DEAR DR. DONOHUE: When does a cold become an ear infection or sinus infection, and how can one tell? My husband and I have disagreements about when to go to the doctor. He says one should never go to the doctor for a cold because it is a viral infection and nothing can be done. I agree. But how long does a cold last, and how do we know when it might be complicated by a bacterial infection? I have kids, 5 months and 4 years. I don’t want them to get antibiotics unnecessarily, but my school-age daughter gets a cold a month. – C.N.

ANSWER:
Colds are viral infections, and the rhinoviruses – of which there are more than 100 strains – are the ones most often implicated as a cause of colds. Antibiotics do nothing for viral infections

Cold symptoms appear from less than a day to three days after the virus has entered the body. They include a runny or stuffed nose, a low-grade rise in temperature, a scratchy or sore throat and sometimes hoarseness and a dry cough. On average, a cold lasts seven days.

This makes cold diagnosis simple. Well, it’s not always so simple. Some things that prompt a doctor visit are colds lasting longer than 10 days, a temperature over 101 F (38.3 C), a cough with lots of thick, yellow sputum and labored breathing. If young children clutch their ear, that’s a sign of an ear infection, and they should see a doctor.

Adults get fewer colds than children because they have been exposed to many cold viruses and have developed a quasi immunity to them. Very young children get anywhere from eight to 10 colds a year; adults come down with two to four each year.

A word about spreading colds is worthwhile. The virus can be transmitted through droplets that are sneezed or coughed, but they’re mainly spread from hand-to-hand contact. People with colds have a coat of virus on their fingers. When they touch the hands of another, virus sticks to the hands and fingers of the second person, who then touches the nose or eyes, and the virus has found a new home. Hand-washing is the best preventive.

DEAR DR. DONOHUE: What kinds of foods cause kidney stones? Do almonds have anything in them that cause stones? I love to put almonds in some of my baking. – A.

ANSWER:
The most common kind of kidney stone is a calcium oxalate stone. Logically, that would make cutting back on calcium foods (dairy products including cheese) the way to prevent them. For years, doctors told their stone patients to cut back on calcium. The fact is that calcium foods don’t cause stones. In fact, a low-calcium diet favors their formation.

Oxalate foods might have a role to play. Chocolate, peanuts, spinach, beets, rhubarb and sweet potatoes are high in oxalate. Almonds are on the list. A person doesn’t have to completely cut these foods out of the diet, but he should eat them in moderation. Adding almonds to your baking isn’t going to put anyone in trouble.

The best preventive for kidney stones is staying well-hydrated. Drink lots of fluid. You know you’re drinking enough if your urine is pale yellow to colorless.

DEAR DR. DONOHUE: Some time ago, you answered a letter from an 80-year-old lady who asked if she still needed to have mammograms. I say an unqualified yes. Two years ago, at the age of 82½, my mammogram detected cancer. Surgery was followed by radiation. Two years later, I am feeling fine and doing well. – A.S.

ANSWER: Experts argue about the value of mammograms late in life. Stories like yours make me side with those who promote having mammograms as long as a woman is in reasonable health. If a woman has an estimate of living at least four more years, mammograms are a good idea.

DEAR DR. DONOHUE: Everyone talks about restless leg syndrome. Is it the same thing as when your legs jump while in bed? My doctor is afraid to give me Requip because I take so much Ativan. My legs are driving me crazy. I started taking 6 ounces of tonic water at night. It helps some, but my legs still jump. I don’t get much exercise. Can you suggest anything? – A.N.

ANSWER:
Restless leg syndrome is a most disagreeable sensation in the legs that people describe as something creeping beneath the skin. The sensation mostly comes on at night when in bed and keeps people awake or wakens them. Between 5 percent and 10 percent of adults have it, and the numbers increase with age.

A cause hasn’t been found. For some, iron deficiency provokes it, and you should have your iron level checked. Cut out all caffeine. Daily exercise can reduce the sensations. Walking is fine. A half-hour to an hour a day is the goal, but start much more modestly. Hot baths before sleep are helpful. So are leg massages. Stretching is recommended. Stand about 2 feet from a wall and then lean into the wall by supporting yourself with hands placed on the wall. You should feel a stretch in your calves. If you don’t, you’re too close to the wall. Back up. Make sure you do this with someone at your side who can rescue you if you start to wobble. Hold the stretched position 10 to 20 seconds, and repeat the exercise five times.

Requip and Mirapex are two Parkinson’s disease medicines that have given relief to many with restless legs. If your dose of Ativan makes the standard dose of these medicines unacceptable, your doctor might agree to a lower dose. Or a different medicine, like Tegretol, could be tried. First take the nonmedicine route.

Eighty percent of people with restless leg syndrome have another disorder, periodic limb movements of sleep – PLMS. Affected people, while asleep, bend the toes, ankles or knees and can pummel a sleeping bed partner. Usually PLMS doesn’t rouse a person from sleep. The same medicines used for restless legs can be used for PLMS.

The booklet on restless leg syndrome and night cramps discusses their treatments in detail. Readers can obtain a copy by writing: Dr. Donohue – No. 306, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.


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