Cough with common cold (URI)? Lasts a LONG time.

Most Americans surveyed will guess that a common cold cough should disappear after one week (7 days).

However, the AVERAGE duration of cough is 18 days!! In fact even by 28 days (4 wks), 1 out of 4 Americans will still have some residual cough.

So when should an otherwise healthy person worry?

  1. Double dip or roller coaster course: worsening cold symptoms x 3-7 days, then improve for a few days, then worsen again.
  2. NEW fever after the first week, after the initial round of fevers for the first several days have resolved.
  3. Severe illness or short of breath/cannot get enough oxygen.
  4. Failure to have at least SOME of your total symptoms (congestion, runny nose, sore throat, cough) BEGIN to improve by 7-10 days.

Sadly, none of the $Millions spend each yr in the cough/cold aisle at the drug store significantly help

The BEST evidence is for bee honey (after age 1 yo).

It is important to remember that cough is actually desirable. God gave us cough to get rid of the sticky mucus in our lungs caused by viral infections. If that mucus is NOT coughed up, then good chance bacteria can set up a more serious infection like pneumonia. I take care of some patients with disabilities who are unable to cough, and surprise….they get recurring pneumonia infections and end up in the hospital more often. Pneumonia is serious. It is the #1 cause of death worldwide in children and in the USA, it is the #8 cause of death for all Americans.

#chondroitin & #glucosamine fail to benefit in arthritis…again

Like many Americans, I am eager to use natural and safer medications that effectively treat diseases.

To promote them however, we need evidence.

Unfortunately for #chondroitin & #glucosamine, the evidence continues to collect for LACK of benefit.

A recent review from the journal Arthritis & Rheumatology (@rheumatology) evaluated 164 patients with moderate-to-severe degenerative arthritis, and compared once-daily chondroitin/glucosamine (1200 mg/1500 mg) with placebo.

After six months, mean pain scores decreased from baseline by 33% in the placebo group, but only 19% in the chondroitin/glucosamine group — a statistically significant difference, in favor of placebo!

We hope researchers continue to evaluate herbal and natural medicines, so we can find the ones that truly benefit and can promote their use.


Home Sleep studies to evaluate for Sleep Apnea are noninferior

#SleepApnea ( is a common cause of fatigue, poor sleep and high blood pressure.

Multiple screening tools are available to identify people who need testing. ( @sleepinfo.

A review in Annals of Internal Medicine @annalsofim suggests that Home Sleep testing is NOT inferior to much more expensive testing at a formal sleep lab for most people. (

Different companies such as @Novasominc or @VirtuOxSleep can express ship a kit to your home, which allows you to sleep in your own bed while performing the test. When completed, the results are sent back to your physician.

Multiple companies can provide #CPAP treatment, such as Medicap @medicapmeridianparma, Pacific Pulmonary, CPAP Now @cpapnowtv or Norco @norcomedical.

Also, mouthguards or oral splints are available for some folks. Clinics like the Center for Sleep Apnea and TMJ @sleepidaho can assist.



Not Too Late For Flu Shot

We still have #influenza #vaccine; it is not too late.

Primary Care Value And Incrementalism

Great article from #NewYorker on value of primary care and long term relationships

Medical Marijuana


People who report marijuana use for medical reasons are very similar to recreational users, as determined from a recent analysis of survey data on 96,100 adults from all 50 U.S. states.

Often, users already suffering from #anxiety and #mood symptoms experience further harmful effects with #marijuana that uniformly improve with stopping the #drug.

Wellness Exams

Please know “physical exams” do not include any medical issues unique to you (high blood pressure, asthma, arthritis, high cholesterol, diabetes, anxiety, depression, etc.).  Under insurance company billing rules, physical/wellness exams and treatment of your specific medical problems are two different services, even if both are performed during a single visit. Doctors are required to document and bill each separately, otherwise risk fraud charges from your insurance company.

What this means to you is that when you receive the Explanation of Benefits (EOB) from your insurance company, you may see two office visits listed. One will be zero copay (annual wellness physical), but the other will be billed as a routine office visit. Any amount not covered under the general physical/wellness exam is considered by insurance company policy as patient responsibility; the deductible or coinsurance is billed to the patient.

Our clinic finds these insurance policies to be misleading and confusing; they violate patient expectations for a “zero” copay annual physical visit that should include review of all health conditions and medication adjustments, yet to participate in network with your insurance carrier we are obligated to comply.