Cochin Cardiac Club

Health Blog by Dr.Uday Nair


Throat infections

  • Pharyngitis: inflammation in the mouth - the back of the mouth and throat is sore, red and inflamed.
  • Tonsillitis: again the tonsils can be easily seen in some people, especially children, as cherry red lumps at the back of the mouth (so long as the mouth can be opened wide enough). With acute tonsillitis (or glandular fever) they may have white spots of pus on them. If the tonsillitis does not settle within a week, then blood test for glandular fever. Recurrent tonsillitis is often a symptom of allergy to dairy products.
  • Epiglottitis: a nasty and dangerous throat infection which may cause severe difficulty breathing, noisy breathing (stridor), hoarseness, drooling and difficulty swallowing. Don't try to look in the throat: just movement of the jaw can precipitate a serious relapse. Professional help needed urgently.
  • Laryngitis causes a hoarse voice in adults and often croup in children. Again croup is a nasty thing, once the cough is heard it is instantly recognisable. Treatment is with inhaled steroids (or oral steroids, say 20-40 mgs, but takes 2-6 hours to work) to reduce the laryngeal oedema. Sometimes just steam will relieve the cough (hot steamy bathroom or basin of hot water and towel over the head!).
  • Otitis media: ear infections. Sometimes I think all mums should be issued with auroscopes so they can check ears! An ear infection is a common cause of illness in children, often secondary to chronic catarrh. Again I usually treat with antibiotics. Try to avoid using pain killers because they have the undesirable effect of bringing the temperature down: running a temperature is the body's way of killing infection. Warm olive oil poured into the ear often relieves pain.
If any of these problems are recurrent think of allergy! The commonest cause is dairy products. Indeed a colleague of mine who is a paediatrician considers it medical negligence to perform a tonsilectomy in a child without first doing a dairy free diet.

Chest infections

  • Bronchiolitis: children only. Causes fast breathing rate and fever and other respiratory symptoms. May need hospital admission. Contact a doctor if there is respiratory distress.
  • Bronchitis: often follows a cold "which goes onto the chest". Presents with productive cough, illness, fever and sometimes shortness of breath.
  • Bronchiectasis: usually an acute flare on a chronic condition. Patients with bronchiectesis I give an emergency supply of antibiotics so they can take them at the first sign of a flare.
  • Pneumonia: may present with fever, cough, shortness of breath, feeling very ill, pleuritic chest pain and signs of collapse or shock.Pneumonia can be fatal: get a doctor to see.
  • Pleurisy: characterised by pain in the chest when a deep breath is taken. Pleuritic type chest pain can also be caused by pulmonary embolus or pneumonia, so professional help should be sought!
  • Tuberculosis: can present with any of the above symptoms.

Are antibiotics needed?

One obvious sign is hallitosis. Often the patient notices this first: a foul smelling breath on exhalation. 

It is impossible to say whether infection is due to virus or bacteria just by looking.
Sputum changing colour: if the patient coughs up discoloured sputum, either yellow or green or rusty coloured, this suggests infection.Sputum culture: this is worth doing because if antibiotics are prescribed on a "best guess" basis and the patient is no better then at least one can see from the sputum culture whether there is a bug and if so to which antibiotic it is sensitive

Which antibiotic?

Sometimes it is an "old friend" rearing its ugly head and the patient knows exactly which antibiotic does the trick. I usually prescribe on a best guess and take sputum cultures so that if there is no response, I can check to see if an appropriate antibiotic has been prescribed. I like all my patients who are prone to chest infections to hold a supply of the correct antibiotic so they can use it to nip problems in the bud!
Antibiotics are a two edged sword. Whilst they do have side effects, untreated bacterial lung infections leave damaged lung behind which is more likely to get infected in the future. Antibiotics do have a role to play! 

  • Antibiotic treatment of upper respiratory tract infection (URTI) does not prevent LRTI/pneumonia.
  • However, it can be difficult to distinguish between viral and bacterial infection and young children can deteriorate rapidly, so consider antibiotic therapy depending on presentation, and likelihood of bacterial aetiology.
  • Choice of agent appears to be largely arbitrary 
  • A penicillin, such as amoxicillin in a child-friendly formulation, should be used first-line, unless there is reason to suspect a penicillin-insensitive organism (particularly pneumococcal disease). Recent research indicates that children with non-severe pneumonia on amoxicillin for 3 days do as well as those who receive it for 5 days.
  • If a child is genuinely allergic to penicillin, consider using a cephalosporin, macrolide or quinolone, depending on any local antibiotic prescription guidelines, patterns of resistance and suspected organism.
  • Vancomycin may be added to treatment of toxic-looking children when there is a high rate of penicillin resistance.
  • Aciclovir is used for herpes virus pneumonia.

When to use steroids?

Again these are a two edged sword because they may be essential in reducing "useless" and life threatening swelling as can occur in acute allergic attacks, acute asthma and occasionally croup. However they also suppress the immune system and stop the body responding appropriately to infections: therefore often antibiotic cover is required. Seek professional advice!

Viral infections(Cold,fever,flu) and treatments.

Obviously one cannot avoid all viruses, but do your best. There tends to be a mini-epidemic of colds at the start of every school term as every virus acquired is shared around!
Vaccinations can certainly trigger flares of CFS(Chronic Fatigue Syndrome) – some are probably essential and less likely to cause CFS such as tetanus and oral polio. Most other vaccinations have the potential to flare CFS.
My view is that the nutritional approach is so effective at protecting against viral infection that vaccination against seasonal 'flu is not necessary. Vaccination has the potential to trigger other problems such as CFS.
The best defence against viral infections is a healthy body and healthy immune system. Indeed I believe that if you have a perfect immune system you should never get a cold. Getting a cold is a symptom of a poorly functioning immune system.
I am further concerned by the possible erosion of the immune system by excessive use of hygiene, antibiotics, vaccinations and exposure to toxic chemicals such as pesticides. There is a place and necessity for antibiotics and vaccinations but in my opinion they are overused. A recent study indicated that the rising incidence of asthma was due to over-prescribing of antibiotics in early life. Excessive hygiene (too many baths, hand washing, use of disinfectants etc) is also associated with increased risk of allergy. Recurrent infections are a real problem for some CFS patients who simply go from one illness to the next without remission. Furthermore, viruses often cause a mild immuno-suppression which then opens the door for other infections to get in – not an easy situation! 
Actually immune suppression I suspect is a very common problem. The immune system is particularly susceptible to micronutrient deficiencies and toxic stress. Clinically this manifests as susceptibility to viral infections. Indeed if the immune system was working perfectly then an upper respiratory tract infection at worst should cause very minor symptoms for just a day or two. We all know of people who never catch a cold – these are the people with perfectly functioning immune systems. This should not be confused with CFS patients who do not get the local symptoms required to blast the virus out – ie acute rhinitis (runny nose) but just get a flare of all their CFS symptoms. In this event the immune system is so poor it cannot mount a local acute response to physically flush out the virus.

  • Ensure good micronutrient status.
  • Take vitamin D. Why we tend to see more coughs,colds and flu in the Winter compared to the Summer. The answer is vitamin D – the only significant source is sunshine and vit D is highly protective against infections of all sorts. My advice is we should take at least 2,000 iu daily on days where we get less than 20 minutes of good sunshine directly on our skins.
  • Allow inflammation. The body reacts against viruses with inflammation and the result of inflammation is either directly toxic to the virus, or helps to physically expel virus from the body. For example, viruses are very temperature sensitive – for the body to run a fever is a good thing – fever kills viruses (and bacteria). A good snotty nose helps to wash out virus from the nose and a hacking cough blasts the bugs from the lungs. Symptoms may be uncomfortable but should be welcomed as an appropriate way to get rid of virus. This is why I hate to see symptom-suppressing cold remedies such as paracetamol, antihistamines, alcohol, decongestants, cough mixtures which interfere with the body\’s natural mechanisms of killing and expelling virus. SO DO NOT SUPPRESS SYMPTOMS – THEY ARE NATURE’S WAY OF EXPELLING INFECTIONS.
  • Run a temperature – there is no doubt that people who tend to run cold all the time are more prone to picking up infections and indeed this is the basis of the age old tradition to wrap up well in cold weather or you will catch a "cold". It would be interesting to measure your basal temperature. Low temperature can be indicative of borderline hypothyroidism and this can certainly present with recurrent infections. Children are very good at running a temperature at the first sign of virus, but adults less good.
The only exception to using paracetamol for fevers is in some children who tend to get fits if their temperature goes up too high. In this event paracetamol and tepid sponging should be used to prevent this happening. It is therefore doubly important in these children that micronutrients are used to improve the immune response.
  • Rest and warmth sound like common sense but are ignored by many. Rest allows the immune system to work unhampered whilst warmth kills bugs.
    • Take high dose vitamin C. Vitamin C kills all bacteria and viruses, but is remarkably non-toxic to human cells! Firstly use the neutral form of vitamin C (magnesium ascorbate – does not dissolve tooth enamel), open a capsule a tip into the mouth. It quickly dissolves in saliva. Hold in the mouth for as long as you can – this gets rid of all microbes in the mouth including dental plaque. Secondly take large doses of vitamin C (as ascorbic acid – acidifies the stomach and kills microbes there) dissolved in water or fruit juice. I suggest 10 grams initially and then more or less according to symptoms. Aim to cause diarrhoea – this is called taking vitamin C to bowel tolerance. One’s bowel tolerance increases with illness as more vitamin C is needed.
    • Zinc drops 10mgs four times daily into the mouth kills microbes. Zinc is probably the most common deficiency resulting in poor immunity.
    • Check for hypochlorhydria (low stomach acid). Most bacteria and viruses get into our bodies either by inhaling them or swallowing them. One interesting exception is measles virus which gets in through the conjunctivae of the eye. Those inhaled are caught in the mucous which lines the respiratory tract, are swept up and swallowed. All end up in the stomach where they should be killed by stomach acid. However, where there is low stomach acid ie HYPOCHLORHYDRIA the bugs will survive to cause infection. 
    • Consider a detox regime. There is no doubt that chemicals have immuno-suppressive effects – they also depress the bone marrow and this could explain borderline anaemia and low white cell counts.Increasingly I am coming to the view that we should all do detox regimes. First of all we should avoid chemicals as much as we possibly can, secondly take good micronutrients to improve the liver detoxification of chemicals and thirdly sweating regimes. Obviously the most physiological sweating regime is to take exercise.
    • Think allergy – allergy to dairy products often presents with recurrent infections, especially tonsillitis. Sometimes allergy symptoms can present with symptoms of an acute cold – ie rhinitis and cough.
      • Think thyroid – hypothyroidism may present with a tendency to infection because the body runs cold and the immune system goes slow.
      • Avoid female sex hormones, which are immunosuppressive and increase susceptibility to viral infections
      There are some very useful antiviral herbal preparations on the market such as  lime tea etc. but it is really a case of trying as many things as you can until you find a combination that suits you.

      So the basic principles are:

      • Rest, keep warm.
      • Get your micronutrient status as good as possible. Think vitamin D, zinc and C.
      • Do not symptom suppress! Allow a temperature. Aggressively attack viruses at the first symptom with heat, high dose vitamin C as ascorbic acid (swallowed) and magnesium ascorbate (dissolved in mouth) or whichever herbal preparations you find suit you.
      • Check for hypochlorhydria
      • Detoxify as much as possible – including sweating regimes
      • Identify any allergies you may have – think dairy
      • Correct thyroid hormone abnormalities – for this you need to test a free T4 a T3 and a TSH.
      If the symptoms of a virus do not improve after 3-4 days, then it is possible that a secondary bacterial infection has developed. A healthy body and immune system can deal with most bacterial infections, but call for professional help for less than healthy people such as the very young, old, smokers, diabetics, heart failures, people with a history of chest infections, etc.

Advice to all Parents-Smoking in the home is a major risk factor for all childhood respiratory infection.


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