Coughing

“Dr. Sanders, I’m still sick”… It was strange, she told me; she was fine during the day — with maybe the occasional cough — but at night, when she lay down, it was unbearable. She slept in a chair the past two nights, because in bed she kept waking up to cough. And the day before, she had a strange pressure in her chest… Cough is the most common single reason for a visit to a primary-care doctor. Most of the time it’s caused by an upper-respiratory infection or a cold. But that type of cough usually resolves on its own. A persistent cough has many possible causes. The most likely is an allergy…  Now she was back, sicker than ever, and I was starting to get nervous. I had already referred her to an ear, nose and throat doctor and a gastroenterologist. If none of this panned out, I wasn’t sure what to do next.

Lisa Sanders. (4 Jun 2013). The Cough That Wouldn’t Stop. http://archive.nytimes.com/www.nytimes.com/interactive/2013/06/16/magazine/diagnosis-cough-that-wouldnt-stop.html?_r=0#/#abnormal. The New York Times.

 

On Thursday, we challenged Well readers to unravel the mystery of a 75-year-old woman with a cough that lasted for months. In addition, we asked you to tell us what kind of test you would order to clinch the diagnosis.

The correct diagnosis is…
Lady Windermere syndrome
And the necessary test is…
A culture of the patient’s sputum

… Lady Windermere syndrome is an infection of the lung caused by mycobacterium avium-intracellulare, a bacterium related to the bug that causes tuberculosis. This bug is ubiquitous and commonly found in dust and dirt, in households and farmyards.

Lisa Sanders. (7 Jun 2013). Think Like a Doctor: A Cough Solved. https://well.blogs.nytimes.com/2013/06/07/think-like-a-doctor-a-cough-solved/. Well Blog. The New York Times.

Related references

  • [… she writes the popular Diagnosis column for the New York Times Magazine and the Think Like a Doctor column featured in the New York Times blog, The Well. Her column was the inspiration for the Fox program House MD (2004-2012) and she served as a consultant to the show.] Lisa Sanders, MD, FACP. Associate Professor of Medicine (General Medicine). Biography. https://medicine.yale.edu/intmed/people/lisa_sanders.profile. Yale School of Medicine.
  • Rhinitis – 鼻炎 [post on condition affected by coughing]
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Rhinitis – 鼻炎

Note – Chinese translation of ‘Rhinitis’ was checked against Google Translate and Cambridge Dictionary Translator [https://dictionary.cambridge.org/translate/]. This post is a record to help the author understand challenges and treatments for rhinitis sufferers. Sentences/parts shortened by the author are indicated with “…”

Rhinitis is inflammation of the nose.

Post-nasal drip is mucus accumulation in the back of the nose and throat leading to, or giving the sensation of, mucus dripping downward from the back of the nose… common characteristics of chronic rhinitis is post-nasal drip… may lead to chronic sore throat, chronic cough, or throat clearing… can be caused by excessive or thick mucus secretions or impairment in the normal clearance of mucus from the nose and throat.

Forms of non-allergic rhinitis include:

  • Idiopathic rhinitis often does not have a specific cause… but commonly includes upper respiratory infections.
  • Vasomotor rhinitis is thought to occur because of abnormal regulation of nasal blood flow and may be induced by temperature fluctuations in the environment such as, cold or dry air, or irritants such as
    • Air pollution
    • Smog
    • Tobacco smoke
    • Car exhaust
    • Strong odors such as, detergents or fragrances
    • Weather conditions (such as the arrival of a weather front)

Other causes… :

… rhinitis may be related to other generalized medical conditions such as:

… primary reason for impaired clearance of nasal secretions within the nasal cavities is from smoking… impairs the movement of the cilia (microscopic hairs) and their ability to push the secretions out of the nasal cavity to be swallowed. Other conditions that can impact clearance of secretions in the nose include allergies and some genetic disorders. Swallowing problems can make it difficult to clear normal secretions from the back of the throat. This may result in the accumulation of material in the throat, which can spill into the voice box, causing hoarseness, throat clearing, or cough.

Irrigating the nose with salt water is a home remedy that is very useful therapy for non-allergic rhinitis, and especially beneficial for treatment and relief post-nasal drip.

Nasal irrigation utilizing a buffered isotonic saline solution (salt water) helps to reduce swollen and congested nasal and sinus tissues… it washes out thickened nasal secretions, irritants (smog, pollens, etc.), bacteria, and crusts from the nose and sinuses. Non-prescription nasal sprays (Ocean spray, Ayr, Nasal) can be used frequently, and are very convenient to use.

John P. Cunha. (Medically Reviewed on 1/10/2018 – this could mean Jan 2018 due to the US calendar order). Chronic Rhinitis and Post-Nasal Drip Symptoms, Causes, Treatment. https://www.medicinenet.com/chronic_rhinitis/article.htm#chronic_rhinitis_and_post-nasal_drip_definition_and_facts. MedicineNet, Inc. – Owned and Operated by WebMD and part of the WebMD Network. [MedicineNet is an online, healthcare media publishing company. Webster's New World Medical Dictionary - authored by MedicineNet  … The doctors of MedicineNet are also proud to author Webster’s New World™   Medical Dictionary First, Second and Third Editions (May, 2008) John Wiley & Sons, Inc.; ISBN-10: 0470189282.]

 

Alternative medicine

Some small studies.. shown repeated applications of capsaicin — the ingredient… in hot peppers — to the inside of the nose can ease nasal congestion… treatment is often given multiple times on the same day, and relief has been shown to last as long as 36 weeks. But larger studies are needed.

Nonallergic rhinitis. (4 Jan 2018). https://www.mayoclinic.org/diseases-conditions/nonallergic-rhinitis/diagnosis-treatment/drc-20351235. Mayo Clinic.

Chinese Medicine – Diabetes

Xiao-ke syndrome means “wasting and thirsting.” Diabetes… three types: upper, middle, and lower Xiao-ke… upper type is characterized by excessive thirst, the middle by excessive hunger, and the lower by excessive urination… associated with the lungs, stomach, and kidneys, respectively, and all… associated with Yin deficiency.

Some of the most commonly used herbal substances for diabetes in TCM include:

1. Panax ginseng (Korean ginseng)… long history… as a hypoglycemic agent. At least five constituents of this herb have been shown to exert hypoglycemic effects. In one study, treatment with ginseng lowered blood glucose levels and improved mood and psychological performance as compared with placebo. Recommended dosage is 100–200 mg/day. [Footnote 14 – Choate C: http://www.jcm.co.uk/SampleArticles/DIABETES1.html (accessed March 2001) “Diabetes: modern medicine and traditional Chinese medicine (Part One)]

2. Momodica charantia (balsam pear)… dried, powdered, and made into pills. A dosage of 18 g/day has been shown to reduce blood glucose. [Footnote 15 – Keji C: Understanding and treatment of diabetes mellitus by Traditional Chinese Medicine. Am J Chinese Med 9:93–94, 1981]

Maggie B. Covington. Traditional Chinese Medicine in the Treatment of Diabetes. Diabetes Spectrum 2001 Aug; 14(3): 154-159. http://spectrum.diabetesjournals.org/content/14/3/154. American Diabetes Association. [accessed 18 May 2018]

Cross checks

Being rich: Superman Li Ka-shing

Wealth cannot insulate one from pain and terror: ‘His wife died in 1990 and his son Victor was kidnapped in 1996.

Hong Kong’s Richest Man Li Ka-shing Retires. (16 Mar 2018). Bloomberg. [I first read the shortened version of the article in the Business Times Weekend, 17-18 Mar 2018.]

Li Ka-shing reportedly paid $134 million (U.S.)‘ to redeem his son.

Victor Victorious? (29 Dec 2003 – updated 19 Apr 2018). The Globe and Mail. Canada.

See also: Being Blind [to consider life from another’s perspective]

Improve supervisor/subordinate relations!

John J. Gabarro and John P. Kotter. (2008). Managing your boss. Boston. Harvard Business School Press. (p.44 – 55).

Checklist [Selection/Paraphrased]

  • Understand his/her desired outcomes; push factors and drivers
  • His/her competencies, and areas of neglect/areas constantly unnoticed by him/her: ‘blindspots’
  • Work/Decision making style
    • ‘Listeners’: face to face briefings; ‘Readers’: written document then meeting
    • Active participant versus informing them only on key decisions (ask yourself whether you are deferential or more independent/strong willed; know yourself)
    • Information: openly share positive and negative information [how realistic is this?]; check if your boss knows enough about the issue at hand and provide more where necessary
    • Produce what is promised
    • Clarify mutual expectations
    • Tap on your boss’s time and resources wisely for the highest prioritised tasks/goals

Adults English – 3 helpsites : )

The company recently entrusted me with the opportunity to teach English to adults; I was able to find the below sites for preparation:

Three common tips: (a) understand the goals of the learners. For this Bowens suggested asking through conversations; (b) relate learning to their work or life (use but not be restricted by textbooks); (c) allow the learners to help mould the learning process [similar to what I learnt in (ACTA) – WSQ Advanced Certificate in Training and Assessment].

Hope this helps!

HR Reflections

I was tasked to be part of the Recruitment process at work. Merrily, I took the chance to research!

This time the book is from Veechi Curtis. (2016). Small Business for Dummies. (5th Australian & New Zealand edition). Milton. John Wiley.

Curtis (Chapter 11) highlights the importance of a detailed and specific job description (5 qualities, quantifiable/clear goals, purpose, reporting officer etc). This becomes crucial for selecting the right candidate and even asking valid/suitable questions during the interview.

For the interview, she suggests:

  • Tests during the interview e.g. on the spot Excel calculations or note taking.(where applicable of course)
  • A scale say out of 5 or 10 is useful in tracking questions repsponses and comparing between candidates.
  • Unconventional questions – ask what the person would do if he/she became Prime Minister or President. [This is a good, and polite way to understand the person’s values and working style]
  • Inquire of the candidate how he/she tackled a difficult situation; also ask whether they would have used another method/way [Rather helpful in seeking out problem solving ability and whether the person reflects/learns]
  • [Trap] Find out what the candidate disliked or liked least about his/her previous/current company [Hmmm… I shan’t say more…]