Many people in Colorado are dealing with coughs even after getting the COVID vaccine. A
cough is one of the body’s ways to get rid of an irritant. When your airways are blocked with
something that isn't supposed to be there, the brain is alerted. It reacts by telling the muscles in
your belly and chest to generate a burst of air, thus getting rid of the irritants and making it
easier to breathe. Read on to learn about the causes of coughs and when to seek advice from a
healthcare provider. These visits are often appropriate for a telemedicine visit.

What Causes a Cough?

A cough is a reflex mechanism that protects your body. The coughs may be every once in a
while or they can be more persistent. Here are the primary triggers.

• Irritants — Things like cigarette smoke, cold air, dust, or strong perfumes can trigger a
  cough even if you're not allergic.
• Viruses and bacteria — The most common causes of cough are colds,flu and
  pneumonia. After a cold, some coughs may last for months or weeks. Coughing also
  irritates the lungs, resulting in prolonged symptoms. Productive coughs remove germy
  mucus from your lungs and may fade away in a few days.
• Allergies and asthma — Many adults and children with allergies experience coughs
  after inhaling molds or other irritants, causing the lungs to overreact.
• Acid reflux — Whenever you are experiencing heartburn, stomach acids find their way
  to the throat, especially at night. This can irritate your vocal cords and windpipe.
• Postnasal drip — Mucus tends to drip down from the nose to the throat when you're
  congested, causing a cough. Postnasal drops are caused by allergens, colds, and sinus
  infections.

A Few Basic Home Remedies for Coughs

You can try several home remedies to help ease your symptoms initially. Here are a few
essential remedies for an irritating cough.

• Honey or ginger tea — Research has found that honey and ginger may help relieve
  coughs. When your kid has a cough, mix two teaspoons with tea or warm water and give
  the kid the mixture once or twice a day.
• Drink plenty of water — Staying hydrated is crucial for people with a cough. You can
  relieve coughs by always staying hydrated.
• Steaming — A wet cough that causes mucus production may ease with steam. To do
  this, fill a bowl with boiling water. Add essential oils such as rosemary or eucalyptus,
  lean over the bowl and place a towel over your head. Inhale the trapped vapor for
  around five minutes. Avoid irritating the skin with hot steam.
• A saltwater gargle — Saltwater lessens mucus and phlegm in the back of the throat.
  Gargle with warm water to soothe the throat.

When Should I Seek Medical Advice and Treatment?

Coughs may seem similar, especially during the flu season. However, if your immune system is
compromised due to persistent coughs, you may require medical attention. Below are
symptoms of cough in adults and children that may benefit from an evaluation by a medical
professional, often via telehealth.

1. Shortness of breath
2. Difficulty in taking breaths
3. Coughing up blood
4. Trouble swallowing
5. Swelling on one side of the throat
6. High fever
7. Muffled voice
8. Unable to open mouth all the way
9. Coughing to the point you feel like you are going to throw up or can't breathe

What Does Having a Cough Mean?

Worried that your cough is a symptom of COVID-19 or pneumonia? Care on Location can help
you determine if it might be and what your best steps are, including treatment.

Our online providers can evaluate and treat your cough, send in an inhaler or antibiotics if
required, and order labs and x-rays if needed. We also give some home treatment advice to get
you feeling better, plus advise you on what to look out for if your symptoms are worsening or not
going away. The risk of delaying care can lead to more inconvenient and costly care and
worsen the illness. You may miss more events, work, and family care. Don't delay; see a Care
on Location provider now for advice, treatment, and peace of mind.

Care on Location wants you to be ready for this year’s flu season. As things open back up and children return to school, flu will start to spread. 

Here are a few steps to keep your family healthy.

1. Sleeve Up! Get your flu shot by the end of October. Most pharmacies offer a free flu shot. Call the pharmacies to see if they accept your insurance. If you don’t have insurance, retail pharmacies will tell you how much a shot will cost.
2. Lather Up! The flu virus can live on surfaces, so wipe down high touch surfaces like light switches or doorknobs and wash your hands frequently. 
3. Mask Up! To help stop the spread, wear your mask. It is important to always cover your cough and sneezes since flu and COVID19 are both respiratory diseases. 
4. Schedule an appointment with Care on Location if you feel sick. It is important to talk to a healthcare provider about your symptoms and next steps to feel better. 
5. Ask your doctor about antivirals medicines. These medicines can be used to treat flu illness and shorten the time you are sick. 

Visit our website at www.careonlocation.com for any other medical questions or urgent care needs. We are here for you and want you to have a safe and healthy Fall and Winter seasons!

Follow us on social media

---

	Please make sure the provider matches your location, care needed, and insurance prior to booking an appointment.
States Licensed:	Colorado
Care Provided:	General Medicine, Urgent Care
Insurance Accepted	Cash/Credit, FSA, HSA, Medicaid(CO)

---

	Please make sure the provider matches your location, care needed, and insurance prior to booking an appointment.
States Licensed:	Colorado
Care Provided:	General Medicine, Urgent Care
Insurance Accepted	Cash/Credit, FSA, HSA, Medicaid(CO)

---

	Please make sure the provider matches your location, care needed, and insurance prior to booking an appointment.
States Licensed:	Colorado
Care Provided:	General Medicine, Urgent Care
Insurance Accepted	Cash/Credit, FSA, HSA, Medicaid(CO)

Care on Location is responding to the current pandemic by stepping in to fill the gap in medical care. Many medical offices have closed or reduced hours, and patients are being strongly encouraged to manage their symptoms at home. As a result of this situation, telehealth has become a key solution to provide the care needed while allowing patients to stay at home. At Care on Location, we have over five years of experience providing telemedicine to our patients, and we now - more than ever - are working to expand telehealth in Colorado.

As a patient, you can access our providers directly through our ‘Request Care’ button. We accept Colorado Medicaid at no cost to you. If you are uninsured or have private insurance with a high-cost deductible, our COVID-19 reduced self-pay price of $49.99 is an affordable option. We are open 7 days a week with convenient hours each day. 

With the increase of telehealth utilization by patients, Care on Location has reason to expand. We’ve hired more providers to ensure that as COVID-19 continues to spread, we are prepared to manage higher volumes of patients. 

Our efforts are also being applied on a broader scale across the state. We are currently coordinating with the Office of eHealth Innovation (OeHI) and the Colorado Department of Public Health and Environment (CDPHE) to address state and community needs. This work has brought changes in state reimbursement and telehealth policy, as well as begun the effort to coordinate a state-wide telehealth response. Stay tuned for more details as we roll out these efforts. Many patients have been trying to connect with their own primary care providers and are being told that they can see them again when the pandemic has resolved and the office reopens. We believe that there is a better answer to this problem. Our software solutions allow any provider to schedule and perform telehealth encounters and have backup through Care on Location when needed. Contact us today to find out more.

Seeking out the prescribing power of an online medical provider to refill a prescription does not make up a large portion of telemedicine visits, but it is also not a rare occurrence.  According to the Centers for Disease Control, about 50% of us are on at least one prescribed medication, 23% take three or more, and 12% take 5 or more medications.  For the 50% who take regular medications, many of us see that we are approaching the end of the prescription and say to ourselves "I need to get my prescription renewed soon".  But life often gets in the way and we never get around to it.  Or, if we do not have refills waiting for us, we need to make an appointment with the prescribing medical provider which can be days to weeks away and we end up running out before we can make or get the appointment.  Under some circumstances, we might even decide to simply not refill the medication because we feel fine and think we do not need them anymore, or we don't like the side effects.  This last scenario is common with things like blood pressure medications and cholesterol-lowering medications.  Heck, the last time the blood pressure and cholesterol tests were checked they were normal, right? (Hint: the medications are probably working as they are supposed to and stopping will possibly change those nice results)

Common Scenarios When an Online Prescriptions Refill Is Used

You should plan ahead so that you can see or at least talk to your medical provider in time so that you do not run out. But the reality of what should happened and what does happen are often different.  So when in a prescription bind, there luckily are multiple telemedicine services willing to help out.

Let's take a look at a few commonly seen circumstances when an online refill is used:

• Traveling and forgot the regular medicines back home
• Ran out of medication with serious withdrawal risks
• Ran out of medication where not taking it short-term will worsen the underlying medical problem
• Medication was lost or in rare circumstances, stolen
• There is an appointment with the regular care provider, or a new one, but the needed medication will run out before the appointment and they will not provide a short-term bridge prescription without being seen first.
• Taking medications but no longer have a doctor - doctor retired, patient or doctor moved, lost or changed insurance, etc.

Limitations of Telemedicine Prescription Refills

1. To start, if you are going to go this route to get medications refilled, be mindful that the prescriptions will usually be a short-term refill.  So you are not off the hook with getting that prescription refilled through a regular medical provider.
2. Also, many telemedicine services limit prescription refills to just a few times per year.  So this cannot become your standard method of obtaining medications.
3. Additionally, nearly all telemedicine services do not allow for the prescribing of controlled substances such as narcotics and anxiety meds/muscle relaxants. Under most circumstances, prescribing of these Drug Enforcement Agency controlled substances without an in-person examination is a violation of the Ryan Haight Act.  There are a few exceptions to this regulation, these exceptions are relatively rare and are beyond the scope of this article but you can find a good discussion of these exceptions from telemedicine legal expert Nathaniel Lacktman here.

Risks of Running Out, Stopping, or Rapidly Decreasing Certain Medications

There are several types of medications that if you are taking them long-term, you really should not be running out or going cold-turkey without them because of potential problems with suddenly stopping.

Let's take a look at a few:

1. Blood pressure pills - As mentioned above, this is also one that many people decide to simply stop because they have had normal blood pressures recently and do not think they need it or want to spend money on it anymore.  Adequately controlling your blood pressure is associated with a significantly reduced risk of stroke, where more than 50% of cases are attributed to high blood pressure.  Similarly, the risk of heart attack and heart failure can also be reduced with good blood pressure control.  So you literally are increasing your risk of stroke, heart attack, and dying by not taking your medications.  Even worse is if you are out of one particular blood pressure medicine called Clonidine(Catapres).  Stopping this medication suddenly can lead to a rebound blood pressure effect where you can get extremely high pressures, also putting you at risk.  Other blood pressure pills such as the class called beta-blockers(metoprolol, propranolol and others) are also associated with withdrawal effects and increased risk of heart irregularities and death when stopping them suddenly.
2. Benzodiazepines - This category of medication is commonly used for anxiety and muscle relaxation and all are considered DEA controlled substances.  Stopping these medications suddenly is associated with the risk of having a seizure, generally within the first few days after stopping.  While you will not be able to refill these online legally in most circumstances, you should plan ahead to make sure you do not suddenly run out.  If you are going to stop long-term use of these medications, it is generally best done through a monitored slow wean off the medication as directed by a doctor or other licensed medical provider.  Medications in this category include Valium, Ativan, and Xanax.
3. Antidepressants - Not only can stopping antidepressants suddenly lead to a sudden worsening of the depression, including leading to suicidal thoughts and behavior, but the withdrawal symptoms can be very unpleasant as well.  Some the the withdrawal symptoms may include vomiting, diarrhea, head and stomach pain, nightmares, inability to sleep, sweats, and tremors.
4. Narcotics - Narcotic addiction is a major problem in our country.  And while narcotic withdrawal itself is unlikely the cause someone to die, the symptoms of withdrawal make it feel that way and can be so powerful and unpleasant that getting rid of withdrawal symptoms is a key component of the cycle of addiction.  These withdrawal symptoms commonly include runny nose, yawning a lot, sweating, vomiting, stomach pain, agitation and anxiety, insomnia, high blood pressure, fast heart rate, and depression.  Similar to benzodiazepines, these medications usually cannot be refilled through a telemedicine evaluation.  Entering a controlled narcotic treatment program is recommended.
5. Steroids - Long time steroid use is associated with a long list of side effects, but stopping suddenly can be dangerous too.  Prolonged steroid use decreases our natural hormone activity of our adrenal glands which can take months to recover.  Stopping or tapering off too quickly can lead to vomiting, severe weakness and fatigue, dizziness, as well as body, stomach, and joint pain.

There are additional types of medicines associated with significant withdrawal symptoms such as some seizure medications, muscle relaxants, headache medications, and even aspirin.  So it is generally recommended to plan your stopping of most medications but particularly those in the categories listed here.

Information for Getting Your Prescription Refilled Online

For those that are not considered a controlled substance, many telemedicine services are happy to help you bridge the gap between being out of a medication and getting in to be seen again to renew your long-term prescription. Getting back on your meds can be as simple as a phone call or video chat. Many primary care doctors are now starting to use telemedicine as part of their practice.  With access to your records, they may be able to renew longer-term prescriptionswithout the need for an office visit.  No matter where you obtain your online prescription from, it is helpful to have the following information readily available (having the actual bottle or prescription information in your hands at time to the visit is recommended):

1. Your full name and date of birth
2. The name of the medication
3. The dose or strength
4. How often you take it
5. How long has it been since it was last taken
6. All other medicines you take(including over the counter and herbal medicines)
7. Any allergies to medications
8. For children, how much the child weighs as medicines for kids are often based on weight
9. The name, location, and phone number of your preferred pharmacy

Conclusion

Getting a short-term refill of your regular medication through a telemedicine service is legal, quick, easy, and inexpensive.  However, unless your regular doctor is using telemedicine, this method is great for getting you out of a pinch but not the best method for your long-term medication management.  Keep an eye on your prescriptions, when they will run out, and plan accordingly.  There are several services available to you to help you out in your time of need, and there likely is one in your home state.

As a final word of advice, make sure that the service you use to obtain your prescription refill is legitimate.  If it is not your regular care provider, most legitimate telemedicine companies either list the doctors or licensed medical providers on the website or your can see who is available to see you once you sign into their service.  Consider calling or getting on the website of your state's medical board and find out if the medical provider is licensed in your state and check to see if they have any negative medical background you should be aware of before proceeding.

Care On.