Monday, March 15, 2010

My Spinning Head

My head is spinning. Seriously spinning.

Let me see. A combined twelve years of elementary school and high school. Four years of college. Four years of medical school. One year of internship. And three years of residency. Oh yeah, don't forget about the thirteen years of "life" I've had since all of this formal schooling and training has finished.

Yet, for all of this experience and hard work, I felt abandoned. Confused. Wayward. Standing in the middle of a store aisle. I ended up looking to my left, ready to plead for a stranger's help. I looked to my right, hopeful that some angelic vision enveloped in a bright, shining aura would proclaim the answer to my question. And I looked ahead of me, acutely aware of all of my options.

Which cough and cold medicine should I buy?

You might laugh but, seriously, how does the common person do this? Here I am, with all of this medical knowledge and ER experience in my back pocket, and even I can't make a decision to what I should buy in this endless cough and cold medicine aisle.

It started out simple enough. Traveling down the fourteen hours to Hilton Head these past few days, staying in a hotel room halfway through the trip, lots of car time with some lingering kid-coughs, closed continuous car circulating air, and, before I could blink, my wife has a runny nose, sinus congestion, and headache. And is feeling rundown. And is achy everywhere. And has a sore throat. And a fever, "well, maybe I don't have a fever but I feel warm." I'm sure it was brewing before we left but, unfortunately, presented itself at the start of our vacation.

The thing is, my wife never gets sick. Seriously. She takes her vitamins, she exercises, she eats her vegetables, and not from a can, mind you (that would be me and my love-affair with young, tender peas). She consistently partakes in all the things that I only do on a sporadic basis. But, here we are, on vacation, and she's the one whose ass is dragging. I would take one for the team, in a heartbeat, if I could spare her this misery. But, I have to admit, for once, it's nice to not be the adult in the house getting the kids' spill-off illnesses.

She's not a complainer (of the two of us, that would be me), so when she asked me if there were any medications she could take to feel better, I knew she was not feeling well.

We went out as a family to WalMart to buy her some medication for her symptoms. The irony of it--driving fourteen hours to go to a store that exists five minutes from our home--was not lost on me. But to our credit, we did try the local grocery store first.

I walked into the store, very clear about what kind of medicines she needed to get back on track. How hard could this be, really? She and the kids grabbed a cart to fill-up on our needed supplies for a week of condo-living. I searched out the pharmacy section. "I'll meet up with you in a few minutes," I had said. On hindsight, a stupid statement.

I found the cough and cold medication aisle quickly. I started picking up the boxes to read the active ingredients. Cough suppressant? Cough expectorant? Nasal decongestant? Antihistamine? After sorting through all of those options, then, I had to decide if I wanted acetaminophen (Tylenol) or ibuprofen (Motrin or Advil). Okay Jim, I comforted myself, just take your time and start over.

I decided a different approach--let's go with the proclamations on the front of the box. Cold Multi-Symptom (regular or severe), Sinus Congestion, Headache and Sinus, Cough and Headache, Sore Throat and Cough, Sore Throat, Cough, and get the picture. If nothing else, I appreciated the selling of every single variable you could squeeze out of the common cold.

So picture it, you are at the store shopping and you see a guy scratching his head, rubbing his chin, pacing back and forth, picking up a box off the shelf just to replace it back in seconds, and that would be me. With all of my infinite medical wisdom.

I finally sorted through all of these options before realizing, "Wait, she'll need both a daytime and a nighttime medication." I sure didn't want my wife to get tired in the daytime during our time at Hilton Head, right? Possibly risk sleepwalking through our vacation? So, guess what? She'd need the nighttime version, too. Unfortunately, though, the daytime formula I had decided on didn't have an alternate nighttime version (it's usually just an addition of some form of antihistamine). So what did I do? Well, of course, I started over.

The minutes dragged, the active ingredients blurred, and the box-front symptoms united to form one big blob of an illness. Finally, after much frustration, I picked out what I thought was the best option for my wife's illness.

"Daddy," I heard my youngest call, just as I was wrapping up my choice. Looking down the aisle, I saw my smiling family approach me. "What took you so long?"

I held up the boxes I chose for my wife to see. I must have looked like the village idiot, extreme pride radiating from my pathetic face, eagerly anticipating my wife's approval of the two $2.68 boxes of miracles. Please, please, I remember thinking, tell me how good I did.

What she asked next was like fingernails on my brain's chalkboard. "What about the liquid, Jim? How's that?" I think I stomped my feet, my mind screaming "No, no, no" while my voice remained silent. "Or," she continued, walking down the aisle, scanning the options, "maybe I'll just do gel-caps." She looked at several boxes quickly, scanning each's front and back in just short of ten seconds. "Yeah," she said, "I think these will do." She had found a combo-box of both daytime and nighttime medication with, evidently, just the right active ingredients to treat her symptoms.

I think I'll just place this whole experience in the "knows too much," category, thank you very much. I might just be giving myself too much credit, though, on that one.

Now, if you don't mind, I have to go take a couple Tylenol for my headache. Or maybe Motrin. Oops, I mean Aleve...

As usual, big thanks for reading. Next post follows on Wednesday, March 17. Hope everyone is well...see you then...


WrightStuff said...

This is why women are so much at shopping than men. If it takes a doctor that long to pick out a cold remedy, I'd hate to see you attempting a weekly grocery shop... I think you do it on purpose so we won't take you in there again...

Rogue Medic said...

I think I'll just place this whole experience in the "knows too much," category, thank you very much.

That is a legitimate problem, when it comes to cough/cold/etc. remedies.

I do not like the combination medications, because almost all of them contain a full adult dose of acetaminophen in each dose. In the US, it is considered almost unpatriotic to take less than a double dose of anything. If you also take something for any other symptom, you are probably also getting a full adult dose of acetaminophen with each dose of that medicine. You can quickly approach toxic levels unintentionally.

This can be more of a problem with children, since they do not necessarilly have a good vocabulary to describe their symptoms, so they may be describing something in a way that leads to ineffective treatment or too much treatment.

Acetaminophen is cheap. There is no good reason to buy name brand Tylenol, unless you find that a particular Tylenol mixture works best for you. That happens to be the case for my daughter, when it is also combined with chocolate. Since I only experience second hand symptoms, I take her word for it.

The liquid is almost always my preferred formulation, since it is easiest to adjust the dose, it is gentler going down with a sore throat, and the taste seems to produce a bit of a conditioned response/placebo supplemental effect.

The pharmacist is also a great help in figuring out what is best. You explain what you want, ask what the advantages and disadvantages of the first recommendation are, if there are any issues with that recommendation, they will recommend something else, and provide information about that. My experiences with pharmacists have been very positive, at least when they have not been too busy filling prescriptions.

Combination medications seem to be designed to confuse. They also seem to only work best when you have the right combination of symptoms, and you respond best to the mixture of medication the manufacturer decided on. I am not that normal. ;-)

There is also appears to be something in the lighting in the aisles of stores that only has a y-linked disorienting effect. Women appear to be immune to this Kryptonite, and have been known to rescue men from the abysmal aisle affliction.

Tanya said...

Heh-this is why I never go grocery shopping with Hubby-too many choices of everything! Seriously-ketchup alone can take him hours to choose...

Jacqueline said...

I am loving the irony of can't figure out what medicine to get :)

I hope your wife feels better soon. It really sucks when you have vacation time and are too sick to enjoy it.

I like the Tylenol sinus or dayquil sinus. I know Tylenol cold has a day and night formula. Although, I hardly ever take the night time one...again, don't like how it makes me feel. And, I usually try to steer clear of the ones with cough suppressants because I'd rather cough for a few days than end up with a secondary bacterial infection (yeah, I'm a little paranoid thanks to the pneumonia episode with my dad).

And of course, if the coughing gets too bad, she could always take a shot of Jack :D

Anonymous said...

If it were me I'd would also go easy on anything with acetaminophen, especially at a place where there is a chance of adult beverages being consumed.

Rositta said...

I'm not a doctor but I also find the miracle cold cure aisle confusing so don't feel bad; Too many choices for sure. Enjoy your holiday and I hope your wife feels better soon...ciao

Leslie said...

So Jim, are we to understand that those labels that say "doctor recommended" are just hype, cause the doctors don't really know which is best either? LOL!

I love your story telling abilities! Thanks for the laugh this morning.

Cathy said...

I once sent my husband to the drug store to get cold medicine and he came home with one of everything. Granted there wasn't near as many on the market as there are now, but still he came home with a bunch of it.

BubbleGirl said...

Don't you just love how the simplest things in life are so complicated? Sure, you're the doctor, but she's the MOM. "Dr.MOM to the rescue!"

Isn't life grand?

Thanks for the laugh.

Anonymous said...

This sounds like a case of, "Know too much and can't concentrate on exactly what you need because everything you think works contradicts itself."

If you're ever in Toronto, there's a great pub called "The Village Idiot." They'd be happy to serve you a good brew to take off the edge ;) haha

Hope your wife feels better soon! Make her some chicken noodle soup and give her lots of flat gingerale.

Hope said...

Here's what you do:

Stay away from combination medications.

You want:
Sudafed (the real thing)
Mucinex (either kind)
Tylenol or Advil or both
children's liquid Benedryl

I used brand names but generic is fine. Mucinex only applies if there's lots of snot draining down the back of your throat, or if you already know you have a productive cough. The Benedryl should be used sparingly, hence the liquid version. In fact, every doctor I've seen in the last five years for a URI (I had three that were worse than a cold but not as bad as the flu) has said do not take an antihistamine. I only use Benedryl at the point of extreme sleep deprivation, and then I usually pay for it the next day in the form of a massive headache. Sudafed and lots of fluid are the most important thing. Steamy showers and drinking hot tea without milk is helpful too. I tend to skip the painkillers unless I'm really uncomfortable because I suspect they inhibit the immune response, but I can't back that up. :)

I have no idea what is appropriate for children.

Cal said...

I am sorry that your wife in under the weather, especially at vacation time. I hate the combo cold medicines, as you cannot titrate each individual component to meet your needs. Also I never understood using an anti-histamine for colds, makes no sense to me, unless you really need it as a sleep aid at night.
Spicy chicken soup is magic, highly recommend it!
I always treated colds with pain relief and decongestant, but for the last few years I had to forgo the decongestant, which I miss.
Finally, the story is really well written, loved it! (nails on brain chalkboard a favorite) Enjoy the vacation as best as you guys can!

SeaSpray said...

I thought you were gonna say your wife had you out shopping for cotton ponies! LOL! THAT ..does my husband in every time ..too many choices the embarrassment factor... he pretends he's looking at something else as soon as someone else comes into the aisle and he buys other things to cover them up and make them look like an incidental item in the carriage ..while feigning surprise there in the carriage but to keep things simple for the clerk allows her to ring up anyway. Something like that anyway. ;)

Cold meds daunting too. We women are used to these aisles tho. You were over thinking because of your training. WOW! That sure is a lot of education!! And it continues.

I laughed all through this post.

Just think of the entertainment the staff gets when they have the opportunity to watch wayward men befuddled in these aisles.

Personally ..we always prefer daytime/nighttime *theraflu* and have used it for colds.

It enabled my husband to work through the flu.

And enabled me to work through the mother of all colds.

And we prefer the powder mixed with hot, steamy water. There is just something soothing about holding that hot mug and the steam wafting up.

I am telling you... that only half way into sipping the theraflu ..we are feeling better. AMAZING product!

If you've never tried it *must* the next time you feel really ill with an upper respiratory infection. These day/night theraflu products really go the extra mile.

It tasted awful at first, but then we acquired a taste for it and looked forward to it much so I could've served it in a tea pot. ;)

My husband is a hardcore non complainer..stoic and has to be feeling at death's door and maybe he will ask for something. Now ..he asks for the Theraflu because he knows how much better he can feel. The only negative is last I knew it has that ingredient that isn't good for htn. But I don't know if it is still in the product now.

Also ..sipping good old honey,lemon and tea works wonders in helping with irritated throat and helping with coughing along with the steamy shower. You know that though. I didn't and a couple of years ago ..the tea and shower were the only things that helped me stop the hideous coughing.

I love what you said here: "Yet, for all of this experience and hard work, I felt abandoned. Confused. Wayward. Standing in the middle of a store aisle. I ended up looking to my left, ready to plead for a stranger's help. I looked to my right, hopeful that some angelic vision enveloped in a bright, shining aura would proclaim the answer to my question. And I looked ahead of me, acutely aware of all of my options." LOL! And I did LOL! when I read your next line after this. :)

Thanks for the laughs Jim. :)

Maha said...

Before I became a nurse, I used to pick up any box that said, 'cold and congestion relief' and now I too scour the aisles, reading each label carefully and then just walk out of the drug store completely frustrated because I'll just end up taking ibuprofen at home anyways!

SnowLite said...
This comment has been removed by the author.
Anonymous said...

it's comforting to hear this if for no other reason than job security as a pharmacist. ask us! we're there for you!

enjoy hilton head, I'm crazy jealous you'll be there. if you're a fan of SC, perhaps check out Fripp Island sometime. it's perfect.

Tonjia said...

OK let the ER nurse help you:

cough? Delsym or mucinex

cold symptoms: the kind your wife bought, dayquil/nyquil combo box.

see, its easy!!! LOLOL

hang in there doc, most people wouldnt know how to treat a Mobitz Type II heart block so you are still ahead of the game. ;-)

Katie said...

LOL! It's sad how well I understand this post. I spend this past weekend ten hours from home living out of a hotel, and awoke this morning to my aunt in the bathroom with some... well, unpleasant problems. A phone call to a triage nurse at home (wait a second, isn't my aunt a triage nurse herself? this is the knows too much part) and a trip to urgent care later we found ourselves in Walgreens (also a store we have at home) filling a plethora of perscriptions. While she did that, I scanned the Tylenol aisle for MY headache. Maybe I was a step ahead of you because I knew Head-On wasn't doing the trick and had decided on Tylenol. Much to my chagrin, I couldn't find "my kind." First off, why does everything have to be super strength? No, thanks. Secondly, it is really that challenging make adult-strength chewable medication? I find it very hard to believe I'm the only person in this world who can't swallow pills. Whatever. I think this puts me with you on the complainer list...

"Please, please, I remember thinking, tell me how well I did."
Sorry... couldn't help it.

Oh, and a writer note: I like to seperate out my thoughts from the rest of the action so the reader doesn't get confused. For example, I would have written "Please, please I remember thinking, tell me how well I did." (Did that actually show up properly?) Just a thought.

Great and funny post,
<>< Katie

mommy-medic said...

Excedrin for headaches!!! (No idea if it's spelled correctly, and too lazy to go check, but the stuff works wonders!)

coulrophobic agnostic said...

I've never found a cold medication that does fuck-all anyway. I just want to be able to breathe, but nothing will unclog my nose except for sitting in a hot shower.

Mucinex is pretty awesome stuff, though.

Smalltown RN said...

Yes it can be daunting task....I think of the symptoms and what I want the drug to achieve....I also buy generic brands...rarely do I buy name brand...why pay for the name when I can get the same thing for less in the generic brand.

Hope your wife feels better real soon and that you have a fantastic holiday!

Anna said...

STORYTELLERDOC hope all will work out for all of you. You know the virus got her just in time when here immune system was low. It happens to me all the time, I usually do not get sick at all, once for three years, and then I was tired one day - got shingles (yeah who gets shingles at age of 35, only me I guess). Hopefully your choices worked out. I find it is hard to pick the right one, especially when there is so much, they are probably all the same anyway, just marketing strategy. Thanks for sharing your great story again, Anna :) (ps wishing you well)

girlvet said...

a little knowledge is a dangerous thing...

Sandra said...

I am SO good at this type of thing - Rogue Medic is right - NO combo stuff.
1. Mucinex DM - don't go cheap and buy generic as you want the extended release which is only in the brand name. You only have to remember to take it twice a day.
2. Sudafed - and take a sharpie and write a big D for DAY on the box.
3. Benadryl or Tavist for night - and use a markie to write a big N for night on the box.
4. Tylenol for the aches and pains. Other stuff might irritate you stomach if you end up getting up in the middle of the night and taking it on an empty stomach.
5. Nasal spray. Because of the rebound effect use it ONLY at night and ONLY in one nostril. And each night alternate the nostril you used it in.
6. Saline nasal spray. Use this throughout the days as moist sinuses drain better than dry ones.

Dr. Woof-Woof said...

I LOVED this post! Mostly because it makes me feel better that I'm not the only Doctor who stands in the middle of the cold meds aisle completely befuddled! ;) I feel 100% silly every time. I think I hate it most because I don't want meds that I (or the kids or the husband) has no need for... So I look at the labels and play the "well, he has A&B but not C&D, but does have E" - "where is the AB&E med?" - "nope, thats ACDE... and thats BDE... and there's ABEFG..." Seems like they NEVER have the combo I need to find! But there ARE 500 other combos... Crazy stuff. Thanks for the laugh, though, and for letting me know I'm not alone! ;)

terri c said...

Hope your wife is much better now! Probably the best cure would be: Dad takes the kids out all day and lets Mom stay in bed and sleep.

Dr. Mongo Lloyd said...

When picking a cold medication, I only have a few questions that I ask myself.

1) How much does it burn when it goes up my nose?

2) How well does it mix with red phosphorous and blue iodine? What will it look like in a glass pipe when I'm done mixing the cold medicine with red phosphorous and blue iodine?

3) Will I have enough cash left over for life's important things, like lye and lithium ion batteries?

4) Will purchasing this product facilitate my late-night trips to Farmer Jim-Bob's field for a late-night fill-up of anhydrous ammonia?

If you get into the habit of considering these factors when buying cold medicine, my time on this blog will not be ill-spent.

t. said...

Hahahaha!! Oh, the sweet, sweet irony of a doctor totally confused in the cold & flu aisle.

For me, though, it's Advil Cold & Sinus with a day- or nyQuil chaser, Robitussin (either DM or with guaifenacin) homemade chicken soup (comfort food!) and gallons of water.

Medically sound? Probably not. Do I feel better? I like to tell myself I do (though maybe it's cuz I'm too looped on all the dextromethrophan).

Jabulani said...

Ya know, surprised I am not. Amused? Oh yeah... The "knows too much" thing is totally correct. So here's a little tip from a 'Cousin Across The Pond': Lemsip. Honestly it has more magical properties than Chocolate and Chardonnay. At the first whiff of something unpleasant, I boil up the kettle and stir in the powder. Yup, Sea Spray's right - caressing your medication like a therapeutic cuppa somethin' is 85% of the cure! In fact, I'm on the stuff now because I have to keep myself awake so's I can finish making my mother's cousin's 60th birthday cake (otherwise I'd be in bed having drained a cup of Lemsip before I went Nod). So next time one of your lot gets sick Jim, holler. I'll beam you over some Lemsip :)

Anna: my sister-in-law got Shingles when she was 32. Horribly. Poor love.

SeaSpray said...

Sandra - I'm impressed!

Jabulani - what exactly is lemsip?

Also ..Jabulani ..I enjoyed reading about Zippy's stay with you and checking out all the pictures. At one point I was going to have him come stay with me, but then ended up stented for the summer ..but perhaps I will try again. However castles in NJ that I'm aware of. :)

I need to go back and comment in Zippy's blog. :)

Jabulani said...

Sea Spray: Exactly what it says: it's a lemon-flavoured powdered medication that you dissolve in boiling water and sip!!!! It sounds like Theraflu. It most likely has all sorts of other 'stuff' in it that I just don't want to think about; I could end up havering like Jim for hours when I should instead be just making a cup and drinking it on down. I can always guarantee that 10-15 mins after I've drunk it, I'll be feeling better and then 10-15 mins before the 4 hours is up, I start to feel all snotty and achey again so I prepare the next dose. 24hrs later, I am fit enough to run the London Marathon. OK, maybe that's a teensy weensy exaggeration but ... you get my drift I'm sure :)

Yeah, I had great fun doing the Zippy post. My kids loved having him here; poor thing got dragged all over the place! You could still host him; just contact Doc Rob. He needs venues after NYC - you could probably go fetch him!

kristi said...

This is too funny! I never knew a doctor would have difficulty picking out otc meds!

SeaSpray said...

Hi Jabulani - it does sound like theraflu and it is a wonder drug in our house.

I live in Sussex county. Interesting little coincidence. :)

I'm not ready to host yet but perhaps sometime this year.

Regarding otc choices ..they can make you crazy ..but I end up looking for things that cover the symptoms I have ..but if it also covers symptoms I don't have ..I take it anyway because the crazy making part is either they don't cover all symptoms ..targeting only a few ..or they overlap into things you don't need. Since I'm a girl that believes in covering all her bases ..I go for the overlap ..better safe than sorry.

Rositta said...

This cold is making the rounds I think. I've had it for almost a week now and no OTC meds worked. I finally went to a walk in clinic today for some serious medicine. Now my cataract surgery is probably on hold. Wouldn't want to be coughing while the doc has a scalpel near my eye...ciao