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A Rough Guide to Coughs and other symptoms
Since this issue is focusing on TB, I thought I'd get my oar in about one of the key TB symptoms which leads to people pitching up at the surgery: the cough. Most of the other TB symptoms - coughing up blood, night sweats, weight loss and fever - are fairly self-evident, but when is a cough just a cough? At what point does a tickle in the throat, a great hacking beast or a phlegmy fur-ball mean you should down tools and head for the doc's, anticipating antibiotics, chest x-rays and immediate isolation to stop your spluttering carcass from infecting your nearest and dearest?
It's a tough one, as the fear of being whisked off to the nearest infectious diseases unit is off-set by the potential embarrassment of being told that all you have is a cold and to stop being so melodramatic...
What most of us could do with is a one of those magazine tick-box quizzes ("you have mostly 'A's and so you have bird flu" or "you have all 'B's and should be on life support‚Äö?Ñ??), but unfortunately, that's just not a realistic option - even if it feels like the way in which NHS Direct operates! Instead, the cougher (you) and the recipient of your phlegm-filled tissue (me) need to have a chat about your cough, and then I need to listen to your rasping airways.
I'm going to ask when you first noticed your cough and whether it has changed since then. Are you bringing up sputum and if so, what colour is it? Are you coughing up blood? When do you cough and what triggers it? Do you cough at night or after exertion? Have you taken anything that makes it better, or worse? Bear in mind that the key feature of a worrying cough is persistence (ie, a cough that has lasted over three weeks), so try and think back to when it all kicked off.
Now I've a good idea about your cough, I will need to ask about other symptoms such as fever, wheeze, chest pain, weight loss, night sweats and loss of appetite. Of course, it's really important to know about any prescribed meds you're taking and any other drugs - including tobacco. It makes sense, too, if I ask about your social situation and whether anyone else you share space with has been unwell. Naturally, if you've any medical conditions I need to know, even if it's something you consider unrelated.
Your answers to these questions give a good indication as to whether I should fill in X-ray referral forms or shuffle you out the door without a backwards glance, but first I've got to listen to your chest. For starters, most people with a cough expect me to do so: there's something about a stethoscope that just looks so professional... and also I love the squeaks, crackles and groans that lungs make.
Once that's done, we can talk about how likely you are to have something - or nothing - to be worried about.
As has been been discussed elsewhere in this issue, the homeless suffer disproportionately from TB, so I'm more likely to ship you up to the hospital for a chest X-ray if you are in a hostel or sleeping rough. But it is up to you to get the pics done and to come on back for the results. Key management for TB is to identify those people with the condition as early as possible and to get them into treatment. Bear in mind that every one person who has active, untreated TB will infect 12-15 others every year, so see it as your duty to others to seek diagnosis. I'm hoping this Rough Guide to Coughs gives you some understanding about what, how and why we ask what we do, to give you heads-up when you're coming on in to the surgery.
October – November 2024 : Change
CONTENTS
BACK ISSUES
- Issue 152 : October – November 2024 : Change
- Issue 151 : August – September 2024 : Being Heard
- Issue 150 : June – July 2024 : Reflections
- Issue 149 : April – May 2024 : Compassion
- Issue 148 : February – March 2024 : The little things
- Issue 147 : December 2023 – January 2024 : Next steps
- Issue 146 : October 2023 – November 2023 : Kind acts
- Issue 145 : August 2023 – September 2023 : Mental health
- Issue 144 : June 2023 – July 2023 : Community
- Issue 143 : April 2023 - May 2023 : Hope springs
- Issue 142 : February 2023 - March 2023 : New Beginnings
- Issue 141 : December 2022 - January 2023 : Winter Homeless
- Issue 140 : October - November 2022 : Resolve
- Issue 139 : August - September 2022 : Creativity
- Issue 138 : June - July 2022 : Practical advice
- Issue 137 : April - May 2022 : Connection
- Issue 136 : February - March 2022 : RESPECT
- Issue 135 : Dec 2021 - Jan 2022 : OPPORTUNITY
- Issue 134 : September-October 2021 : Losses and gains
- Issue 133 : July-August 2021 : Know Your Rights
- Issue 132 : May-June 2021 : Access to Healthcare
- Issue 131 : Mar-Apr 2021 : SOLUTIONS
- Issue 130 : Jan-Feb 2021 : CHANGE
- Issue 129 : Nov-Dec 2020 : UNBELIEVABLE
- Issue 128 : Sep-Oct 2020 : COPING
- Issue 127 : Jul-Aug 2020 : HOPE
- Issue 126 : Health & Wellbeing in a Crisis
- Issue 125 : Mar-Apr 2020 : MOVING ON
- Issue 124 : Jan-Feb 2020 : STREET FOOD
- Issue 123 : Nov-Dec 2019 : HOSTELS
- Issue 122 : Sep 2019 : DEATH ON THE STREETS
- Issue 121 : July-Aug 2019 : INVISIBLE YOUTH
- Issue 120 : May-June 2019 : RECOVERY
- Issue 119 : Mar-Apr 2019 : WELLBEING
- Issue 118 : Jan-Feb 2019 : WORKING HOMELESS
- Issue 117 : Nov-Dec 2018 : HER STORY
- Issue 116 : Sept-Oct 2018 : TOILET TALK
- Issue 115 : July-Aug 2018 : HIDDEN HOMELESS
- Issue 114 : May-Jun 2018 : REBUILD YOUR LIFE
- Issue 113 : Mar–Apr 2018 : REMEMBRANCE
- Issue 112 : Jan-Feb 2018
- Issue 111 : Nov-Dec 2017
- Issue 110 : Sept-Oct 2017
- Issue 109 : July-Aug 2017
- Issue 108 : Apr-May 2017
- Issue 107 : Feb-Mar 2017
- Issue 106 : Dec 2016 - Jan 2017
- Issue 105 : Oct-Nov 2016
- Issue 104 : Aug-Sept 2016
- Issue 103 : May-June 2016
- Issue 102 : Mar-Apr 2016
- Issue 101 : Jan-Feb 2016
- Issue 100 : Nov-Dec 2015
- Issue 99 : Sept-Oct 2015
- Issue 98 : July-Aug 2015
- Issue 97 : May-Jun 2015
- Issue 96 : April 2015 [Mini Issue]
- Issue 95 : March 2015
- Issue 94 : February 2015
- Issue 93 : December 2014
- Issue 92 : November 2014
- Issue 91 : October 2014
- Issue 90 : September 2014
- Issue 89 : July 2014
- Issue 88 : June 2014
- Issue 87 : May 2014
- Issue 86 : April 2014
- Issue 85 : March 2014
- Issue 84 : February 2014
- Issue 83 : December 2013
- Issue 82 : November 2013
- Issue 81 : October 2013
- Issue 80 : September 2013
- Issue 79 : June 2013
- Issue 78 : 78
- Issue 77 : 77
- Issue 76 : 76
- Issue 75 : 75
- Issue 74 : 74
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- Issue 49 : 49
- Issue 48 : 48
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- Issue 45 : 45
- Issue 44 : 44
- Issue 43 : 43
- Issue 42 : 42
- Issue 5 : 05
- Issue 4 : 04
- Issue 2 : 02
- Issue 1 : 01
- Issue 41 : 41
- Issue 40 : 40
- Issue 39 : 39
- Issue 38 : 38
- Issue 37 : 37
- Issue 36 : 36
- Issue 35 : 35
- Issue 34 : 34
- Issue 33 : 33
- Issue 10 : 10
- Issue 9 : 09
- Issue 6 : 06
- Issue 3 : 03
- Issue 32 : 32
- Issue 31 : 31
- Issue 30 : 30
- Issue 29 : 29
- Issue 11 : 11
- Issue 12 : 12
- Issue 13 : 13
- Issue 14 : 14
- Issue 15 : 15
- Issue 16 : 16
- Issue 17 : 17
- Issue 18 : 18
- Issue 19 : 19
- Issue 20 : 20
- Issue 21 : 21
- Issue 22 : 22
- Issue 23 : 23
- Issue 24 : 24
- Issue 25 : 25
- Issue 8 : 08
- Issue 7 : 07
- Issue 26 : 26
- Issue 27 : 27
- Issue 28 : 28
- Issue 1 : 01