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Cold Sores - What Brass Players Should Know



 
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DrDave
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PostPosted: Sun Sep 15, 2013 2:53 pm    Post subject: Cold Sores - What Brass Players Should Know Reply with quote

Here is some information that I hope people might find useful. It is part of a series of posts about medical issues for brass players.

Cold Sores - Herpes Labialis Caused by HSV-1 Vurus

Cold sores are caused by reactivation of the HSV-1 virus. The virus is spread by close contact with oral secretions (saliva) or oral lesions, usually on the lips. In different studies up to 70 to 90% of adults show evidence of prior infection and as many as 10 to 15% of adults are shedding the virus in saliva at any given time. The virus remains dormant in the body after the primary infection and reactivates periodically, sometimes in response to triggers such as sunlight, minor trauma, surgery, other illness, or fatigue. It is not always just bad luck when a cold sore breaks out right when you are in the middle of strenuous woodshedding for an important gig.

Recurrences happen as often as once a month in up to 25% of people and 3 to 4 times a year in over 50% of people. Active lesions can make it difficult to play a brass instrument, and last on average 6 to 8 days. This can obviously take a big chunk away from playing time.

There are several options to deal with recurrences. One is to not treat with anything and wait them out. Another is to start treatment as soon as symptoms begin. Many players experience some burning or tingling hours before a lesion appears. Studies have shown that starting topical antiviral cream (acyclovir) within hours of the first symptom decreases the mean time to healing by a little less than a day. Over the counter non prescription remedies do not have strong evidence supporting their effectiveness, but could help some people. Taking prescription antiviral pills for one to 5 days, depending on the drug, reduced healing time by about 2 days, from 6 to 4 days in clinical trials.

Players who do not get warning signs or who have frequent episodes might consider suppressive therapy, consisting if taking a reduced dose of oral antiviral medication on a daily basis. This has been shown to decrease the number and frequency or recurrences by at least 50%. Taking antiviral medicine for a prolonged duration has been shown to be safe, but you will still require monitoring by your doctor. Daily treatments can also be expensive if you pay for your own medications, but perhaps not as expensive as missing gigs on a regular basis because you have cold sores. If you have frequent outbreaks a discussion with your physician might be worthwhile.

Dr Dave MD, CCFP, FRCPC (Emergency Medicine) - in case anyone is wondering about my credentials.
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Dale Proctor
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PostPosted: Sun Sep 15, 2013 6:29 pm    Post subject: Reply with quote

I occasionally get cold sores, and like you said, it's when I'm really fatigued or run down with a cold. I've found Abreva to work very well in stopping the development of a cold sore if it's applied at the first hint of one. If you don't catch it early, Abreva will still limit it's growth and shorten the duration of a cold sore.
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LittleRusty
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PostPosted: Sun Sep 15, 2013 6:49 pm    Post subject: Reply with quote

This is one of those things that are very hard to judge. Even if one has two colds sores and uses medication on one and not the other, one cannot say if that the medication shortened the healing time or lessened the effect of the cold sore.

After playing two back to back Easter performances with blood on the mouthpiece I now use abreva, but am not convinced it makes a difference.
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Dale Proctor
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PostPosted: Sun Sep 15, 2013 7:40 pm    Post subject: Reply with quote

Well, I know what I know. I averaged 2 or 3 cold sores a year for many years, sometimes in spots on my lip that prevented me from playing for days. One painful one I vividly remember was in the center of my lower lip, and it erupted on the way to St. Louis for a 3-day gig. I played through it, but it hurt like #&!! and my playing was really compromised. Since I discovered Abreva 4 or 5 years ago, I haven't had one develop into anything other than a small irritation. Of course, as they say, your mileage may vary.
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DrDave
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PostPosted: Sun Sep 15, 2013 9:42 pm    Post subject: Reply with quote

Abreva does seem to work for some people. Two studies showed it decreased average healing time by about 18 hours. 40% of people using it within an hour of symptom onset were able to stop the progression of symptoms. It is interesting that in the same study 30% of people applying the placebo cream without the active ingredient had a similar effect. Acyclovir seems in clinical trials to do better, reducing healing times by 1.6 days.

If Abreva works for you stick with it. It can certainly help. If results are unsatisfactory the added expense of the prescription acyclovir might be worth it.
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Craig Swartz
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PostPosted: Tue Sep 17, 2013 9:28 am    Post subject: Reply with quote

I use a large hit of Valtrex (generic) if/when I feel the tingle. It's saved me several times, although I haven't had an incident in a while. I'd usually experience some sort of minor trauma before flare-up. I remember one time my dog reared up and hit me in the face with her head, for example.
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James B. Quick
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PostPosted: Tue Sep 17, 2013 8:41 pm    Post subject: Reply with quote

Quote:
I'd usually experience some sort of minor trauma before flare-up


So, maybe a cold sore could be triggered by having to play a Polka gig?

jbq
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ConnArtist
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PostPosted: Wed Sep 18, 2013 1:17 pm    Post subject: Reply with quote

This thread reminds me why I shouldn't be so casual about letting someone blow my mpc, and merely wiping it on my shirt before I play it

Made it this far in life without a sore. Would be a bummer to blow that trend...
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LittleRusty
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PostPosted: Wed Sep 18, 2013 1:23 pm    Post subject: Reply with quote

DrDave,

Will disinfecting with alcohol kill the virus on a mouthpiece?
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bamajazzlady
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PostPosted: Wed Sep 18, 2013 1:26 pm    Post subject: Reply with quote

ConnArtist wrote:
This thread reminds me why I shouldn't be so casual about letting someone blow my mpc, and merely wiping it on my shirt before I play it

Made it this far in life without a sore. Would be a bummer to blow that trend...


Never let anyone other than you blow your mpc nor is wiping it on your shirt a good idea either.
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Avan
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PostPosted: Thu Sep 19, 2013 8:07 am    Post subject: Reply with quote

I usually get them maybe once or twice a year, as soon as I feel that tingling sensation I use Carmex, and apply it at least once every two hours every day for about three days, this always worked for me, " so far ". Never tried Abreva but a lot of peeps I know use it and claim it works.
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DrDave
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PostPosted: Fri Sep 20, 2013 11:31 pm    Post subject: Reply with quote

Below is some information about killing the HSV virus taken from the Heath Canada website. Many disinfectants kill it, but it can take a few minutes.

SUSCEPTIBILITY TO DISINFECTANTS: HSV virus is easily inactivated by lipid solvents. It can be inactivated by 0.5% Lysol in 5 min; by Listerine (1:1 mixtures) in 5 min; by 2,000 ppm (2,000 ul/liter) of bleach in 10 min; by rubbing alcohol (1:1 mixtures). HSV is also susceptible to quaternary ammonium compound. Most herpes viruses are also susceptible to 30% ethanol and isopropanol, 0.12% orthophenyl phenol, and 0.04% glutaraldehyde.
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trumpetteacher1
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PostPosted: Sat Sep 21, 2013 5:41 am    Post subject: Reply with quote

For a completely different perspective:

http://articles.mercola.com/sites/articles/archive/2009/02/14/are-cold-sores-really-herpes-heres-the-truth.aspx

Jeff
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Dale Proctor
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PostPosted: Sat Sep 21, 2013 6:35 am    Post subject: Reply with quote

Maybe there's a problem with the nomenclature. I've always heard the sores inside the mouth called canker sores, and the blistery ones on the lips called cold sores. According to the link Jeff posted, canker sores and cold sores are the same thing, and the blistery ones on the lip are called oral herpes. When talking about Abreva helping mine, I was referring to the oral herpes.
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mikatpt
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PostPosted: Sat Sep 21, 2013 11:22 am    Post subject: Reply with quote

I used to get real bad cold sores all the time. I use abreva whenever I feel tingling, and I take L-lysine tablets for several days following any kind of sensation. (amino acids, easily found at the local pharmacy - purportedly, they help prevent cold sores).
I've been sore-free for nearly three years now. I still use the stuff whenever my lips tingle, but I can't even remember the last time I've felt the need.

Michael
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WxJeff
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PostPosted: Mon Sep 23, 2013 7:05 am    Post subject: Reply with quote

I use L-Lysine also, and during the winter make it part of my morning regimen (along with Vitamin C.) I still get two - three episodes a year, but they are not as serious or long-lasting as they were before I started using L-Lysine.
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WxJeff
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PostPosted: Wed Sep 25, 2013 7:04 am    Post subject: Reply with quote

DrDave:

Thanks for initiating this thread. Just got back from CVS for a little pre-season shopping.

I was a bit put off by the Abreva price tag ($22.) Of course, my wife responded with her usual wisdom, "What's it worth to you... and if the tube lasts a year....???" I noted that the CVS brand cold sore remedy had the active ingredient Benzalkonium oxide compared to Docosanol in Abreva.

Is this a "your mileage may vary" thing or is the Docosanol statistically more effective to allow it to carry double the price tag?
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