Hello everyone…

It’s been a tough week at my house. Both of my kids, Luke (3) and Gemma Rose (10 months) have been sick with colds and I am going out of my mind. No one’s eating, no one’s sleeping, no one’s cooperating. I’ve been thinking about a few things that I’d like to post in the rare moment that I am not being coughed at or sneezed in the eye, and they are:
1. The amount of time that I have had to “go to a pleasant place in my head” to escape completely losing it in front of my family has been staggering, and
2. I should probably review the right way to bulb suction an infant’s nose.

Let’s take #1 first. While I don’t pretend to necessarily have the patience of Job, I’m not someone who immediately loses it at the first sign of adversity. However, what I have learned about myself this week is that if I were a glamourous international spy who drives a fabulous car and always has my hair done perfectly, who holds national security secrets in my head, the easiest and quickest way for me to spill it all would be to put me in a house with my 2 kids with colds and I would be completely broken within 36 hours. No joke, it’s been grim.

But before I get lost in my rich “Quantum of Solace” fantasy life, let’s get to #2. If you can help a little one out by aiding in the getting rid of the buckets of nasal secretions they have, you are indeed a good soul. You will not know it at the time, however, because they will likely act like they are being tortured in the most egregious sense of the word. Please appreciate this going into the procedure. So here’s what I recommend:

Have some saline water or drops handy. Get your bulb syringe. Lay your baby down, and drop 2 or 3 drops of saline into one side of the nose and count to 3. Your child will really not like you at this point. Then compress the bulb syringe, insert the long end into the nostril about one centimeter, and let the syringe open back up as you withdraw the tip from the nostril. Squeeze out the bulb syringe onto a tissue and sit your baby up to “recover” for a few minutes. Then repeat on the other side. You can do this a few times a day in between your seemingly endless efforts to wipe your baby’s nose. Ahhhhh parenting, isn’t it great!?

Ok back to #1. How ‘bout that Daniel Craig!!!!

By: Dr. Christina Johns

My cool friend and colleague Dr. Marion wrote in to comment about my last post, and just remembering our time together in the Emerg inspired me to remind everyone that while we love Madame Superstar's calendar idea, remember that your doctor probably can't solve a calendar's worth of different problems in 15 minutes. In fact, many doctors believe that the likelihood of actually having a serious problem is inversely related to the number of varied complaints a patient has. That being said, still bring your calendar to your doctor, just highlight the 2 or 3 most important issues.

For the record, Dr. Marion was writing to commiserate with me about the baby barf issue; her daughter Hannah is trying to turn spit up into an art career.

KIDS! What will they come up with next??

By: Dr. Christina Johns

Ok, here's another good "medical records" idea that Jalina (who I will now call Madame Superstar) sent me that I think is definitely worth passing on: she chronicles all her symptoms on her calendar so that when she goes to see her physician she not only doesn't "miss" telling him/her something but she also can sequence it. This can be really key for diagnosis. Can you imagine how overcome with "preparedness" I would be if one of my patients used both Marilyn's and Madame Superstar's ideas? It might cause me to have 2 of Paul's candy apples. At once.

One thing that I must add: if you ever accompany someone to the Emerg after they overdose (accidental or not) or ingest something unusual (see a few posts back), please bring in the bottles of whatever they took because it can be really helpful to estimate how much was ingested, which will then guide therapy.

Thanks so much to my regular readers whose inspiring input makes my posts much more fun to write!

I would write more tonight but I have to go wash the barf out of my sweatshirt that Gemma Rose, my 10 month old, planted on me a little while ago. I am finding that it does NOT add to my charm. At all.

By: Dr. Christina Johns

A big thank you goes out to Paul who got me reminiscing about candy apples-- remember those-- when people used to give those out for Halloween? Yummmm. Paul, next year, I'm there. And I do pledge to brush and floss my teeth after I eat the entire thing in under 4 minutes.

On another note, I was at a party last weekend chatting with a gal named Marilyn who I adore not only because she loves my blog and thinks I'm hys-TER-i-cal (ok that does indeed help) but also because she's smart and sassy. She had a pretty good idea: she printed out a page of label stickers with all of her medical information on them-- name, date of birth, insurance info, allergies, medical problems, current medications and dosing. Then when she has a doctor's appointment she just brings a label, peels it off, and sticks it on the intake form, saving her time and decreasing her risk of errors. Brilliant and easy! As a physician, I must say it's always nice to see all the medications a patient takes at one time rather than hearing about them one by one through the course of the visit. While it's sometimes fun to guess, finding out the whole story at the beginning generally makes things go a lot smoother.

So I'm passing that one on to everyone. Do you have another good idea like that to share? I'm all ears......

By: Dr. Christina Johns

Are you a large size or "fun-size" candy bar household? Do you give out pretzels or raisins? Money? Toys? Toothbrushes? I'm interested to know which neighborhood I should trick or treat in next year. Did anyone hand out anything unusual?

Many dentists and pediatrician's offices will offer kids money if they "donate" some of their candy.

My opinion on that-- it's a free country, so everyone gets to make their own decision about whether or not their kids can eat all the candy they get on Halloween; I just hope that during this time we don't turn our backs on our kids' dental health. So redouble your efforts to brush, floss, and use mouthwash. Feel free to nag and model good behavior.

But can you save me the large size candy bars please?

By: Dr. Christina Johns

Did anybody see the health story on the news the other night about the prostate cancer research study that was stopped early since it didn’t appear that “it was working” to prevent prostate cancer? Basically, a large study (like 35,000 men) of the preventative effect of Vitamin E and Selenium therapy in prostate cancer was stopped after a preliminary analysis of the data demonstrated that it may actually be adding to a man’s risk of getting prostate cancer, and at the bare minimum it doesn’t help.

There was a lot of negative publicity associated with this, and no surprise, I can’t stay quiet about it. Medical research is critical for advancing our understanding and treatment of diseases both simple and complex. And all research results are helpful, even “negative” ones. Clinical trials involving human beings are well governed these days by institutions’ Offices of Human Protection, which are vigilant about thoroughly vetting and monitoring studies. You’re really not a “guinea pig” in any way. It’s an opportunity to learn about yourself, academic medicine, and it may give you an inroad to the healthcare system. And who can shake a stick at that?

So here’s my plug for the day—if you have the chance to participate in a clinical trial or research study, please do it. Several savvy readers have written to me asking for answers to questions like “why is there no cure for cancer?” and I don’t have good answers, largely because we’re still in the thick of running studies to figure it all out. Come be part of the process.

By: Dr. Christina Johns

Today’s shout out goes to all the parents out there. Man! And they say the President’s job is tough! Oval office shmoval shmoffice! I know you are reading this thinking to yourself- “Gee what will that smarty come up with next? Grass is green? Fire is Hot?” “And what does this have to do with health news”, you say? Well, every now and then when I’m having a day with my 2 kids (Luke is 3 and Gemma Rose is 10 months) that tries my patience (ok so actually this is approximately every day), I’m completely amazed by all of the patient, crafty, smart, wise, calm, cool and collected parents I interact with at work. And this is the Emerg, people, when people typically aren’t at their shiny best. I salute the Moms and Dads out there who bravely hold their 1 year old’s arm still during an IV placement, or who keep it all together during major trauma to give me accurate, succinct, and complete information about their child. Not to mention the parents who come with their other children in tow, having to keep a watchful eye on them while caring for their other sick one. Not easy, yet impressive. And it happens every day. Maybe these people should be working on world peace in the waiting room. The crisis in Afghanistan could probably be settled by a Mom of a 6 year old with an arm injury who was waiting for her xrays to be ready.

My perspective on parenting has changed completely since I became one. This sounds obvious, but as a pediatrician, merely by training you get some perspective on parents and parenting. But I now tell pediatricians who aren’t parents that they must have a rich fantasy life if they think they have any idea about how raising children should be done. Before I had kids I would look askance (twenty-five cent word) at parents who had to “leave the room” while their child got immunizations; now I am that parent.

I don’t know if I could measure up to half of the parents I meet in the Emerg, but I do want all of them to know how grateful and honored I am to know them. Sometimes it’s a reassuring thought about our future that there really are a bunch of parents out there doing a great job raising the next generation of human beings. And I’m doing my best to be one of them.

By: Dr. Christina Johns

Can I ask a simple favor? Could everyone please pay a little more attention to how you dose your own at home medications? Especially your kid’s! Overdoses and toxic ingestions are tough pills for me to swallow (wink wink -!-) because they could so easily be prevented simply by demonstrating that you have slightly more common sense than your kitchen table. Unfortunately recently in the Emerg I had to take care of an infant who was admitted after receiving 8 times the therapeutic dose of a prescription medication. The parents weren’t ill intended; they just weren’t demonstrating common sense comparable with their dinette set. Every year people die from ingestions of prescription medications and other regular household stuff because someone wasn’t careful. This needs to stop pronto.

Here’s my “slightly more common sense than your kitchen table” approach to prescription meds:

1. Know the names of all medications that you are taking: the “little purple pill” just isn’t good enough. I can’t tell you how much it slays me when I think of the sheer number of patients I see who have ABSOLUTELY NO IDEA what medications they take or why they take them.
2. Read up about the medication, and don’t be afraid to ask your doctor or pharmacist about its properties, interactions with other medications you may be taking, and side effects.
3. Be smart about how you store them. If the bottles all look alike, mark each label with a different colored marker to help jog your absent minded self when you can’t remember which pill you just took from which bottle (e.g. Oh yeah…..I remember I just took the green striped one….). Or get one of those daily pill dispensers, you know the ones with a little compartment for each day of the week? We all promise not to make fun of you.
4. If you are dosing your child, know that all pediatric dosing is weight based, so if your 9 month old is getting the same amount of medicine as your 9 year old, something probably isn’t right.
5. Be careful. Follow the directions exactly. They aren’t suggestions.

I am not trying to sound like an alarmist here, really. In fact, just for laughs I occasionally pull out one of my Emerg Med textbooks that has a table in it called “Products that are Nontoxic if Ingested in Small Amounts.” This table has items on it like “perfumes,” “laundry detergent and fabric softener,” “candles” (hmmmmmm….), and “matches” – stuff that ranges from a complete crack up to very very weird. Here’s the topper: “fish bowl additives.” Now please tell me how many cases of THAT the authors had to see to be able to include it in a textbook. WHO IS EATING THAT? Unusual on so many levels.

Ok, enough for now. I’ll close with a question for all of you out there: does anyone have a “near miss” story about some type of ingestion that they’d be willing to share? COME ON, email me and tell tell tell.

By: Dr. Christina Johns

Everyone----

Finally, the suggestions are starting to pour in, but note for the record it was only after I had to plead like a complete desperado!

Nevertheless, it's all in the name of gettin' it out there, so here are a few important bits of "breaking news" from my pals in cyberspace.

First and foremost, from Jalina the orange juice and rest lover, we all need to remember to be judicious in considering whether we're too sick to go to work. No non-sick person likes to be hacked and coughed on; even less so in an enclosed office space. I'm not saying that if you get a cold you should call in sick for an entire week, but if your symptoms are a complete distraction to everyone around you, maybe you need to bite the bullet and use your sick leave for what it's intended.

And while you're keeping the Kleenex company in business, try this from Paul--

"When you're sick you have zero time for food prep. Making Granny's soup involves hours of work that sick folks don't have. Here's what I do and it takes 3 minutes. Boil water and grab 2 boullion cubes, a tablespoon of dried onion, a spritz of garlic powder and some Cayenne Pepper powder and dump it into a cup or mug. Add the boiling water and in minutes you have a great sinus clearing homemade 'Med."

Can't wait to hear from anyone who tries this. Paul made the excellent point that when you're sick you frequently can't taste much (when your nose is congested and you can't smell you also can't taste real well-- the human body! Brilliant), and this recipe has the added bonus of being strong enough to impart some taste in an otherwise "tasteless" time.

More on this to come. I just couldn't resist sharing some of this good stuff. Keep it coming!

By: Dr. Christina Johns

I had an interesting day at work on Thursday, and this time not because of an individual patient or any clinical time in the Emerg. I was running our faculty meeting and in the middle of it got a request to do a quick interview for the CBS Evening News with Katie Couric.

It was a story about the American Academy of Pediatrics' position on using over-the-counter cold medicines in children under six: namely, DON'T USE THEM. I had done a similar story a few years earlier when I was a medical contributor/correspondent for ABC News' Good Morning America.

There's no scientific evidence that OTC cold medicines work in any capacity and have the potential to have serious harmful systemic side effects. Sounds like a bad deal to me. This story was quite timely given my last post about getting ready for flu season (thank you very much), and I stand by the AAP and then some by saying to anyone-- use your best supportive care measures from your mom and grandmother (and Chesapeake neighbors, hint hint) and maybe some plain ole' acetaminophen (Tylenol and others) or ibuprofen (Advil, Motrin and others) but don't waste your money on the cold medicine. Especially in this economy.

Here's the link to the segment if you want to check out my quick soundbite:

http://www.cbsnews.com/video/watch/?id=4496845n

By: Dr. Christina Johns

Hellooooooooo out there!

At the time of this post I have received approximately ZERO suggestions for good comfort measures during the flu season. Is there no one who absolutely believes in zinc and echinacea, ginger ale vs. sports drinks, chicken soup vs. saltine crackers? I'm dying to hear something at least slightly more interesting than the usual stuff.

Can ya help a girlMD out?

By: Dr. Christina Johns

Well, I want everyone to know that at work we are officially ramping up in a MAJOR WAY for the upcoming flu season. What this basically means is that everyone has to psych up for a very LOOOOONG couple of months in the ED with zillions of patients who are waiting hours and hours just for staff to tell them to hang in there, rest, drink a lot of fluids, eat chicken soup, and deal with the fact that there’s no medicine that will cure the flu. It’s about as satisfying as a poke in the eye.

So let’s get ready by reviewing a few things about the flu (have you noticed I like to make these lists?):

1. It’s a drag, and if you get it you’ll feel crappy. (Sorry, I’m not going to be a jerk and lie and say, “it’s not that bad.”)
2. It’s really contagious, so try not to get it by WASHING YOUR HANDS CONSTANTLY.
3. Get a flu shot if you can. It won’t protect you from every type of flu virus (there are many), but usually the Big Flu Thinkers are pretty good about predicting the principal ones.
4. Cough into the folded crook of your arm, not your hand covering your mouth. You’ll spread fewer germs that way, and no one likes a germ spewer.
5. Don’t get all bent out of shape if you go to the ED and you’re told you have the flu or flu-like illness and you don’t get any medicines. There’s really nothing that cures it. Nothing. You’ve just got to stick it out and HYDRATE yourself like crazy. This is a critical element in your recovery.
6. You will get better.

Ok, deep cleansing breath. It’s been awhile since I’ve gotten the flu or a similar virus. Working for as long as I have in the ED has given me the immune system of the Incredible Hulk, which is a good thing since I find nasal congestion and headache approximately as bad a situation as the current national financial crisis.

I’m sure we’ll talk more about this as we get knee deep into flu season, but I’ve got all your backs out there and just want to get you in the right frame of mind early.

Please email me if you have a helpful suggestion for what gets you through those illnesses where you just have to “tough it out.” I do know that it’s often easier said than done, but won’t it be more interesting this year if we’ve got some great ideas from our Chesapeake neighbors?

By: Dr. Christina Johns

Sometimes it feels great to have a scapegoat, and today my lucky winner is my insurance company. I’d like to blame all of my problems on them, but first I want to clear up right away the common misunderstanding that we doctors are in any way aligned with the (usually) painful bureaucracy of health insurance companies. We are not. In fact, I believe I have recently made no fewer than 43 phone calls to my insurance company trying to clear up a relatively straightforward issue that remains unsolved because they can merely outlast me.

The story is this: we paid out of pocket for some medical appointments, and due to some weird twilight zone administrative snafu, the insurance company is reimbursing the hospital where the physician has privileges, not us. When I try to call to reach someone about this:

1. I can rarely actually reach a person, and the voice menu is so confusing that even a savvy sister with 2 graduate degrees like myself has trouble keeping it straight.
2. When I do reach a person after a mind numbing 14 minutes of ridiculous muzak, it appears as though s/he has unwittingly left his/her brain at home for the day, and so consequently is completely unable to help me. I am tempted to prove myself correct by asking questions like: “When was the war of 1812?” but worry that my representative will think it’s a “trick question” and answer incorrectly. Then I’ll really be bummed. I refrain from the quiz.
3. So, they tell me they’ll have to “look into it” and call me back, which I’m guessing means they immediately place my number in the “do not call back” pile which probably has papers stacked as high as the Washington Monument.
4. I have never received a call back despite trying to escalate the issue and ask for a supervisor, manager, EVP, boss-lady, etc. There are still hundreds of my dollars floating around somewhere in the universe that I can’t rightfully get back because I can’t even have a reasonable telephone conversation with one of the insurance company employees. Can you top that? Can you?

All I know is that if I did my job this way, I would have lost my medical license long ago. In medicine I took an oath to do what’s best for the patient no matter what, and in tricky times I put that into practice in a very serious way. It’s too bad that insurance companies make roadblocks and stalling their standard operating procedure and that the only people who work there don’t even seem to know the answer to “Who is buried in Grant’s tomb?”

I think our health deserves better. Can I get an ‘Amen’ on this or what?

By: Dr. Christina Johns

I knew I’d strike a familiar chord with a few folks when I wrote my previous post about shoulder dislocation. Think about it—throwing out your shoulder can certainly be classified as a MAJOR DRAG if it happens to you once, but if it happens regularly, then it really loses its charm. Before I wrote that post and despite how often I see it in practice, I couldn’t really quite imagine it, but after several pithy emails from the regularly dislocating crowd out there, I think I’m getting it. And the “yipes” factor is still pretty high for me.

So I promised everyone I’d describe a few ways that shoulders get relocated, so here come some descriptions. In the interest of space, I’m just going to give the 25 cent versions—
1. You lay down on your stomach and hang your arm down off of a stretcher holding a weight. Then you arm pops back into your shoulder.
2. You sit up with your elbow bent and arm across your stomach. Your doctor then puts pressure on top of your shoulder and “opens” your arm like a door. Then your arm pops back into your shoulder.
3. Your doctor stands behind you, pressing on your shoulder blade, trying to “massage” the shoulder back into joint. Then your arm pops back into your shoulder.

Kinda interesting, huh? Those are some of the textbook and taught methods, and here’s one that our Chesapeake neighbor Richard taught me. He’s a regular dislocator and he does this on his own WITHOUT ANY PAIN MEDS----
And I quote: “Usually I am able to relocate the joint by standing perpendicular to a wall, placing my hand on the wall at about shoulder-height, and slowly (emphasis on "slowly") crouching down until things "roll" back into place.” Roll? ROLL? I’m guessing Richard would think swallowing a handful of nails was “just a little bit crunchy.”

Is anyone else out there sweating as they read that? No surprise here, Richard gets the “tough guy” award for the week. Wow. Thanks for your great email, Richard. I give you and all the regular dislocators a round of applause with an arm with full range of motion.

By: Dr. Christina Johns

Ok friends, lest you think that I’m just a boring doctor who doesn’t think about anything other than medicine (do you think that?), today’s topic is for all you sports fans out there. When football season rolls around I find myself totally revving up for two things: 1. Big 10 football, and 2. Dislocated shoulders. If you must know, joint dislocations totally give me the creeps. For whatever reason, I’m a little wigged out by that “clunking” sound and the feeling when the joint relocates. Please don’t tell my patients this.

So last weekend in the ER a huge 17 year old kid rolled in wearing football pads and saying that “his shoulder’s out.” (Like where? Out to lunch?) I immediately tried to look for one of my colleagues to rescue me but to no avail. I was on my own. I could hear that familiar “clunk” sound in my head as I was reviewing his vital signs.

What I had to do was this: after plying him with enough pain medicine to put a large farm animal out for a 2 day nap, I basically pulled on his arm as hard as I could (envision me waterskiing on the South River pulling hard across the wake but without the wipeout that I referenced in an earlier post) and then changed the angle of my pull, and sure enough, “CLUNK.” Shoulder back in, but complete with bonus horrified look on my face for the family to see. Nice. I’m sure his parents felt really great about me at that moment. (Actually they were terrific and were glad indeed that their son was fixed!)

I’d love to hear from any readers out there who are “regular dislocators.” This is not a joke. There is a small percentage of people who dislocate their shoulders frequently. Are you one of them? If you are, email me and tell me the technique that best gets your shoulder back “in” (from it’s lunch date- see above). There are several ways to fix a dislocated shoulder. More on this later. Meanwhile, go Blue!

By: Dr. Christina Johns

At the risk of appearing as though I have an unhealthy fascination with sinus irrigation, I have to keep going a little more with this. One of our hardworking county paramedics, Brett, wrote to me that he discovered, through what I think is a stroke of creative genius, that he could make his own sinus irrigation with, get this, a 20cc (translation: kinda large) syringe and homemade saline solution. It is taking all the restraint I can muster not to make the comparison between its generated force and the pressure coming out of a fire hose on a large AA Co. fire department pumper truck. Whoops, I did it. Anyway, Brett, you get the tough guy award for the week.

He sagely recommends that if you try this you don’t make your saline solution too salty or else it can be really irritating to the nasal tissues. Perhaps like a potato chip up your nose? I tell people who want to make their own saline solution to use 1-2 tablespoons of salt dissolved in a cup or cup and a half of warm water.

Anyway, bravo to you all who are obviously taking very good care of your sinuses. Without doubt, your nose, head, and lungs will thank you for it.

By: Dr. Christina Johns

I wasn’t planning on jumping into the deep end of health controversy today, but the evening news forces me to do so. Measles infection is on the rise again, and cases are being attributed to the fact that the unimmunized population is increasing. Look, I’ve heard all the arguments about the MMR (measles, mumps, rubella) vaccine causing autism and all that, but so far I haven’t seen any HARD evidence linking the two, so I have no other scientific choice than to think that it is an irresponsible thing to do NOT to immunize against this disease.

This is going to be short and sweet so I don’t find myself gaining too much momentum: I want to remind everyone that before there were vaccines, millions of people died due to communicable diseases like measles, polio and smallpox. Vaccines have revolutionized public health much like clean drinking water and penicillin. When massive vaccine initiatives take place, in the end even those few who haven’t gotten immunized are protected in a phenomenon called “herd immunity.” So this stuff is important for all of us.

I recognize that it’s a free country and everyone can make their own choices about immunizations. I respect that, but I am putting it in writing that I am giving the ole’ hairy eyeball to those who refuse immunization because they know someone who thinks their kid got autism from the MMR. Think big numbers, people.

Wow, usually I crack myself up writing these posts. Not today.

By: Dr. Christina Johns

Ok friends, so there are indeed more fans of the fire hydrant nasal irrigation than just Wendy. Many thanks to those who wrote with their voices clearly in the camp of "this is not some weird torture." My brother is now even more smug than usual.

The best and most hy-STER-ical advice came from Kim who recommends that after you irrigate you need to bend over and touch your toes to get "all the drainage" (yuk) out or else you never know when it will surprise you and come dripping out when you least expect it.

Ahhhhhh, what shall we talk about next?

Email me and let me know.

By: Dr. Christina Johns

Today I want to talk about one of my very very best friends. Let’s call her "Wendy” (because that’s her name). There are a few things I want you to know about her: she’s one of the best mothers I know, she's got a great sense of humor and doesn’t mind when we overshare everything (sorry Joe and Peter), and she’s got bad sinus disease. Over the past several years she’s been on a million different types of antibiotics, steroids, and nasal sprays; she can discuss nasal secretions in intricate detail, including color and consistency (ack); heck she’s even been roto-rooted out a couple times (endoscopic sinus surgery for all you sticklers out there). But the thing she swears by is a brisk, invigorating nasal wash. What is this? Depends on whom you ask. If you ask her, or my brother and father who are both Ear Nose and Throat surgeons, they will say that this nasal wash is cleansing, calming, and clarifying, soothing an irritated upper respiratory tree. If you ask me, it is something slightly worse than one of my early embarrassing waterskiing wipeouts on the South River where I landed face-first into the wake while I was in the fast part of a turn. On a slalom ski.

But I digress. Let’s start at the beginning, and then I’ll get to the sinus wash. Sinuses are tricky little useless spaces that are to bacteria, viruses, and fungus what Las Vegas is to gamblers. Once those germs set up shop there it can be extremely hard to evict them and can cause especially gross symptoms like a constant nasal drip or congestion, headache, or the worst: bad breath. (Now you can see one of the main reasons I didn’t follow in the family footsteps of ENT: am not mature enough to handle discussing snot while maintaining reasonable composure).

Sinus disease can be chronic and incapacitating and is a bajillion times worse if you smoke. If you are congested all the time and get frequent headaches, you definitely need to have your sinuses checked out. Sinus disease can be diagnosed by your doctor either by just examining you or by getting a simple CT scan. Sinusitis can be caused by viruses, allergies, bacterial or fungal infections. Unlike what most people think, antibiotics aren’t a cure-all. You may need that for flare-ups but the big thing I want to talk about is the importance of maintaining a minimally inflamed sinus zone. For this, your doctor may give you a steroid nasal spray and recommend that you perform these daily nasal rinses.

Here’s the highlight of this post: These nasal rinses involve (I am not kidding) squirting a bottle-not just a spray- of saline all the way up your nose with a similar force as water coming out of a broken fire hydrant. The wash goes in one nostril and comes out the other. Can you imagine! For all you naturalists out there, you can use the “netty pot,” a little teapot-looking contraption that works in a similar manner, just has better feng shui than the utilitarian plastic irrigator. Wendy is equipped with both contraptions, and although she swears by them, she looks equally frightening regardless of the chosen instrument. But ok, the last laugh is on me because since starting this “maintenance” regimen she has been sinus disease-free for a few years. Can anyone out there let me know your experience with this? And do you enjoy it as much as Wendy?

By: Dr. Christina Johns

You would not BELIEVE the number of people who come to the Emergency Department (it's not just a room) complaining of a rash. "Skin bumps", you say? "An Emergency?" I don't know about you but the last time I had those two phrases together it was in reference to an enormous cheek zit the afternoon before my senior prom, which I knew up to that point had all the makings of a magical night for my date and me.

I know you are thinking in your head, "Why would anyone ever come and wait all those hours just for a rash?" Let me tell you, I and the majority of all my colleagues are thinking this too. Believe me, I understand that rashes can be a pain (literally and figuratively) and quite visually dramatic, but I can count on one hand the number of rashes that are true emergencies. So let's make a few categories and we'll see if this helps anyone's judgment:

Rash category 1: Run, don't walk (time warp yourself if you can) to your nearest Emergency Department
Rash category 2: Well, I guess it was worth the 4 hour wait, maybe
Rash category 3: Why did that doctor look at me in disbelief like I was really there trying to get narcotics?

OK, the diseases that make up category 1 are true emergencies. If you have a purplish non-itchy rash that is rapidly spreading accompanied by fever and neck pain, call 911. You need to be seen fast. Likewise if you have a non-itchy rash with lots of bruises all of a sudden or some gum bleeding.

Category 2 is for things like an itchy, red, poison ivy type rash around the eyes or in the groin area (the swelling from poison ivy in these areas can really be a problem- just ask Luke, my 3 year old) or a painful boil- non-life threatening, but clearly can't wait.

Category 3 is for non-spreading, isolated itchy red plaques or bumps like insect bites. And yes, more people than you would think come to the ER for mosquito or flea bites.

As a rule, I am happy to examine and treat anyone who comes to see me in the ER, but I just don't want you to be totally let down when I don't give you some fantastic emergency miracle cure for your red itchy skin bumps. For rash categories 2 and 3, it's important to check in with your primary care doctor before heading out to seek emergency care, and it's not unreasonable to try some over the counter hydrocortisone cream at home. I recommend trying that in conjunction with some Benadryl and an oatmeal soak bath (warm water, never hot since hot water releases histamine, one of the major "itch" factors)- these can really save you from adding to an emergency doctor's daily category 3 tally, and most importantly, you may actually get better on your own. Doctor you.

By: Dr. Christina Johns