#50% of adults experience nausea at some point each YEAR | Explore Tumblr Posts and Blogs

rayarmat · 3 years

Text

A Guide to Outpatient COVID Treatment: Step-By-Step Doctors’ Plan That Could Save Your Life

Recently, Dr. Peter McCullough, MD, of Baylor University Medical Center in Dallas testified to Texas Senate HHS Committee about how mass media and even some government agencies are silencing clinical outpatient evidence for effective treatment of COVID19 and instead push vaccines only (video shown below).

Treatments like those mentioned by Dr. McCullough can be found in sites like https://c19early.com/ but specifically, McCullough refers to the following Appendix to a document published by Association of American Physicians and Surgeons (AAPSonline.org) as an educational resource. It is based on a paper published in American Journal of Medicine (link), by Dr. Peter McCullough and 22 other clinicians (MDs) and researchers (PhDs).

“Seek early treatment and be your own advocate. All of the physicians contributing to this booklet are on the frontlines treating outpatients at the first signs of COVID illness. Studies in the US and many other countries clearly show that patients who are treated within the first 5 days of symptoms have better outcomes using the combination of medications in the algorithm below.”

COVID-19 hospitalizations and death can be reduced with outpatient treatment.

Principles of COVID-19 outpatient care include: 1) reduction of reinoculation, 2) combination antiviral therapy, 3) immunomodulation, 4) antiplatelet/antithrombotic therapy 5) administration of oxygen, monitoring, and telemedicine.

“For the ambulatory patient with recognized early signs and symptoms of COVID-19, often with nasal real-time reverse transcription or oral antigen testing pending, the following 4 principles could be deployed in a layered and escalating manner depending on clinical manifestations of COVID-19-like illness and confirmed infection: 1) reduction of reinoculation, 2) combination antiviral therapy, 3) immunomodulation, and 4) antiplatelet/antithrombotic therapy. Because the results of testing could take up to a week to return, treatment can be started before the results are known. For patients with cardinal features of the syndrome (ie, fever, body aches, nasal congestion, loss of taste and smell, etc.) and suspected false-negative testing, treatment can be the same as those with confirmed COVID-19. Future randomized trials are expected to confirm, reject, refine, and expand these principles. In this article, they are set forth in emergency response to the growing pandemic as shown in Figure 1 .

Treatment algorithm for COVID-19-like and confirmed COVID-19 illness in ambulatory patients at home in self-quarantine. BMI = body mass index; CKD = chronic kidney disease; CVD = cardiovascular disease; DM = diabetes mellitus; Dz = disease; HCQ = hydroxychloroquine; Mgt = management; O2 = oxygen; Ox = oximetry; Yr = year.

The basic groups of prescription medicines and other therapies used in COVID-19:

▪ Combination anti-viral medicines started as soon as symptoms occur ▪ Medicines to decrease inflammation, such as corticosteroids (called immunomodulators)

▪ Anticoagulant therapy to prevent blood-clots that can cause strokes, heart attacks, kidney shut-down, and death.

▪ Non-prescription supportive treatments with zinc, vitamin D, vitamin C, electrolyte drinks such as Pedialyte, and others.

▪ Home-based oxygen support, such as with an oxygen concentrator. These machines are available by physician prescription from home health medical supply businesses and are covered on most medical insurance plans.

I. Antiviral Agents:

These must be started quickly at STAGE I (Days 1-5):

Symptoms include sore throat, nasal stuffiness, fatigue, headaches, body aches, loss of taste and/or smell, loss of appetite, nausea, diarrhea, fever.

These medicines stop the virus from (1) entering the cells and (2) from multiplying once inside the cells, and they reduce bacterial invasion in the sinuses and lung:

▪ *Hydroxychloroquine (HCQ) with azithromycin (AZM) or doxycycline

▪ Ivermectin with azithromycin (AZM) or doxycycline

Either combination above must also include zinc sulfate or gluconate, plus supplemental vitamin D, and vitamin C. Some doctors also recommend adding a B complex vitamin.

Zinc is critical. It helps block the virus from multiplying.

Hydroxychloroquine is the carrier taking zinc INTO the cells to do its job.

An educational resource from The Association of American Physicians and Surgeons (AAPSonline.org) 16

II. Anti-inflammatory Agents - Corticosteroids (“steroids”): Oral and Nebulized.

These are started at STAGE II (Days 3-14) to reduce inflammation, the cause of added damage to the lungs and critical organs. Symptoms include worsening cough, difficulty breathing, chest heaviness/tightness or chest pain.

As inflammation damages the airways interfering with normal oxygen-carbon dioxide exchange, blood oxygen levels drop and people experience loss of focus, drowsiness, confusion, difficulty concentrating, low energy and severe fatigue.

The exaggerated Inflammation response in COVID further increases the risk of blood clots.

Prescription medicines and other support added now to Stage I medicines are: ▪ nebulized budesonide to help penetrate the lungs and reduce inflammation ▪ oral prednisone, methylprednisolone, dexamethasone

▪ colchicine – may also be added to reduce inflammation

▪ full strength adult aspirin 325 mg to reduce inflammation and risk of blood clots ▪ home oxygen concentrator may be needed to improve oxygen levels (requires physician prescription)

III. Prescription Anticoagulants (“blood thinners”):

STAGE III (Day 7 and beyond): Symptoms seen in Stage II intensify. Difficulty breathing becomes extreme, oxygen levels drop sharply, risk of heart attack or stroke increases. At this point, people are critically ill.

The medicines to be added to Stage I and II medicines now include:

▪ Aspirin 325 mg unless told not to take by your doctors

▪ And/or low molecular weight heparin injections (e.g. enoxaparin [Lovenox]) OR

▪ apixaban (Eliquis), or rivaroxaban (Xarelto), or dabigatran (Pradaxa) or

edoxaban (Savaysa) in standard doses for 5 to 30 days

If these added steps do not lead to improvement, or the patient becomes unstable, a 911 call is warranted for ER evaluation and hospital admission so that more aggressive IV medications (such as remdesivir, Regeneron, and others) may be considered, and more intensive ventilation regimens are possible in ICU settings.

IV. Vitamins, Supplements, and Oxygen.

▪ Zinc sulfate, gluconate or citrate. These forms are available in pharmacies, health food stores, and sold online. Zinc sulfate 220 mg provides 50 mg elemental zinc, the recommended anti-viral dose. Zinc in the form of zinc picolinate form is not recommended following reports of liver damage and tumors from studies about 20 years ago. Following these reports, the German Commission E that regulates supplements used in medical practice in Germany banned this form of zinc.

An educational resource from The Association of American Physicians and Surgeons (AAPSonline.org) 17

▪ Vitamin D3, preferable in oil in capsules for better absorption. Recommended doses for anti-viral benefit vary from 5000 IU or more for 5-30 days

▪ Vitamin C with bioflavonoids for antioxidant, anti-inflammatory effects. Dose

recommendations from our contributors vary from 1000 mg (1 gram) once or twice a day up to 4 or more times a day.

▪ A word about quercetin. Some physicians are recommending this supplement to reduce viral illnesses because quercetin acts as a zinc ionophore to improve zinc

uptake into cells. It is much less potent than HCQ as a zinc transporter, and it does

not reach high concentrations in lung cells that HCQ does. Quercetin may help

reduce risk of viral illness if you are basically healthy. But it is not potent enough to replace HCQ for treatment of COVID once you have symptoms, and it does not

adequately get into lung tissue unless you take massive doses (3-5 grams a day),

which cause significant GI side effects such as diarrhea.

Control of Contagion

A major goal of self-quarantine is the control of contagion. Many sources of information suggest the main place of viral transmission occurs in the home. Facial covering for all contacts within the home as well as frequent use of hand sanitizer and hand washing is mandatory. Sterilizing surfaces such as countertops, door handles, phones, and other devices is advised. When possible, other close contacts can move out of the domicile and temporarily stay with others not ill with SARS-CoV-2. Findings from multiple studies indicate that policies concerning control of the spread of SARS-CoV-2 are effective and extension into the home as the most frequent site of viral transfer is paramount.

Reduction of Self-Reinoculation

It is well-recognized that COVID-19 exists outside the human body in a bioaerosol of airborne particles and droplets. Because exhaled air in an infected person is considered to be “loaded” with inoculum, each exhalation and inhalation is effectively reinoculation. In patients who are hospitalized, negative pressure is applied to the room air largely to reduce spread outside of the room. We propose that fresh air could reduce reinoculation and potentially reduce the severity of illness and possibly reduce household spread during quarantine. This calls for open windows, fans for aeration, or spending long periods of time outdoors away from others with no face covering to disperse and not reinhale the viral bioaerosol.

Combination Antiviral Therapy

Rapid and amplified viral replication is the hallmark of most acute viral infections. By reducing the rate, quantity, or duration of viral replication, the degree of direct viral injury to the respiratory epithelium, vasculature, and organs may be lessened. Additionally, secondary processes that depend on viral stimulation, including the activation of inflammatory cells, cytokines, and coagulation, could potentially be lessened if viral replication is attenuated. Because no form of readily available medication has been designed specifically to inhibit SARS-CoV-2 replication, 2 or more of the nonspecific agents listed here can be entertained. None of the approaches listed have specific regulatory approved advertising labels for their manufacturers; thus all would be appropriately considered acceptable “off-label” use.

Zinc Lozenges and Zinc Sulfate

Zinc is a known inhibitor of coronavirus replication. Clinical trials of zinc lozenges in the common cold have demonstrated modest reductions in the duration and or severity of symptoms. By extension, this readily available nontoxic therapy could be deployed at the first signs of COVID-19. Zinc lozenges can be administered 5 times a day for up to 5 days and extended if needed if symptoms persist. The amount of elemental zinc lozenges is <25% of that in a single 220-mg zinc sulfate daily tablet. This dose of zinc sulfate has been effectively used in combination with antimalarials in early treatment of high-risk outpatients with COVID-19.

Antimalarials

Hydroxychloroquine (HCQ) is an antimalarial/anti-inflammatory drug that impairs endosomal transfer of virions within human cells. HCQ is also a zinc ionophore that conveys zinc intracellularly to block the SARS-CoV-2 RNA-dependent RNA polymerase, which is the core enzyme of the virus replication. The currently completed retrospective studies and randomized trials have generally shown these findings: 1) when started late in the hospital course and for short durations of time, antimalarials appear to be ineffective, 2) when started earlier in the hospital course, for progressively longer durations and in outpatients, antimalarials may reduce the progression of disease, prevent hospitalization, and are associated with reduced mortality. In a retrospective inpatient study of 2541 patients hospitalized with COVID-19, therapy associated with an adjusted reduction in mortality was HCQ alone (hazard ratio [HR] = 0.34, 95% confidence interval [CI] 0.25-0.46, P <0.001) and HCQ with azithromycin (HR = 0.29, 95% CI 0.22-0.40, P <0.001). HCQ was approved by the US Food and Drug Administration in 1955, has been used by hundreds of millions of people worldwide since then, is sold over the counter in many countries, and has a well-characterized safety profile that should not raise undue alarm. Although asymptomatic QT prolongation is a well-recognized and infrequent (<1%) complication of HCQ, it is possible that in the setting of acute illness symptomatic arrhythmias could develop. Data safety and monitoring boards have not declared safety concerns in any clinical trial published to date. Rare patients with a personal or family history of prolonged QT syndrome and those on additional QT prolonging, contraindicated drugs (eg, dofetilide, sotalol) should be treated with caution and a plan to monitor the QTc in the ambulatory setting. A typical HCQ regimen is 200 mg bid for 5 days and extended to 30 days for continued symptoms. A minimal sufficient dose of HCQ should be used, because in excessive doses the drug can interfere with early immune response to the virus.

Azithromycin

Azithromycin is a commonly used macrolide antibiotic that has antiviral properties mainly attributed to reduced endosomal transfer of virions as well as established anti-inflammatory effects. It has been commonly used in COVID-19 studies initially based on French reports demonstrating markedly reduced durations of viral shedding, fewer hospitalizations, and reduced mortality combination with HCQ as compared to those untreated. In the large inpatient study (n = 2451) discussed previously, those who received azithromycin alone had an adjusted HR for mortality of 1.05, 95% CI 0.68-1.62, and P = 0.83.23 The combination of HCQ and azithromycin has been used as standard of care in other contexts as a standard of care in more than 300,000 older adults with multiple comorbidities. This agent is well-tolerated and like HCQ can prolong the QTc in <1% of patients. The same safety precautions for HCQ listed previously could be extended to azithromycin with or without HCQ. Azithromycin provides additional coverage of bacterial upper respiratory pathogens that could potentially play a role in concurrent or secondary infection. Thus, this agent can serve as a safety net for patients with COVID-19 against clinical failure of the bacterial component of community-acquired pneumonia. The same safety precautions for HCQ could be extended to azithromycin with or without HCQ. Because both HCQ and azithromycin have small but potentially additive risks of QTc prolongation, patients with known or suspected arrhythmias or taking contraindicated medications or should have more thorough workup (eg, review of baseline electrocardiogram, imaging studies, etc.) before receiving these 2 together. One of many dosing schemes is 250 mg po bid for 5 days and may extend to 30 days for persistent symptoms or evidence of bacterial superinfection.

Doxycycline

Doxycycline is another common antibiotic with multiple intracellular effects that may reduce viral replication, cellular damage, and expression of inflammatory factors. This drug has no effect on cardiac conduction and has the main caveat of gastrointestinal upset and esophagitis. As with azithromycin, doxycycline has the advantage of offering antibacterial coverage for superimposed bacterial infection in the upper respiratory tract. Doxycycline has a high degree of activity against many common respiratory pathogens including Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, anaerobes such as Bacteroides and anaerobic/microaerophilic streptococci and atypical agents like Legionella, Mycoplasma pneumoniae, and Chlamydia pneumoniae. One of many dosing schemes is 200 mg po followed by 100 mg po bid for 5 days and may extend to 30 days for persistent symptoms or evidence of bacterial superinfection. Doxycycline may be useful with HCQ for patients in whom the HCQ-azithromycin combination is not desired.

Favipiravir

Favipiravir, an oral selective inhibitor of RNA-dependent RNA polymerase, is approved for ambulatory use in COVID-19 in Russia, India, and other countries outside of the United States.35 It has been previously used for treatment of some life-threatening infections such as Ebola virus, Lassa virus, and rabies. Its therapeutic efficacy has been proven in these diseases. Like, the antimalarials and antibiotics, favipiravir has no large-scale randomized trials completed at this time, given the short time frame of the pandemic. A dose administration could be 1600 mg po bid on day 1, following by 600 mg po bid for 14 days.

Immunomodulators

The manifestations of COVID-19 that prompt hospitalization and that may well lead to multiorgan system failure are attributed to a cytokine storm. The characteristic profile of a patient acutely ill with COVID-19 includes leukocytosis with a relative neutropenia. These patients have higher serum level of cytokines (ie, TNF-α, IFN-γ, IL-1β, IL-2, IL-4, IL-6, and IL-10) and C-reactive protein than control individuals. Among patients with COVID-19, serum IL-6 and IL-10 levels appear even more elevated in the critically ill. As with any acute inflammatory state, early treatment with immunomodulators is expected to impart greater benefit. In COVID-19, some of the first respiratory findings are nasal congestion, cough, and wheezing. These features are due to excess inflammation and cytokine activation. Early use of corticosteroids is a rational intervention for patients with COVID-19 with these features as they would be in acute asthma or reactive airways disease. The RECOVERY trial randomized 6425 hospitalized patients with COVID-19 in a 2:1 ratio to dexamethasone 6 mg po/IV daily for up to 10 days and found dexamethasone reduced mortality (HR = 0.65, 95% CI 0.51-0.82, P <0.001). One potential dosing scheme for outpatients starting on day 5 or the onset of respiratory symptoms is prednisone 1 mg/kg given daily for 5 days with or without a subsequent taper.

Colchicine

Colchicine is a nonsteroidal antimitotic drug that blocks metaphase by binding to the ends of microtubules to prevent the elongation of the microtubule polymer. This agent has proven useful in gout and idiopathic recurrent pericarditis. The GRECCO-19 randomized open-label trial in 105 hospitalized patients with COVID-19 found that colchicine was associated with a reduction in D-dimer levels and improved clinical outcomes. The clinical primary end point (2-point change in World Health Organization ordinal scale) occurred in 14.0% in the control group (7 of 50 patients) and 1.8% in the colchicine group (1 of 55 patients) (odds ratio, 0.11; 95% CI, 0.01-0.96; P = 0.02). Because the short-term safety profile is well understood, it is reasonable to consider this agent along with corticosteroids in an attempt to reduce the effects of cytokine storm. A dosing scheme of 1.2 mg po, followed by 0.6 mg po bid for 3 weeks can be considered.

Antiplatelet Agents and Antithrombotics

Multiple studies have described increased rates of pathological macro- and micro-thrombosis. Patients with COVID-19 have described chest heaviness associated with desaturation that suggests the possibility of pulmonary thrombosis. Multiple reports have described elevated D-dimer levels in acutely ill patients with COVID-19, which has been consistently associated with increased risk of deep venous thrombosis and pulmonary embolism. Necropsy studies have described pulmonary microthrombosis in COVID-19. These observations support the notion that endothelial injury and thrombosis play a role oxygen desaturation, a cardinal reason for hospitalization and supportive care. Based on this pathophysiologic rationale, aspirin 81 mg daily can be administered as an initial antiplatelet and anti-inflammatory agent. Ambulatory patients can be additionally treated with subcutaneous low-molecular-weight heparin or with short-acting novel anticoagulant drugs in dosing schemes similar to those use in outpatient thromboprophylaxis. In a retrospective study of 2773 inpatients with COVID-19, 28% received anticoagulant therapy within 2 days of admission, and despite being used in more severe cases, anticoagulant administration was associated with a reduction in mortality (HR = 0.86 per day of therapy, 95% CI: 0.82-0.89; P <0.001). Additional supportive data on the use anticoagulants reducing mortality has been reported in hospitalized patients with elevated D-dimer levels and higher comorbidity scores.53 Many acutely ill outpatients also have general indications for venous thromboembolism prophylaxis applicable to COVID-19.

Delivery of Oxygen and Monitoring

Because ambulatory centers and clinics have been reticent to have face-to-face visits with patients with COVID-19, telemedicine is a reasonable platform for monitoring. Clinical impressions can be gained with audio and video interviews by the physician with the patient. Supplemental information, including vital signs and symptoms, will be important to guide the physician. A significant component of safe outpatient management is maintenance of arterial oxygen saturation on room air or prescribed home oxygen under direct supervision by daily telemedicine with escalation to hospitalization for assisted ventilation if needed. Self-proning could be entertained for confident patients with good at-home monitoring.

Many of the measures discussed in this article could be extended to seniors in COVID-19 treatment units in nursing homes and other nonhospital settings. This would leave the purposes of hospitalization to the administration of intravenous fluid and parenteral medication, assisted pressure or mechanical ventilation, and advanced mechanical circulatory support.”

youtube

This is the group’s statement on vaccines:

“Vaccines in Development:

Several vaccine models are being investigated for SARS-CoV-2 (COVID-19) including DNA and RNA vaccines. These vaccines take genetic information from other sources that is introduced into the cells. This information includes instructions to produce a SARS2-like viral antigen itself, and the immune system then reacts to it to develop immunity to the virus.

The most important consideration before approving a vaccine for human use is to make sure that the vaccine is safe and effective. Developing safe and controlled infection models for humans normally takes many years of phased testing in the lab and then in humans. Many physicians and scientists have been concerned that vaccine manufacturers, with government support, are speeding up this process in ways that are not allowing adequate time for the usual phased testing leading up to human clinical trials. Two vaccine manufacturers already have voluntarily paused their clinical trials in people due to serious adverse events.

Currently, there are no RNA-based vaccines approved for human use so it would seem prudent to take the time needed to ensure safety. Vaccines for RNA viruses are notoriously challenging and difficult to develop. We still, after all these years since AIDS emerged in the 1980s, do not have a vaccine for the AIDS virus, or the SARS-1 coronavirus that emerged in 2002-2003, and both are RNA viruses.

Several attempts have been made to create vaccines for coronavirus and other respiratory viruses but none of the vaccines have survived the testing phases. The vaccine trials for SARS-1 from 2003, for example, was shut down because it produced autoimmune hypersensitivity reactions when exposed to the natural virus after immunization in animal studies.

Another problem is that the SARS-2 virus has already shown many mutations. Viruses adapt to the environment to survive. Like the flu virus, it is difficult to predict what mutations will occur and circulate around the world each season. A new vaccine must be reformulated to adjust to the changing genetic makeup of the SARS-2 virus.

Even the best vaccines for flu are only about 30-60% effective. Compare that with an effectiveness for improvement ranging from 64% to more than 90% in more than 100 new studies showing early, outpatient treatment with our existing medications described in chapters.

As research on the vaccine continues, safety and effectiveness are of primary concern. The good news is there are very safe and effective early treatments already available as we described in Chapter 3. Clearly, early, home-based treatment has now been so successful and offers so much hope, there is less urgency to have a vaccine.”

You can sign up to receive the full protocol here: https://aapsonline.org/covidpatientguide/ or find the research paper here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7410805/

#coronavirus #medicine #pandemic #virus #ivermectin tablets

5 notes · View notes

skylersummer · 5 years

Text

My Secret Phobia

Until I was eighteen years old, I kept a secret from every single person in my life. I didn’t tell a soul. Had I been brave enough to take to the internet and read about my secret, I would have realised that what I was dealing with on a day to day basis was nothing to be ashamed of or embarrassed about, in fact it’s fairly common.

My secret? I suffer from emetophobia.

Emetophobia is the fear of vomit; either physically being sick, seeing, hearing or smelling sick will send me in to a panic attack. Anxiety UK claims that 6-7% of women and 1.7 - 3.1% men will experience emetophobia in their lifetime. Had I known earlier that this anxiety disorder existed outside of my own personal life, let alone amongst thousands of people, I am certain I would have confided in someone about my fear. There’s only a handful of information on the internet (that I’m not too scared to read) about this disorder I’ve grown up with, so I would like to share my own personal experience in the hopes that it helps those suffering in silence realise that they are not alone and to help those who don’t have it, understand the complexities of the condition. I want to keep this as trigger-free as possible, as a lot of sources I have found on the internet I’ve found far too graphic to be of any help to actual sufferers of emetophobia, but bare in mind I will be continuously using the word vomit (a word which would make me flinch and feel physically sick until recent years.)

I am not aware of any one trigger for my emetophobia, there was no obvious experience that set off this whole disorder, all I know is that I have had it for as long as I can remember, from around the age of four.

Here’s something I want to make clear now, to those who don’t have emetophobia. It is a phobia of vomit. When I’ve told people in recent years, I’ve had some laugh at me, Of course you don’t like sick, no one likes being sick. Emetophobics don’t just ‘not like’ vomit, or being sick. Of course, it’s not pleasant for anyone and no one particularly enjoys the experience, however this is a fear. We fear it on a daily basis.

When I was younger, and suffered with more severe symptoms of anxiety, the sound of someone nearby coughing would be enough to set me off into a panic attack. I avoided school trips for fear of anyone getting travel sick on coaches and I avoided places I couldn’t easily exit in case someone did vomit. For these reasons I found school, in particular, very troublesome as there were rules and regulations - you couldn’t just leave lessons whenever you felt worried.

No one could work out exactly why I was so scared of school trips, or wanted to sit by the door in assembly or in class. Age 11 I had my first counselling session with the NHS Child and Adolescent Mental Health Services (CAMHS). I quickly came up with a lie, telling my psychologists that I had claustrophobia (ironically a phobia I actually gave myself), an excuse I deemed socially acceptable and far less embarrassing than the truth. I discharged myself within 6 weeks.

The fact that no one understand the root of why I was so scared of seemingly normal situations meant that no one could properly help give me the therapy that I needed, and I don’t want this to appear as a critique of CAMHS, or school, or my family who I know tried to do what they could, given the information they had.

As I joined secondary school my anxiety and panic attacks became more and more frequent. I would have to leave lessons almost every day, and would avoid the school toilets where possible.

Unfortunately one of the main symptoms that my emetophobia causes is nausea, and naturally this makes me worry even more that I will be sick. It becomes a vicious cycle.

Throughout my adolescent years I was in and out of doctors and hospitals multiple times as healthcare professionals tried to find the cause of my stomach pain and nausea. I had blood tests upon blood tests, I tried cutting out dairy, cutting out gluten, but nothing worked for me long term. The daily nausea persisted: from the moment I got out of bed to the moment I fell asleep at night.

During some of my worse periods I feared leaving the house entirely, in case I somehow became sick outside the safety of my home or in case I came into contact with someone else who was sick. I refused to go to school on a daily basis; until the age of 16 I would be dragged into school crying and screaming by my parents. By the time I was 17 and on study leave for my AS levels my school attendance had dropped below 50% and I was very depressed. My claustrophobia had turned into agoraphobia and being home alone during study leave had me spiralling into periods of psychosis, imagining voices and seeing imaginary figures around my house.

My parents and sisters tried desperately to find the source of what we all knew was just pure anxiety. I persevered with CAMHS until an unfortunate misdiagnosis of my emetophobia as anorexia. Only recently have I started to realise how much the emetophobia affects the way I treat food. I’ve always been naturally slim but, I think, during my school years I was subconsciously eating very little, for fear of feeling too full in case it made me feel sick. Between the ages of 16-18 I had an average BMI of 13.5 which, upon discovering, doctors believed was caused by anorexia. I’ve read recently of emetophobics who’ve become hospitalised; their fear of vomiting making them too scared to eat anything at all. I only wish that the mental health professionals I dealt with at 17 had known about other atypical eating disorders instead of quickly trying to label me with anorexia, which ultimately led me never to return to them (I did a full on running-out-of-the-CAMHS-building and never looked back).

By the time I was 18 I thought I’d exhausted every way of getting better. I had heard the phrase ‘fight or flight’ in reference to my panic attacks (if you know, you know) too many times to count and I was begging for someone, anyone to figure it out, so I didn’t have to tell them. I legitimately thought my daily panic attacks were normal, and that this giant secret that was gnawing away at my insides was going to be something I dealt with my whole adult life. The thought of being stuck like this made me even more depressed and my body was struggling to keep me healthy at such a low weight - I had severe (and recurring) bronchitis during my final year of school which led to me getting post-viral fatigue; I was completely exhausted. I was so tired of being tired all the time, I really felt close to giving up.

Whilst my friends were out experiencing their adolescence as they rightly should, I was instead being picked up from parties at 9pm, too scared to drink alcohol in case it made me sick, too scared of someone else being sick from over-drinking as was so common at teenage parties - unfortunately something I couldn’t always avoid. I wouldn’t touch cigarettes as I’d heard so many people say they’d been sick after trying their first one. I couldn’t, and still can’t, go to the cinema for fear of an unexpected and graphic vomit scene, or go to fairgrounds or theme parks. I’m still petrified of flying in case myself or anyone around me is sick. I couldn’t enjoy anything a normal teenager was supposed to and I became somewhat of a recluse.

During my final year of school I was attending a private therapist with my mother and sister (I was too anxious to be alone with strangers by this point.) It was around then that I started to crack, and they began to notice how I reacted when the word ‘vomit’ was mentioned - I would immediately leave the room, crying in panic. They’d always known I didn’t like being sick, but I don’t think anyone really knew the extent of the phobia, how it dominated my life each day.

At age 18, I was finally put on Citalopram to target my anxiety and panic disorder as well as the depression. I know that antidepressants do not work for everyone, but personally it changed my life. I’d been a shell of a person for the past 5 years, and I honestly think I would have just vanished had it not been for the medication. Alongside the relief of being honest with my family (and eventually friends) I dramatically became a fuller, happier version of myself. I finished school with three A Levels (something I am not sure anyone expected to happen only a year before) and even managed to go on holiday with my friends for a week (taking an aeroplane and even a dreaded coach!) Without the structure and pressure of school I really was a new person.

I started my Art Foundation at Oxford Brooke’s University in September 2015, and my exposure to lots of student drinking and therefore vomiting (other people’s as well as my own) dramatically helped me begin to overcome this phobia which has stolen half my life.

I’m in my final year of university now and living in London, and it hasn't been a completely smooth ride. I’ve had to switch medication twice now and I still struggle daily with public transport and the thought of being sick in public, but it’s definitely an improvement on where I was only 4 years ago, barely even living.

I still haven’t received any professional help or treatment besides my medication, for my emetophobia and that’s something I really want to do in the future, but I’m just trying to take small steps at the moment whilst I finish my degree. The thought of potentially having children (morning sickness, general kid sickness etc.) seems completely unattainable and terrifying to me, but one day I’d like to be brave enough to have the option.

I’m still recovering and I do have set backs, I’m still only just figuring out the extent of how much this phobia affects my daily life, but I do want to say that it is possible to get better. Age 11 I would have never dreamed of even telling someone about my phobia let alone be writing a public post on the internet like this, ten years later, but I think that’s probably why it’s so important that I do this. It’s not going to be easy, and I know the most obvious way forward for me is to get proper exposure therapy (gently exposing myself to sounds, television shows and movies featuring vomit etc.) but I do know for sure that I am going to beat this, one day, whatever it takes.

#emetophobia #emeto tw #emetophobic #mental health #mental disorder #positive mental attitude #tw ed

26 notes · View notes

kristinsimmons · 4 years

Text

Cold Sores: Pictures, Symptoms, Causes, and Treatments

Cold sores, or “fever blisters”, are painful blisters that form on the face, usually near the lips.

They’re caused by one of the most common viral infections in the world. According to the CDC, nearly 50% of people have at least one cold sore outbreak every year.

You can’t cure cold sores permanently, but certain medications and home remedies may help shorten outbreaks and improve symptoms.

IF YOU PURCHASE A PRODUCT USING A LINK BELOW, WE MAY RECEIVE A SMALL COMMISSION AT NO ADDITIONAL COST TO YOU. READ OUR AD POLICY HERE.

What is a cold sore?

A cold sore is a red or dark pink fluid-filled blister around the mouth caused by the herpes simplex virus. Cold sores may appear on other parts of your face. Rarely, cold sores can spread to your nose, inside of your mouth, or even your fingers.

Cold sores are also known as fever blisters, herpes labialis, or oral herpes.

Generally, cold sores spread through close contact, like kissing or oral sex, with another person during an outbreak. Even before you can see the blisters, cold sores may be contagious if skin contact is made.

Cold sores may come back at any time, even after an active outbreak has ended. There is no known cure for cold sores, which are a recurring skin condition.

What does a cold sore look like?

There are 5 cold sore stages that each look different:

Stage 1/Tingling: For about 24 hours, your mouth may itch and/or tingle. Many people describe the feeling as a burning sensation. No visible signs may appear.

Stage 2/Blistering: Blisters form and fill with fluid. You may develop several small blisters or one large blister. Sores appear white, greyish, or yellow while skin becomes inflamed and red.

Stage 3/Weeping: Blisters break (burst) and may ooze. Painful sores form and are often varying shades of red.

Stage 4/Crusting: After a few days, sores dry out and a scab forms. Itching and cracking are common.

Stage 5/Healing: The scab falls off and the skin heals.

Cold sores are contagious at every stage until they heal completely. They spread most easily during stage 3.

You cannot speed up cold sore healing by popping it or by ripping off the scab. Both of these actions may lead to a scar once the cold sore has healed completely.

Cold Sore Symptoms

Tingling, burning, and itchy facial skin are the first signs of a fever blister/cold sore. Catching a cold sore early is important to shorten its duration, so begin treatment immediately.

As the cold sore virus progresses, you’ll experience pain and tenderness. Multiple sores may appear.

Especially during your first cold sore outbreak, you may also experience symptoms like:

Sore throat

Painful gums

Dehydration

Swollen lips

Fever

Headache

Nausea

Swelling of the lymph nodes

General muscle and joint aches

During your first cold sore, you may contract gingivostomatitis, an infection of the gums and mouth. This may be accompanied by swollen lymph nodes, bad breath, and a desire to avoid drinking water.

Rarely, your eyes may become infected. If you experience any symptoms in or around your eyes during a cold sore infection, call a doctor immediately. HSV-1 infections in the eyes may lead to vision loss if not addressed right away.

What causes cold sores?

Cold sores are caused by the herpes simplex virus (HSV-1).

“Herpes” can sound alarming, but it’s an incredibly common virus. 50-80% of adults in the United States carry HSV-1, according to Johns Hopkins Medicine. However, some individuals never develop a cold sore even though they carry the virus.

Most people, however, will experience at least one or two cold sores in their lifetime.

The herpes virus “hides” in the ganglion of nerve cells under the skin of your face after an initial outbreak has ended. There, it is considered “dormant” or “latent.” When triggered again, HSV-1 replicates through the nerve and out to the skin to create a new cold sore. This is why recurring oral herpes outbreaks often happen around the same area of the face as prior outbreaks.

HSV-2 (herpes simplex virus 2) is a related viral strain that causes genital herpes. HSV-2 can rarely spread to the face, and HSV-1 can be transmitted to the genitals.

A person may not develop their first cold sore for up to 20 days after exposure to HSV-1. During this time, they may still spread the virus.

Risk Factors

As 90% of people carry the herpes virus that causes cold sores, most people are at risk of developing a cold sore at some point in their lifetime. A weak immune system is the most significant risk factor for cold sores.

If you have any of the following conditions, your immune system is weaker than average. This puts you at a higher risk of HSV-1 infections or complications:

Eczema (atopic dermatitis)

HIV/AIDS

Autoimmune disease

Third-degree burns over much of the body

Cancer (especially during chemotherapy treatment)

Organ transplants (because of anti-rejection drugs)

Certain genetic factors may also increase your risk of cold sores. The C21orf91 gene is associated with more frequent herpes labialis outbreaks.

What triggers a cold sore? New or recurring cold sore outbreaks may be triggered by:

A weak immune system for any reason

Any viral or bacterial infection (cold, flu, etc.)

Sun exposure

Chronic stress

Fatigue

Menstruation

Dental work

Injury to facial skin

Complications

In some cases, cold sore outbreaks may lead to serious medical complications such as:

Eczema: Eczema combined with cold sore infections can cause eczema herpeticum, a potentially life-threatening medical emergency. People with eczema are more susceptible to cold sores because they have an inflammatory autoimmune condition across a large area of skin. No longer limited only to the face, cold sores can spread to any area of the body. This is most common in children.

Herpetic whitlow: HSV-1 may be transferred to the fingertips, a condition known as herpetic whitlow (“whitlow finger”). This is why some babies and toddlers who suck their thumbs and fingers will get fever blisters on fingers. Dentists suffer from this type of cold sore complication more frequently than the general population.

Eye infections: Herpes simplex can travel to the eyes and cause infections like herpetic keratoconjunctivitis or viral keratitis. This can result in inflammation and ulcers on the cornea. If left untreated, eye infections from cold sores can result in permanent vision loss. Call a doctor right away if you experience eye symptoms during a cold sore outbreak.

Genital sores: Usually, HSV-1 causes cold sores on the face and HSV-2 causes genital herpes. However, it’s possible to spread HSV-1 sores to the genitals or HSV-2 sores to the face.

Acute herpetic pharyngotonsillitis: In adults, cold sores may lead to this throat/tonsil infection. You may develop a fever, headache, tiredness, and a sore throat, but this infection is not usually serious.

Gingivostomatitis: This gum/mouth infection usually happens only once, if ever, and heals in 7-10 days. However, it can spread to the central nervous system and may lead to meningoencephalitis and/or death.

Meningitis or encephalitis: In immunocompromised individuals, HSV viruses may travel to and cause inflammation in the spinal cord (meningitis) and brain (encephalitis). This is a very rare and dangerous complication of the herpes virus.

When to Call a Doctor

Most cold sores can be treated at home without problems. However, children and people at risk of complications should be monitored more closely and may need professional attention.

You should contact a doctor immediately if you or your child have a cold sore and:

High or long-lasting fever

Breathing or swallowing problems

Irritation around the eyes which may or may not cause redness or discharge

The spread of cold sores to an eczema breakout

You should also call your doctor if you develop a cold sore and have a compromised immune system, such as with cancer or AIDS.

Diagnosis

To diagnose a cold sore, your doctor can perform a physical exam. Cold sores are usually easy to identify, but he or she may order lab tests to confirm the diagnosis in some cases.

If you are at high risk of complications, your physician may sample the fluid from an oozing cold sore.

Cold Sore Treatment

How do you get rid of a cold sore fast? Over-the-counter topical ointments or creams like Abreva may shorten the length of a cold sore outbreak.

In some cases, your doctor may recommend prescription antiviral medications to prevent recurring infections.

Several home remedies may also improve symptoms of cold sores.

According to available scientific evidence, no treatment can get rid of a cold sore in 24 hours.

Without treatment, most cold sore infections will clear up within 7-10 days.

Creams & Ointments

Prescription topical creams or ointments that your doctor may prescribe for a cold sore include:

Xerese (acyclovir and hydrocortisone)

Soothelip (acyclovir)

Denavir (penciclovir)

Over-the-counter topical creams or ointments that may help improve cold sore symptoms and/or shorten an outbreak include:

Abreva (docosanol)

Zinc oxide cream (typically sold for diaper rash)

Aloe vera gel

Zilactin (benzyl alcohol)

Abreva (docosanol) is the only over-the-counter antiviral treatment approved by the FDA to shorten the healing time of cold sores. Aloe vera gel and zinc oxide cream may also shorten outbreaks and reduce cold sore symptoms.

Zilactin is marketed for topical cold sore relief. No studies support its efficacy for improving symptoms, but it may dry out the area and reduce the pain caused by a cold sore.

All topical creams or gels for cold sores should be applied to the tingling or burning area 4-5 times each day for maximum effectiveness.

Touching a cold sore directly greatly increases your risk of spreading the infection to another part of your body or another person. When using creams and ointments for cold sores, always apply with a cotton swab.

Medications

Oral medications are available by prescription for prolonged or recurring cold sore infections:

Zovirax (acyclovir)

Valtrex (valacyclovir)

Famvir (famciclovir)

These antiviral medicines may be prescribed for daily use if you have frequent cold sore outbreaks and/or you are at a high risk of complications.

Home Remedies

Several cold sore remedies may improve your symptoms or even reduce your risk of future infections. These include:

Bee propolis

Apple cider vinegar

Essential oils (eucalyptus, tea tree, peppermint, ginger, thyme, hyssop, and sandalwood)

Lemon balm (salve or oral dietary supplement)

Kanuka honey

Aloe vera gel

Lysine

Does toothpaste get rid of cold sores? No one knows for sure if toothpaste can get rid of cold sores. Anecdotal reports suggest that toothpaste containing SLS may help to dry out cold sores. However, no scientific evidence supports this claim.

Sodium lauryl sulfate (SLS) may actually cause canker sores, so avoid using this as a treatment for your cold sores.

Cold Sore Pain Relief

Even if your infection time is shortened by effective treatment, you’ll probably still experience pain during your outbreak.

To reduce pain from a cold sore:

Use ice or a cold compress against the skin

Take over-the-counter painkillers like ibuprofen (Advil) or acetaminophen (Tylenol)

Use benzocaine or lidocaine gel to numb the area

Remember not to touch the sore with your hands and use a cotton ball or swab when applying a topical anesthetic.

Aspirin should not be used for cold sore pain — or any pain during a viral infection — especially in children.

Rarely, aspirin use during a viral infection may lead to Reye syndrome, a serious childhood condition that begins with persistent vomiting and may lead to neurological problems and other life-threatening complications.

How to Prevent Cold Sores

The virus is generally passed through skin contact or by touching personal items used by an infected person. To prevent spreading cold sores, do not:

Share drinking glasses, water bottles, or eating utensils

Use someone else’s lip balm

Share toothbrushes or other hygiene products

Kiss someone who has a cold sore or has been in close contact with another person who has a cold sore

Perform or receive oral sex with someone who may have a cold sore or genital herpes

You should also wash your hands frequently and thoroughly during a cold sore outbreak.

To prevent or reduce your risk for recurring cold sore infections, you should avoid triggers for new outbreaks and keep your immune system healthy:

Use a lip balm with sunscreen: Use an SPF 30 or higher lip balm.

Avoid sun overexposure: Always use sunscreen and avoid spending several hours in the sun on a regular basis.

Replace your toothbrush regularly: Your toothbrush or toothbrush head can hang onto viruses including HSV-1. Replace your toothbrush every 1-3 months and immediately after a cold sore outbreak.

Practice stress-relief techniques: Journaling, meditation, time outdoors, exercise, and restful sleep can all help reduce stress and fatigue that can trigger cold sores.

Support immune health during menstruation: Women may be more prone to cold sores during their periods. Don’t neglect immunity and healthy habits/eating during your cycle, as this could increase your risk of new cold sores.

Boost your immune system: As with any virus, cold sores are less likely if your immune system is strong. Ensure you’re getting plenty of vitamin C, vitamin D, and nutrient-dense foods. You may also try a probiotic supplement and/or oral probiotics to support a healthy microbiome.

Be cautious after dental work: Dental cleanings and other procedures can temporarily weaken your immune system by exposing your bloodstream to higher amounts of oral bacteria than normal.

How long do cold sores last?

First cold sore outbreaks may last as long as 2 weeks.

Recurrent outbreaks usually heal in 7-10 days.

The cold sore virus does not go away, even when a cold sore outbreak has healed. It remains dormant in nerve cells until the infection is triggered again.

Cold Sores vs. Canker Sores

A cold sore outbreak is the result of a viral infection, while canker sores are non-contagious ulcers caused by several different factors.

The easiest way to spot the difference between cold sores and canker sores is by their location and appearance.

Cold SoreCanker SoreLocationFace, usually on or around the lipsInside the mouth, on the tongue, cheeks, or throatAppearanceRaised, red, fluid-filled blisters; eventually, ooze then scab overFlat, red circular ulcers surrounded by a white haloCausesViral infection from herpes simplex virus 1 (HSV-1) Outbreaks may be triggered by: – Weakened immunity – Stress – Sun exposure – Hormonal imbalance– Injury (biting your cheek) – Toothpaste with sodium lauryl sulfate (SLS) – Zinc, iron, or vitamin B12 deficiency – Hormonal imbalance – Oral microbiome imbalanceTime to Recovery7-14 days1-6 weeksContagious?YesNo

Popping a Cold Sore

Does popping a cold sore help it heal faster? No, popping a cold sore does not help the blister heal faster. In fact, popping your cold sore will more than likely lead to:

More cold sores as the blister fluid spreads

Risk of new, different infections by exposing an open sore

Scarring

Increased pain

Popping a cold sore is especially dangerous if you are at risk of complications due to a compromised immune system. Skin conditions like eczema or psoriasis make it easier for the HSV-1 virus to spread all over the body, which may lead to life-threatening complications.

FAQs

Are there clinical trials available for people with frequent cold sores?

A: The US National Library of Medicine has a database for active clinical trials for oral herpes treatments.

Do cold sores mean you have an STD?

A: Most people contract the HSV-1 virus during childhood years, not related to any type of sexual contact. Cold sores are not considered an STD, unlike genital herpes caused by HSV-2.

Keep in mind, though, that HSV-2 outbreaks in the genital area can pass to the mouth during oral sex and cause sores on the face. It’s also harder to prevent with condoms than other STDs since it can be transferred from the skin not covered by a condom.If you’re concerned you’ve contracted the HSV-2 virus, see your doctor for treatment options.

11 References

McQuillan, G. M., Kruszon-Moran, D., Flagg, E. W., & Paulose-Ram, R. (2018). Prevalence of herpes simplex virus type 1 and type 2 in persons aged 14-49: United States, 2015-2016 (pp. 1-8). US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Full text: https://www.cdc.gov/nchs/products/databriefs/db304.htm

Kolokotronis, A., & Doumas, S. (2006). Herpes simplex virus infection, with particular reference to the progression and complications of primary herpetic gingivostomatitis. Clinical microbiology and infection, 12(3), 202-211. Full text: https://www.researchgate.net/profile/Stergios_Doumas/publication/7323444_Herpes_simplex_virus_infection_with_particular_reference_to_the_progression_and_complications_of_primary_herpetic_gingivostomatitis/links/59dd40ba458515f6efef4cd7/Herpes-simplex-virus-infection-with-particular-reference-to-the-progression-and-complications-of-primary-herpetic-gingivostomatitis.pdf

Arduino, P. G., & Porter, S. R. (2008). Herpes Simplex Virus Type 1 infection: overview on relevant clinico‐pathological features. Journal of oral pathology & medicine, 37(2), 107-121. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/18197856

Kriesel, J. D., Jones, B. B., Matsunami, N., Patel, M. K., St. Pierre, C. A., Kurt-Jones, E. A., … & Hobbs, M. R. (2011). C21orf91 genotypes correlate with herpes simplex labialis (cold sore) frequency: description of a cold sore susceptibility gene. Journal of Infectious Diseases, 204(11), 1654-1662. Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3203230/

Rowe, N. H., Heine, C. S., & Kowalski, C. J. (1982). Herpetic whitlow: an occupational disease of practicing dentists. Journal of the American Dental Association (1939), 105(3), 471-473. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/6957456

Dawson, C. R., & Togni, B. (1976). Herpes simplex eye infections: clinical manifestations, pathogenesis and management. Survey of ophthalmology, 21(2), 121-135. Abstract: https://www.ncbi.nlm.nih.gov/pubmed/988644

Klastersky, J., Cappel, R., Snoeck, J. M., Flament, J., & Thiry, L. (1972). Ascending myelitis in association with herpes-simplex virus. New England Journal of Medicine, 287(4), 182-184. Abstract: https://www.nejm.org/doi/pdf/10.1056/NEJM197207272870411

Sacks, S. L., Thisted, R. A., Jones, T. M., Barbarash, R. A., Mikolich, D. J., Ruoff, G. E., … & Morrow, P. R. (2001). Clinical efficacy of topical docosanol 10% cream for herpes simplex labialis: a multicenter, randomized, placebo-controlled trial. Journal of the American Academy of Dermatology, 45(2), 222-230. Abstract: https://pubmed.ncbi.nlm.nih.gov/11464183/

Godfrey, H. R., Godfrey, N. J., Godfrey, J. C., & Riley, D. (2001). A randomized clinical trial on the treatment of oral herpes with topical zinc oxide/glycine. Alternative therapies in health and medicine, 7(3), 49. Abstract: https://pubmed.ncbi.nlm.nih.gov/11347285/

Rezazadeh, F., Moshaverinia, M., Motamedifar, M., & Alyaseri, M. (2016). Assessment of anti HSV-1 activity of Aloe vera gel extract: an in vitro study. Journal of Dentistry, 17(1), 49. Abstract: https://pubmed.ncbi.nlm.nih.gov/26966709/

Chavan, M., Jain, H., Diwan, N., Khedkar, S., Shete, A., & Durkar, S. (2012). Recurrent aphthous stomatitis: a review. Journal of Oral Pathology & Medicine, 41(8), 577-583. Full text: https://www.researchgate.net/profile/Mahesh_Chavan5/publication/221891773_Recurrent_aphthous_stomatitis_A_review/links/5b69611392851ca650512153/Recurrent-aphthous-stomatitis-A-review.pdf

The post Cold Sores: Pictures, Symptoms, Causes, and Treatments appeared first on Ask the Dentist.

Cold Sores: Pictures, Symptoms, Causes, and Treatments published first on https://wittooth.tumblr.com/

0 notes

dentalinfotoday · 4 years

Link

Cold sores, or “fever blisters”, are painful blisters that form on the face, usually near the lips.

They’re caused by one of the most common viral infections in the world. According to the CDC, nearly 50% of people have at least one cold sore outbreak every year.

You can’t cure cold sores permanently, but certain medications and home remedies may help shorten outbreaks and improve symptoms.

IF YOU PURCHASE A PRODUCT USING A LINK BELOW, WE MAY RECEIVE A SMALL COMMISSION AT NO ADDITIONAL COST TO YOU. READ OUR AD POLICY HERE.

What is a cold sore?

Cold sores are also known as fever blisters, herpes labialis, or oral herpes.

Cold sores may come back at any time, even after an active outbreak has ended. There is no known cure for cold sores, which are a recurring skin condition.

What does a cold sore look like?

There are 5 cold sore stages that each look different:

Stage 1/Tingling: For about 24 hours, your mouth may itch and/or tingle. Many people describe the feeling as a burning sensation. No visible signs may appear.

Stage 2/Blistering: Blisters form and fill with fluid. You may develop several small blisters or one large blister. Sores appear white, greyish, or yellow while skin becomes inflamed and red.

Stage 3/Weeping: Blisters break (burst) and may ooze. Painful sores form and are often varying shades of red.

Stage 4/Crusting: After a few days, sores dry out and a scab forms. Itching and cracking are common.

Stage 5/Healing: The scab falls off and the skin heals.

Cold sores are contagious at every stage until they heal completely. They spread most easily during stage 3.

You cannot speed up cold sore healing by popping it or by ripping off the scab. Both of these actions may lead to a scar once the cold sore has healed completely.

Cold Sore Symptoms

Tingling, burning, and itchy facial skin are the first signs of a fever blister/cold sore. Catching a cold sore early is important to shorten its duration, so begin treatment immediately.

As the cold sore virus progresses, you’ll experience pain and tenderness. Multiple sores may appear.

Especially during your first cold sore outbreak, you may also experience symptoms like:

Sore throat

Painful gums

Dehydration

Swollen lips

Fever

Headache

Nausea

Swelling of the lymph nodes

General muscle and joint aches

During your first cold sore, you may contract gingivostomatitis, an infection of the gums and mouth. This may be accompanied by swollen lymph nodes, bad breath, and a desire to avoid drinking water.

Rarely, your eyes may become infected, known as viral keratitis. If you experience any symptoms in or around your eyes during a cold sore infection, call a doctor immediately. HSV-1 infections in the eyes may lead to vision loss if not addressed right away.

What causes cold sores?

Cold sores are caused by the herpes simplex virus (HSV-1).

Most people, however, will experience at least or two cold sores in their lifetime.

The herpes virus “hides” in the ganglion nerve cells after an initial outbreak has ended. There, it is considered “dormant” or “latent.” When triggered again, HSV-1 replicates through the nerve and out to the skin to create a new cold sore. This is why recurring oral herpes outbreaks often happen around the same area of the face as prior outbreaks.

HSV-2 (herpes simplex virus 2) is a related viral strain that causes genital herpes. HSV-2 can rarely spread to the face, and HSV-1 can be transmitted to the genitals.

A person may not develop their first cold sore for up to 20 days after exposure to HSV-1. During this time, they may still spread the virus.

Risk Factors

If you have any of the following conditions, your immune system is weaker than average. This puts you at a higher risk of HSV-1 infections or complications:

Eczema (atopic dermatitis)

HIV/AIDS

Autoimmune disease

Third-degree burns over much of the body

Cancer (especially during chemotherapy treatment)

Organ transplants (because of anti-rejection drugs)

Certain genetic factors may also increase your risk of cold sores. The C21orf91 gene is associated with more frequent herpes labialis outbreaks.

What triggers a cold sore? New or recurring cold sore outbreaks may be triggered by:

A weak immune system for any reason

Any viral or bacterial infection (cold, flu, etc.)

Sun exposure

Chronic stress

Fatigue

Menstruation

Dental work

Injury to facial skin

Complications

In some cases, cold sore outbreaks may lead to serious medical complications such as:

Genital sores: Usually, HSV-1 causes cold sores on the face and HSV-2 causes genital herpes. However, it’s possible to spread HSV-1 sores to the genitals or HSV-2 sores to the face.

When to Call a Doctor

Most cold sores can be treated at home without problems. However, children and people at risk of complications should be monitored more closely and may need professional attention.

You should contact a doctor immediately if you or your child have a cold sore and:

High or long-lasting fever

Breathing or swallowing problems

Irritation around the eyes which may or may not cause redness or discharge

The spread of cold sores to an eczema breakout

You should also call your doctor if you develop a cold sore and have a compromised immune system, such as with cancer or AIDS.

Diagnosis

To diagnose a cold sore, your doctor can perform a physical exam. Cold sores are usually easy to identify, but he or she may order lab tests to confirm the diagnosis in some cases.

If you are at high risk of complications, your physician may sample the fluid from an oozing cold sore.

Cold Sore Treatment

How do you get rid of a cold sore fast? Over-the-counter topical ointments or creams like Abreva may shorten the length of a cold sore outbreak.

In some cases, your doctor may recommend prescription antiviral medications to prevent recurring infections.

Several home remedies may also improve symptoms of cold sores.

According to available scientific evidence, no treatment can get rid of a cold sore in 24 hours.

Without treatment, most cold sore infections will clear up within 7-10 days.

Creams & Ointments

Prescription topical creams or ointments that your doctor may prescribe for a cold sore include:

Xerese (acyclovir and hydrocortisone)

Soothelip (acyclovir)

Denavir (penciclovir)

Over-the-counter topical creams or ointments that may help improve cold sore symptoms and/or shorten an outbreak include:

Abreva (docosanol)

Zinc oxide cream (typically sold for diaper rash)

Aloe vera gel

Zilactin (benzyl alcohol)

Zilactin is marketed for topical cold sore relief. No studies support its efficacy for improving symptoms, but it may dry out the area and reduce the pain caused by a cold sore.

All topical creams or gels for cold sores should be applied to the tingling or burning area 4-5 times each day for maximum effectiveness.

Medications

Oral medications are available by prescription for prolonged or recurring cold sore infections:

Zovirax (acyclovir)

Valtrex (valacyclovir)

Famvir (famciclovir)

These antiviral medicines may be prescribed for daily use if you have frequent cold sore outbreaks and/or you are at a high risk of complications.

Home Remedies

Several cold sore remedies may improve your symptoms or even reduce your risk of future infections. These include:

Bee propolis

Apple cider vinegar

Essential oils (eucalyptus, tea tree, peppermint, ginger, thyme, hyssop, and sandalwood)

Lemon balm (salve or oral dietary supplement)

Kanuka honey

Aloe vera gel

Lysine

Sodium lauryl sulfate (SLS) may actually cause canker sores, so avoid using this as a treatment for your cold sores.

Cold Sore Pain Relief

Even if your infection time is shortened by effective treatment, you’ll probably still experience pain during your outbreak.

To reduce pain from a cold sore:

Use ice or a cold compress against the skin

Take over-the-counter painkillers like ibuprofen (Advil) or acetaminophen (Tylenol)

Use benzocaine or lidocaine gel to numb the area

Remember not to touch the sore with your hands and use a cotton ball or swab when applying a topical anesthetic.

Aspirin should not be used for cold sore pain — or any pain during a viral infection — especially in children.

Rarely, it may lead to Reye syndrome, a serious childhood condition that begins with persistent vomiting and may lead to neurological problems and other life-threatening complications.