpful if you are coughing up phlegm (you will get more phlegm up and then cough less). The main expectorant on the market is guaifenesin (Mucinex). This only works if you're really well hydrated.

Cough suppressants: The main medication available for this, besides first generation antihistamines, is dextromethophan. Generally you should only use this for dry coughs because you *do* want to cough up phlegm if it's in there. Taking it with guaifenesin kind of partially cancels out the benefit of the guaifenesin.

Combinations: There are a number of combination medications available for colds, and are sometimes what people think of when they think of "cold medicine". NyQuil is a popular brand. Basically, they're a mixture of the above options. They can be convenient, but relatively expensive for what they are. Plus they often have more meds in them than you actually need.

Complications: Colds on their own are generally not dangerous for most people, but they can cause secondary infections that car be more dangerous. These include:

Ear infections: Generally look for ear pain and dizziness after a cold. This can be viral (from the virus that caused the cold) or bacterial (the swelling from the cold trapped bacteria in the middle ear, causing a bacterial infection).

Sinus infections: Facial pain and drainage that is severe or lasts longer than 14 days from the start of the cold. swelling in the sinus cavities from a cold virus can trap bacteria and cause a bacterial infection of the sinuses.

Pneumonia: Cold viruses can spread to lungs and cause pneumonia. Symptoms include fever, severe coughing, and chest pain. Generally this happens in people who are very old, very young, or are immunocompromised.

Letying themselves in, A finds B napping on their sofa as is their habit. B loves a good late afternoon nap. Silly, really, to be so worried over nothing.

Feeling quite embarrassed, A makes to leave, hoping B hasn't noticed what an utterly ridiculous worrywart A has been.

Except... aren't B's cheeks a bit flushed? And why is B suddenly curling up under their blanket as if they are cold? Isn't B's nose a touch pink?

Stepping closer, A ever so slightly touches the back of their hand against B's forehead, finding it far too hot for their liking. B squirms and makes whimpering sounds of discomfort.