Aisle full of cold medicine choices, but which is the right one?

Achoo!  Gesundheit!  If you are coughing, sneezing and sniffling right about now, you’re not alone. The vast majority of people we’re seeing at the office at this time of year for same-day sick visits have an upper respiratory infection…aka, a cold. Now, colds come in different varieties; there’s the garden variety “Rhinovirus” which gives the old tried and true cold symptoms. There’s also the more powerful RSV (Respiratory Syncitial Virus) which packs a punch to all who get in it’s way but even more to our littlest babies (more to come on this, keep reading). The flu is also still out there too (yes, still time to call the office to get your flu shot). So if you’re in battle with any of these right now, you’re not alone. I was in a visit with a patient last week and we got into a lengthy discussion about cold medicines; I joked with him at the time that I should blog about this topic then thought about it some and thought it would be worth sharing…so now I am!

I’ve read estimates of Americans getting 4 billion colds every year. This is why the US spends in the neighborhood of 4.2 billion dollars (yes, that reads billion) every year in cold remedies. By the USA Today report I read, that is only the “traditional” medicines, not the alternative ones (think Vitamin C, Echinacea and Zinc…so that number could double!). So now you realize why the cold/cough/flu remedy aisle in your local pharmacy or grocery store is SOOOO long and full of options. Simply stated, we buy them. I hope to help clear up which options to consider in your quest to feel better.

The thing about any and all cold medicines is this: they don’t make you better. They help you feel better sometimes. I hear all the time that the cold medicines help, but as soon as they wear off, the love is gone and symptoms return. They mostly exist as 4 hour formulations, which is not really that great. By the time you find improvement in your symptoms, the medicine is just about to wear off. Taking it every 4 hours is so time consuming. I don’t think there is anything I can manage to do every 4 hours during a busy day as a mom and at work. So I can practically recommend the 12 hour extended release formulations of any drug you take. Take one in the mornings when you wake up to help you with those daytime symptoms and another sometime 12 hours later—this second dose will help you manage symptoms overnight while you’re sleeping. Getting rest can be the difference in getting better or lingering sick. It won’t magically make you better but when you’re rested, you’ll FEEL better…and isn’t that really what you’re looking to do?

Let me start with the one I wish didn’t really have such a big place on the shelves. Dextromethorphan. It is billed as a cough suppressant. This makes sense at first. Yes, stop the cough. But think about it a little more carefully and you’ll see that the cough is actually protecting you. Let’s consider two scenarios. One - the cough is from lung/heart/stomach disease; so suppressing it allows you to go undiagnosed and that could be life-threatening…so, suppressing that cough is not a great idea. Two - the cough is from your upper respiratory area; the mucous is coming from your nose and sinuses and is caused by the mucous as it drips and drains into the upper part of your throat. The body tries to avoid that mucous from getting into the lungs to cause a pneumonia/lung infection...so the cough is actually a good thing there. The other thing about dextromethorphan is that it actually could be DANGEROUS! Yes, dangerous. It can interact with many depression/anxiety medicines causing a serious interaction. Since you can buy dextromethorphan without a prescription or even a talk with your pharmacist, this frightens me. So look for this drug and think three times before you buy it. Look for any drug that has a DM after it (DextroMethorphan) and, in my opinion, avoid it.

The one I really DO like is pseudoephedrine. This drug is not for everyone. Some people don’t tolerate it. I’d say, in my experience, 1 in 10 people tell me they cannot take it because it makes them jittery or have a fast heart beat. The other consideration is people with high blood pressure. For most patients who have controlled, treated high blood pressure, it’s OK to take this drug FOR A FEW DAYS while you’re sick and not worry it will cause serious damage (if your blood pressure is uncontrolled or it’s used beyond a few days, your doctor or provider should be involved). If you’re one of those people, this drug is not for you. If you’re not, this may be something that helps open up your nasal passages and keep you moving air…which is a good thing! In addition to causing nasal passages to clear, this can dry up some mucous secretion (more of a side effect than anything) making you feel better too, reducing that pesky cough. Phenylephrine is an alternative to the pseudoephedrine;  it is less stimulating and doesn’t raise the blood pressure. To buy pseudoephedrine, you must show a photo ID to the pharmacy staff. Phenylephrine is available grab-and-go off the shelf. Be warned, it doesn’t have the same power pack the pseudoephedrine punches.

The next among the big-three of cold medications is guaifenesin. This functions to loosen the mucous and help make it slippery and ready to cough/blow/spit out. This keeps down the likelihood that the mucous will be a breeding ground for bacteria to come in and infect later. This is a particularly good one to consider if you’re prone to sinus and ear infections after a cold. All in all, it’s not a bad choice.

One word of advice: READ!  Read the label of the drug you are about to buy and put into your body. This is important. If you decide to get a multi-symptom drug it has multiple drugs in it. Often, one of those drugs is a fever reducer/pain medication. If you don’t have pain or a fever, that may be unnecessary. Also, you may not need a cough suppressant AND decongestant AND mucous thinner AND fever reducer. I’m a minimalist. If you are not experiencing a particular symptom, don’t take a drug to fix it. There are side effects and interactions for every drug so choose them carefully and only when necessary. Many of them interact with prescription drugs—fever reducers can interact with blood thinners and contain the same active ingredient as some pain medicines. If you’re taking a prescription drug and see the same ingredient on the cold medicine label, think again and consider asking the pharmacist or your healthcare provider if it’s OK. Also, it’s helpful to us if you know what you’re taking if you come to see us. It helps us know what to avoid giving you to avoid further interaction if a prescription drug is provided at your visit. So please, read labels.

I mentioned RSV and babies. This is yet ANOTHER reminder that there are NO SAFE COLD MEDICINES FOR BABIES and children under age 5. Never give a child with a fever aspirin. Also, remember that doses of medicines are weight based. If you don’t know what dose of acetaminophen or ibuprofen to give your child/baby, don’t guess…please ask your doctor or pharmacist for some help.

Now, I’m a mom of 3 little boys. So I understand that weakness you feel at 3 a.m. with a coughing child (or more) wanting to get them to feel better and get everyone back to sleep. The problem is, the cough and cold medicines not only don’t work for them, but they also cause HARM to them. Many thousands of children under age 5 were taken to emergency rooms yearly when the FDA allowed the sale of those medicines. They removed them from shelves after it was clear they were causing more harm than good.

So what can you do for those little ones? There are a few old-school remedies that can help. At any age, the menthol/eucalyptus/rosemary rubs can be wonderful. They make reduced strength formulations for the little babies. It’s been shown to reduce symptoms in trials but this mom can tell you that it works. There’s no placebo effect (improvement/positive change in symptoms caused by the person’s desire to improve rather than the medication) when you’re dealing with a baby. So rub away! The other thing that helps lots of kid viruses (RSV, Croup) is humidified air. The humidity is helpful in decreasing the irritation of the lining of the respiratory tract. Finally, in children OVER AGE ONE; taking two teaspoons of honey before bed can help reduce cough symptoms.

Many will say these methods lack serious scientific clinical trials. I agree but challenge…is a safety trial needed for honey in a 3 year old? Dr. Andrew Weil spoke at the American Academy of Family Physicians’ educational meeting in Philadelphia this past fall. I was in the audience and was struck by something he said - I’ll paraphrase:  the more harm that can be done, the more studies that should be done. The harm factor of honey in a child OVER THE AGE OF ONE is minimal and so should be the trials. In my house, we mix in a little lemon juice and we call it honey-syrup (my kids don’t like the sweetness of honey straight-up).

I didn’t get into the alternative options much for adults but can say the honey trick would be something worth trying. I also read adding Cinnamon to that mixture in adults helps decrease the sugar-shock factor in people with blood sugar problems—so be sure to track your home blood sugars with your monitor to be sure your sugars are not bouncing high with this treatment. Remember, a sudden spike in your blood sugars could be a sign a serious infection is lurking.

I hope you all feel better soon. I keep hoping for an early spring but fear we are destined to another 5-6 weeks of winter. Well, mostly because that’s when it ends….March 21st! So keep hoping and marking off your calendar and before you know it, we’ll be right back here talking about seasonal allergy treatments!

Sandra R. Costa, DO, FAAFP

Heritage Family Medicine

Member, PinnacleHealth Medical Group

Cold versus Flu

OK, we’re knee-deep in cold and flu season. As I sit here contemplating the difference between cold and flu, it strikes me that flu season has yet to hit us. So, if you’ve been sick so far this year, you’ve probably had the cold.

What is the “common cold”?  Well, it’s a viral infection, generally rhinovirus. Rhino…like the nose, not the animal (although the animal derives its name from the Greek word for nose due to the large nose-like proboscis on its head). So that can help you understand that the primary symptoms of colds are nasal symptoms. The first few days you feel tired and run-down.  Your throat starts to hurt. Then the nose starts to run and you sneeze. The nose then also becomes stuffy and congested.  It’s the stuffy and runny combination that if you really think about it is rather odd. How can something both be stuffed and running? That is more than I can say for Uncle Pat after Thanksgiving dinner! The interesting thing is that influenza (flu) also does that. The difference between the two is the intensity of symptoms.  Flu is a much more intense version of the cold.  Often, the mucous that is causing the congestion and runny nose causes a cough. I’d say easily, the cough is what brings people to the office when dealing with a cold.  It comes later in the course of illness and lasts beyond the time when you feel “sick."  You feel like the cold is gone but the cough can linger for weeks (yes, I said WEEKS).

One thing you may have noticed is that I did not mention fever. That’s because the cold doesn’t cause a fever. That’s not to say it won’t raise your body temperature, because it will. You just won’t have a fever.  So here’s a little tip. A temperature greater than 98.6 is NOT a fever. We refer to them as low-grade fevers but really they are not fevers. A fever starts when the temperature reaches 100.4. That seems like an odd number. It’s because scientific and global measurements are done with Centigrade temperatures. So that corresponds to 38C. Normal body temperature on that scale is 37. That one degree Celsius separates normal from febrile. So from 98.6 to 100.4 is not a fever. Why does it raise your temperature? Well, that’s because in fighting off this virus, your immune system gets activated. The T cells notice the virus and deploy a search-and-destroy call to other T cells.

Other symptoms include 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.

The good news is you don’t have to face this alone! Your healthcare provider at your PinnacleHealth Medical Group primary care office has you covered. If you feel you are sick and not sure if it’s the cold or the flu, ask one of the pros. It’s why we’re here, after all! Be well and stay well!!

Sandra R. Costa, DO, FAAFP

Heritage Family Medicine

Member, PinnacleHealth Medical Group

Common Cold Versus Flu - an Easy to Read Comparison

In summary, because both illnesses are respiratory viruses the symptoms can overlap.  It can be clinically impossible to distinguish a mild flu from a severe cold. However, influenza is usually a much more severe illness with the degree of fatigue, body aches, fever and cough. If you feel you may have a cold, or the flu, see your primary care physician as soon as possible.

How to Avoid Getting Sick

Well, it’s official. Cold and flu season is officially here!! We sure hope you’ve been able to keep yourself healthy so far. It’s a long season, so I’m here to help you prepare yourself for the brunt of it, still to come our way. The best way to get over the cold or flu is to never get sick in the first place!!  How on earth do you do that, you ask? Well, it’s easy and hard, all at the same time. Oh, and much of what our moms taught us was right on…they’re almost always right, after all!

WASH YOUR HANDS!! Yes, I did yell it at you. I cannot underscore enough how important it is to wash your hands, so I’ll say it again. Wash your hands. Wash them after a trip to the grocery store, gas pump, religious service, doctor’s office (especially there!), work, school…. Do you get a sense that I want you to wash your hands a lot? Well, yes, I do. It is the single best means to prevent the spread of germs. That includes the cold, flu, stomach “bugs” and various other contagious creatures. We cannot protect ourselves from catching an “airborne” illness (more to come on that, keep reading) but we can protect ourselves from literally “catching” it in our hands. Perhaps that is where that term came from? So wash your hands.

Cover your cough. It is harder to keep from getting what we call a “airborne” illnesses. These are defined as something that when put out in the air (like from talking or coughing or sneezing) lingers like little droplets in the air. Think of the mist you see after spraying your cologne/perfume or those room deodorizers. The bacteria and viruses we blow out of our noses and mouths linger like that, for a longer period of time than those sprays. This malicious mist can go as far as 3 feet away! The droplets settle onto surfaces (think…telephone, keyboard, doorknobs) and we the pick them up with our hands (remember…wash your hands!).

The time they linger in the air is prime-time for spread to others. While we cannot keep that mist from getting into our noses/mouths, we can at least keep the mist from ever getting there in the first place.  That’s why I advise you to cover your cough. It keeps the particles from being spread among your family, friends, coworkers and classmates. It’s just the nice thing to do. Here’s the catch. Don’t cover it with your hand. That will just spread it in a different way. Cover your mouth/nose with the bend in your arm…think of grabbing your left ear with your right hand…that brings your elbow crease to your mouth causing that to get coated in germs instead of your hand. I can’t think of anyone who uses that part of their body to touch things on a regular basis. Do this when you cough or sneeze, every time; and take a moment to teach your children this trick as well.

Be good to yourself. I know this one is a hard one to do and there are many excuses as to why we don’t do this, but treat yourself well. Eat balanced, healthy, wholesome foods that are not filled with preservatives. The antioxidants in food are destroyed by the processing of food. We need those antioxidants to help us from getting sick. Eat a variety of colors in your diet and eat regularly throughout the day. If your body is trying not to starve, it won’t pay much attention to the virus or bacteria that are trying to invade your body. Also, sleep well. Get the optimum number of hours of sleep that you need. Everyone is different, so I won’t preach for you to get eight hours. Some can do fewer, some need more. Children are some who need more (if your child has to be dragged out of bed in the morning, perhaps an earlier bedtime is in order?).

If we don’t get enough time asleep to rest and recharge, the body has increased amount of stress hormones. While back in the days of cavemen those hormones kept us alive running from saber-tooth tigers, the stress of our lives now is not that significant. However, these hormones keep your body on high alert, thinking something big is coming to get us. The thing is, that big thing is not looming over our shoulders with sharp fangs. Sleeping is the one time of the day that we are supposed to relax and let go. When that doesn’t happen, the body is worried more about that tiger than the virus or bacteria trying to make its way into your system. The body has a very eloquent method of protecting itself and if we let that work, it can do wonders.

Vaccinate whenever possible. When we can amplify the body’s natural immunity with vaccinations that is even better; so if you haven’t yet called your PinnacleHealth Medical Group office to get yourself vaccinated against the flu yet, there’s still time and supply available. Some people also need vaccines against streptococcus Pneumoniae (pneumonia vaccine): diabetics, people with lung disease (including asthma) and those without spleens. If you are one of those people, talk to your provider about what other vaccines you may need as well.

Good luck with getting through this cold season. With some preparation, hand washing and TLC, this should be very manageable. If, despite your best efforts, you do get sick, know that we at PinnacleHealth Medical Group are here to help get you better and make you feel better along the way to wellness.

Sandra R. Costa, DO, FAAFP

Heritage Family Medicine

Member, PinnacleHealth Medical Group

Treatment for the Common Cold -- Responsible Antibiotic Usage

Last week we learned about the "dreaded" common cold-- what is it and what can be done to treat it. This week we will concentrate more on what was touched on in the last blog, something that has been a bit of a hot topic in medicine the media in the last few years: antibiotics--when to use them and when are they not necessary. If you've heard in the media about topics such as MRSA, superbug infections, etc., then you may be already familiar with this subject. The development of antibiotics in the 1940’s is certainly one of the greatest advancements in medicine, but in recent years antibiotic overuse has become a serious healthcare concern. Antibiotics are more and more commonly being taken for infections that are known to be caused by viruses, such as the common cold.

So what is the harm in treating a viral infection like Rhinovirus (which usually causes the common cold) with an antibiotic? Many people believe that there are really no downsides to taking an antibiotic; if it helps, then great! If not, then symptoms will improve on their own. This is unfortunately very dangerous thinking. Every time we as practitioners prescribe an antibiotic, and you as a patient take it, the bacteria in your body build a reaction to the antibiotic--they try to fight it. As the bacteria evolve, this can lead the antibiotics to stop working effectively on the bacteria they designed to target.

A common example most are familiar with is the serious topic of MRSA infections. MRSA stands for Methicillin-Resistant Staphylococcus Aureus. Staph aureus is a common bacteria that is normally found on your skin, in your nasal passages, etc. This specific type of Staph described by the term MRSA refers to bacteria that have developed a resistance to the antibiotic methicillin (and others in the same class such as penicillins; drugs that have been used effectively for many, many years). We are now limited to just a few antibiotics that are still effective against this strain of bacteria. This is a very scary thought. Imagine if this scenario continues with this type of bacteria and others? Illnesses that would normally be fairly easy to cure, such as sinus infections, Strep throat, or skin infections without proper treatment could result in a person becoming very sick, and could possibly lead to death.

Not only does antibiotic overuse lead to drug-resistant superbug infections, but it also alters the normal bacteria in your body that help to keep you healthy. Furthermore, it contributes to unnecessary health care costs to pay for the antibiotic, and then pay for prolonged or more serious treatments in the future as antibiotic resistance emerges.

So then, when is it okay to take an antibiotic for the common cold? The answer is NEVER. When the common cold develops into a secondary bacterial infection such as some sinus infections, an ear infection or pneumonia - then an antibiotic could be administered. That is the responsibility of your healthcare provider to determine, and he/she will determine when an antibiotic is needed based on your history and physical. Remember, just because your doctor doesn't give you an antibiotic does not mean that you aren't sick!

If you're still reading, thank you! If you started skimming halfway through (I don't blame you!) then here is the bottom line: Antibiotics do NOT treat viral infections like the common cold and most upper respiratory infections, and can actually lead to harm if prescribed or taken unnecessarily. Please be proactive, take responsibility and join the discussion with your healthcare provider about what the Center for Disease Control (CDC) calls "one of the world’s most pressing public health problems."

Bethany Rhoads, PA-C

Evening Care Camp Hill

The Common Cold

It’s October! It’s back to school time, and the beginning of cold and flu season. Colds and flu tend to be spread more this time of year in part because we all tend to be indoors more, and children are back in school so we are often in closer quarters. But what causes colds? How can we protect ourselves? Are there any good treatments?

Colds and bronchitis are typically caused by viruses. Cold viruses can cause a lot of different symptoms, including sore throat, runny nose and congestion, cough, sinus pressure, headache, ear pressure, and even fever, nausea, vomiting and diarrhea, and rash in some cases. They can make us feel miserable, but are usually not serious. Antibiotics are useless against viruses.

The average viral cold lasts for 7 to 10 days, but some symptoms (especially cough) can last for several weeks. Sore throats from colds usually resolve in the first few days. (Note: If you have a cough with your sore throat, it probably isn’t strep throat.)

Although most colds resolve on their own no matter what we do, occasionally bacteria can start to grow in the mucus in your respiratory tract and cause a secondary infection. Unlike viruses, which can cause symptoms all over your body, bacteria tend to hit only one area. Secondary infections following a cold include sinus infections (sinusitis), ear infections (otitis media), and pneumonia. Signs of a secondary bacterial infection include a prolonged illness (more than 10 days) or new symptoms such as earache, high fever, sinus pain, or loss of appetite several days into a cold. (Yellow or green nasal drainage is common during a cold, and does not necessarily indicate a sinus infection.)

Antibiotics are used to treat bacterial infections like sinusitis or pneumonia, but are useless against viruses. Using antibiotics unnecessarily can cause problems. Antibiotics can cause side effects like yeast infections or diarrhea, or occasionally allergic reactions. In addition, when antibiotics are used frequently, bacteria can become resistant to them and they will no longer work. Unfortunately, antibiotic resistance is becoming more and more common, and there are now bacteria that are resistant to many antibiotics. Because of these risks, we try to prescribe antibiotics only when we feel they will be effective, such as for sinusitis or pneumonia. Please don’t pressure your doctor to prescribe an antibiotic if he or she feels it isn’t needed. Taking an antibiotic when you have a cold will not reliably prevent a bacterial infection, may give you side effects, and may increase the likelihood that your next infection will be resistant to that antibiotic.

There are several things you can do to prevent catching or spreading colds:

• Wash your hands or use hand sanitizer regularly throughout the day, especially if you touch or blow your nose, or before eating.
• Try to make sure you are getting enough sleep.  People who get less than 7 hours of sleep daily are much more likely to catch colds.
• Try to eat a healthy diet, with several servings of fruits and vegetables daily.  Better nutrition will improve your resistance to cold viruses.
• Cover coughs and sneezes by coughing into a tissue or into your sleeve.

If you do catch a cold, there are some things you can do. Get plenty of sleep. Try nasal saline spray to thin nasal mucus. Try sips of ice water or suck on throat lozenges to ease a sore throat. Cold medicines may help improve some symptoms of colds, but they will not cure a cold or get you better any faster. They can also cause side effects, so if you must take something, try to stick to products with single ingredients just for the symptoms you have.

There are some cold remedies that should be avoided by certain people:

• Avoid decongestants if you have high blood pressure. They can cause an unsafe rise in blood pressure.
• Avoid antihistamines if you have glaucoma or an enlarged prostate. They can increase eye pressure or make it difficult to urinate.
• Avoid cough suppressants if you are taking antidepressants, since they can cause a rare but serious interaction. Ask your healthcare provider if you aren’t sure.

I hope you find this information helpful.  Have a healthy, safe autumn!

Megan Borror, M.D.

Colonial Park Family Practice
PinnacleHealth Medical Group

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

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!

Symptoms
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.

Complications
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

Kathleen M. Zimmerman, MD

Heritage Pediatrics
Pinnacle Heath Medical Group

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

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 21^st 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 R. Costa, DO, FAAFP

Heritage Family Medicine

Member, PinnacleHealth Medical Group