A bi-weekly podcast on the latest medical, science and telehealth news.
The common cold is one of the most frequent of human diseases, and causes billions of dollars in lost work yearly. I haven’t heard of many cases of colds or flu recently, in the Era of Covid.
Distancing, mask wearing, and hand washing prevents colds too. The common cold spreads by AEROSOL transmission, and autoinnoculation into the nose from contaminated surfaces, just like Covid.
By far the most common cause of the Common Cold is the RHINOVIRUS, of which there are 100 serotypes. Coronaviruses, Influenza, Parainfluenza, RSV and enteroviruses also produce cold-like symptoms. The large number of viruses causing the Common cold makes developing an effective vaccine difficult.
Adults eventually encounter most of the serotypes prevalent in their community, and don’t catch many colds. However, when adults travel, they experience a new, unfamiliar group of viruses endemic to their destination. How often do we take a trip and come back with a Cold, or worse. We lack immunity to the microorganisms we have not yet encountered, just like children.
When I was in pediatric allergy practice, I feared nothing so much as the cold temperatures in October. The kids would come back to school, and start getting colds, averaging 7-8 per year. It is commonly thought by researchers that cold symptoms are not produced so much by viral damage to the respiratory membranes, as by the body’s immune response to those viruses.
My experience confirms that opinion. A cold was a worry for my patients. Rhinovirus infection often triggered a severe ashmatic response, sometimes sending the children to the ER if not the Hospital ICU.
It was the allergic reaction to the virus that caused the severe wheezing. After the epidemic of Covid subsides, and becomes endemic, don’t give up all of your newly-acquired habits. Hand-washing, distancing, and even masks prevent other respiratory disease transmission too.
The infographic by the allergy and asthma foundation aims to distinguish between Covid, Influenza and allergy. I would like to discuss more than symptoms. Covid and Influenza are both caused by invading infectious viruses.
Allergy is an over-response by the sensitized body to harmless proteins from the environment Covid and Influenza viruses cause direct damage to the lining membranes of the respiratory tract provoking a protective response by the body which produces inflammation in the nose and lung. Rhinitis, bronchitis and pneumonia result, depending on the site of the inflammation.
The symptoms of Allergy are far different from both Influenza and covid. ITCHING of the nose, eyes and skin is the hallmark of allergic Rhinitis, allergic conjunctivitis and Hives, respectively. Influenza or Covid Infection of the nose, eyes and airways can produce sneezing, redness, coughing and difficulty breathing, but not usually itching.
Fever is characteristic of Influenza and Covid, but not of uncomplicated Allergy. Asthma can result from either infection or allergy, but is a separate beast, caused by release of different inflammatory cytokines.
The ASTHMATIC REACTION shows itself in the BLOCKAGE of breathing of air OUT of the lung, on EXHALATION. This blockage on exhalation in asthma is heard as wheezing, a musical sound. Just ask the wheezing person to take a deep breath IN, which should be easier, and then breathe out as fast as possible, which should be slower and more difficult. Fever is not a feature of uncomplicated Asthma. Influenza and Covid.
Both produce FEVER, fatigue, aching and usually coughing. Covid has the greater linkage with Coughing, which often progresses to Shortness of breath. Both Influenza and Covid can produce a sore throat and runny nose. LOSS OF SENSE OF SMELL is unique to Covid, although if your nose is stuffy, the sense of smell can be impaired. Influenza preys on the very young, which are generally spared from Covid.
If you are careful about social distancing and wear masks in public, and get sick, Covid is more likely, since COVID IS MORE CONTAGIOUS THAN INFLUENZA. Covid protections will probably result in fewer cases of Influenza this winter.
To summarize,both the “flu” and Covid 19 are infectious conditions, vastly different from allergy, which is a derailed body defense mechanism. Any of the three can result in an asthmatic reaction, though the fever of influenza often lessens the Asthmatic response to that condition.. Covid is much more contagious and severe than influenza and can cause more widespread organ damage. Be sure to practice MASK WEARING AND SOCIAL DISTANCING.
If you have asthma and it worsens, in my opinion, this favors covid. My asthmatic patients often got better with the fever of Influenza. If you have a CHILD that gets sick, it is more likely to be Influenza than Covid.
Prostate cancer is perhaps the most common cancer in men. It increases in incidence with age, and if you live long enough, most men will contract prostate cancer. A family history of cancer and obesity are also risk factors. But many times the cancer is so slow growing that it will not kill you. In the age of modern, aggressive medicine, the treatment has often been worse than the disease.
Treating Cancer EARLY is much more successful. The PSA test was one of the first really sensitive blood tests for cancer, and it was once performed routinely, on a yearly basis, usually at the time of your annual physical.
The PSA (Prostate-Specific Antigen) test is VERY sensitive,however. In responding to an elevated PSA, very slow growing tumors would often be treated aggressively, creating more morbidity than the untreated tumor would have caused.
The treatment seemed to be worse than the disease. Many physicians stopped doing the PSA test altogether, relying on symptoms, or detecting an abnormality on RECTAL EXAM to trigger an investigation. Some years ago, a physician friend of mine elected to stop PSA testing, and two years later was discovered to have METASTATIC Prostate cancer. It had already spread to his bones, and he eventually died of that cancer.
This encouraged me to continue with PSA screening, though it is still considered optional. Very recently, a test has been developed which I think tips the scales back toward annual PSA testing. EXOSOMES are little (10-120 nm.) particles that effuse from many cells, especially cancer cells.
They contain a variety of DNA, RNA, proteins and lipids which allow the cells to communicate with one another. Recently, a company, ExoDx, was created to take commercial advantage of Exosomes in the diagnosis of various diseases, by testing body fluids.
Their test, ExoRx Prostate EPI test of urine, has been shown to be helpful in distinguishing AGGRESSIVE prostate cancer from the slower growing kind, when the PSA test is in the “grey zone” between 2 and 10 ng/ml. PSA test results above 10 ng. were always acted on, especially if the numbers were increasing. I would be surprised if the PSA did not reenter the annual testing protocol.
The annual digital rectal exam in men older than 50 years will continue to be done, although it is not very sensitive, and is often not abnormal until the cancer is more advanced. Pain in the prostate area, blood in the urine or semen, and trouble urinating are symptoms worth investigating, but if cancer is detected, it may well be advanced and harder to treat. With abnormal tests,
Risk factors or suspicious symptoms, further testing is often done. Ultrasound or biopsy may be indicated. Sometimes the biopsy is guided by MRI, to increase the likelihood that the cancer, if small, is included in the tissue sample taken. Examining the cells of the biopsy sample will yield a “gleason score” which grades the aggressiveness of the cancer.
This in turn dictates the treatment, which may include different extents of surgical removal, radiation, hormonal or chemotherapy treatment. None of this is pleasant, and you are better off, of course with prevention.
Our old friends, DIET AND EXERCISE are thought to be helpful. Although not proven, eating lots of fruits and vegetables, and maintaining a healthy weight are recommended.
Finasteride, one of the drugs in my medicine cabinet is mentioned as a possible aid. I will be discussing this later. I suggest that you press the green box with the magnifying glass, and type the name of the drug to see if i have discussed it. –Dr. C.
COVID 19 is a nasty disease, in case you hadn’t noticed. It is SNEAKY: you can catch it from a person who has no symptoms.
It is UNPREDICTABLE: you may develop no symptoms or Die from it. It can affect any part of your body, including HEART and BRAIN.
And now we hear that it can DRAG ON. The outstanding infographic, “a multi-systems disease, which is intended for PRIMARY CARE PROVIDERS, has a lot to offer patients, who can do a lot to Care for themselves:
- –They can get a THERMOMETER and a PULSE OXIMETER to watch their own temperatures and oxygen saturations
- –They can monitor their own COMORBIDITIES, like Diabetes and HYPERTENSION, which are common with severe Covid. In patients who get very ill .
- –They can watch their GENERAL HEALTH, including SLEEP and DIET (the exercise part is relegated to DOCTORS recommendations).
You should also RESTRICT Alcohol, Caffeine and it goes without saying CIGARETTE SMOKING. Of course PREVENTION, with DISTANCING, MASKING and being Outside, coupled with SLEEP, DIET and EXERCISE is always best.