Doc: There are many causes of post-surgery cough

Dear Dr. Roach: A year ago, I had cardiac bypass surgery. Everything went great: I had no pain.

About a day or two after getting home, I started coughing. I would cough and cough and cough. It started when I would lie down, and sitting up initially helped. Later, I was coughing all the time. Cough drops or syrup didn’t help. The doctors could not find any fluid around my heart, or anything out of the ordinary.

To make a long story short, my doctor prescribed a short course of steroids and then benzonatate, which was the only thing that would stop my cough. What would have caused a post-surgical cough?

K.C.

Dear K.C.: There are many possible causes for cough after surgery. During surgery, a plastic tube is inserted into your airway so the machine can breathe for you: This can cause irritation, and is a frequent cause for cough. (That usually lasts only a few days.) Fluid overload can also do it. Infection in the lung is probably the biggest concern. Often, medications that are started after surgery, especially ACE inhibitors (their generic name ends in “-pril,” like “lisinopril”), cause cough after being on them a short while. The nerve to the diaphragm, the phrenic nerve, can be damaged or irritated during surgery, causing a cough that might last for months.

Benzonatate is a nonspecific cough remedy: It is modestly effective at suppressing cough of any type. The short course of steroids makes me wonder if there was a suspicion for reactive airway disease (on the asthma spectrum). Some people without any history of asthma still may have some asthma symptoms, especially a cough, after surgery.

Dear Dr. Roach: I’m a 67-year-old male. I occasionally get lower-back pain. I’ve been reading about inversion therapy (hanging upside down), and would like to know if there are any benefits from this activity, or if it is just another fad. Are there any risks?

L.C.

Dear L.C.: There are many causes for back pain, but in some people, the cause is pressure on the nerve roots by the vertebrae. Inversion therapy, which puts someone upside down via a wide variety of devices, is a way of taking pressure off the nerve roots. It can provide short-term relief; however, it has been found to be ineffective in long-term use.

There are several possible risks. The biggest probably is that the pressure in the eye increases dramatically, so it is not recommended for people with glaucoma. After a few minutes, blood pressure tends to increase and the heart rate slows, which can be a problem in people with poorly controlled high blood pressure or some types of heart disease.

The position itself is not a general exercise. There certainly are good exercises involving your body in upside-down positions, but these are separate from inversion therapy for back pain.

Email questions to ToYourGoodHealth@med.cornell.edu.