A Nasty Flu Season

February 7th, 2013 By Steven Knope, MD

As you have all learned by now, this has been a particularly ugly cold and flu season. The flu epidemic hit the country about 5 weeks early this year. Fortunately, this epidemic has peaked and the number of cases is declining. However, you are still at risk of getting influenza – even if you have had the flu shot – and it will be the end of February before this is all over.

In addition to the flu there are two other infectious diseases that have been circulating throughout the Tucson community. This edition of the Pearl will cover the 3 most common infections you are likely to encounter: Flu, Gastroenteritis and The Common Cold.

Flu:
Flu, or influenza, is a viral infection that is manifest by fever, cough and malaise. People feel very ill with the flu. Flu is quite different from the common cold, which starts out slowly, is manifest by sneezing and a runny nose and is merely an annoyance. Flu often has a sudden onset. Many people have such an abrupt onset of symptoms that they can remember the exact time of day that their symptoms began.

People with flu often have profound fatigue. They can have chills and muscle aches. Some have diarrhea and GI symptoms in addition to cough and fever. Unfortunately, some of the fatigue associated with the flu can last for weeks. Flu can be complicated by viral or secondary bacterial pneumonia, so persistent fever and cough are red flags, which should prompt a call to me. People with heart conditions, lung conditions, chronic kidney disease, the young and the elderly are at most risk of developing the complications of flu.

Gastroenteritis Due to Norovirus:
The second most common infection spreading through Tucson is gastroenteritis. Gastroenteritis is an illness associated with nausea, vomiting and diarrhea. The present epidemic of gastroenteritis is due to a virus called Norovirus, which can be quite uncomfortable.

The full-blown syndrome of Norovirus infection includes nausea, vomiting and diarrhea. Some people suffer from a milder version, with only diarrhea or nausea. The good news is that this illness generally lasts no more than 24 to 48 hours.

Norovirus is extremely contagious. It is the cause of most cruise ship outbreaks of gastroenteritis. You can become infected with Norovirus with as few as 5 viral particles on your hand.

Common Cold: There are many people who confuse a cold with the flu. Again, a cold comes on more slowly. It is associated with a scratchy or sore throat, runny nose and sniffles. Colds do not cause a high fever in adults. Colds are annoying to be sure, but a cold does not cause debilitating symptoms.

Prevention

The best way to prevent getting these three infections is to take the following measures:

1) Become a compulsive hand washer during the winter months.

2) Stay away from sick people. If someone coughs or sneezes near you, stop inhaling and walk away. The droplets carrying virus particle from a sneeze can travel 6 to 12 feet.

3) Try to avoid touching your face and mouth during the cold and flu season.

4) If you are exposed to someone with flu, especially if you have not had a flu shot, call me and we can talk about whether you should take Tamiflu on a preventative basis.

5) Flu Shots: The flu shot is about 65% effective. This means that the flu shot does not prevent everyone from getting the flu. It means that about 65% of people who have received the flu shot will not require medical attention for treatment of the flu.

However, some of these people will still get a milder case of the flu.

What to do if you get these Infections

General: First, if you have any concerns feel free to call me and tell me about your symptoms. I can easily tell you if you have something to worry about and whether or not you need to see me. If you have a fever of 101 or higher, always call me.

Flu: If you develop a fever and cough, and you think you may have the flu, call me promptly – whether or not you’ve had the flu shot. The drug Tamiflu is quite effective in reducing the severity and duration of the flu, provided that it is given early. Tamiflu is most effective when given within the first 24 hours of symptoms. If you have had the flu for 48 hours or longer, Tamiflu will not help. Most flu experts warn that doctors are not prescribing enough Tamiflu, believing that if people have had a flu shot their symptoms may be due to something else. Flu is a clinical diagnosis. If it looks like flu, and you are in the middle of a flu epidemic, it should be treated as flu with Tamiflu, even if you’d had a flu shot.

Norovirus: If you ever have vomiting it is a good idea to call me. Even if your symptoms are likely due to Norovirus, I can call in a very effective drug to stop the vomiting and resolve your nausea. In addition, there are many medical problems that can cause nausea and vomiting, so you should not just assume that your symptoms are due to a viral infection – especially if you have a fever or abdominal pain. I’ve seen people for nausea and vomiting, believing that they had a virus during an epidemic, when they were having a heart attack. Don’t try to be your own doctor.

Provided that you do not have a high fever, or bloody diarrhea, Imodium is the best drug to stop the diarrhea from a viral infection like Norovirus. Imodium is available over-the-counter. Take two tablets after the first bout of diarrhea, and then take one additional tablet after each subsequent episode of diarrhea.

During a GI infection like Norovirus, you will want to keep well hydrated. You will want to eat foods that are easy to digest, since the virus causes a temporary injury to the lining of your intestines. It is a good idea to follow the BRAT Diet: Bananas, rice, apples, and toast – foods that are bland and easy to digest. Noodle soup is fine. Stay away from milk products and fatty foods until your GI tract returns to normal.

Cold: Despite the belief that there is nothing that you can do to treat a cold there is one prescription drug that has proven effective in reducing the duration and severity of common cold symptoms. This drug is called Ipratropium nasal spray and it is taken at a dose of two puffs in each nostril, 4 times per day for 4 days. Since I get a fair number of colds from my kids and my patients I use this drug regularly. This is a prescription drug, so if you want to try it, you will need to get a prescription from me. The key is to start the drug as soon as you get a scratchy throat. If you wait until you are all stuffed up it will not work as well.

I recommend using Ipratropium in combination with over-the-counter Afrin nasal spray in a very specific sequence. If you’d like instructions on how to use these drugs, along with a prescription for Ipratropium, just let me know. I’ll send you a simple protocol that I follow when I get a cold. A word of caution: Do not take over-the-counter Afrin for more than 4 days, as doing so can cause a rebound swelling of your nasal passages that can last for months and is very difficult to treat.


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