That Time Of Year Again: Cold and Flu Season

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By Mary O’Brien, M.D.

It’s that time of the year again.  It’s that awful season when nearly every third person you encounter looks and feels miserable.  Headache, fever, cough, congestion, myalgia, and malaise signal flu season is in full force.  Health officials are already proclaiming this (2017-18) the worst flu outbreak in over a decade.  Considering the dreadful natural disasters of 2017 and record-breaking cold temperatures across two-thirds of the nation, we shouldn’t be surprised.  Every year flu outbreaks spike shortly after the holidays, and the travel, stress, sleep deprivation, and crowds associated with the holidays.

A few time-tested, common sense measures may help protect you, your loved ones, colleagues, and patients:

  • Wash your hands. Wash your hands.  Wash your hands — thoroughly and often.  Hot, soapy water is best, but hand sanitizers and disinfectant wipes come in handy at the grocery store or in the car.
  • Avoid touching your face, especially around your eyes, nose, and mouth. These areas can serve as an entrance ramp for viruses.  Try to resist the temptation.
  • Increase your fluid intake. Bitter cold temperatures combined with heat from furnaces and fireplaces increase insensible fluid losses (fluid lost from skin and breathing).  The resulting dry mucus membranes are not only uncomfortable, but they’re more vulnerable to viral penetration.  Water is best here.
  • Get more sleep than you think you need. A single night of inadequate sleep can compromise lymphocyte numbers and function.  Give your immune system the restorative time it needs to protect you.
  • Don’t overextend yourself. Most folks are already tired from the holidays.  Give yourself some downtime before you have no choice in the matter.
  • Avoid crowds like the plague. Contagion is partly a numbers game.  No one has to go to a crowded movie theater or restaurant.  Stay home and clean out a closet.
  • Consider getting a flu shot now. So far this year (2018), the efficacy rating is not good.  But, some protection is better than none.  Remember, antibody production will take about two weeks after the shot.

And — finally — if you do get the flu, please stay home.  There is nothing noble or heroic about spreading influenza to colleagues and patients.

In the meantime, stay warm and well.  I have to go wash my hands now.

Influenza

Posted on Posted in Continuing Education, Elder Care, Homestudy, Nutrition, Seminars, Webinars

By Raj Hullon, M.D., J.D.

The flu is a contagious infection that affects the nose, throat, and lungs.  Onset is more abrupt compared to the common cold.  Symptoms can range from mild to severe, even leading to life-threatening complications.  Nausea, vomiting, and diarrhea are more common in children than in adults.  Other flu symptoms include:

  • fever (usually high).
  • extreme fatigue.
  • dry cough.
  • sore throat.
  • nasal congestion or runny nose.
  • muscle aches.
  • impaired sense of taste and smell.
  • loss of appetite.

Although flu-related morbidity and mortality vary from year to year, the CDC estimates that between five and 20 percent of Americans contract flu in a given year and that 200,000 people are hospitalized for treatment of flu-related complications.  Approximately 36,000 deaths a year result from flu-related causes in the United States (cdc.gov).

Seasonal flu refers to any of the combinations of influenza viruses that circulate throughout the world each year.  The flu season in the United States can begin as early as October and run through March.  The Center for Disease Control (CDC) tracks circulating flu viruses and related disease activity all year and, between October and May, provides weekly influenza updates at http://www.cdc.gov/flu/weekly/fluactivitysurv.htm.   Pandemic flu refers to a global outbreak of flu that can overwhelm the health care system.  The cause is most likely a strain of influenza virus that is new or that has not circulated recently enough for large portions of affected populations to have built up gradual immunity to it.  Therefore, healthy individuals are at risk for complications following infection during a pandemic flu outbreak.  Seasonal flu, however, usually leads to fewer complications in healthy adults.  During the 1918 pandemic, for example, the estimated deaths from the disease and disease-related complications reached 20 to 40 million individuals globally. Fortunately, pandemic flu outbreaks are rare.  There were only three pandemic outbreaks in the 20th century while seasonal flu is annual and peaks in January or February.

Cold Symptoms and Prevention

Posted on Posted in Continuing Education, Homestudy, Seminars, Webinars

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By Ben Hayes, MD, PhD, FAAD

Cold symptoms generally emerge between one and three days after a cold virus enters the body.  The symptoms resolve in a week — with or without medication. One cold in four lasts up to 14 days; this most often occurs in children, the elderly, and people who are in poor health. Smokers often have more severe, extended cold symptoms than nonsmokers.

Fewer than five percent of colds lead to such complications as bronchitis, middle ear infection, or sinusitis accompanied by a prolonged cough, but between 5 and 15 percent of children who have colds develop acute ear infection when bacteria or viruses infiltrate the space behind the eardrum. A cold can produce wheezing, even in children who do not have asthma, and symptoms of asthma, bronchitis, and emphysema can be exacerbated for many weeks. Symptoms that persist for more than two weeks or that recur might be more allergy than infection-related.

Post-infectious cough, which usually produces phlegm, may disrupt sleep and persist for weeks or months following a cold. This complication has been associated with asthma-like symptoms and can be treated with asthma medications prescribed by a physician.  Medical attention is indicated if symptoms progress to:

  • ear pain.
  • high fever.
  • a cough that worsens as other symptoms abate.
  • a flare-up of asthma or of another chronic lung problem.
  • significantly swollen glands.
  • strep throat.

Babies can have between five to seven colds during their first two years of life. This enhanced susceptibility results both from immature immune systems and from exposure to older children who are often careless abut washing their hands or covering coughs and sneezes. Nasal congestion and runny nose are the most common symptoms of colds in babies. Treatment consists of breathing moist air and drinking plenty of fluids. Medical attention is indicated at the first sign of a cold in infants less than three months of age because of a heightened risk for pneumonia, coup, and other complications.

Physician evaluation is also necessary if a baby of any age:

  • has an uncomplicated cold, the symptoms of which last for more than seven days.
  • does not wet a diaper properly.
  • refuses to nurse or accept fluids.
  • coughs up blood-tinged sputum or coughs hard enough to cause vomiting or changes in skin color.
  • has trouble breathing.
  • has bluish-tinted lips or mouth.
  • has a temperature higher than 102°F for one day.
  • has a temperature higher than 101°F for more than three days.
  • shows signs of having ear pain.
  • has reddened eyes or yellow eye discharge.
  • has a cough or thick green nasal discharge for more than a week
  • has any other symptoms that concern parents and/or caregivers

Prevention

Common sense plays an important part in preventing the common cold. Absolute avoidance of cold viruses is virtually impossible to achieve, but experts advise keeping a healthy distance from anyone who is ill. The actions the human body takes to clear infection are the same actions that spread the infection to others. Sneezing, for example, is a response to irritation of the nose and mouth. Sneezing as well as a runny nose is the body’s attempt to expel cold viruses before they can invade the nasal passages more deeply. Unfortunately, a sneeze sends infectious particles hurtling through the air at a speed of more than 100 miles an hour.

Simply being in the company of someone who has a cold can contaminate the hands of another person. Touching one’s eyes, nose, or mouth can transfer the infection. It is imperative to wash hands thoroughly after touching someone who has a cold or something that has been touched by someone who has a cold. Playthings touched by a child who has a cold should be washed before being put away. Cleaning surfaces with antiviral disinfectant may help prevent the spread of infection, and increasing interior humidity can reduce susceptibility.

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Flu Vaccines and How They Work

Posted on Posted in Continuing Education, Elder Care, Seminars, Webinars

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By Dr. Mary O’Brien MD

Composed of two type A viruses and one type B virus, seasonal flu vaccines change annually to reflect the viral types and strains that international surveillance and scientific analysis predict will circulate during a given year. Each vaccine’s protective potential is determined by individual health status and by similarities among the viruses contained in the vaccine and those in circulation. A vaccine that closely matches circulating viruses protects most people from serious flu-related illness.
Even a vaccine that is not a close match affords a degree of protection. Flu vaccines do not protect against flu-like illnesses, which are caused by non-influenza viruses. Also, seasonal flu vaccine does not provide protection against type C influenza.
Seasonal flu vaccine is available in two forms: injected and intranasal routes. Injected vaccine is made from inactivated viruses while the intranasal is an live-attenuated virus.

Live-attenuated influenza vaccine (LAIV) is a flu vaccine in the form of a nasal spray. LAIV is made from live, weakened viruses that do not cause the flu. The Center for Disease Control has approved LAIV for use in people between two years and 49 years of age who are healthy and who are not pregnant. LAIV is also an approved option for people who live with or care for those at high risk for contracting flu. It is not recommended for caregivers of people whose severely compromised immune systems require a protected environment. These healthy individuals should get the flu shot.

Flu vaccinations may be given at the same time that other vaccines are administered. Although vaccination is advisable as soon as seasonal vaccines become available, being vaccinated later in the flu season, like December, still confers benefit in most years. One dose of vaccine a year is sufficient for most people. Children under nine years of age who are being vaccinated against flu for the first time or who were initially vaccinated with a single dose during the previous flu season should receive two doses of vaccine at least four weeks apart.

Side effects associated with flu shots are generally mild, appear shortly after the injection, and persist for a day or two. They include soreness: redness; and swelling at the injection site; low-grade fever; sore or red eyes; and aches. LAIV can cause headache and runny nose. Adults may also develop sore throat or a cough, and children may wheeze, vomit, and have muscle aches or fever.

Symptoms of rare, serious reactions include:

  • high fever
  • behavioral changes
  • breathing difficulties
  • hoarseness or wheezing
  • hives
  • paleness
  • weakness
  • rapid heartbeat
  • dizziness

Although flu-related morbidity and mortality vary from year to year, the CDC estimates that between five and 20 percent of Americans contract flu in a given year and that 200,000 are hospitalized for treatment of flu-related complications. Approximately 36,000 deaths a year result from flu-related causes in the United States. Always check with your doctor before getting a flu vaccination. Also, many local pharmacies offer flu vaccinations in the store to fit your schedule.

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The Case of the Common Cold

Posted on Posted in Continuing Education, Elder Care, Homestudy, Nutrition

The most prevalent of all human illnesses, the common cold, is a minor infection of the upper respiratory tract. It mainly involves the nose and throat but can extend to the sinuses, ears, and bronchial tubes. As a general rule, cold symptoms are milder than flu symptoms and most people recover in seven to ten days. Some signs of the common cold are:cold-treatment

  • low grade fever
  • sore throat
  • coughing and/or sneezing
  • nasal congestion or runny nose
  • slight muscle aches
  • mild headaches
  • watery eyes

Cold symptoms generally emerge between one and three days after a cold virus enters the body and resolve in a week — with or without medication. One cold in four lasts up to 14 days; this most often occurs in children, the elderly, and people who are in poor health. Smokers often have more severe, extended cold symptoms than nonsmokers.

Fewer than 5 percent of colds lead to such complications as bronchitis, middle-ear infection, or sinusitis accompanied by a prolonged cough, but between 5 and 15 percent of children who have colds develop acute ear infection when bacteria or viruses infiltrate the space behind the eardrum. A cold can produce wheezing, even in children who do not have asthma, and symptoms of asthma, bronchitis, and emphysema can be exacerbated for many weeks. Symptoms that persist for more than two weeks or that recur might be more allergy than infection related.

Post-infectious cough, which usually produces phlegm, may disrupt sleep and persist for weeks or months following a cold. This complication has been associated with asthma-like symptoms and can be treated with asthma medications prescribed by a physician. Medical attention is indicated if symptoms progress to:

  • sinusitis
  • ear pain
  • high fever
  • a cough that worsens as other symptoms abate
  • a flare-up of asthma or of another chronic lung problem
  • significantly swollen glands
  • strep throat
  • bronchiolitis
  • pneumonia
  • croup

Beginning in late August or early September, the incidence of infection rises gradually for a few weeks and remains elevated until declining in March or April. Seasonal variations in susceptibility may be related to cold weather or to months when school is in session―times when people spend more hours indoors and chances of interpersonal transmission are enhanced. Changes in relative humidity may also have an effect. Cold temperatures dry the lining of nasal passages and increase vulnerability to infection by common cold-causing viruses that thrive in such weather.

Over the course of a lifetime, a person has been estimated to spend the equivalent of five years suffering from the common cold. One-fifth of that time, cold symptoms are severe enough to require bed rest. Women get more colds than men―especially women between 20 and 30 years of age―and adults over 60 years of age get less than one cold a year on average.

Learn more about the common cold and influenza through our homestudy courses.

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