Saturday, December 7, 2013

Ugh, My Throat is Sore!

Let's talk about sore throats for a minute. But not too long, or we might get laryngitis. When fall and winter arrive, so do the viruses: colds, the flu, bronchitis, and all that coughing and aching. Sore throat is a symptom related to inflammation of the tissues of the throat, and as such can have a variety of causes: strep, allergies, post-nasal drip, GERD, smoking, even voice abuse. Still, behind most sore throats there lurks a virus. As I write this, I'm feeling a little catch in my throat myself.

At least 200 different viruses have been found to cause the "common cold", but 3 make up the majority of cases: rhinovirus is most common, coronavirus second, and (especially concerning in younger children) respiratory syncytial virus. Most of these viral infections cause inflammation of the mucous membranes of the nose, mouth and throat, leading to the most common symptoms of congestion, sore throat, and cough. If the virus targets the vocal cords, laryngitis ensues causing hoarseness and even complete voice loss for a short time.

In addition to common cold viruses, mono is a more severe viral illness that can cause long-lasting fatigue, fever, neck lymph node swelling, and persistent sore throat. Although it's called the "kissing disease", the Epstein-Barr virus that causes it can be contracted by the same mechanism as other sore throat viruses: contact with virus-contaminated food, objects or people. To avoid viruses of any kind (or avoid spreading a virus to others), wash your hands frequently, cover your cough or sneeze, use hand sanitizers, and don't kiss strangers.

About the flu shot: contrary to a well-known former Playboy bunny, immunizations of any kind, including the flu shot, DO NOT CAUSE AUTISM. In case Ms. McCarthy or her supporters are listening, I'll say it again: VACCINES DO NOT CAUSE AUTISM. Get the flu shot every year, even if you are not prone to the flu. Even if you have an iron constitution. The flu vaccine, like all others, works by "herd immunity": if a large enough percentage of the "herd" is immune to a communicable disease, the spread of the disease is slowed down, and an epidemic can be avoided.

For those conspiracy theorists who persist in believing a stripper over a doctor, I'm not going to convince you to immunize yourselves and your children against measles, mumps, tetanus, hepatitis, or H. flu, but I do have this favor to ask: please tell all your friends, neighbors, and fellow citizens THANK YOU. They are the ones, the silent majority, who listen to their doctors and get immunized so that your children don't catch deadly childhood diseases like polio.

Polio? Who gets polio these days? I'm glad you asked: unimmunized children get polio, that's who. Just ask the moms and dads of thousands of Syrian children who have contracted polio the past several years because the despotic Syrian government has withheld polio vaccines and other needed medical supplies from rebel-held areas of Syria. It didn't take long for the herd immunity to fade, leaving hundreds of thousands or millions of children in these areas at risk for polio, diphtheria, and other deadly viral infections. It happens. All I'm saying to you parents who opt out is be grateful to your fellow citizens who opt in and save your bacon. 'Nuf said.

Sorry for the vaccine rant. Back to sore throats: 9 out of 10 sore throats are viral, only 1 in 10 is strep. 90% of you sitting right there with a sore throat will get better with fluids, rest (8 or 9 hours of night time sleep and a nap or two during the day), ibuprofen or tylenol, and hot salt water gargles (1/4 teaspoon salt to 8 oz of hot tap watet, gargle and spit until the glass is empty). VIRAL INFECTIONS DO NOT RESOLVE ANY FASTER WITH ANTIBIOTICS. Don't waste your time and money on them for a viral sore throat.

If you have a very sore throat with a fever above 101 degrees F without any other cold type symptoms (congestion, cough, or bronchitis), chances are higher that you have strep throat. Strep throat is a bacterial sore throat caused by group A streptococcus (S. pyogenes), and usually involve the tonsils (strep tonsillitis) and/or throat (strep pharyngitis). 

About those antibiotics you are always hoping for when you see your doctor with a sore throat: even if your throat swab is positive for strep, it turns out your strep throat would likely get better just as fast without antibiotics as with them. There are two reasons to take antibiotics regularly for strep, and neither have to do with your sore throat: first, antibiotics reduce the length of time you are infectious to others (so you avoid spreading strep to others) and second, antibiotics reduce the risk of post-streptococcal systemic diseases like rheumatic fever, scarlet fever, and glomerulonephritis (kidney damage). These are rare but debilitating diseases with lifelong consequences. 

Lots of other illnesses can present with sore throat as one of the symptoms, so if you have a sore throat without typical cold symptoms or if your sore throat lasts more than 7 days, you should see your doctor to see if further testing or treatment is advisable. If any sore throat is getting worse quickly, or causing breathing problems or inablility to swallow even liquids, then see your doctor on an ungent basis.

Sorry, I have to stop now. My throat hurts. I'm going to finish my honey and lemon tea, take an Aleve, and hit the sack for an afternoon nap.