## Cold logic

Everyone knows that if you have a cold, the most important thing (besides chicken soup) is to get plenty of sleep. Sleep is when your white blood cells stop reading The Onion and watching Simpsons reruns, and start snacking on viruses.

But what if your cold is so severe that you can’t sleep, not even for an hour or two? What do you do then? Not knowing the answer — but knowing readers of your blog will be getting increasingly antsy — you go see a doctor. The doctor says to take NyQuil to sleep.

The problem is that NyQuil tastes worse than Vegemite, and (another Catch-22) you can barely force a drop of it down your swollen throat. So you mix a Coke and NyQuil, on the rocks. But this merely converts a small disgusting green beverage into a large disgusting greenish-brown one.

So you go back to the drugstore, where you’re relieved to learn that NyQuil is also sold in capsule form. You take two capsules. Hours later, you’re still not asleep. So you take a third. An hour later you’re still not asleep, and your throat is in indescribable pain. So you take two Advils. The pain doesn’t go away, so you take a third Advil.

At this point you start hallucinating and feeling dizzy. Your skin is pale, your pupils are dilated, and you’re sweating profusely. Uh-oh. What was in those pills, anyway? In each NyQuil: Dextromethorphan HBr 15mg, Pseudoephedrine HCl 30mg, Acetaminophen 325mg, Doxylamine succinate 6.25mg. In each Advil Cold & Sinus: Ibuprofen 200mg, Pseudoephedrine HCl 30mg. So, you’ve now ingested 180mg of Pseudoephedrine HCl, whatever the hell that is.

“In case of accidental overdose contact a physician or poison control centre immediately, even if there are no symptoms.”

Staggering over to your computer, you read that overdosing on antihistamines and decongestants can be fatal, and that indeed, the proper thing to do would be to get your stomach pumped as soon as possible. But it’s 4AM, and for better or worse, you decide to leave the 9-1-1 operator alone, and trust that three billion years of Darwinian natural selection weren’t for bleaaaarrrrrgghhhhhhhhh…

The Moral: Never assume that, just because a single dose of a drug doesn’t help you, a double or triple dose isn’t going to kill you.

It actually gets even more nauseating, but I’ll cut to the end: after more than a week, I can eat again. I can blog again. I can lower-bound again. I can even talk again, though I won’t be playing female leads in Broadway musicals anytime soon.

It’s good to be back.

### 24 Responses to “Cold logic”

1. Anonymous Says:

Hi Scott

I certainl agree with your moral for the story. However, I still find it somewhat amazing that you succeeded in overdosing… I thought off-the-counter meds never tell you anything close to the true maximum dosage, because the drug companies are worried about lawsuits. I’ve encountered doctors that will cheerfully prescribe an amount of painkiller that is twice the absolute maximum dosage stated on the bottle.

Anyway, glad that you are feeling better and are back to blogging!

Varsha

2. Dave Bacon Says:

I wonder if there is any medicine we can give you to make you “upper bound” 😉 Glad to hear your not dead.

3. Greg Kuperberg Says:

My in-laws are unsentimental doctors (the kind that I like to talk to) and I have learned a great deal from them.

Principle #1: Every interesting drug Does Something. If it Does Something, that means that if you take too much of it, it can kill you.

Principle #2: Every non-prescription drug is a watered down version of a prescription drug. If it didn’t Do Something, it would be a fraud, and would not deserve FDA approval. But doctors know can both recognize and avoid overdoses with greater skill than lay patients, therefore the OTC version Does Only a Little. It’s not just about lawsuits; it’s a safety margin around ignorance.

Corollary of Principle #2: Life isn’t fair. When doctors get medicine for themselves, they can blithely ignore the recommended dosage in favor of their own wisdom. That doesn’t mean that you should.

Principle #3: Some drug formulations assume that not only do you know nothing about overdoses, you also know nothing about diagnosis. They are therefore minuiature drug stores rolled into one pill. You know they jingle about Nyquil being the “stuffy, achy, sneezy” medicine? They mean it.

A doctor who doesn’t really know you from Adam might well treat you the same way.

Even if you aren’t a doctor, you don’t have to be that stupid. If the main problem is a sore throat, you can take medicine just for that. The system will trust you with a higher dose, if the pill only pushes one button instead of all of them.

After my in-laws, my best source of medical wisdom concerning specific drugs is Wikipedia. You can add wisdom to many Google searches by adding “wikipedia” to the end. For example “pseudoephedrine wikipedia” tells you in the first sentence of the Wikipedia page that Pseudoephedrine is a decongestant.

4. Anonymous Says:

Scott, sorry to hear about it. How did you get sick?

5. Anonymous Says:

Dude, let’s be honest: You overreacted. I have taken a lot more than triple NyQuil and octuple Advil and come out without a scratch. Maybe you should push your boundaries more often, just to know where they are.

6. Kea Says:

Hey! Vegemite is yummy. And if you could swallow that many pills, how sick could you be?

7. Anonymous Says:

Scott,
1) I’m glad to hear you’re in good health. Missed your blog.
2) In medicine, apparently, (I don’t know if Dave meant this), upper bounds are also important.

8. Anonymous Says:

Hey Scott, you said that you couldn’t sleep? I don’t know if that was because of the pain (e.g. bodyaches)? But if it was, I had a nurse tell me that staggering a dosage of acetaminophen and ibuprofen would knock out the aches. Well taking the acetaminophen and several hours later taking the ibuprofen worked for me. Got rid of the bodyaches and allowed me to sleep. I think the nurse did tell me that I could take more of the acetaminophen than I thought I could but that seems to be because they don’t want you to overdose.

9. Anonymous Says:

You need Yoga, Scott. That’s all!

10. Anonymous Says:

Good to know that you’re alright. Congrats!

As for counter-measures, I’m not sure if it was the pain or the running nose that didn’t let you sleep, if it was the latter, I have got a suggestion. In India, we use a drug called ‘Vicks’ which is basically a paste that you apply to your nose and go to sleep. No more running nose for at least 2-3 hours. It helps to cover your face with something, if you can bear it.

If you had such a bad throat that the pain didn’t let you sleep, I don’t really know of any way for instantaneous relief. But surely, one week was too much to lose to a sore throat.

Anyway, it’s good that we’ll have more of your blogs to read

11. Scott Says:

“Dude, let’s be honest: You overreacted.”

OK, I’ll let my digestive system know.

12. Scott Says:

“How did you get sick?”

Presumably, by getting a virus into my nose or eyes (possibly via my hands), which then entered the tissues between my nose and throat and multiplied rapidly, commandeering my own cells to do so.

13. Scott Says:

“You need Yoga, Scott. That’s all!”

(closes eyes, crosses legs)

Ohhhhmmmmmmmmmm

OK, was that good?

14. Scott Says:

“I wonder if there is any medicine we can give you to make you ‘upper bound’ ;)”

Dave: I’ve heard there’s an “upper” that does that; its street name is Big-O. According to legend, a certain theoretician spent 20 years obsessing about P vs. NP, then took one hit of Big-O and, by the next morning, had coauthored three dozen FOCS papers giving improved approximation algorithms for the minimum undirected edge-disjoint sparsest multicut problem. Personally, I intend to stay clean.

15. Andrei Lopatenko Says:

Hi, Scott
I am very sorry for a comment which is not related to your post but I hope information provided is useful for you.
In a “Complexity Zoo Introduction” part of your the Complexity Zoo, you references compendia of complexity classes.
The list is not complete

Fixed-Parameter Tractability and Completeness I: Basic Results, Rod G. Downey and Michael R. Fellows, SIAM. J. COMPUTING, Vol. 24, No. 4., pp. 873-921 (August 1997) contains a compendium of fixed-parameter problems. (between 150 and 200 problems)
Of course, all these problems are in Downey, Fellows books, but I believe it is easer to get an article then a book (the Downey, Fellows book is very expensive).

Completeness in the Polynomial-Time Hierarchy: A Compendium
Marcus Schaefer, Chris Umans; Sigact News, September 2002.
Completeness in the Polynomial-Time Hierarchy: Part II, Marcus Schaefer, Chris Umans, Sigact News, December 2002.
is a compendium of problems for Polynomial-Time Hierarchy. This compendium is very comprehensive and contains almost all rpoblems prooved to be hatd for some of Delta, Pi, Sigma classes.

16. Andrei Lopatenko Says:

“You need Yoga, Scott. That’s all!”
(closes eyes, crosses legs)
Ohhhhmmmmmmmmmm
OK, was that good?

I prefer Tai-Chi

17. Scott Says:

Andrei: I was restricting myself to compendia of complexity classes, not problems complete for some particular class. But the Zoo is now a wiki, so feel free to add a list of problem compendia if you want. (You could start with Garey & Johnson.)

18. mick Says:

I’m with Kea, Vegemite kicks ass.

19. Anonymous Says:

Vegemite tastes *way* worse than Nyquil, IMHO.

20. Anonymous Says:

My mom who comes from South Africa also swears by ‘Vicks’. Must be a British Empire thing

21. Anonymous Says:

“Must be a British Empire thing.”

Probably. That gives a reason why you don’t see it in the US, just like cricket, rugby and colour (were) morphed into baseball, American football and color 😉

22. Anonymous Says:

Pseudoephedrine HCl, whatever the hell that is.

Also known as colloquially as “itchy scratchy”, pseudoephedrine is quite popular as an illicit stimulant, although its effectiveness as such is somewhat dubious.

23. Andrei Lopatenko Says:

Maybe it makes sense to put a material into a reference part instead of a compendium part?
Then description of some complexity classes can be enriched by “A compendium of problems complete for X is”
I believe it would be really useful. For some classes, like $FP^NP(log n)$ it really takes time to read many articles to find a “good” complete problem which suits your needs. Everybody knows about Garey and Johnson book or the Viggo’s compendium, but to prove FP^NP(log n) hardness people read Krentel, Papadimimitrou, etc articles
I any case you list Gerey and Johnson and Viggo’s compendia as “Other Theory Compendia” at Complexity Zoo Introduction page.

24. Beth Says:

Hi,

I have a cold and can’t sleep, and hence a google search revealed this post. My grandfather is a doctor, and always said you could double or triple any OTC meds except aceteminophen. It’s a very effective suicide drug. And my guess is that some people are very sensitive to even a double dosage of it…. I’m glad you didn’t take any more of it than you did!

Uggggh, I can’t sleep.

Beth