Influenza Cases On the Rise in Pennsylvania

 Blog contributed by Dr. Joseph Cincotta, primary care physician

Flu season has arrived!!  And, there is still time for you to get your annual Flu Vaccine.

Pennsylvania is experiencing a rising number of cases of acute influenza, most of which is due to the H1N1 virus strain – a strain that is in this year’s influenza vaccine. So, if you get vaccinated timely you should have increased protection from getting ‘The Flu’.

Why are we so concerned about this infection?  Acute Influenza is NOT the same as getting ‘a bad cold’.  Acute Influenza can be a deadly disease – even for otherwise healthy individuals.  Comments like ‘I usually don’t get sick’, or ‘This will never happen to me’, or ‘The risk of a flu shot is more than the risk of me getting sick from the flu’ are examples of comments I have had from patients who decline an annual flu shot.  And, each of these comments leaves those patients who decline the opportunity to get immunized vulnerable to a deadly infection.  So, first and foremost – GET VACCINATED – AND DO IT TODAY.

Other ways to reduce your risk of getting Influenza include:

• Avoid crowded areas
• Wash your hands regularly, or use an alcohol based hand cleanser, regularly
• Cover your mouth if you are coughing or sneezing – the Flu virus is spread by microscopic droplets when people cough or sneeze
• If you are sick, stay home – do not expose others to your illness

Influenza (or ‘The Flu’) is characterized by the rapid onset of a number of symptoms that may be severe. People who get ‘the flu’ often tell us they were fine in the morning but by the afternoon they felt terrible and had developed a number of the symptoms detailed blow.  Flu generally does not come on slowly over the course of a couple of days.  Symptoms include:

• Fever (which often can be quite high)
• Headache (which often can be severe)
• Muscle/body aching (which often is severe)
• Runny or congested nose
• Sore Throat
• Cough
• Vomiting and/or diarrhea (not as common as the other symptoms and less common in adults with the flu)

If you feel you have ‘The Flu’, please contact your primary care physician’s office for additional recommendations.  You may be asked to go to the office for an evaluation, particularly if you have other chronic illnesses, such as COPD, emphysema, asthma, heart disease, diabetes, or chronic kidney disease. Depending on your particular situation you may be eligible for an antiviral medication to help treat the flu. Other measures you can take to help treat some of your symptoms include:

• Rest
• Maintain a good fluid intake
• Acetaminophen for the fever and aching (as long as you may take this medication)

Here are some warning signs that the illness may be more severe and may require the assistance of your primary care provider for treatment (these are taken from the Centers for Disease Control and Prevention website):

What are the emergency warning signs?

In children

• Fast breathing or trouble breathing
• Bluish skin color
• Not drinking enough fluids
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough
• Fever with a rash

In addition to the signs above, get medical help right away for any infant who has any of these signs:
Being unable to eat

• Has trouble breathing
• Has no tears when crying
• Significantly fewer wet diapers than normal

In adults

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms that improve but then return with fever and worse cough

Influenza season is here once again – and we all can take steps to reduce our risk of this serious illness.

Follow the steps outlined above – and, most of all please get your Flu Vaccine, if you have not already done so.  Thank you.

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

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