Pertussis

Contributed by  Betsey Miller, CRNP, PinnacleHealth Medical Group

I was lying awake, listening to my son cough – again. How many nights had it been?  I was trying to count them up in my head and remember when his cough had first started.  Had it been two weeks or three? My thoughts were interrupted by another coughing fit.  I went in to check on him.   He was sitting up now, gasping for air in between fits of coughing.  Tomorrow, I promised myself.  Tomorrow I would call for an appointment. 

When it comes to my kids, I’m a mother first.  But I’m also a family nurse practitioner.  And as I settled us both back to bed that night the list of possible diagnoses were running through my head.  As I thought about his coughing fits and the length of time he’d been coughing, I couldn’t help but consider pertussis as a possibility.

Pertussis, also known as whooping cough, is a highly contagious illness, characterized by severe coughing fits that can last for weeks.  It can be hard to detect initially, because its early symptoms are not unlike those of a common cold – runny nose, mild cough, low grade fever.  But as the disease progresses the coughing fits become more pronounced.  And the cough can last for up to 10 weeks!

Pertussis has made a resurgence in the last few years.  There are a number of reasons behind this, but the driving force has been a decreased immunity in our overall population.  Our children get immunized against pertussis as part of their routine immunization series as babies, but it is a series of immunizations, and they are not considered to be fully protected until they have completed the series at age 5.  Even then, no immunization is considered 100% perfect. However, studies have shown that immunization lessens the spread of the illness significantly.  Additionally, persons who become infected who were previously immunized have shorter courses of illness and do not become as sick.  

Because adults are more likely to transmit the illness, and because infants are the most susceptible, it is recommended that all caregivers of infants be updated with a Tdap vaccine.  Pregnant women are often offered this vaccine in their third trimester, or in the hospital shortly after delivery.  But other caregivers including fathers and grandparents should consider getting immunized too.  Pertussis infection in an infant can truly be a life threatening situation. 

As an adult, if you’re due for a tetanus shot, you should check to see if you need a pertussis booster.  If so, instead of getting just a plain tetanus shot (Td), you should consider getting an injection with pertussis (Tdap).  Remember, this will not only help to protect you from getting whooping cough, but it will also protect those around you. 

As for my son, I did take him to his primary care provider the following day.  He had a culture for pertussis, but thankfully it came back negative.  A chest xray showed pneumonia, but after a short course of antibiotics, he’s no longer coughing and is back to his old self!

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

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