Doctor, explain nosebleeds.
Doctor, what is Post-Nasal Drip?
Surgery of the Nose: Improving Form and Function
You and Your Stuffy Nose
Your Nose: A Guardian to Your Lungs
Insight into care and prevention of epistaxis (nosebleeds)
What causes a nosebleed?
Most nosebleeds (epistaxis) are mere nuisances.
But some are quite frightening, and a few are even life threatening.
Physicians classify nosebleeds into two different
Anterior nosebleed: Most nosebleeds
begin in the lower part of the septum, the semi-rigid wall that
separates the two nostrils of the nose. The septum contains
blood vessels that can be broken by a blow to the nose or the
edge of a sharp fingernail. This type of nosebleed comes from
the front of the nose and begins with a flow of blood out one
nostril when the patient is sitting or standing.
Posterior nosebleed: More rarely,
a nosebleed can begin high and deep within the nose and flow
down the back of the mouth and throat even if the patient is
sitting or standing.
Which type of nosebleed did I have?
Obviously, when the patient is lying down, even
anterior (front of nasal cavity) nosebleeds may seem to flow
posteriorly, especially if the patient is coughing or blowing
It is important to try to make the distinction
since posterior (back of nasal cavity) nosebleeds are often
more severe and almost always require a physician's care. Posterior
nosebleeds are more likely to occur in older people, persons
with high blood pressure, and in cases of injury to the nose
Anterior nosebleeds are common
in dry climates or during the winter months when heated, dry
indoor air dehydrates the nasal membranes. Dryness may result
in crusting, cracking, and bleeding. This can be prevented if
you place a bit of lubricating cream or ointment about the size
of a pea on the end of your fingertip and then rub it inside
the nose, especially on the middle portion of the nose (the
What are my treatment options?
Many physicians suggest any of the following
lubricating creams or ointments. They can all be purchased without
a prescription: Bacitracin, A and D Ointment, Eucerin, Polysporin,
and Vaseline. Up to three applications a day may be needed,
but usually every night at bedtime is enough. A saline nasal
spray will also moisten dry nasal membranes.
If the nosebleeds persist, you should see your
doctor. Using an endoscope, a tube with a light for seeing inside
the nose, your physician may find a problem within the nose
that can be fixed. He or she may recommend cauterization (sealing)
of the blood vessel that is causing the trouble.
What about rebleeding?
To prevent rebleeding after initial
bleeding has stopped:
Do not pick or blow nose.
Do not strain
or bend down to lift anything heavy.
Keep head higher
than the heart.
Use a humidifier
during dry winter months.
If rebleeding occurs:
Attempt to clear nose of all blood clots.
Spray nose four
times in the bleeding nostril(s) with a decongestant spray such
as Afrin or Neo-Synephrine.
1 and 2 shown in the "To stop an anterior nosebleed"
box in this leaflet. Repeat these steps as necessary.
Call your doctor
if bleeding persists.
What causes my nose to bleed?
or dryness that cause itching and lead to picking of the nose.
blowing that ruptures superficial blood vessels in the elderly
and in the young.
that run in families or are due to medications.
the nose or of the base of the skull that can cause bleeding
and should be regarded seriously when the bleeding follows a
(both malignant and nonmalignant) have to be considered, particularly
in the older patient or in smokers.
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Doctor, what is Post-Nasal Drip?
Insight into normal and abnormal secretions
The glands in your nose and throat continually
produce mucus (one to two quarts a day). It moistens and cleans
the nasal membranes, humidifies air, traps and clears inhaled
foreign matter, and fights infection. Although mucus normally
is swallowed unconsciously, the feeling that it is accumulating
in the throat or dripping from the back of your nose is called
This feeling can be caused by excessive or thick
secretions or by throat muscle and swallowing disorders.
What Causes Abnormal Secretions - Thin
Increased thin clear secretions
can be due to colds and flu, allergies, cold temperatures, bright
lights, certain foods/spices, pregnancy, and other hormonal
changes. Various drugs (including birth control pills and high
blood pressure medications) and structural abnormalities can
also produce increased secretions. These abnormalities might
include a deviated or irregular nasal septum (the cartilage
and bony dividing wall that separates the two nostrils).
Increased thick secretions in
the winter often result from too little moisture in heated buildings
and homes. They can also result from sinus or nose infections
and some allergies, especially to certain foods such as dairy
products. If thin secretions become thick and green or yellow,
it is likely that a bacterial sinus infection is developing.
In children, thick secretions from one side of the nose can
mean that something is stuck in the nose (such as a bean, wadded
paper, or piece of toy, etc.).
are air-filled cavities in the skull. They drain into the nose
through small openings. Blockages in the openings from swelling
due to colds, flu, or allergies may lead to acute sinus infection.
A viral "cold" that persists for 10 days or more may
have become a bacterial sinus infection. With this infection
you may notice increased post-nasal drip. If you suspect that
you have a sinus infection, you should see your physician for
Chronic sinusitis occurs when
sinus blockages persist and the lining of the sinuses swell
further. Polyps (growths in the
nose) may develop with chronic sinusitis. Patients with polyps
tend to have irritating, persistent post-nasal drip. Evaluation
by an otolaryngologist may include an exam of the interior of
the nose with a fiberoptic scope and CAT scan x-rays. If medication
does not relieve the problem, surgery may be recommended.
Vasomotor rhinitis describes
a nonallergic "hyperirritable nose" that feels congested,
blocked, or wet.
Swallowing problems may result in accumulation of solids or
liquids in the throat that may complicate or feel like post-nasal
drip. When the nerve and muscle interaction in the mouth, throat,
and food passage (esophagus) aren't working properly, overflow
secretions can spill into the voice box (larynx) and breathing
passages (trachea and bronchi) causing hoarseness, throat clearing,
Several factors contribute to swallowing
With age, swallowing muscles often lose strength
and coordination. Thus, even normal secretions may not pass
smoothly into the stomach.
swallowing occurs much less frequently, and secretions may gather.
Coughing and vigorous throat clearing are often needed when
or under stress, throat muscles can trigger
spasms that feel like a lump in the throat. Frequent throat
clearing, which usually produces little or no mucus, can make
the problem worse by increasing irritation.
or swelling in the food passage can slow or
prevent the movement of liquids and/or solids.
Swallowing problems may be caused also by gastroesophageal
reflux disease (GERD). This is a return of stomach
contents and acid into the esophagus or throat. Heartburn, indigestion,
and sore throat are common symptoms. GERD may be aggravated
by lying down especially following eating. Hiatal hernia, a
pouch-like tissue mass where the esophagus meets the stomach,
often contributes to the reflux.
Chronic Sore Throat
Post-nasal drip often leads to a sore, irritated throat. Although
there is usually no infection, the tonsils and other tissues
in the throat may swell. This can cause discomfort or a feeling
of a lump in the throat. Successful treatment of the post-nasal
drip will usually clear up these throat symptoms.
A correct diagnosis requires a detailed ear,
nose, and throat exam and possible laboratory, endoscopic, and
x-ray studies. Each treatment is different:
Bacterial infection, when present, is treated
with antibiotics. These drugs may provide only temporary relief.
In cases of chronic sinusitis, surgery to open the blocked sinuses
may be required.
is managed by avoiding the cause if possible. Antihistamines
and decongestants, cromolyn and steroid (cortisone type) nasal
sprays, and other forms of steroids may offer relief. Immunotherapy
(allergy shots) also may be helpful. However, some older, sedating
antihistamines may dry and thicken post-nasal secretions even
more; newer nonsedating antihistamines, available by prescription
only, do not have this effect. Decongestants can aggravate high
blood pressure, heart, and thyroid disease. Steroid sprays generally
may be used safely under medical supervision. Oral and injectable
steroids rarely produce serious complications in short-term
use. Because significant side-effects can occur, steroids must
be monitored carefully when used for more than one week.
Gastroesophageal reflux is
treated by elevating the head of the bed six to eight inches,
avoiding foods and beverages for two to three hours before bedtime,
and eliminating alcohol and caffeine from the daily diet. Antacids
(e.g., Maalox®, Mylanta®, Gaviscon ®) and drugs that block stomach
acid production (e.g., Zantac®, Tagamet®, Pepcid®) or more powerful
medications may be prescribed. A trial treatment may be suggested
before x-rays and other diagnostic studies are performed.
General measures for thinning
secretions so they can pass more easily may be recommended when
it is not possible to determine whether an existing structural
abnormality is causing the post-nasal drip or if some other
condition is to blame.
Many people, especially older persons, need
more fluids to thin secretions. Drinking more water, eliminating
caffeine, and avoiding diuretics (fluid pills) will help. Mucus
thinning agents such as guaifenesin (Humibid®, Robitussin®)
may also thin secretions.
Nasal irrigations may alleviate thickened secretions.
These can be performed two to four times a day either with a
nasal douche device or a Water Pik® with a nasal irrigation
nozzle. Warm water with baking soda or salt (1/2 to 1 tsp. to
the pint) or Alkalol®, a nonprescription irrigating solution
(full strength or diluted by half warm water), may be helpful.
Finally, use of simple saline (salt) nonprescription nasal sprays
(e.g., Ocean®, Ayr®, or Nasal®) to moisten the nose is often
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Surgery of the Nose: Improving Form and
Each year thousands of people undergo surgery of the nose. Nasal
surgery may be
performed for cosmetic purposes, or a combination procedure
to improve both form and function. It also may alleviate or
cure nasal breathing problems, correct deformities from birth
or injury, or support an aging, drooping nose.
Patients who are considering nasal surgery for
any reason should seek a doctor who is a specialist in nasal
airway function, as well as plastic surgery. This will ensure
that efficient breathing is as high a priority as appearance.
Can Cosmetic Nasal Surgery Create a
Aesthetic nasal surgery (rhinoplasty) refines
the shape of the nose, bringing it into balance with the other
features of the face. Because the nose is the most prominent
facial feature, even a slight alteration can greatly improve
appearance. (Some patients elect chin augmentation in conjunction
with rhinoplasty to better balance their features.) Rhinoplasty
alone cannot give you a perfect profile, make you look like
someone else, or improve your personal life. Before surgery,
it is very important that the patient have a clear, realistic
understanding of what change is possible as well as the limitations
and risks of the procedure.
type, ethnic background, and age will be among the factors considered
preoperatively by the surgeon. Except in cases of severe breathing
impairment, young patients usually are not candidates until
their noses are fully-grown, at 15 or 16 years of age. The surgeon
will also discuss risk factors, which are generally minor, as
well as where the surgery will be performed-in a hospital, freestanding
outpatient surgical center, or a certified office operating
To reshape the nose, the skin is lifted, allowing
the surgeon to remove or rearrange the bone and cartilage. The
skin is then redraped and sutured over the new frame. A nasal
splint on the outside of the nose helps retain the new shape
during healing. If soft, absorbent material is placed inside
the nose to stabilize the septum, it will normally be removed
the morning after surgery. External nasal dressings and splints
are usually removed five to seven days after surgery.
When Should Surgery Be Considered to
Correct a Chronically Stuffy Nose?
of Americans perennially suffer the discomfort of nasal stuffiness.
This may be indicative of chronic breathing problems that don't
respond well to ordinary treatment. The blockage may be related
to structural abnormalities inside the nose or to swelling caused
by allergies or viruses.
There are numerous causes of nasal obstruction.
A deviated septum (the partition between the nostrils) can be
crooked or bent as the result of abnormal growth or injury.
This can partially or completely close one or both nasal passages.
The deviated septum can be corrected with a surgical procedure
called septoplasty. Cosmetic changes to the nose are often performed
at the same time, in a combination procedure called septorhinoplasty.
Overgrowth of the turbinates is yet another
cause of stuffiness. (The turbinates are the tissues that line
the inside of the nasal passages.) Sometimes the turbinates
need treatment to make them smaller and expand the nasal passages.
Treatments include injection, freezing, and partial removal.
Allergies, too, can cause internal nasal swelling, and allergy
evaluation and therapy may be necessary.
Can Surgery Correct a Stuffy, Aging
Aging is a common cause of nasal obstruction.
This occurs when the cartilage in the nose and its tip are weakened
by age and droop because of gravity. This causes the sides of
the nose to collapse inward, obstructing airflow. Mouth breathing
or noisy and restricted breathing are common.
Try lifting the tip of your nose to see if you
breathe better. If so, the external adhesive nasal strips that
athletes have popularized may help. Or talk to a facial plastic
surgeon/otolaryngolgist about septoplasty, which will involve
trimming, reshaping or repositioning portions of septal cartilage
and bone. (This is an ideal time to make other cosmetic improvements
as well.) Internal splints or soft packing may be placed in
the nostrils to hold the septum in its new position. Usually,
patients experience some swelling for a week or two. However,
after the packing is removed, most people enjoy a dramatic improvement
What Treatment is Needed for a Broken
Bruises around the eyes and/or a slightly crooked
nose following injury usually indicate a fractured nose. If
the bones are pushed over or out to one side, immediate medical
attention is ideal. But once soft tissue swelling distorts the
nose, waiting 48-72 hours for a doctor's appointment may actually
help the doctor in evaluating your injury as the swelling recedes.
(Apply ice while waiting to see the doctor.) What's most important
is whether the nasal bones have been displaced, rather than
just fractured or broken.
For markedly displaced bones, surgeons often
attempt to return the nasal bones
to a straighter position under local or general anesthesia.
This is usually done within seven to ten days after injury,
so that the bones don't heal in a displaced position. Because
so many fractures are irregular and won't "pop" back
into place, the procedure is successful only half the time.
Displacement due to injury often results in compromised breathing
so corrective nasal surgery, typically septorhinoplasty, may
then be elected. This procedure is typically done on an outpatient
basis, and patients usually plan to avoid appearing in public
for about a week due to swelling and bruising.
Will Insurance Cover Nasal Surgery?
Insurance usually does not cover cosmetic surgery.
However, surgery to correct or improve breathing function, major
deformity, or injury is frequently covered in whole or in part.
Patients should obtain cost information from their surgeons
and discuss with their insurance carrier prior to surgery. For
more information about cosmetic surgery and medical skin rejuvenation
please visit our other site www.skintastic.com
or call 972-620-FACE (3223) for a free consultation
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You and Your Stuffy Nose
Nasal congestion, stuffiness, or obstruction to nasal breathing
is one of man's oldest and most common complaints. While it
may be a mere nuisance to some persons, to others it is a source
of considerable discomfort, and it detracts from the quality
of their lives.
Medical writers have classified the causes of
nasal obstruction into four categories, recognizing that overlap
exists between these categories and that it is not unusual for
a patient to have more than one factor involved in his particular
An average adult suffers a common "cold" two to three
times per year, more often in childhood and less often the older
he gets as he develops more immunity. The common "cold"
is caused by any number of different viruses, some of which
are transmitted through the air, but most are transmitted from
hand-to-nose contact. Once the virus gets established in the
nose, it causes release of the body chemical histamine, which
dramatically increases the blood flow to the nose -- causing
swelling and congestion of nasal tissues -- and which stimulates
the nasal membranes to produce excessive amounts of mucus. Antihistamines
and decongestants help relieve the symptoms of a "cold,"
but time alone cures it.
During a virus infection, the nose has poor
resistance against bacterial infections, which explains why
bacterial infections of the nose and sinuses so often follow
a "cold." When the nasal mucus turns from clear to
yellow or green, it usually means that a bacterial infection
has taken over and a physician should be consulted.
Acute sinus infections produce nasal congestion,
thick discharge, and pain and tenderness in the cheeks and upper
teeth, between and behind the eyes, or above the eyes and in
the forehead, depending on which sinuses are involved.
Chronic sinus infections may or may not cause
pain, but nasal obstruction and offensive nasal or postnasal
discharge is often present. Some persons develop polyps (fleshy
growths in the nose) from sinus infections, and the infection
can spread down into the lower airways leading to chronic cough,
bronchitis, and asthma. Acute sinus infection generally responds
to antibiotic treatment; chronic sinusitis usually requires
Included in this category are deformities of the nose and the
nasal septum, which is the thin, flat cartilage and bone that
separates the nostrils and nose into its two sides. These deformities
are usually due to an injury at some time in one's life. The
injury may have been many years earlier and may even have been
in childhood and long since forgotten. It is a fact that 7 percent
of newborn babies suffer significant nasal injury just from
the birth process; and, of course, it is almost impossible to
go through life without getting hit on the nose at least once.
Therefore, deformities of the nose and the deviated septum should
be fairly common problems -- and they are. If they create obstruction
to breathing, they can be corrected with surgery.
One of the most common causes for nasal obstruction
in children is enlargement of the adenoids: tonsil-like tissues
that fill the back of the nose up behind the palate. Children
with this problem breath noisily at night and even snore. They
also are chronic mouth breathers, and they develop a "sad"
long face and sometimes dental deformities. Surgery to remove
the adenoids and sometimes the tonsils may be advisable.
Other causes in this category include nasal
tumors and foreign bodies. Children are prone to inserting various
objects such as peas, beans, cherry pits, beads, buttons, safety
pins, and bits of plastic toys into their noses. Beware of one-sided
foul smelling discharge, which can be caused by a foreign body.
A physician should be consulted.
Hay fever, rose fever, grass fever, and "summertime colds"
are various names for allergic rhinitis. Allergy is an exaggerated
inflammatory response to a foreign substance which, in the case
of a stuffy nose, is usually a pollen, mold, animal dander,
or some element in house dust. Foods sometime play a role. Pollens
cause problems in spring (trees) and summer (grasses) or fall
(weeds) whereas house dust allergies and mold may be a year-around
problem. Ideally the best treatment is avoidance of these substances,
but that is impractical in most cases.
In the allergic patient, the release of histamine
and similar substances results in congestion and excess production
of watery nasal mucus. Antihistamine helps relieve the sneezing
and runny nose of allergy. Many antihistamines are now available
without a prescription. The most familiar brands include Chlor-Trimeton®,
Benadryl®, or Dimetane® (although most are also available in
generic forms). Newer, nonsedating antihistamines, which require
a prescription include Claritin®, Zyrtec®, and Allegra®. Decongestants
shrink congested nasal tissues. Examples include Sudafed®, Guaifed®,
and Entex® that are available without a prescription in several
generic forms. Combinations of antihistamines with decongestants
are also available. All these preparations have potential side
effects, and patients must heed the warnings of the package
or prescription insert. This is especially important if the
patient suffers from high blood pressure, glaucoma, irregular
heart beats, difficulty in urination, or is pregnant.
are the most specific treatment available, and they are highly
successful in allergic patients. Skin tests or at times blood
tests are used to make up treatment vials of substances to which
the patient is allergic. The physician determines the best concentration
for initiating the treatment. These treatments are given by
injection. They work by forming blocking antibodies in the patient's
blood stream, which then interfere with the allergic reaction.
Many patients prefer allergy shots over drugs because of the
side effects of the drugs.
Patients with allergies have an increased tendency
to develop sinus infections and require treatment as discussed
in the previous section.
''Rhinitis" means inflammation of the nose and nasal membranes.
"Vasomotor" means blood vessel forces. The membranes
of the nose have an abundant supply of arteries, veins, and
capillaries, which have a great capacity for both expansion
and constriction. Normally these blood vessels are in a half-constricted,
half-open state. But when a person exercises vigorously, his/her
hormones of stimulation (i.e., adrenaline) increase. The adrenaline
causes constriction or squeezing of the nasal membranes so that
the air passages open up and the person breathes more freely.
The opposite takes place when an allergic attack
or a ''cold'' develops: The blood vessels expand, the membranes
become congested (full of excess blood), and the nose becomes
stuffy, or blocked.
In addition to allergies and infections, other
events can also cause nasal blood vessels to expand, leading
to vasomotor rhinitis. These include psychological stress, inadequate
thyroid function, pregnancy, certain anti-high blood pressure
drugs, and overuse or prolonged use of decongesting nasal sprays
and irritants such as perfumes and tobacco smoke.
In the early stages of each of these disorders,
the nasal stuffiness is temporary and reversible. That is, it
will improve if the primary cause is corrected. However, if
the condition persists for a long enough period, the blood vessels
lose their capacity to constrict. They become somewhat like
varicose veins. They fill up when the patient lies down and
when he/she lies on one side, the lower side becomes congested.
The congestion often interferes with sleep. So it is helpful
for stuffy patients to sleep with the head of the bed elevated
two to four inches. Accomplish this by placing a brick or two
under each castor of the bedposts at the head of the bed. Surgery
may offer dramatic and long time relief.
Stuffy nose is one symptom caused by a remarkable array of different
disorders, and the physician with special interest in nasal
disorders will offer treatments based on the specific causes.
Additional information and suggestions can be found in the AAO-HNS
pamphlets "Hayfever, Summer Colds and Allergies" and
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Your Nose: A Guardian to Your Lungs
You might not think your nose is a “vital organ,” but indeed
it is! To understand its importance, all that most people need
to experience is a bad cold. Nasal congestion and a runny nose
have a noticeable effect on quality of life, energy level, ability
to breathe, ability to sleep, and ability to function in general.
Why is your nose so important?
It processes the air that you breathe before
it enters your lungs. Most of this activity takes place in and
on the turbinates, located on the sides of the nasal passages.
In an adult, 18,000 to 20,000 liters of air pass through the
nose each day.
Keep a list of all your medications; know all the
potential side effects; and discuss possible interactions
with your doctors.
Your nose protects your health
that air and retaining particles as small as a pollen grain
with 100% efficiency.
the air that you breathe, adding moisture to the air to prevent
dryness of the lining of the lungs and bronchial tubes.
air to body temperature before it arrives in your lungs.
For these and many other reasons, normal nasal function is essential.
Do your lungs a favor; take care of your nose.
Because the connection between the nose and
lungs is so important, paying attention to problems in the nose--allergic
rhinitis for instance – can reduce or avoid problems in the
lungs such as bronchitis and asthma. Ignoring nasal symptoms
such as congestion, sneezing, runny nose, or thick nasal discharge
can aggravate lung problems and lead to other problems:
Nasal congestion reduces the sense of smell.
causes dry mouth, which increases the risk of mouth and throat
infections and reduces the sense of taste. Mouth breathing also
pulls all pollution and germs directly into the lungs; dry cold
air in the lungs makes the secretions thick, slows the cleaning
cilia, and slows down the passage of oxygen into the blood stream.
allergies increases the chance that you will develop asthma;
it also makes asthma worse if you already have it.
So, it is important to treat nasal symptoms promptly to prevent
worsening of lung problems.
Tips to improve the health of your nose
If your nose is dry, its various functions will be impaired.
Try over-the-counter salt-water (saline) nasal mists and sprays
to help maintain nasal health. These can be used liberally and
at your discretion.
Beware of over-the-counter
nasal decongestant sprays; prolonged use of these sprays may
damage the cilia that clear the nose and sinuses. Decongestants
can become addictive and actually cause nasal congestion to
Think of your
nose when you’re traveling. Air-conditioned cruise ships may
have high levels of mold in the cabins. Airplane air is very
dry and contains a lot of recirculated particles and germs;
a dry nose is more susceptible to germs. Use saline nasal mist
frequently during the flight, and drink lots of water.
Medications prescribed to treat nasal problems:
Be aware of the nasal effects of other
pressure medications cause dryness in the nose and throat, making
them more susceptible to germs and pollens.
medications also have a drying effect on the nose and throat.
pills, blood pressure medicines called beta-blockers, and Viagra
can cause increased nasal congestion.
Eye drops can
aggravate nasal symptoms when they drain into the nose with
Be sure you understand their purpose.
Each one is important and plays a separate role in treating
The foundation of the treatment of chronic nasal
conditions is the regular use of an anti-inflammatory prescription
nasal spray, which address all types of nose and sinus inflammation.
These sprays should be used only as directed by your doctor.
This is in contrast to medications that are inhaled by mouth
into the lungs, which often have high levels of absorption into
the blood stream. Always aim nasal sprays to the side of the
nose; spraying into the center of the nose can cause too much
relieve sneezing, itching and runny nose, but they have no effect
on nasal congestion at least in the short term. Over-the-counter
antihistamines cause drowsiness, slow the cleaning function
of the cilia, and increase the stickiness of nasal mucus--causing
germs and pollens to stay in the nose longer. There are prescription
antihistamines that do not have any of these side effects. To
achieve this safety, the relief is often slower starting, so
patience is required.
Decongestants help to unclog
stopped up noses but do very little for runny noses and sneezing.
They work much faster to unclog the nose, but to achieve this
quick action, there are often side-effects such as dry mouth,
nervousness, and insomnia. The correct dose often has to be
customized to get the benefit without the side-effects.
Be aware of medication side effects; no medicine
works well for all people, and all medications can cause side
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