Severe sore throat pain--what should I do?

[flippet]

I've had a severe sore throat for three days now--it just came on on Wednesday with no warning. I was able to deal with it for two days (ibuprofen, comtrex, throat spray) with so-so results (one dose of painkillers would mostly work, the next dose wouldn't touch it, etc.), but today it's just been unbearable. I saw the doctor this morning, and he gave me a scrip for amoxicillin, but of course that's not a painkiller, and will take some time to get a foothold on the infection.

Is there anything I can do for the pain? I've been taking ibuprofen, 400mg, every four hours, but since the last dose didn't do much, I tried acetaminophen this time, 1000mg (even though tylenol, etc., doesn't usually do a whole lot for me). I've tried gargling with salt water, and using hot and cold packs, but nothing seems to be working. The pain is so bad that it's brought me to tears a few times today, and it's very difficult to sleep through it. Every swallow makes me want to find a scalpel and cut the infection out myself. My ear and neck muscles are killing me as well, from the pressure, and tensing up around the pain.

Should I go to the emergency room? That's an expensive way to go, and I don't want to do it unless they'd be able to do something for me to stop the pain.

[mikey]

I'm not sure there is much out there that will help. Most people get a little relief from throat losenges like Chloraseptic... Other then that, in extreme cases, I have seen doctor's prescribe something called viscous lidocaine, which is a good oral anesthetic. The problem is, you really shouldn't swallow it because if a lot of it is absorbed, it can cause cardiac dysrhythmias. It is meant to only be gargled, but it works well.

Did they do a rapid strep test to confirm strep, ir are they just treating empirically? If it is strep, the pain should go way down in 24 hours, if that helps at all.

My pet peeve: Strictly speaking, amoxicillin is not the best antibiotic for strep- penicillin is. The #2 bug causing identical symptoms is Epstein-Barr virus, and lots of people get a terrible looking rash when they combine that virus and amoxicillin.

[md2be]

call your MD, talk about the pain and lack of alleviation, and he will prescribe you vicodin or percoset. These will work or knock you out :).

[flippet]

I've thought of the Vicodin or Percoset thing. I'm even willing to consider the Vicodin, even though I swore off it since the last time I used it, it lowered my blood pressure and I passed out for a few seconds--scaring the heck out of my husband. (It was for a torn hamstring...and I wasn't told or didn't understand to cut the initial dose down after a day or two.) That should give you an idea of how much this throat hurts.

The doc didn't swab for strep--he said they'd treat it the same way regardless, so I imagine he thought it wasn't worth the bother.

My mom probably has some Vicodin or Percoset around, since she had surgery recently, and had a few weeks of in-facility wound care. Can I just take a dose of her stuff, or is that a really, really bad idea? Could it interact with anything I've already taken? Since I really don't care for the stuff, I doubt I'd take more than one dose anyway...I might even halve it.

(Short note on 'sharing meds'--I know generally it's frowned on, but I did tell the doc this morning that my husband was probably getting the same thing, and so he just doubled my amox scrip and told me that hubby could share it.)


Sigh....I guess I'll call the med office anyway and deal with going through the answering service....so frustrating, but I see the point. You know these things always wait to happen or get bad for Friday or the weekend. :roll:

[flippet]

Good news...some Darvocet is on the way! Hopefully it works. This thing is just crazy painful.

[7302005]

I hope that it works. Usually my doctor is so sympathic about throat pain, he prescribes something at the time. A liquid codiene syrup, because as you noted, swallowing is next to impossible. The liquid not only contains a pain killer but as it coats the throat, there is some absorption of the medication.

Keep us posted.

[BarbraM]

A good shot of whiskey will help :lol: :lol: :lol:

I had strep so bad one time, it would wake me up from sleeping and I would practically sit up in bed by reflex it hurt so bad. But it did go away after about a day or two on the antibiotics.

Popsicles can sooth it a bit. Have you tried gargling with listerine?

[Koala]

Oh you poor thing, I know exactly what you are going thru!!

I am very prone to getting tonsilitis..... anyway you should get some penacillin tablets and also a penacilin injection to kick start it........

Try to drink lots of fluids......

Hope you feel better!

[Sing_Alto]

Do you have strep, flippet? I had strep throat so bad one time when I was a kid that I had to use this icky cherry-flavored stuff to numb my throat before I could eat. I still remember how much it hurt. Hope you're feeling better soon.

[TashaKat]

Poor you :( I'm just getting rid of a sore throat so can sympathise :(

My doctor recommends ice lollipops (which suits me fine) and also gargling with dispersible aspirin can help a bit.

All the best hun, and yes, a tot of whisky .... or even better, a hot toddy can do you the WORLD of good ;) I know that you shouldn't take alcohol with antibiotics but it's PURELY medicinal isn't it ;)

[dobiesk8r]

A good shot of whiskey will help :lol: :lol: :lol:

Popsicles can sooth it a bit. Have you tried gargling with listerine?

Listerine is caustic as hell, don't gargle with it. And no whiskey with narcotics. ;) Popsicle is a very good idea.

I hope you feel better flippet.

[cello]

Yeah when I had strep it felt like I had cut glass in my throat. I took a percocet or something similar but it didn't help. The only relief came from the antibiotics. Hope you feel better.

[md2be]

Strep, much like flu, is mostly diagnosed without a confirmatory swab. There are rapid tests and cultures, but most MDs will treat it as strep. The only problem with that is the strain - they will give you a general antibx rather than a specific one to the strain, which some argue will eventually lead to antibx resistance.

I had strep 2 years ago and vicodin worked. Then, a month ago, I had wrist surgery (15 year old injury from skating!!!!), and the MD gave me percocet. My blood pressure dropped at 3am and I blacked out. I was so light headed I had to slide on my back to the cool kitchen floor to get some water. It was very scary. I also itched from head to toe, although never got hives. The scariest part, other than I was alone during this because Im stubborn and sent my friends home, was that I had to take benadryl to counteract the percocet - which knocks me out. So I took the Benadryl and *hoped* that I would wake up the next day.

Hope you are feeling better. Stay off the milk products.

By the way - my company is also doing some research in flu/strep = can I ask what state you live in?

[jp1andOnly]

sounds like a case of strep throat. I get it probably 4-5 times a year. The joys of working around kiddies all year. Go to the doctor and get meds. If you dohn't and it clears up itself, it is likely to come back and be more drug resistant. Not getting strep treated is creating super bugs.

I ended up with Scarlet fever because of a strep strain. It was not fun. Get thee to the docs.

[mikey]

Strep, much like flu, is mostly diagnosed without a confirmatory swab. There are rapid tests and cultures, but most MDs will treat it as strep. The only problem with that is the strain - they will give you a general antibx rather than a specific one to the strain, which some argue will eventually lead to antibx resistance.

In an era of emerging antibiotic resistance and widespread, indescriminate overuse of antibiotics, I would agrue that this approach is outdated and perhaps irresponsible. The more recent guideline is that, if you suspect strep, you do a throat swab for a rapid strep test AND a throat culture. If the rapid test is positive, you treat with antibiotics and throw the culture away. If the rapid screen is negative, you incubate the throat culture but do not start antibiotics unless the culture grows strep. It is well-established in the medical literature that treatment with antibiotics does absolutely NOTHING to shorten the course or improve the symptoms of strep throat. It will resolve equally with or without antibiotics. What the antibiotics are doing is trying to eliminate the carrier state and the complications of strep that occur much later- rhumatic heart disease, post-strep glomerulonephritis, PANDAS, etc. Because these complications are so serious, most would argue that anyone with a sore throat should be screened for strep. The duration of treatment is still under considerable debate. The standard has always been 10 days, but that was arbitrary. 7 days is probably enough, and possibly even 5, although the rate of complications increases somewhat. A single penicillin injection may the best treatment, but it involves a needle.

[md2be]

Mikey,
Great in theory, not true in practice.
I have a link for you on my work computer, but I wont be there until later...

[flippet]

Well, I'm still alive. At times today, I was wondering if that was the best alternative, though! :cry:

The narcotic did very little to help...I took the first dose at around 11pm (since I'd taken some acetaminophen shortly before the scrip came in, and since it also has that in it, it said not to also take additional acetaminophen with it, so I thought I'd better wait), and by 1am, when the baby woke, I was still hurting. It did relieve the muscle pain in my neck, shoulders, and ear, but didn't touch the throat pain. I took another dose at 2am (an hour early...I got confused about how many hours had actually passed), and that didn't touch it either. I didn't take another dose until 8:30am, because I wasn't sure if I was going to call or try for something else, I was in such agony. Anyway, this dose lowered my blood pressure after a couple of hours, and it took probably three hours and some sleep with my feet elevated to come back to feeling 'normal' again. I don't think I'll be taking any more of that. (And I think I'm swearing off narcotics from now on...I don't think any of them have ever really helped the pain, at any time in my life. They just lower my blood pressure, or make me loopy.)

I finally took some more ibuprofen at 4:30, saying that if it didn't help, I was either calling the doc, or going to the emergency room--the pain was really that bad. Everything between my ears and my shoulders hurt, and the throat was, like cello said, like cut glass. It took the edge off for a couple of hours, enough for me to eat a little something, but it just seems that for a 4-hour dose, the first and last hours of it are worthless.

I just don't remember strep as a kid being *this* bad. It seemed the medicine was always worse than the throat. And, I also thought strep looked like flat, white patches of infection on the throat? Am I wrong about that? My throat is full of swollen nodule-like stuff, with some small white cankers on top.

Well, I don't want to jump off the roof at the moment, so I suppose with some more ibuprofen, I might make it. The worst part is not really knowing when to expect real relief. At least with nausea, you know that once you puke, things get better from there. This just seems interminable.

Thanks for all the advice. I was going to at least have some wine the other night, until I remembered that alcohol and meds don't mix! (I rarely drink.) I did try gargling with some Peroxyl (hydrogen peroxide stuff), but I don't know how much good it did.

Oh, md2be, I'm in Michigan.

[A.H.Black]

I am not recommending this so don't quote me.

When I had some bad tooth pain my brother, the dentist, told me that sometimes it takes a LOT of ibuprofen to start killing the pain of these things. Like 4 pills at a time. You have to get it going and keep it going.

Hope the antibiotics kick in soon.

Watch out with that ear. I had a bad one with the ears a few years ago and now every time I get a cold it goes straight to my ears. Just one of life's little revenges I guess.

[BarbraM]

You can take a max of 800 mg. of ibuprofen every 8 hours

[flippet]

I've been taking 400mg every 4 hours, so that fits in. I did pretty well with the first two doses last night, but then the one in the middle of the night and the one this morning have barely done any good. That's what I don't understand....how some doses work well, and other doses almost don't work at all.

At this rate, I won't be at work tomorrow, either, which isn't good, since I just started a new (second) job, and I had already planned to be gone for a camping trip for this next weekend, starting Thursday.

Is it possible to get an injection of something, right in the infection--both for pain, and for reduction of swelling? I was thinking last night that I'd like nothing better than to have a shot of Novocaine or something, and then have one of those suction tubes since I wouldn't be able to swallow. That just sounded like heaven at the time. :lol:

I feel like seeing the doc again...but of course it's Sunday...and I don't know what the doc would do, anyway. I feel that this thing is either worse, or just not getting better at all, but I feel like the doctor will just shrug it off as normal and send me home. What does it take to get more than 30 seconds of a doctor's time any more?

Sigh. I'm just crabby because this is the fifth day, and I'm really, really sick of being in pain, and not being able to swallow the crap in my throat. :( Sorry for being a broken record. :(

[md2be]

Sounds like you have the wrong antibx....which is consistent with what Mikey and I were saying....a culture is needed to find out what strain it is. You should ask for a culture (not just a rapid strep test).

Mikey - I cant link it what I wanted to - I have a hard copy. But Up-To-Date, which is a main site for MDs to learn about and use standard of care, advises a swab, but says it is also widely treated by signs and symptoms.

[cello]

I don't think anyone mentioned this but a family remedy that does provide a few minutes (I know not much help) of relief for even these nasty sore throats - gargle with warm salted water for 10 or so seconds. The relief doesn't last very long but it feels good while you are doing it and it can help release some of the gook in your throat.

[Kelli]

If you've never had mono before, ask for a blood test to rule that out. If you've been feeling sick for 5 days, a mono-related sore throat should be on its way out in a day or two.

Be careful with ibuprofen, because high doses on an empty stomach can do icky things to your stomach. Thowing up with a sore throat is one of the most unpleasant things ever.

Feel better!

[iceskaterdawn]

I'd call the doc and get a different antibiotic. I've had several occaisions with either strep, sinus infections or brohncitus when I was put on an antibiotic and was told I should feel relief in a few days. When absolutely no releif came after about 3 days, I called the doc back and was put on a different antibiotic and within about 36 hours I was feeling so much better, and within about 3 days I felt back to my normal self. It certainly cant hurt to call them back.

And I was told that some narcotics, don't actually treat the pain, but just make you loopy and comfortable so that way you don't care about the pain. Tylenol and Advil to more to treat the actual symptoms of the pain.

[Louis]

I can relate. When I had mono, I honestly thought about slitting my wrists for the only time in my life. The pain was unbearable. Forget about eating, I couldn't even drink water. And I was in so much pain that I could not fall asleep for three days. If I attempted to walk anywhere, I would get horrible dizzy spells and end up collapsed in a heap on the floor.

For a mono sore throat, no antibiotic will help. The doctor will tell you that he can't give you anything, but after my doctor saw that I was about half a day away from hospitalization, I was put on some steroid (methylprednizone, or something like that?) to reduce the swelling. Perhaps by the then (the fourth day), the sore throat had run its course, but it was honestly like a miracle drug for me. The swelling went away immediately, the pain stopped, and I was back at work two days later.

[flippet]

Well, I saw the nurse practitioner today...she was thinking maybe mono, but since the swelling and pain are only on one side of my throat, she thought it probably wasn't. She thought it could possibly be abcessed, so she sent me to the ENT around the corner. The ENT stabbed it with a needle, and it wasn't abcessed, so that's good, but now it's hurting from the stabbing. :roll: She did prescribe a new antibiotic (that cost me about 10X what the first one did 8O ), but it's a twice a day, 12-hour thing, so I figured I'd better start it at supper, rather than lunch and then be looking at a midnight dose.

I can't wait...and I really hope this helps. I don't think I've even been so sick...at least, not as an adult. My energy isn't totally shot, so even I don't think it's mono. Aside from the throat pain itself, the toughest part is not being to turn my head fully to either side because my neck is so stiff and sore. (I can touch my chin to my chest though, so I'm not worried about meningitis at the moment.)

Now, I'm just worried about my 16-month-old. He got really feverish and lethargic last night, and we got an antibiotic for him, but today, before we took him to see the nurse practitioner, I noticed that his right ear was 'sticking out'--which I thought was weird. DH noticed that the area behind his ear was all red and hot, a tad swollen, and painful to the touch. I don't think he bumped or bruised it, and the nurse didn't find a bite mark (and it's not the right place for any lymph nodes, she didn't think), so we're not sure what's going on there. Baby does have a red throat, but he's been fairly happy today, so we're just going to keep an eye on things, and stick with the antibiotic.

[iceskaterdawn]

She did prescribe a new antibiotic (that cost me about 10X what the first one did 8O ), but it's a twice a day, 12-hour thing,

That sounds like the antibiotic I was on. I can't recall the name of it though. But it was almost $200 and I didn't have insurance. I had to take it for 3 weeks because I was having recurrent sinus/throat infections and they wanted to make sure everything was cleared up. The antibiotic did wonders in about 2 days worth of doses so I guess it was worth it. I hope you and your baby are feeling better soon!

[flippet]

Well, apparently I'm on the right thing now, because I'm finally, just this afternoon, beginning to feel like I might get better. Swallowing is still something I'd rather not do, but it's not painful any more. (Yawning, on the other hand! 8O ) And, I can turn my head again, at least enough to drive and not feel like I'd cause an accident.

I can't remember the name of the antibiotic....A-something XR....it's a combo of amoxicillin and something else that starts with C. 1000mg of amox, and 63mg of the other....two pills twice a day, and boy, are these suckers HORSE pills! I nearly choked on one last night, and even with cutting them in half this morning, managed to choke on a half. I guess, the larger the swelling in the throat, the bigger the pill. Of course. :roll: :D

Thanks for all the advice and good wishes. :) It's nice to know that someone's out there.

[Kelli]

Glad to hear you're feeling better!

Careful cutting pills in half. Did you doc or a pharmacist say it's ok? The XR stands for extended-release, which means that cutting it in half can be bad. It needs to take a long time to dissolve - that's how it becomes an extended release pill. So keep getting better, but double check with your doctor if you're going to cut the pill in half, ok? We don't want you getting sick again next week!

[iceskaterdawn]

I can't remember the name of the antibiotic....A-something XR....it's a combo of amoxicillin and something else that starts with C. 1000mg of amox, and 63mg of the other....two pills twice a day, and boy, are these suckers HORSE pills! I nearly choked on one last night, and even with cutting them in half this morning, managed to choke on a half. I guess, the larger the swelling in the throat, the bigger the pill. Of course. :roll: :D



That sounds like the antibiotic I had to take.

[mikey]

I swore I wouldn't reply again, but... lol 8-)

I suspect you are taking AugmentinXR (http://us.gsk.com/products/assets/us_augmentin_xr.pdf)- 2 pills twice a day, right? Well, since I work in academic medicine, I should say that this drug has ONLY been approved by the FDA to treat sinusitis and pneumonia, neither of which do you have. You are feeling better, and that is important, but is that because you had a bacteria that was resistant to your previous antibiotic, or because you are now 5 days into the natural course of the infection, when it would be clearing up even without antibiotics? We will never know because your practitioner did not follow standard of care and obtain a throat culture. Personally, I suspect that you had a nasty virus (Epstein-Barr, CMV, or coxsackie, most likely), but we'll never be sure now...

What md2be says may be true- what is right is not what a lot of docs do, but again, that doesn't make it right. Indiscriminate use of antibiotics is an area that needs a huge amount of education, and a public health issue as more and more bugs become resistant due to over-exposure to random antibiotics. I can verify that most docs out there, when faced with a return patient who still has symptoms, will jump to a more broad-spectrum antibiotic indiscriminately. I suspect there was no culture done at the second visit either, so there is no way to verify that you have a resistant bacteria?? Had a throat culture been done at your initial visit 5 days ago, we could have known for sure (1) what bacteria was present (4 days ago), or if no bacteria grew, that it was a virus; AND (2) what drugs it was susceptible to (3 days ago), so which antibiotic was most appropriate.

Most importantly, and not to send mixed messages, now that you are treating a presumed resistant bacterial infection, please be sure to take the entire course of antibiotics- 7 or 10 days, whatever they prescribed. You are not treating the acute infection, you are trying to prevent the long-term complications- Rheumatic heart disease, post-strep glomerulonephritis, etc...

Never take only part of an XR type of medication. The dosing is based on the pharmacology of only 1 of the medications in the combination. It is ok to cut the pills IF you take all parts of the cut up pill at the same setting.

Most importantly- you are feeling better. Great news! And I will officially shut up now 8-)

[iceskaterdawn]

I swore I wouldn't reply again, but... lol 8-)

I suspect you are taking AugmentinXR

That is the antibiotic I was refering to. I was having severe/recurrent sinus infections and the first antiobiotic they put me on didn't clear it up, and I had a severe allergic reaction to the second antibiotic, and ended up taking Augmentin. It worked great, but it put a HUGE dent in my pocketbook!

[Andie]

Hope you're getting better. I'd hate to be in that much pain!
I've had some bad sore throats, but the only time I had strep was once when I was little. I had my tonsils and adenoids taken out as a child, so I'm not supposed to be able to get strep, although I've experienced some bad episodes of regular sore throat.

As a child I also had horrible ear infections, which is another thing they helped stop when they yanked out my tonsils/adenoids.

[Rachel]

Strep, much like flu, is mostly diagnosed without a confirmatory swab.

Really? I find that amazing. I must be lucky--or unlucky, as the case my be.

I've never had strep in my life, but I frequently get pharyngitis secondary to sinus infections and allergy flare-ups. I've had more throat swabs than I can count, both as a kid and then again since having children. My son caught strep all the time for years and finally developed antobiotic-resistant strep. He has never once been diagnosed without a swab and twice I've been swabbed just because I had a red throat and he was sick at the time. My daughter has caught strep twice and both times she was diagnosed with a swab. This has been true regardless of whether we were seeing our regular doctor (who is not one for handing out antibiotics unless she's pretty sure of what you've got) or were at an Urgent Care center.

I always thought a swab was SOP. I am really shocked that flippet didn't get one.

I have a really nasty sore throat at the moment, which is why I am here :P. I was looking for solutions, but maybe I should be looking for a doctor who doesn't do throat swabs instead--I HATE those things.

[flippet]

I swore I wouldn't reply again, but... lol 8-)

I suspect you are taking AugmentinXR (http://us.gsk.com/products/assets/us_augmentin_xr.pdf)- 2 pills twice a day, right? Yep, that's it.

Well, since I work in academic medicine, I should say that this drug has ONLY been approved by the FDA to treat sinusitis and pneumonia, neither of which do you have. You are feeling better, and that is important, but is that because you had a bacteria that was resistant to your previous antibiotic, or because you are now 5 days into the natural course of the infection, when it would be clearing up even without antibiotics? We will never know because your practitioner did not follow standard of care and obtain a throat culture. Personally, I suspect that you had a nasty virus (Epstein-Barr, CMV, or coxsackie, most likely), but we'll never be sure now... Oh....lovely. :roll: I think I'm going to print out this thread, so that if I come down with anything worse, or have strange symptoms in the future, at least I can point back to something. My son had coxsackie (hand, foot and mouth, right?) a couple of months ago, but since everything I read online about it said that there was no treatment necessary (except for fever), we didn't bother to take him in to the doc. So, I suppose he wasn't 'diagnosed' for that either, but we know where he got it (son of a friend), and my friend told me what her son had--and, it matched right up with the symptoms I found online. Another friend of mine picked it up from her kids (who hadn't been near mine--it was just going around), and she ended up with meningitis from it, so that was kind of scary.

The Epstein-Barr is a bit scary though...isn't that more than just straight-up mononucleosis? I thought I'd once read about some really nasty, mysterious symptoms that are often traced back to E-B.


I suspect there was no culture done at the second visit either, so there is no way to verify that you have a resistant bacteria?? Had a throat culture been done at your initial visit 5 days ago, we could have known for sure (1) what bacteria was present (4 days ago), or if no bacteria grew, that it was a virus; AND (2) what drugs it was susceptible to (3 days ago), so which antibiotic was most appropriate. Nope...no culture. I think the nurse-practitioner I saw the second time was concerned that my tonsil might be abcessed, so she just sent me straight to the ENT, who happened to have an immediate appointment, and the ENT didn't do a culture. I think part of the problem is that I never saw my regular doctor for any of this...she is so busy, that I got the first available appointment the first time, but it was with another doctor in the practice (the one none of my extended family likes very much, but what can you do?), and the second time only the nurse-practitioner was available. (Hey, at least I got more than 60 seconds with her, even if she didn't do a culture.) I've been considering a switch in medical practices for a few months now....I just never seem to get enough time to make my concerns heard, even though I know that my doctor does personally care about me. Switching practices is just such a hassle though---all the research and insurance checking and such....:(

Most importantly, and not to send mixed messages, now that you are treating a presumed resistant bacterial infection, please be sure to take the entire course of antibiotics- 7 or 10 days, whatever they prescribed. You are not treating the acute infection, you are trying to prevent the long-term complications- Rheumatic heart disease, post-strep glomerulonephritis, etc...

Never take only part of an XR type of medication. The dosing is based on the pharmacology of only 1 of the medications in the combination. It is ok to cut the pills IF you take all parts of the cut up pill at the same setting.

Yep, I'm taking it all. I wouldn't quit halfway--I, at least, will not contribute to creating superbugs! :D And yes, I did take all of the proper dose of the pills I cut. I wouldn't have cut them, except they do have a scored line, and I was choking on the whole thing.

I'm feeling lots better, and thank you all for the concern and great information! Y'all are swell. :mrgreen:

[1lutz2klutz]

Glad you're feeling better, flippet!

[PAskate]

The Epstein-Barr is a bit scary though...isn't that more than just straight-up mononucleosis? I thought I'd once read about some really nasty, mysterious symptoms that are often traced back to E-B.

I'm feeling lots better, and thank you all for the concern and great information! Y'all are swell. :mrgreen:


Glad you're feeling better. :D Make sure that you still get plenty of sleep for a good while afterwards.

EP is nasty - that's what they did all the testing on me for in April. Actually it is confirmed by blood tests not cultures. It turned out that I didn't have it just some other type of nasty virus. Mono, EP, rubella, and just a nasty virus can all present similiar symptoms - speaking from experience, since they were looking for all of those with me.