array of medications by a glass of water

Yes, I’m still sick, and it looks likely that my bronchitis has shifted into reactive airway disease.  I did want to write about another aspect of being sick while managing a chronic condition(and the medications that go with it) – namely drug interactions with over the counter medications, unexpected side effects or complications,  and the tendency of physicians to over-prescribe antibiotics.

Drug interactions

There are a lot of treatments for cold and flu available over the counter, and just because they are provided that way does not mean that they are safe for you to take!  Dextromethorphan is an ingredient in many cold and flu treatments and it has many interactions, some possibly life-threatening, with many medications.

Most, if not all, psychiatric medications have a risk of interaction with anything containing this drug, as well as others that serve similar purposes.  Your best bet if you are taking any medication regularly is to check in with your pharmacist or doctor about what over-the-counter medications are and are not safe for you to take.  If you are managing a mental health issue and using medications, this is especially important.

being sick can often expose you to multiple new medications

Drug interactions can be relatively mild or may be deadly, so you want to be able to minimize your risks and be aware of the potential dangers.  For example, many antidepressants interact with cold and flu medications by increasing some of the side effects – including fatigue.  Being sick already makes you tired, and often sleep is one of the best remedies – however, many medications that make you fall asleep run the risk of depressing(slowing down) your system enough to potentially be deadly, and the recommended dosages do not take the drug interactions into consideration.

There are also more uncommon side effects specifically from those drugs interacting, like serotonin syndrome.

I am currently taking a medication that has known interactions with one of my antidepressants.  My doctor and I discussed it and agreed it was worth the risk.  The medication helps relax airways and treat asthma-like symptoms, but there is a risk that it lowers my body’s inhibitions against seizures.

If I had a history of seizures, this would be extremely dangerous, but in my case, my FND symptoms have never expressed in a seizure-like way, and in my diagnosis process, I showed no signs of a seizure disorder.

Since that was the least-dangerous option in my case, we agreed it was worth the risk.  Just stopping my anti-depressant would not have been helpful, as generally antidepressants are designed to build up in your body over time and maintain a certain level for treatment – it can take more than a week for the chemicals involved to clear the body enough to decrease the risk – and I need the treatment now.

The current plan is that with all the new treatments I am taking to calm my lungs and associated symptoms down I should feel better by the end of the week – and if I don’t, it’s time to get my chest x-rayed to check for pneumonia.

The type and variety of these interactions are extensive, so your best bet is to keep your medication list up to date with your doctor, and when they prescribe your treatment if you go in, ask them to double-check for drug interactions.

You can also ask your pharmacist when you pick up the prescriptions – generally, their system will flag known interactions, but that’s only with prescribed medications – as a general rule, just avoid the multi-symptom treatments and cough syrups unless your doctor or pharmacist(who knows what you are taking) confirms that you don’t have interaction risks. 

Also, when you see your doctor, you can double-check if an over the counter treatment is safe for you.

Basically, you want to make sure that you don’t take something that might make you worse, instead of better, and medications don’t carry their interaction warnings on the box.

Allergies, side effects, and increased infection risks

Even if you’ve got all of your regular medication prescriptions under control, getting sick often leads to additional treatments and life habit changes.  You generally can do even less than you could otherwise, and you often have less energy to put into food preparation or planning if you are dealing with allergies or other food sensitivities.

Your regular treatment schedules may be affected as well since you don’t want to increase your immune system’s overload when already dealing with an illness

Also, while many colds and flus are viruses(and so are not directly treatable), many of us are at increased risk of developing a bacterial infection while fighting a viral infection.  Most chronic conditions are associated with a weakening of the immune system, and that may also be the case with many mental health conditions as well.

Often, when sick, doing anything saps your energy – rest can be your best friend.

There is also an apparently uncommon occurrence of mental health conditions being caused by our immune response to infection, so it is possible for strep throat or other relatively minor infections to cause mental health conditions, such as PANDAS.

Some conditions are also very responsive to infections, and getting minor conditions may trigger a much more severe illness – for example, asthma and other lung-related conditions can lead to relatively minor infections turning into bronchitis or pneumonia.  Looks like that is occurring in my case.

I have found that when I get a cold, it almost always turns into some form of bacterial problem that requires antibiotics to treat.  For this reason, I do end up going to my doctors after I have been sick for a while.  This experience with bronchitis is definitely an example of a secondary infection, though I’m not yet sure if it’s bacterial.

What can you do at home?

When you are sick, the best treatment usually is rest.  Sleeping and lots of fluids are generally the best treatments, followed by eating relatively simple foods to avoid stomach upset, which often goes with colds or the flu.

There is absolutely nothing that a doctor can do to treat a viral infection – the only thing to do is let your immune system do its job.  All you can do is try to support your immune system, which can include rest, lots of water(or broth or tea), and possibly packing in extra nutrients that might help.

Now with products like emergen-c and airborne on the market, they are pretty easy to get – the most basic needs are zinc and vitamin C.

Minimizing dairy products can cut down on mucus production, and if your stomach seems relatively unaffected(no vomiting, nausea, diarrhea, etc), it may be safe to eat some spicy food(if you like it and isn’t otherwise contraindicated) to help clear out your sinuses temporarily.

When should you go to the doctor?

So I have mentioned doctors multiple times here, and I want to be clear: going to a doctor within a day or so of coming down with a cold or flu is usually not helpful and not a good idea.   Rest at home first so you don’t increase your body’s stress.

Most colds and cases of flu come with a runny nose, and it’s a time-honored, but incorrect belief that the color of your mucus can indicate the type of infection.  I personally do still use it at times, but the more accurate information is in the timing.

If you immediately have very thick and colorful mucus, you’re likely to have a bacterial infection.  Or if you have a period of feeling better, then feel worse again(my most common scenario), it’s also likely to have started as a virus then turned into a bacterial infection.  Those infections do often need an antibiotic, which your doctor can prescribe.

If you do need an antibiotic, you need to see your doctor.

You also need to go in if you have a high fever – personally, I’d go in if it goes over 101, or stayed over 100 consistently for more than a day or two.

If you are having difficulty breathing or you are coughing severely for more than a few hours, you need to be seen too.

There are a few reasons that I am advocating that you wait to see your doctor.  Making an appointment and going to the doctor is going to be expensive, both in terms of your energy and your finances.

Also, people go to doctors offices when they are sick, which means that you are likely to be exposed to other people’s illnesses.  Given that your immune system is already weakened, seeing the doctor increases your risk of getting a more severe illness or an additional infection.

The third reason is that if you see your doctor, it’s very likely you will get antibiotics, even if you don’t need them.  This may actually be the most severe risk to our population as a whole.

Antibiotic-resistant bacteria

We are unintentionally breeding ‘superbugs‘ through overuse of antibiotics

Many people go to the doctor hoping for a quick fix.  The doctors often feel obliged to give their patients something, and often that something is various forms of antibiotics.

This means that a lot of people are unnecessarily taking antibiotics.

Antibiotic misuse leads to more and more species of bacteria that have antibiotic resistance.  Resistant strains of bacteria require treatment with new and different antibiotics, which when used increase the risk of creating multiply-resistant strains.

Do people try to create resistant bacteria?  Of course not, but it occurs very often due to patients misusing antibiotics.

Antibiotic treatment regimens are designed to kill off all the bacteria involved.  We usually start feeling better before that has completed.  Many people neglect to complete their treatment or do not stay on schedule, which increases the risk that the remaining bacteria – the most robust ones, and the most likely to be resistant – don’t die, but instead are available to infect other hosts.

To show you an extreme case, Russia had a severe outbreak of multiple-antibiotic-resistant tuberculosis due in part to the limited availability of antibiotics.  There are more and more drug-resistant strains of bacteria emerging every year, and the fall and winter tend to be the time when many such conditions run rampant.

This is one of our larger health crises, and not enough people recognize the risks.

Do we have extra risks?

Of course, the disabled and chronically ill communities, along with the poor(and those two groups often overlap) are at the greatest risk of the worst damage from antibiotic-resistant bacteria.

As I mentioned above, we usually have a more limited list of available medications to take due to concerns over drug interactions, which can be deadly in themselves.

We also are more likely to get sick, as our immune systems are often weaker than the average person.  Also, with that, we have increased our likelihood of a relatively minor illness turning into something much worse.

Since medical care is expensive, all people struggling financially are more likely to wait on a doctor’s appointment, or try to treat themselves with whatever antibiotics they can find, often not in the proper amounts or for long enough -or try to tough it out, which leads to more care that may be less effective than early treatment would have been.

There are many opportunities for infection in the hospital

Also, the place where the most deadly outbreaks often happen are hospitals, where many of us end up spending more time than the average person. 

Hospitals not only end up treating many of the worst cases but also often have antimicrobial regimens to minimize the risk fo spreading diseases.  This means anything that does survive is going to need to be multiply-resistant.

People slip up, and forget to clean something properly or don’t wash their hands the one time, or accidentally place something on an uncleaned counter.  The combination can be deadly.

Of course, patients in the hospital are also already battling whatever took them there in first place, so their immune systems are already somewhat weakened – which means that diseases that often are not deadly for your average person may be deadly to patients.

Members of our community with allergy issues or who have built up a tolerance to more common medications have a more limited supply of medications that are actually helpful, so have fewer treatment options if infected by something multiply-resistant.

Another risk that is true for all people but may affect us more strongly is that, generally, antibiotics are not selective in what bacteria they kill.  Our bodies are full of all sorts of helpful bacteria, which are not immune to antibiotics.

When they die, the risk of bacteria that are less helpful colonizing us increases, which can wreak havoc with our digestive systems.  For those of us who already have additional health issues, it may be more difficult to rebuild these systems as they are already compromised by our conditions.

What can we do?

The two main things we can do is educate others on the risks, and do thorough research whenever possible.

Try to minimize hospital stays and do your best to go to ones with better reputations – sites like consumer reports may have such information.  Advocate for yourself(or have your personal advocate with you).

Make sure that every person who comes into your room uses the available soap dispensers, as well as pushing to make sure you understand why each medication they give you is necessary.

At home and when you go out, protect yourself from infection.  Explain these issues to your friends and family members – to help them, too, get the proper treatment when they go to health care professionals for treatment, or to know when they do need to get seen.

We also can protect ourselves with flu shots and pneumonia shots as appropriate to protect our systems against the predicted worst offenders.

When taking antibiotics, it may be useful to take some form of probiotic in order to mitigate some of the damage the antibiotics do to your gut flora and fauna.  As the attached article mentions, they have not yet been proven helpful and there is some risk of side effects, so please be judicious in your usage of them.

Conclusion: risks abound!

There are a lot of things to think about when you get sick.  These are things that healthier friends and family members may not need to consider as seriously as you do.

Drug interactions are a big risk to the health of anybody taking many types of medications, especially psychiatric medications, and to people who have a history of allergic responses to medications.

Just because something is prescribed over the counter does not mean that it’s safe for you to take – you need to double-check it against your current medications – the safest is to check with your doctor or to discuss interaction risks with a pharmacist who knows what medications you are currently taking.

Only take antibiotics if you appear to have a bacterial infection – they will do nothing to help you recover from your virus and they increase the risk of creating more antibiotic-resistant strains of bacteria

Viral infections are close to untreatable, though there currently are vaccines for some flu strains and for pneumonia. Use them if you can!

As many of us already have weakened immune systems(physical or emotional stress weakens the immune system) and are statistically more likely to spend (more) time in the hospital, we are at higher risk for infections and complications.  This does not mean we should live in a bubble, but it does mean that being more cautious about public spaces, crowds, or friends and family who know they are sick is appropriate.

We can protect ourselves an minimize many of these risks through common sense, self-advocacy, and educating our loved ones about the risks we face.

I do not write this article to scare you, but instead to give you tools to defend yourself when you are sick to help you heal faster and minimize your risk of complications!

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