Is color a sign of infection in nasal secretions?

Dr. Keith Roach

Question: I’m almost 84, and all my life I have had a problem with sinusitis. Never headaches, just postnasal drip and use of multiple tissues. (I really should buy shares in tissue companies, as I’d rather leave home without my clothes on than without a couple of tissues.) I blow my nose an awful lot.

Anyway, I have always thought that yellow mucus was a sign of infection, but recently my doctor assured me that the color is no longer considered an issue, unless it is a very dark brown. Do you agree with that opinion? — V.M.

Answer: Normal nasal secretions are nearly colorless, and they become colored due to the action of bacteria. So, in cases of bacterial sinus infection, the mucus is usually colored. However, bacteria that normally live in the nasal passages can turn the mucus to a yellow or light-brown color even in the absence of infection. The color intensity is due more to the amount of time the bacteria spend in contact with the mucus. Mucus color is not a reliable infection indicator.

Q: My 73-year-old husband was diagnosed with atrial fibrillation about 10 months ago. His cardiologist feels that, at this time, all he needs to do is take an 81-mg tablet of aspirin each day, and when he turns 75, possibly take a medication such as Xarelto. My husband’s only symptom is shortness of breath when he exerts himself, e.g. walking, mowing the lawn, shoveling snow, etc. Will this type of exercise or work cause him problems with the atrial fibrillation? — J.P.

A: Atrial fibrillation is a common diagnosis. I receive many questions about it. It is a lack of rhythm of the heart, and the heart rate also can become very fast, especially with exercise. The other major issue with atrial fibril- lation is that clots can form in the atria, and these can migrate to critical organs, especially the brain, causing a stroke.

The two issues are treated differently. Stroke risk is assessed by the clinician, often using a scale such as the CHA2DS2-VASc score, a predictor of stroke risk. I suspect your husband’s cardiologist is using this score, since it is at age 75 when the score becomes high enough to recommend an oral anticoagulant, such as warfarin or rivaroxaban (Xarelto). Some atrial fibrillations can be managed with aspirin, but many cannot.

The second issue is control of the heart rate. A few people with atrial fibrillation don’t need medication (or any treatment) for heart rate, but many do. I am concerned that your husband’s heart rate may be getting elevated during exertion. Hopefully his cardiologist has already evaluated this; if not, he should. A stress test or a 24-hour heart monitor are two of the most common ways to evaluate heart rate response to exercise.

Dr. Michael Fox

Question: I have a 13-year-old female Chorkiepoo (a ChihuahuaYorkie-poodle mix). She is spayed and has a heart murmur. She takes furosemide, theophylline and enalapril daily. She mostly eats baked chicken thighs and sometimes canned Purina Beyond dog food.

My dog likes to eat dirt. I have to be careful with commercial potting soil, because she will eat that, too. I asked the veterinary technician if she had ever heard of this, but she hadn’t and had no idea why my dog would do this. I heard that people with a condition called “pica” eat things like laundry starch due to a vitamin deficiency.

Any ideas as to what causes this? Is there anything I should do about it? — P.R., Ste. Genevieve, Missouri

Answer: I am surprised