Last night at about 3 AM, I got up and searched the web for information on cough suppressants. No surprise to your humble servant (who had repeatedly hit the bottles — non-narcotic antitussives, narcotic syrups, and booze), prescription drugs don’t help. My web sources recommend two things, one obvious and one surprising.
The obvious one: honey. Many of the remedies on this page use honey. Lemon combined with white or black pepper, that’s another popular one. And of course honey and lemon together.
The surprising one: dark chocolate.
In a cough suppressant study performed by London’s National Heart and Lung Institute, chocolate’s theobromine significantly outperformed codeine, the primary active ingredient in prescription cough medicine. Participants in the study were treated at different times with a placebo, codeine, and theobromine before being exposed to capsaicin via an inhaled gas. Capsaicin, a chili pepper derivative, has long been used to induce coughing in clinical research.
As a cough medicine, codeine (mostly known as a painkiller) had nominal success compared to the placebo, but theobromine was 33 percent more effective than codeine to stop coughing. Theobromine was found to work directly on the vagus nerve, which is responsible for triggering coughing.
The article points out that codeine isn’t terribly safe (you shouldn’t drive afterward, nor operate heavy machinery), while chocolate is perfectly safe. Well, not “perfectly” safe — those of us who suffer from reflux learn to fear chocolate for its pro-reflux properties.
And so the dilemma. If I do nothing, the cough will keep me up. If I dose up on narcotic cough syrup, the narcotics will give me insomnia and I’ll still cough my lungs out. If I dose up on chocolate, I won’t cough, but the reflux might keep me up.
I’m going to take my chances with chocolate. It has worked well for me all day, so hopefully it’ll serve me well tonight, too. And maybe I’ll take some honey for good measure.
What’s your favorite cough cure?
D.
Sick again. My medical assistant was thoughtful enough to put a mask on the little girl, but she took it off whenever she needed to cough. Unclear on the concept.
In training, two of my co-residents converted their TB test; one developed pulmonary TB. Here in Bako, I get to worry about Valley Fever, too.
Meh, I shouldn’t kvetch. I get great benefits and salary, and tons of support from administration. School teachers are exposed to the same infectious crap, and they don’t get the compensation I get. Cops, same thing. I guess anyone who works with the public is in the same boat.
What gets me is that bank execs don’t have any of those risks, yet they make more money than all of us put together. Go figure.
D.
Yesterday during the day, that was only the tip of the iceberg. Last night and today were the whole damn glacier.
Right now I’m in this weird mode (which I remember well from residency) of expecting the pager to go off at any moment. Or, worse, anticipating that it will go off only after I fall asleep.
What makes it all worthwhile: stopping in this evening to see my patient, an old fellow who had rather abruptly turned the corner. I’m not sure which of the two of us was more relieved. He, I suppose, but his nonchalance makes me wonder if I were the more emotional one.
He could still go south on us but I doubt it. My other patient, the one who gave me fits yesterday — that’s who’s gonna cause me trouble tonight.
I need sleep.
D.
First off, thanks for your comments on yesterday’s post. I appreciate it.
I work in a profession where shit happens. Bad things happen to good people. Bad things happen to bad people. Nothing happens for weeks at a time and then all hell breaks loose. Sometimes it seems that every night is a full moon.
I know in my heart that bad things don’t always happen for a reason. Random chance, that’s all it is, and yet it’s hard not to think magically about such things. What did I do to deserve this. Maybe it’s a generalization from the many areas of our personal universe where we did, in fact, do everything possible to deserve what we find at the end of our spoon. Or maybe it’s the same drive that made people concoct gods and religions to explain the random shit in their lives.
In any case, it struck me this morning as I was being called to the ER not 20 minutes before my own doctor’s appointment. Do you know how tough it is for a doctor to find time for a doctor’s appointment? Is Murphy’s Law the god of my universe?
But the ER doc reassured me that my patient was doing fine for the time being, and indeed everything turned out fine, albeit not a fun afternoon for either of us. He’s a cool guy, has known me for several weeks and treats me like family, was genuinely delighted to see me show up in his treatment bay. The kind of guy who responds to, “What, you’re STILL smoking?” with “HELL YEAH!” I’m hoping bad things don’t happen to this particular good person.
Why is it so hard to accept the role chance plays in our world? Things just happen. There isn’t always a reason.
D.
From Tyson’s The Practice of Medicine: the treatment of Hodgkin’s lymphoma,
Treatment . . . may avert the fatal termination for a long time. Extraordinary results in this respect have followed the administration of arsenic, and even recoveries have been reported. Large doses, arrived at by gradual increment, should be attained and kept up until some physiological effects are observed.
Five-year survival for Hodgkin’s lymphoma was 40% in the early 1960s, just under 92% in the early part of this decade. What do you suppose it was in 1896? I’d guess less than 5%, with or without treatment. Oh! Just googled it and I was damned close. Five-year survival of untreated Hodgkin’s disease is 6%, ten-year survival zero. We’ve come a long way.
Sort of. Depending upon your choice of cancer. With regard to pancreatic cancer,
The prognosis is unfavorable, and the treatment only symptomatic.
Nowadays, five-year survival is less than five percent. So there’s the spectrum, folks, from one of our greatest success stories to one of our persistent dismal failures.
But at least there are some success stories.
D.
ERs have a smell, as do ER waiting rooms. Blood, mostly, but there’s always a background of fear-sweat and other body odors. It’s not like most folks have the leisure time to shower before visiting their local emergency room.
It’s all so much more noticeable in the middle of the night. I’m not sure why that is. Meanwhile, from a doctor’s pov, life takes on a clearer hue; You’re there for one purpose and one purpose only. Depending on the magnitude of the emergency, all other body functions take a back seat to getting the job done. You ignore your thirst, your hunger. Most of all you ignore the desire to sleep. Sleep is the reward at the other end of getting the job done.
I miss residency for one thing only: colleagues. Rare is the case that doesn’t benefit from discussion. And so this morning, I felt the need to talk to someone from the U. Any U. But this morning, it was my U, USC.
Shirley, one of my nurses from back in the 90s, took the call. “Is this our Dr. Hoffman?” she asked.
“I don’t know,” I said. “Is this my Shirley?”
I remembered her, of course. I always remember the pretty ones, and the nice ones, and the ones who mothered me. I suppose she was a bit of all three. Don’t know why she remembered me, other than the fact I tend to be notorious wherever I go. She handed the phone to another nurse who remembered me. She’s the cousin of Jake’s nanny, and she said that whenever they got together they always talked about me (and Jake, of course).
Times like this, I’m happy to be a doctor, even though I’m tired and foggy right now (could only manage five hours sleep after getting home) and worried, too. In TV medical dramas, bad outcomes occur only when there is much angst to be squeezed from the death — wet hanky melodrama. And even then, the tragedy is often temporary. The sting is there for the pulling. In real life, we know that bad things can and will happen to good people, and our only recourse is to do the best job possible. At least then, afterward, we can still live with ourselves.
It would sap the will if good things didn’t happen with the bad. Being remembered helps, too. It isn’t always obvious the impact we have on people’s lives, not just patients, but coworkers, too.
Note that I don’t ask why they remember me. Some things are best left to the imagination.
D.
Seems all I’m doing is working, eating, and sleeping lately. And playing Oblivion. My character in Oblivion, she’s pretty buff right about now. She has a bow that does shock damage and harvests its victims souls, and a staff to paralyze with, and a soul-drinking sword. (Anyone remember Elric’s soul-drinking sword Stormbringer? An absolute pussy compared to my sword.)
I picture myself at the end of life old and confused, blurring World of Warcraft vistas with my travels through the Northwest, Oblivion dungeon-crawls with midnight journeys through the subterranean roads connecting LA County Hospital with Women’s Hospital and the Pediatric Pavilion, Bioshock bloodbaths with ER runs for nosebleeders, XHamster videos with my own relatively paltry exploits. “You were there,” I’ll say to my doctor, thinking him to be my son. “Remember when that patient’s ears were impacted with bile demons? Now, that was a mess. Oh, do be a sport and pick me up some sungrass at the grocery store. I need to make a few Elixirs of Greater Agility. These old bones . . .”
No wonder my son is a computer gaming & internet addict: real life is so much more dull.
I need to take a page from these monkeys and go soak my head.
D.
One of my patients mentioned that she and her mom had watched this on the Internet. I don’t use the coblator to do my tonsillectomies, but I must say I’m sorely tempted. This looks like fun.
Note that the patient is in the surgical position (the tongue is hidden under a retractor at the top of the screen, and the uvula is at the bottom of the screen).
Next is the old technique using electrocautery. The orientation is different — the uvula is at the top of the screen. This is how I did all my tonsils until 2005, which is when I adopted the microdebrider technique. Bloodless to be sure, but it leaves a hellish burn in the throat.
I haven’t found a microdebrider tonsillectomy video. For that matter, they don’t have one of the old scissors-and-snare technique, which I do use on occasion. Maybe I have a bright future ahead of me as a YouTube surgeon?
D.
My doc ordered a slew of labs for me, which I had drawn yesterday morning. Everything’s back except for the occult blood test, and in particular my PSA is normal, so no prostate cancer. Yet. They say it’s inevitable for men if they live long enough, so I guess I haven’t lived long enough. As for the occult blood test, I didn’t quite follow directions. I didn’t pick up the little test kit with its specially designed “poop flotation device” napkin. No, let’s just say I brown-bagged it.
Too bad my son doesn’t read my blog regularly anymore; he appreciates a disgusting pun.
Also not dead are Abe Vigoda (88) and Betty White (88), both of whom I saw minutes ago in a Super Bowl commercial, and both of whom are still working, per IMDB. Mickey Rooney (90) is still kickin’ around, and still working. Funny how some actors keep at it and some pull out of the limelight. Paul Newman, who died a couple of years ago, had his last big role in 1994, with the Coen Brothers film The Hudsucker Proxy. Newman had a few more films after that, and a smattering of TV and voice work, but he essentially retired in the 90s. (Of course, he kept busy with his philanthropic work right up to the end.)
It’s fun cruising Wikipedia, looking to see who’s alive and who’s dead. Mikhail Kalashnikov, inventor of the AK-47 assault rifle, is still alive (90), along with author Frederik Pohl (90) and SNL announcer Don Pardo (92). Here’s Don Pardo blowing out the candles on his birthday cake at age 90.
When I turned 40, that’s when I first started having the thought, oh, something like, “It’s not quite half over.” Getting harder and harder to convince myself that I’m not yet on the back half.
I’m holding out hope for the longevity researchers.
D.
The 1890s, that is. For $20 plus shipping, Powell’s sent me The Practice of Medicine: A Text-Book for Practitioners and Students with Special Reference to Diagnosis and Treatment by James Tyson, MD (1897). If any of my readers are writing a romance circa 1890-1910 and need medical advice, just let me know.
I found this book online while preparing a talk for the pediatricians. Here’s the passage that caught my attention, regarding the treatment of tonsillitis:
In the first place, cold should be applied to the neck by cloths wrung out in cold water or by ice, which is conveniently applied by little muslin bags made to fit under the angle of the jaw and held in place by a bandage. Then iron and chlorate of potassium are, without doubt, the remedies par excellence, and to these may be added the bichloride of mercury, if measures recommended for the throat in diphtheria are not necessary.
Below the cut: more cutting edge medicine from the 19th Century.