Ep.3 - Sinus Signs, Symptoms And Over The Counter Medication
In this Swain Sinus Show episode, Dr. Ron Swain, Jr. talks about the physical signs and common symptoms that tell you it's time to start looking for an ENT (Ear, Nose and Throat) doctor and sinus specialist. Also, we learn how to make sense of the many over-the-counter sinus and allergy medication and why it's good idea to stop self-diagnosing and to seek a professional medical
consultation and opinion.
Ep.3 Swain Sinus Show Transcript
Stacy: In this episode, Dr. Ron Swain talks about the physical signs and common symptoms that tell you it's time to start looking for an ENT doctor and sinus specialist. Also, learn how to make sense of the many over-the-counter sinus and allergy medication choices and why it's good idea to stop self-diagnosing and to seek a professional opinion. All right, so let's get started with an easy one. What are the common sinus conditions and symptoms that should be a sign for me to start seeing a sinus specialist?
Dr. Swain: I think that the number one reason you would see a sinus specialist or someone who's an otolaryngologist would be duration and frequency of the symptoms. I mean, pain is always an ominous sign. I think, when people have pain, that's usually a great motivator for people to seek care. But you know, in terms of a chronic condition, you know, the person that has just one infection every six months, well, that's not bad for Mobile, really. But if you're having symptoms all the time, it's the frequency, the duration, you know. Frequently, people come in and say, "You know, I've been sick for four months. I've been sick for six weeks." That's one of those things that you're gonna want to see someone more than anything else.
Stacy: Is that someone saying they have a runny nose, or is it the sinus pressure? What are some of the things that make it severe? I mean, I'm thinking I get a cough every now and then or maybe even a consistent cough.
Dr. Swain: It can be any of those things, really. People will complain, and it depends on really what's bothering them. What bothers one person doesn't really bother another one, drainage down the back of the throat, pressure in their head, pressure in their nose. People say, "You know, I've been blowing out this yellow and green stuff for two weeks, three weeks. You know, I've been on antibiotics, and it hasn't helped." Occasionally, I'll get someone who comes in and says, "You know, I haven't taken anything prescription-wise, but I've been on all this over-the-counter medicine." And then you start going into, "Okay, well, what over-the-counter medicine are you taking? How long have you been taking it?" People can actually be taking some things over-the-counter that are actually making the condition worse.
And so when you start talking with the patient when they come in, it's an individual problem to try to figure out, "Okay, what's going on, and how can we help ya?" So there's not a one-size-fits-all answer to that question, but it really comes down to duration of symptoms, how long you've had the symptoms, what are the symptoms, especially pain, pain is always one of those things we always worry about, and then family history too. I have patients come in and say, you know, "My mom had sinus surgery. My brother had sinus surgery. You know, my father had sinus surgery," or, "I've had all these sinus conditions." So there is a genetic component to it as well. And then there's some people that just come in. They're like, "Look, you know, I just want an opinion about what's going on."
Stacy: So let's talk about some of the over-the-counter options that are out there. I was telling you earlier that I have some allergy, like scratchy throat feeling, and so I had picked up the generic of Zyrtec.
Dr. Swain: Yeah.
Stacy: And that seems to help, but not necessarily. So tell me kind of, am I picking the right thing? Should I do something else?
Dr. Swain: How do you walk into a drugstore and figure out what you need to take? Basically, you're trying to diagnose yourself. You figure out, "What medicine do I need?" And that can be hard, so if you're gonna self-diagnose, you need to think like your doctor would think. "I have a history of allergies. I cut the grass this morning. I've had all this drainage down the back of my throat. It's all clear and watery. You know, I'm itching all over from emptying out the lawn mower." And using an antihistamine like Zyrtec or Allegra or Claritin or Clarinex, all those over-the-counter medicines are usually generic right now, and so you can use one of those.
If you're having a cold or if you're having an upper respiratory tract infection, if you take a medicine that can be very drying, so all the nice mucus that's coming out of your nose all of a sudden gets thick and sticky and kinda stays in there, you can be setting yourself up for another problem.
So, most sinus infections don't just start immediately overnight. It's not like, "Oh, I woke up one morning, and now I've got bacteria in my sinuses." Usually, it's a process. It starts with inflammation, and then the inflammation leads to obstruction. And once you have obstruction, then you start having pain, and once you have obstruction and pain, usually the bacteria is involved with that. So going to the over-the-counter and picking up some Zyrtec for an allergy problem is great. Going to use some Zyrtec when you have a cold can lead to some problems.
I'm much more of a person who wants to use a mucolytic agent or a decongestant, so what's the difference, I guess, the really question is. So a mucolytic agent is like Mucinex or guaifenesin. They're the same drug, really. But essentially, what that does is it makes the mucus or the drainage from your nose very viscous, and so it's easier to evacuate it from the nose and nasal cavity. The average person's nose and sinuses make about a liter of mucus a day.
Dr. Swain: Yeah, it's a lot.
Stacy: That's a lot.
Dr. Swain: And so that mucus gets, normally, that gets swept through your nose, down the back of your throat, and you swallow it, and you're never even aware that that's happened. And so, when you have a condition, when your nose is inflamed and the sinuses are inflamed, you want that mucus to continue to flowing in its natural pathway, so taking a drug that's gonna dry it up really kind of inhibits that process. So you want a drug that really is gonna help that process.
In addition, those antihistamines work great at what they're doing, but they do have some side effects to 'em as well. Now, a decongestant agent like Sudafed or pseudoephedrine, that's a great drug to use. Unfortunately, because of some of the abuses with that drug, that drug is really limited. I mean, the pharmacies sell it. They sell it behind the counter.
Stacy: Right. Now, you have to, like, show your driver's license to get a Sudafed.
Dr. Swain: You have to show your driver's license. And so that medicine's great. It'll help decongest your nose, but, you know, it can elevate your blood pressure and it's highly regulated right now.
Stacy: Talking about going into the store and picking out, you know, an over-the-counter, I never know and I'd love to hear your perspective on the name brand versus the off-name, generic brand. Should I pick the Claritin or the Movera [SP]?
Dr. Swain: That's a hard question to answer sometimes because, as a customer, I'm standing in the aisle of the drugstore sometimes wondering the exact same thing, "Which one do I pick?" You know, it depends. I mean, obviously, some of the medicines, or generic ones, are cheaper than others. Cost is always a consideration. You know, I always look at where the drug is manufactured, but that's personal preference.
Stacy: That's helpful because I go and I've looked to make sure the ingredients are the same. You know, you can flip it over and look at the percentage of the ingredient or whatever. Well, I have to say it makes me feel much better that a fellowship-trained otolaryngologist in rhinology...if I can get all that right...has a similar concern as I do as a general consumer.
Dr. Swain: Everyone gets sinus infections. There is no doctor that does not get sick, so every doctor has to be somebody's patient sooner or later. So it's humbling to be the one standing in the line at the drugstore. It's also humbling to be waiting in line at the drugstore. I have seen more than one of my patients that I've prescribed medicine standing in the same line that I have been in, so it's just one of those things that I think we'll get through as a community.
How the drugs are gonna be distributed in the future and what happens with over-the-counter medication is gonna be something that we'll all work through together. You know, that's a long answer for a complicated question, but the most important thing, when you walk in the drugstore, is, "Okay, you know, what do I think's wrong?" And that's so hard. I'd love to be able to help people try to figure out what they need.
Stacy: So what I've really learned from you today...and call it Self-Sinus Diagnosis 101...is that, ultimately, and correct me if I'm wrong, antihistamines dry things up, slow things down, the Mucinex, guaifenesin, helps things loosen up, and then the decongestants open up the nasal passages and help things move. Is that correct?
Dr. Swain: Yes, I think that's a great summary of what we just said. And the thing I would add to that would be the saline rinses are good for helping getting things to move as well, and it's very natural, especially in people that are sensitive to medications. And the nasal steroid sprays help most all of that. It does help dry things up, it helps open up the nose, and that's an anti-inflammatory. So, those nasal steroid sprays work really well and one of the things I'll tell people is, how do you use them in combination with each other?
Stacy: Right. That's what I was just thinking the next level of that would be. And this might be getting beyond my self-diagnosis capabilities, and that's when I need to come see you.
Dr. Swain: Well, we're always here, and we'd love to see people. So yes, I think that would be a good, appropriate answer.
Stacy: So those of us that are standing bewildered in the aisle at the drugstore and don't know which things to combine or do or pick or, "Oh, my gosh, it's overwhelming," that's when we need to call your office.
Dr. Swain: Correct, or look for me in the checkout line as well.
Stacy: How do I get an appointment?
Dr. Swain: It's really easy to get an appointment to see me. If you would call and speak to my nurses, the direct line is 251-470-8823. Again, that number is 251-470-8823, and you can find the number on the internet at swainsinusshow.com. My nurses are Mandy Webster and Chasity Wooten and Emily Demet. If you'd call that number directly, my nurses can help you get set up to have an appointment to see me.
Stacy: Thanks for listening to the "Swain Sinus Show." Please subscribe to our show on iTunes, Overcast, Stitcher, and anywhere you download your favorite podcasts. Want to know more about Dr. Swain or to schedule a consultation or appointment, visit swainsinusshow.com or call his amazing nursing staff at 251-470-8823. We would love to hear what you think about the show. Email us at firstname.lastname@example.org. Again, thanks for listening, breathe easy, and have a great day.
This show is brought to you in part by the fine physicians and friendly staff at Premier Medical Group in Mobile, Alabama.
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