"Stuff That Works" - Effective Home Remedies

Taking a cue from a Guy Clark song in which he sings the praises of practical possessions, such as his "ol' blue shirt" and his "used car", today's Health Tip focuses on simple, yet effective home remedies.


Honey for children's cough. Treatment options for symptomatic relief of a cough associated with colds are fairly limited.  In particular, the American Academy of Pediatrics has taken the position that "over-the-counter cough and cold medicines do not work for children younger than 6 years and in some cases may pose a health risk."  Recently, researchers in Israel found that giving two teaspoons of honey before bedtime relieved coughing better than a placebo.  While they did not compare treatment with honey to a cough medication, considering its safety and acceptability, honey is a reasonable first line choice for cold-related coughing in children.  Because of the slight risk of botulism poisoning, honey should not be given to children under the age of one.

Licorice (or liquorice) for cold sores.  Cold sores are caused by the herpes virus and typically resolve on their own after a week or so. Treatment is usually directed at relieving pain or with shortening the length of the outbreak with antiviral medications (Valtrex, Zovirax, etc.).  Licorice contains a compound called glycyrrhizin (or glycyrrhizic acid) which has been used historically to treat several viral infections including colds, flu, and hepatitis.  While chewing licorice will not cure cold sores, it may help speed up their resolution.  Like most medications, licorice can have toxic side effects, particularly if consumed in excess.  These side effects include hypertension and water retention. Licorice is not related to anise or fennel, which have a similar flavor but not the antiviral properties of licorice from the root of the Glycrrhiza plant.

Duct tape for Warts. In The Adventures of Tom Sawyer, Tom proposes to Huck Finn that an effective treatment for warts involves placing a hand in a hollow stump full of water at mid-night and saying 'Barley-corn, barley-corn, injun-meal shorts, Spunk-water, spunk-water, swaller these warts.'  While this seems fairly far-fetched, some of the remedies with scientific backing are similarly exotic.  One of these involves the use of duct tape placed on top of the wart.  The results of studies evaluating this method have been mixed, but there is some evidence to support its use.  Unfortunately, occlusion with duct tape is reported to take several weeks.  More conventional self-care measures involve the use of OTC salicylic acid formulas (Compound W, Occlusal, etc.) and a non-prescription freezing method (Dr. Scholl's Freeze Away).

Zinc for the common cold.  Many people are aware that the mineral zinc is beneficial in the treatment of colds.  When looking at studies evaluating its effectiveness, the strength of this benefit is surprisingly strong.  The Cochrane Foundation reviewed 15 randomized controlled trials, involving 1360 participants and concluded that, when taken within 24 hours of onset of symptoms, zinc (lozenges or syrup) reduced the duration and severity of the common cold in healthy people.  It was also determined from these studies that people taking zinc were less likely to have persistence of their cold symptoms beyond seven days of treatment.  Use of zinc intranasal preparations is not recommended due to the potential for irreversible loss of smell.  A second popular herbal remedy, Echinacea, was not shown to reduce the number of colds that adults catch.

Coffee for Asthma.  Asthma is a serious and sometimes even life-threatening disease. By no means should any "home remedy" be the first line treatment when a number of more effective medications are available.  Nevertheless, there is some evidence to indicate that caffeine, an active ingredient in coffee, tea, and cola drinks may have a beneficial effect by helping to open airways in people with asthma.  Caffeine is chemically similar to the asthma medication, theophylline, which had been a standard treatment for asthma.  Several studies have shown that the amount of caffeine in a cup of coffee can produce improvement in airway function that can last up to a couple of hours.  The 2nd National Health and Nutrition Examination Survey (NHANES II) sought to compare coffee consumption with the presence of asthma and wheezing symptoms in a representative sample of American adults.  Subjects who drank coffee on a regular basis were almost a third less likely to report asthma symptoms as compared to non-coffee drinkers.

Watch for more "Stuff that Works" in future Health Tips!

What an electrocardiogram can (and can't) tell you - Part 2: limitations of the EKG

Last week's Health Tip discussed the usefulness of the EKG, a highly important test used in the diagnosis and management of heart disease.  Like most clinical tests, however, the EKG is not perfect.  Some of the ways in which the EKG falls short in evaluating heart conditions include:

• Evaluating intermittent problems.  Most of us know how difficult it can be to have a problem that comes and goes affecting an automobile "diagnosed" by a mechanic.  The same can be true with an intermittent problem affecting the heart, such as palpitations.  Unless the person with the irregular heart beat is  experiencing symptoms or signs of the condition at the time that the EKG is being performed, it will most likely appear normal.
• Evaluating heart problems that occur only with activity.  The EKG looks at the electrical activity of the heart only in a resting or "static" state.  Underlying heart problems may not be reflected unless the heart is beating rapidly or is under stress as when exercising.  An example of this is someone with constriction of the arteries that supply oxygen to the heart (coronary artery disease) who experiences chest pain (angina) with activity.  Often, when this person is at rest, his or her EKG will not reflect the underlying heart condition.
• Producing false-positive and false-negative findings.  Sometimes the EKG can be overly sensitive and point toward a heart problem that is not really present.  This is called a "false-positive" finding.  Likewise, an EKG may be entirely normal despite the presence of a serious underlying heart condition.  This is called a false-negative finding and is a likely explanation for the person who has a normal EKG during a routine physical exam and shortly afterwards experiences a serious heart attack.
• Causing non-specific changes on EKG.  Sometimes the lines and waves seen on an EKG are "non-specific", meaning that they may or may not be abnormal.  Some of these findings are known as "normal variants", appearing abnormal but occurring without the presence of heart disease.  Other non-specific changes could be due to a number of conditions without pointing to a specific cause.
• Erroneous diagnosis of heart disease in athletes.  As a result of superb conditioning and physiologic adaptation to exercise, athletes may have EKG "abnormalities" that pose no health risk.  A slow heart rate (sometimes as low as 40 beats/minute), enlargement of the heart similar to that seen in long-standing hypertension, and changes in electrical activity (ST segment elevation, inverted T-waves, etc.) suggesting heart stress are some of the most common of these findings.

How can these limitations of the EKG be overcome?  When the EKG findings and the patient's physical condition are at odds, a more in-depth examination, and often other heart tests, may be required to sort things out.  The following are some of the most common of these tests:

• Ambulatory electrocardiography.  In this test, also known as a 24-hr EKG or Holter monitor, a 24 hour recording of the EKG is made while you are going about your normal activities.  It is particularly valuable in someone who has an intermittent problem, such as palpitations.  Also, some heart problems are only present during activity which an ambulatory electrocardiogram will help document.
• Echocardiography. The echocardiogram uses sound waves to scan the heart's muscle and valves that control the flow of blood through and out of the heart.  It even allows doctors to see the heart while it is beating.  The echocardiogram is especially valuable in and in assessing abnormal heart sounds heard during examination, evaluating an enlarged heart, and in helping clear athletes with questionable EKG changes.
• Exercise electrocardiography.  This test is also known as a "treadmill EKG" or "stress test".  During this test the EKG is monitored while the person is walking on a motor-powered treadmill or pedaling a stationary bicycle.  Exercise often provides the additional stress on the heart required to bring out EKG evidence of coronary artery disease.

On occasion even more invasive testing such as a coronary artery catheterization may be required to confirm or rule out a problem noted on EKG.  This is part of the reason that the US Preventive Services Task Force has advised against doctors performing "screening" EKGs on people at low risk of having heart disease.  In "normal" individuals, the EKG is unlikely to predict a heart attack or uncover an undiagnosed heart problem, and because of false-positives and non-specific findings may lead to unnecessary testing.

What an electrocardiogram can (and can't) tell you - Part 1: how and why it's done

The electrocardiogram, also called an EKG or ECG, is a test that records electrical activity within the heart.  With each heartbeat, an electrical signal is conducted through specialized nerves from the upper to lower chambers of the heart.  This causes the heart muscle to contract in a synchronized manner and pump blood throughout the body.  These electrical signals are detected by an EKG machine (electrocardiograph) and recorded as a series of squiggles, lines, and waves that correspond to various events associated with the heartbeat.

When should an EKG be performed?  Some of the reasons that your doctor might recommend that you undergo EKG testing include:

• Unexplained chest pain suggestive of coronary artery disease.
  
• Palpitations or irregular heartbeat
  
• Abnormal heart sounds heard during an examination
  
• Symptoms suggestive of a heart problem, such as shortness of breath, dizziness, or fainting.
  
• Screening for heart problems when multiple risk factors, such as hypertension, high cholesterol, cigarette smoking, diabetes, or a family history of early heart disease are present.
  

How is an EKG performed?  Performing an EKG generally takes around 10 to 15 minutes and is a painless procedure.  Before conducting the test, sticky patches called electrodes are placed on the skin of the chest, arms, and legs.  The electrodes are connected via wires to an EKG machine and allow the EKG machine to study the heart's electrical activity from several different perspectives at the same time.  While lying at rest, a recording is made on paper and/or saved to a computer by the electrocardiograph.

What does the EKG tell the doctor?  The EKG is a highly useful test when performed for the appropriate reasons, such as those described above. Some of the most important findings noted from EKGs include:

1. The presence of coronary artery disease
   
   
2. Heart attacks that are in progress or that have occurred in the past.
   
   
3. Irregularities of normal heart rhythm, such as atrial fibrillation, "extra" heartbeats (e.g. premature ventricular contractions), and heartbeats that are being blocked
   
   
4. Heart enlargement that may have come about from congenital heart disease (e.g. hypertrophic cardiomyopathy), long-standing hypertension or from a viral infection
   
   
5. Inflammation of the sac that surrounds the heart (pericarditis), usually stemming from a viral infection
   
   
6. Abnormalities in the way that electrical impulses travel through the heart (e.g. bundle branch block, long QT syndrome, etc.).
   
   

Since its invention the EKG has been a highly important tool in diagnosing and treating heart disease.  Willem Einthoven, credited with inventing the modern EKG machine, was awarded the Nobel Prize in Medicine in 1924 for his discovery.  As with other tests used in medicine, however, the EKG is not perfect.  There are some significant limitations to its usefulness that will be considered in next week's Health tip.