The common cold affects billons of people every year, with symptoms such as nasal congestion, a scratchy or sore throat, and/or a cough. Colds generally result from any one of hundreds of viruses that infect the upper airways. Cold symptoms often last 7-10 days and will go away on their own. Antibiotics are not effective against viruses, and are only used to treat bacterial infections. Adults usually do not have a fever with a cold. If you develop a fever, pain or pressure over your sinuses, headache, ear ache, or shortness of breath, then your cold may have caused a bacterial infection such as sinusitis, strep throat, bronchitis or pneumonia to develop. If that happens, a prescription for antibiotics should be considered.

Most sore throats (>85%) are caused by viruses. Signs and symptoms of strep might include a rapid onset, fever, swollen lymph glands, and the absence of a cough. A rapid strep test in your doctor’s office can help to determine if your sore throat is due to Group A Strep, the most common bacterial cause of strep throat. If your doctor thinks you have strep and the rapid strep test is negative a culture can be sent to the laboratory or you might be treated with antibiotics presuming your infection is strep. In cases of strep, antibiotics will shorten the course of your symptoms and prevent complications of strep such as a tonsil abscess, rheumatic fever, kidney inflammation, toxic shock syndrome, sinusitis, or pneumonia.

Going out into cold weather without a hat or coat, and getting wet in the rain do not cause colds. Upper respiratory infections are most common in cold weather months because people spend more time indoors. Colds are easily spread via virus-containing aerosolized droplets from coughing and sneezing that are transmitted from person to person when inhaled or rubbed into your eye, nose, or mouth after shaking hands with someone who has a cold. Colds are usually contagious for one or two days preceding the onset of symptoms, and for three to five days after you get sick. Frequent hand washing with plain soap and warm water is the best way to prevent catching and transmitting a cold from person to person. If you have to cough or sneeze, use a tissue or cough into your elbow. Wash your hands often and well.

The body’s healing mechanisms are miraculous indeed, but generally take a fixed period of time whether you cut yourself with a knife and need stitches, pulled a muscle in your back, or break your ankle playing basketball. Here’s how it works:
• Immediately after an injury to any tissue in the body – whether to skin, muscle, or bone - inflammation occurs so that the injured tissue can be absorbed by the body, and the wound is prepare your body can prepare the affected area for healing to begin.
• The inflammation results in swelling and pain, the body’s way of telling you to rest the injured part. It’s good to listen.
• Healing takes place by growing new tissue, and knitting together the injury with scar tissue to add strength. This starts two days after the injury and continues for another 4-6 weeks.
• From 6-8 weeks the healed tissue is continually remodeled, gaining strength while swelling decreases, and re-injury becomes less likely.
• It takes another 2-6 months for complete healing to the point that your injury is fully resolved and you are hopefully good as new.

The frequency of antibiotic treatment (how often) is determined by how long a particular drug lasts in your system before it is metabolized or excreted. For example, Z-Pack (aka Zithromax) 5 days lasts a long time in your system, so is taken once daily, whereas Penicillin is taken 4 times daily. The duration of treatment (how many days) is determined by the location of a bacterial infection in your body. Some organs or structures are more (or less) penetrated by antibiotics, and so treatment needs to take place over a longer period of time. For example – it is harder for antibiotics to get into a sinus infection (10-14 days), easier to get to a urinary bladder infection (3-5 days). Treatment of skin infections (cellulitis) also vary with location and the type of bacteria, usually lasting 10-14 days. Most antibiotics are engineered for ease of use. Once a day is easier to take than 4 times a day, resulting in better patient compliance, and a more likely cure. While 85% of infections may be treated after 5 days, patients sometimes forget doses, and so 7 or 10 days may be preferred in order to achieve a better cure rate (>95%).

Ear infections are the most common childhood condition for which antibiotics are prescribed in the US. Signs of an ear infection include rapid onset of earache, tugging or pulling at the ear, irritability and/or fever. These are non-specific symptoms that may be found commonly in children with upper respiratory infections or “colds” with cough, runny or stuffy nose, and scratchy throats which are due to a viral illness. To diagnose a bacterial ear infection, your doctor can examine the child’s ear for signs of external infection of the ear canal - otitis externa (a.k.a. swimmer’s ear), or inflammation and fluid behind the eardrum that indicate a middle ear infection. Some children depending on their age and frequency and duration of middle ear infection, and presence or lack of fever, may benefit from a trial of observation only and medication for pain relief as the infection may be self-limited. Most ear infections are treated with a prescription for antibiotics over 7-14 days with drops in the ear or antibiotics my mouth.

Low Back Pain is second only to the common cold as the leading cause of missed days from work in the US. It’s also one of the most common reasons to visit your doctor. Most back pain is due to a combination of muscle strain and wear and tear on the ligaments and cartilage (the discs) that support the spinal column. The exact source of the pain may be difficult to pinpoint, but the initial treatment is the same. Rest, heat or cold, and medications that reduce pain, muscle spasm, and inflammation are the mainstay of therapy. Most back pain will resolve within a few weeks. Massage or accupuncture may also help to reduce muscle spasm. Exercises to strengthen the core muscles that provide stability to the spine are beneficial once you are feeling better.
MRI (Magnetic Resonance Imaging) is used to diagnose more chronic or severe back pain that involve the discs or nerves, when a surgical treatment may be considered. Signs of this kind of injury could include pain that radiates down one leg, numbness, tingling or weakness in your legs, difficulty in standing or walking, or problems with controlling bladder or bowel movements. There are many other medical conditions that can cause back pain and some are serious. These include aortic aneurysm, peptic ulcer disease, kidney stones or kidney infections, prostate problems, and spinal infections. You should consult a physician if you have back pain causing a fever, or pain that is worse or does not improve after more than a few days of conservative treatment.

Pink Eye or Conjunctivitis is one of the most common eye problems in both adults and children. Typical symptoms in one or both eyes include one or more of the following: waking up with crusted eyelids, a mucous discharge, redness, itching or burning, blurry vision, light sensitivity, and the sensation that something is in your eye. Conjunctivitis has many causes including viruses, bacteria, chemical irritants (like chlorine in a pool or ammonia in house cleaners) and allergens such as pollen or dust. An ophthalmologist can distinguish between these and recommend a specific treatment. Bacterial infections are treated with antibiotic eye drops while some types of viral or allergic conjunctivitis is treated with drops that provide symptomatic relief. Both bacterial and viral conjunctivitis are contagious so frequent hand washing is recommended to prevent spread from one eye to the other or household and workplace contacts. A warm washcloth frequently applied to the affected eye will help to remove the crusting. Do not share soap, towels or personal items while you have conjunctivitis. Do not wear contact lenses while you have conjunctivitis and all potentially contaminated lenses, lens solutions and eye makeup should be discarded.

There are many kinds of illnesses that cause nausea, vomiting and diarrhea. Among these are food poisoning, traveler’s diarrhea, and gastroenteritis. Food poisoning typically starts rapidly- within a few hours of eating the contaminated food- and presents with stomach cramps followed by nausea, vomiting and diarrhea. Food-borne illnesses include bacteria causes like Staphylococcus, E.Coli and Salmonella. Severe abdominal pain, fever, or blood in your stool would be signs of a more serious infection that could require antibiotics or hospitalization. Viruses such as Norwalk and rotavirus are quite contagious and may also cause vomiting and diarrhea in both adults and children. Regardless of the cause, preventing dehydration by frequently sipping clear liquids such as sports drinks, chicken broth, or ginger ale is one of the most important things in treating this type of illness. You should see your doctor if you are not able to drink enough or keep down liquids at all. Most of these illnesses are self-limiting and will resolve within a few days of onset. You should also see your doctor if your symptoms persist, or if you have severe abdominal pain, fever, or blood in your stool.

Nosebleeds generally occur because there are injured or exposed blood vessels on the surface of the mucous lining of the nasal septum – the partition between your nostrils. A blunt injury to the nose, scratching an itch inside your nostril with a finger, or dry, inflamed mucous membranes due to cold weather or an upper respiratory infection are the most common causes of nosebleeds. Nosebleeds are not a result of high blood pressure, although the stress of a nosebleed may elevate blood pressure readings, especially in people who already have hypertension.
What to do:
• Blow your nose with a tissue to get out any blood clots.
• Then, pinch the fleshy portion of your nose over the nostrils between your thumb and index finger for 7-10 minutes. This will usually stop the bleeding
• Use an over-the-counter saline nasal spray to keep your nasal passages moist, in order to prevent re-bleeding
• If these home remedies are not effective or if you are on blood thinners, you should probably go to an ENT doctor, urgent care office or an ER.

What not to do:
• Don’t insert a tissue into your nostril. Removing it will make you bleed again
• Don’t tilt your head back. This will allow the blood to drain into your throat, and swallowed blood will cause nausea and vomiting.
• Applying ice to your nose will not stop the bleeding, but may be useful in reducing swelling from a blunt injury to your nose.

There are reliable criteria for the evaluation of head injuries in children. The purpose is to determine what sort of injuries require any testing or evaluation beyond a good history and physical by the examining emergency physician or pediatrician. Any child who has an altered mental status, abnormal neurologic findings, or evidence of skull fracture should have a CT Scan of the brain. A CT scan should also be considered when there is a loss of consciousness, amnesia, seizure, headache, persistent vomiting, irritability, or a change in the child’s behavior. Children with mild symptoms may be observed at home, and a CT obtained if symptoms worsen.
Children who are awake, alert, without loss of consciousness or symptoms do not require any imaging. Skull x-rays are of minimal value and CT scans are much preferred if tests are needed. (Annals of Emergency Medicine, “Pediatric Minor Head Trauma“ 37:1, 2001)

Most skin infections are caused by bacteria that enter the body through a small abrasion or cut that allows the resulting wound to become contaminated by bacteria normally prevalent in the environment. Our body’s immune defenses usually prevent bacteria from infecting the frequent nicks and cuts sustained in everyday life. Occasionally an invading bacteria gets the better of our resistance and skin infections such a cellulitis (redness, swelling, pain), abscess (pus pocket), or folliculitis (hair follicle infection) may develop at the site of the wound. The most common bacteria include various types of staph and strep and can be simply treated with an appropriate antibiotic. MRSA stands for Methicillin Resistant Staph Aureus, and is a super-bacteria that has developed resistance to many antibiotics due to mutations from antibiotic overuse. Many people have MRSA that normally live in their nasal passages and so simply wiping a runny nose before touching a cut on your finger might be all it takes to develop a MRSA infection. Because of the increasing frequency of MRSA infections, most doctors routinely suspect MRSA when an otherwise healthy person suddenly develops a boil or cuticle infection, and will prescribe an appropriate antibiotic by mouth as well as an ointment for your nostrils.

The skin is composed of layers that when cut all the way through, need to be repaired in order to minimize scarring, reduce the likelihood of infection, and speed healing. Superficial “lacerations” will heal on their own as the still intact deeper layers of skin form a protective barrier to infection of deeper structures, and provide a good base for the skin to quickly heal itself from the bottom layers up. Deeper wounds may also involve underlying structures such as fat, muscle, tendons or other connective tissues that must likewise be repaired if involved. Deeper tissues are stitched with dissolving suture material, and the skin itself is closed with stronger synthetic sutures or occasionally steel surgical staples, both of which must be removed. Initial wound healing takes place in 5-14 days depending on the body location, after which the stitches or staples are removed. General guidelines for time to suture removal are:
• Face - 5 days,
• Scalp/Torso/Arms/Legs – 7-10 days,
• Hands/Feet – 10-14 days.

To prevent bacterial contamination, wounds should be repaired as soon as possible and ideally less than 6 hours after the injury. Antibiotics are generally not needed unless a wound is heavily contaminated, for example, from dirt or an animal bite. Overall wound healing takes 4-6 months from the time of the injury during which time scar tissue is laid down to strengthen the repair and any inflammation (pink color) that promotes healing resolves. If you have not had a tetanus booster in over 10 years, then this is also a good opportunity for re-immunization.