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


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