Tuesday, September 25, 2012

Preventing and Treating Influenza

As with many medical issues we are interested in prevention first and treatment second. So, following that approach let’s look at some ways to avoid getting sick in the first place.

We know that health is the result of a number of factors all working together – physical, psychological, and spiritual. When things are out of balance in any of these areas we increase our likelihood of getting sick. It is important to pay attention to basic issues of diet, proper rest, and exercise. We also need to manage the stresses in our life. Stress is a natural part of living, but sometimes it can get to a point that overwhelms us and can contribute to illness. Similarly, our spiritual beliefs and focus contribute to the overall balance resulting in health or illness. So, take the time to pay attention to each of these elements. It can help to prevent or lessen the severity of an illness.

Another important area of prevention is good hand hygiene. Remember to clean your hands regularly. You can use soap and water or one of the alcohol-based hand cleaners available in many stores. Carry a hand cleaner with you when you go out so you can clean your hands regularly and help prevent getting sick. Try to stay out of crowded and congested areas as much as possible. These are high risk areas for the spread of germs, particularly if there is someone who is coughing and not following the basic rule of covering your mouth when you cough.

Next, I would strongly recommend that you get your flu vaccine as a basic step in prevention. If you have not gotten your flu vaccine yet this year, call your primary care physician’s office and schedule it today. Do it right after you finish this article!! Vaccination is one of the most effective measures you can take to prevent the flu. If you don't have a primary care physician, we can help with that. Visit our website, find an office, and schedule an appointment today!

Sometimes despite our best efforts we do get sick. And that is the time to follow some basic rules for taking care of yourself and contacting your primary care provider if you have questions or concerns about your illness. Depending on the nature of your symptoms and other medical conditions you may be asked to make an appointment to be seen. Or, you may be given some recommendations about treatments to try at home first before being asked to go to the office for a visit.

Remember the advice from your mother about chicken soup? Well, that is pretty good advice when it comes to a number of illnesses, including influenza. Along with that bowl of chicken soup remember to stay at home and rest, particularly if you are running a fever and are coughing or blowing your nose frequently. If you are on prescription medications be sure that it is safe for you to take over the counter medications to help reduce your fever or treat your headache or body aches or other symptoms you may have. Your primary care office can help you with specific suggestions for over the counter medications that may help control your symptoms while your body is fighting off the infection.

If it is truly Influenza that you have your primary care provider may recommend one of a number of specific medications approved to treat Influenza. However, if you have a viral illness that is not Influenza then these medications will not help. And, antibiotics are never effective for these viral infections. Antibiotics are only effective for bacterial infections. So, you may find that your primary care provider discourages the use of antibiotics when you are ill with a suspected viral illness such as the flu. That is solid medical advice and helps to prevent complications and the unnecessary use of antibiotics.

We hope you stay well – but if you do get sick, your primary care physician’s office is ready to help return you to good health. Together we can work toward the goal of good health.

Joseph A. Cincotta, MD
Medical Director, PinnacleHealth Medical Group

Monday, September 17, 2012

Children and the Flu

Now that school has been back in session, more of our children are coming home with the sniffles, a cough, or even some vomiting and diarrhea. Most of these illnesses are easily managed at home for a day or two and your child is back to school. Pretty soon, however, influenza virus –“the flu” – will be circulating around. This causes a more severe illness and has much more potential for complications.  Therefore it is important to be informed about influenza and be prepared to keep your child as healthy as possible during the flu season.

Influenza virus is a smart virus that makes changes every year (and sometimes within the same season) to trick our immune system so that it can infect anyone, even people who have had the flu before. Influenza is not choosy about who it infects. Adults, children, and babies are all susceptible – even if they are healthy and have never been sick before. So please do not say to yourself (or to your doctor): “My child is never sick and has never had the flu, so I know she won’t get it.”  This is NOT TRUE!

When your child has the flu, he will typically develop a sudden fever (at least 100 degrees F and often higher than 102 degrees) along with chills, muscle aches, headache, and lack of energy. Most children also develop a runny nose, nasal stuffiness, sore throat, and a cough. Some also have stomach pain and vomiting. Don’t be confused:  if your child only has vomiting and/or diarrhea with no respiratory symptoms and no fever – this is not influenza. Some people refer to this type of illness as “stomach flu,” but actually it is a different virus and has nothing to do with influenza.

Flu (influenza) will likely cause your child to miss about a week of school and the fever lasts three to seven days. However, often there are complications or additional (“secondary”) infections that can develop on top of the flu. This is especially true for children under five years old. The most common secondary infections are ear infections and pneumonia. Young children can develop bronchiolitis (wheezing and shortness of breath). These complications of flu require additional visits to your doctor and can also result in hospitalization.

What can you do to help your child?
If your child develops flu symptoms, call your doctor early. Depending on your child’s age, how long they have been sick, and whether they have other chronic illnesses (like asthma), your child’s doctor may decide to prescribe antiviral medicine. These medicines work best in the first 48 hours of symptoms. But they do have side effects and are only going to shorten the illness, so they often are not the right choice for your child.

If your child has fever for more than five days, has ear pain, or has a cough that is not improving after one week, call your doctor again. These are signs of possible complications. If your child is under three months of age or has chronic illnesses, you should have them seen at the office sooner.

There is no treatment for influenza that works 100%. The best thing to do is to give your child rest and plenty of fluids so that their body can fight off the flu virus. Sometimes your doctor will recommend over the counter fever reducers and pain relievers, such as acetaminophen (Tylenol), but never use aspirin (acetylsalicylic acid) – this can a rare but serious illness called Reye syndrome. If your child has fever but is able to rest comfortably, it may be best to not treat the fever – the fever helps the body fight off the virus.

Flu vaccine
The most important and useful thing you can do for your child is to get yourself and your child a flu vaccine every year. This may reduce your child’s chances of getting the flu by 60 – 90%. If everyone in a household is vaccinated, it reduces their chance of getting the flu even more. Contact your doctor’s office now– most offices have vaccine available in September and the sooner your child is vaccinated the better.

If your child is under nine years old they may require a second dose of flu vaccine one month later.  However, if they are over two years old and healthy, they may be able to get the nasal mist (nose spray) vaccine – kids love this because there is NO NEEDLE!  Check with your doctor to see which vaccine is the right choice for your child.

The benefits of the flu vaccine are far greater than the risks of side effects. There are many myths about the flu vaccine out there. Please discuss any concerns you have with your doctor and check out our blog post from last week on the flu vaccine!

Another good resource: http://www.cdc.gov/flu/protect/children.htm

Heritage Pediatrics
Pinnacle Heath Medical Group

Monday, September 10, 2012

Debunking Flu Shot Myths

As the summer draws to a close and the school year begins, so does the start of yet another flu season. Though most people think of winter as flu season, the spread of influenza can begin as early as October. 

The best protection against influenza is a yearly flu shot, yet many people have reservations about getting immunized. There is a lot of misinformation and myth surrounding the flu shot, so it can sometimes be hard to sort out flu-shot-fact from flu-shot-fiction. 

Here are some of the most common concerns I hear in my practice when I offer my patients the flu shot: 
  1. “The flu shot will give me the flu.” The influenza vaccine is inactivated, which means it does not contain any live virus, and therefore cannot infect you with the flu. Any vaccine has the potential to cause mild side effects. These side effects may include soreness at the site of injection, mild body aches and a low grade fever. If these symptoms occur, they begin soon after the shot is given and last 1-2 days.  Most people who receive the flu shot experience no side effects at all.  
  2. “I want to wait until November to get my flu shot, so it will last the entire season.” It takes about two weeks for our bodies to develop antibodies and provide full protection against influenza after receiving the flu shot, and influenza season can actually begin as early as October. For this reason, the CDC (Center for Disease Control) recommends that vaccination begin as soon as the vaccine becomes available – as early as August or September, and continue throughout flu season to ensure the highest possible level of vaccination. Getting your flu shot early in the season will likely provide you with the longest level of protection. 
  3. “Last year I got the flu shot, but I still got sick.” This year’s flu shot will protect you from infection and illness caused by three strains of influenza virus, including the H1N1 virus.  The WHO (World Health Organization) does its best each year to determine which viruses to include in the vaccine based on their surveillance and projections. Flu vaccines do NOT protect against other infections and illnesses caused by other viruses. There are many other viruses that can cause influenza –like symptoms. The flu shot does not protect you against these other viruses or against the common cold or a gastrointestinal virus. 
True influenza is different from a cold. It comes on suddenly. Typical symptoms include fever, cough, body aches, fatigue and headache. Symptoms can range from mild to severe, and complications such as pneumonia can occur. Young children, pregnant women, the elderly and people with chronic illnesses are at higher risk of developing complications.

Getting a flu shot and washing your hands regularly are the best things you can do to keep from getting the flu. So, don’t wait. Get vaccinated today!

Betsey Miller, MSN CRNP
Good Hope Family Practice, a member of PinnacleHealth Medical Group

Monday, September 3, 2012

Influenza, the Basics

So, everyone is getting ready for “cold and flu” season. But what does that really mean? Well, we in the medical world generally find that to be the time between October and April. It’s the time of year when we see a large number of people who are coming in with symptoms that make us think…cold or flu? Well, for the vast majority, the answer is “cold." Fortunately, the flu is much less common. However, when you have the flu, the symptoms are much more intense and have many more complications associated with it. That’s why we get geared-up for flu season by recommending everyone gets their flu shot if they’re over the age of 6 months. Yes, that’s right…everyone. We used to recommend only the very old and very young get immunized but have found by expanding the number of people who are vaccinated, we are able to achieve lower rates of disease across all age groups, especially those age group extremes. It takes up to 3 weeks after you’re vaccinated for you to build up the immunity you need to face the flu in casual social contact and be able to fight it off.   

Now, what is influenza (or flu, as I’ll refer to it from here on out)?  Let’s start by saying it’s a virus. Sounds simple, but at the core of the issue is that it’s a virus.  That means no matter what antibiotic we throw at it, they’ll NEVER rid you of the flu. Antibiotics work on bacteria. That’s it. Not colds, not flu; that’s because they’re viruses and don’t respond to antibiotics. All we accomplish when we prescribe an antibiotic for flu (or a cold, for that matter) is to increase rates of resistant super-bacteria infections in our world (but that’s a blog to come, stay tuned). It’s also a very crafty virus. It has learned over the years that in order to survive in this world, it must change/mutate regularly. It does that by changing its makeup to keep our immune systems guessing. That’s why you can get the flu over and over and over again and your immune system will never be the wiser. That’s also why we need a new flu shot every year. 

Flu starts in Asia. It generally starts from an animal source and transmits to people. People then spread the virus from one to another and because of the magic of travel and technology in the 21st century, presto, it’s now on our doorsteps here in North America.Each year the flu shot is engineered based on major strains from the far east and mixed together to give you protection against multiple possible mutations it may have by the time it gets to us (yes, the flu can change itself within ONE flu season!). You have to remember the swine flu pandemic of 2009-2010 flu season; that was a great example of how flu spreads, but was also a great example of how large scale immunization efforts can stop such a spread. It also really helped advance the technology of flu shots. They’re leaner and meaner than ever; the immunity the shot provides lasts the full year, even beyond the usual flu season. That’s why we’ve already gotten flu shots under way for this flu season. Call your family doctor, internist or pediatrician. Chances are, they have their supply of flu shots in their offices. We sure do here at PinnacleHealth Medical Group

To answer a few very common questions…Yes, my children, husband and I all get our annual flu shots…and, NO, there is no flu in the flu shot! Many, many years ago there was but there hasn’t been any in the shot for a long time. What is it? It’s a manufactured copy of the virus that gives your immune system a peek to see what it looks like so when the real thing comes along, it will know and attack it in a more efficient way. The nasal influenza vaccine DOES have a sleeping version of the live virus so be aware of that when choosing your options. Even with this sleeping virus, a healthy person does a great job of handling it and those are the only people who are even eligible for the nasal vaccine. Talk to your healthcare provider about which one is best for you. We at PinnacleHealth Medical Group make a point to offer you with as many options as possible to provide you the personalized medical care you deserve.

The symptoms of flu are rather simple; runny nose, stuffy nose, cough, congestion, fever (that one is almost a deal-breaker and without it, the flu is not really a consideration—so be sure to check your temperature…with a thermometer!), body aches, sore throat, and sometimes diarrhea. To remind you, the cold has those symptoms as well. The major difference is the sudden onset of the flu (all/most symptoms hit you at once, generally within 12 hours of each other) and the fever over 100.4. The colds all have the same basic symptoms but are generally more gradual in their onset (starts with a tickle in the throat for a day, then runny nose for a day, then cough…and lingers 10 days or more), are much less intense and often without that higher fever. If you realize you have the flu and it’s been more than 48 hours of symptoms, available treatments aren’t going to work anymore.  Even if we do treat these flu episodes, the medication has only been shown to shorten the length of time you’re sick by 1 day. So unless you have major medical conditions, specifically lung disease, we don’t automatically treat the flu with the anti-viral medicines because the side effects (on you, the patient) and the virus (it can make the virus mutate faster) aren’t always worth that 1 day of symptom improvement. We mostly focus our efforts on making you more comfortable while you are fighting this virus off. Once we know flu is in our area, we don’t typically test for it and treat you based on symptoms alone.

I mentioned that flu has many complications. We worry not only about the flu itself but that the flu causes problems in its wake. The most concerning among these is pneumonia. A warning sign that the flu has become pneumonia is that after the typical 10 days of flu you start to feel better then suddenly start to get worse and spike a fever again (that is a temperature greater than 100.4—yes, take that temperature…the number itself means something!) and have cough and or chest/upper back pains.  Another complication we often see is a sinus infection. That too is generally something you notice once you start to feel better then feel worse again; the thing that points us in that direction is pain in the face and teeth. Ear infections can also be a secondary infection. If the ears are the bothersome issue and the temperatures start to climb again call your provider. You may need to be seen in order to see if these complications are why you aren’t getting better in the time period that’s usual for the flu. 

I’d say good luck navigating through cold and flu season, but with a little preparation and your health care provider involved with you along the way, you won’t need luck! PinnacleHealth Medical Group primary care offices are uniquely poised to be able to work with you in every step of this maze. Flu shots are here at PinnacleHealth Medical Group, so don’t wait…call your medical home today to schedule yourself and your family for this today!

Sandra Costa, DO, FAAFP
Heritage Family Medicine
Member, PinnacleHealth Medical Group