Nosing around: Colds, sniffles and other proboscis problems are common during ski season
January 22, 2018
What does the world's best ski racer do when she has a cold?
"I drink a lot of liquids, take a lot of vitamin C and sleep a lot," Mikaela Shiffrin emailed from Cortina d'Ampezzo, Italy, prior to taking a podium at the women's downhill last week.
"I also take a nasal decongestant if I need to sleep or breathe during the day, but not too much because it can have a rebound effect," she wrote and then added, "I watch a lot of 'Madame Secretary' when I'm resting."
She's right on track, according to Dr. Dennis Lipton, internist at Vail Health.
"It's important to stay hydrated in cold, dry weather, especially with exertion. Even though you may not feel the need to hydrate because you are not visibly sweating, you can lose many 100s of ccs (cubic centimeters) of water just through your respiratory tract," Lipton said.
"Fruits, vegetables and spices have nutrients that are important for optimal immune function. Eating a lot of sugar can have an adverse effect on immune function, so it's never a good idea to eat a lot of sugar, especially when you are sick."
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Lipton's physician's assistant Tania Engle added, "Vitamin C is always good, but I'm a big fan of 'Do you need that pill?' Can you increase your diet to include grapefruit or oranges, as much as you can?"
As for the rebound effect, Shiffrin mentioned, Engle said, "With Sudafed or other nasal decongestants there are absolutely side effects that people need to be aware of, among them: dryness, irritation, high blood pressure."
Dr. Tod Olin, director of the pediatric Exercise Tolerance Center at National Jewish Health in Denver, explained that with a decongestant such as Afrin, blood vessels in the nose shrink down. The vessels take up less space, allowing for more air. The decongestants work for a few days, but when the medicine wears off, the blood vessels come back bigger, increasing respiratory difficulty.
"No one has nailed anything down on shrinking a cold, but Mikaela has the right idea about getting a lot of rest and fluids," he said. "The best thing anyone can do is stay rested and wash your hands a lot."
Starve a cold, feed a fever?
"It has no real basis in medical science," Lipton said of the long-used mantra "starve a cold, feed a fever." "In either case, your body is using resources to fight infection, so it may temporarily decrease your appetite."
In addition to proper nutrition, Lipton added, "Regular exercise has also been shown to decrease incidence of colds."
With humor, Engle said, "My parents are foreign, so I didn't grow up hearing these wives' tales or sayings, but I'm going to say, 'No that doesn't sound right.'"
Chiropractor Dr. Joel Dekanich, of Vail Integrated Medical Group, concurred.
"Other symptoms that accompany the common cold include sore throat, fatigue, chills, ear pain and headaches," he said. "Reducing your risk at catching the common cold includes both physical and supplemental interventions, such as hand washing and hand wipes, as well as an arsenal of supplements such as zinc, probiotics, ginseng root extract, garlic and vitamin C."
And then there is the dreaded runny nose that skiers and snowboarders get on the slopes.
Is that a cold? Nope, according to the experts.
"Cold-induced rhinorrhea, or 'skier's nose,' is a common condition caused by exposure to cold climates. Rhinorrhea is the excessive production and secretion of mucus or, in common terms, a runny nose," Dekanich said.
"Your body has this natural reaction to cold entering the body because it needs to warm the air entering the lungs in order to moisturize the respiratory tract, thus, increasing mucus production. When you exhale, the warm air that leaves your lungs then returns the heat and moisture back into the nasal cavity, creating a moist atmosphere."
The cycle is called thermoregulation or, simply, regulation of the temperature of our bodies, which keeps our bodies at an optimal functional level to prevent overheating, Dekanich said.
"The air in your lungs is at body temperature at 100 percent humidity, no matter what the weather is outside," Lipton said. "This means that if it's cold and dry outside, as the air passes from your nostrils into your nasal passages and down the trachea into your bronchi and lungs, your body has to add a lot of heat and moisture to the air. This occurs as the air passes over the warm, wet surface of your respiratory tract."
He added that when it is really cold outside and your body needs all the help it can get to change the air from cold and dry to warm and wet, it secretes more water to the surface of your respiratory tract, including your nasal passages.
"This is why breathing cold air through your nose makes it 'runny' or watery. It's not an illness or virus. Using anticholinergic nasal spray such as ipratropium can stop the secretion of the water into your nasal cavities by the water-secreting cells," Lipton said.
Ipratropium can be purchased over the counter and goes by many brand names, such as Nasacort Allergy Relief Spray, Flonase and ClariSpray. There is even a generic ipratropium that can be purchased online.
For those looking for additional solutions, Dekanich recommended wearing a scarf or gaiter around the nose and mouth to help warm the cold air before you breathe it in, producing less mucous and trapping in moisture between the garment and the nasal cavity.
"Also, applying a small amount of a water-soluble lubricant before and after cold weather activities will help keep the mucosa moist and decrease the risk of nasal dryness that sometimes may appear after bouts of rhinorrhea," he said.
That's Australian slang for a bloody nose. Call it what you will, but Lipton advised that, again, hydration is key.
"Bloody noses occur in winter due to breathing in exceptionally dry, heated air," he said. "The membranes of the nose dry out, especially while sleeping, causing cracking, which can lead to bleeding, especially with mild trauma such as nose-blowing. Also, using nasal saline can help or even gently dabbing some thick emollient such as Aquaphor just inside your nose."
And sometimes bloody noses can be just plain salty, as Dekanich explained.
"While skier's nose is an overproduction of mucous in the nose to create a moist environment, epistaxis happens almost as a secondary complication to rhinorrhea in some individuals," he said. "One of the major components of the mucous your body produces includes inorganic salts. When the individual removes themselves from the cold air and their runny nose stops, the next phase begins of excessive dryness.
"Unresolved dryness from the buildup of these inorganic salts can be the major cause of these nosebleeds. If these nosebleeds occur for longer than 30 minutes, are typical one-sided or you can taste blood in the back of your throat, consult your doctor right away."