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James L. Holly, M.D. |
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| James L. Holly,M.D. |
| October 28, 2004 |
| Your Life Your Health - The Examiner |
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Isn't it amazing how supply and demand work, even in healthcare? When the supply is limited, suddenly the demand becomes unlimited, even when the demand might have been low, when the supply seemed unlimited.
The flu vaccine has become much more popular in the past few years, particularly as the science has improved. Taking a flu shot decreases your probability of getting the flu by almost 90%. With over 30,000,000 people in the US getting the flu each year and with over 30,000 deaths from the complications of the flu, this is not an inconsequential benefit from taking a simple immunization.
However, these statistics need to be balanced by the fact that almost 90% of people in the United States DO NOT get the flu, even if they don't take the flu shot. A flu shot is imperative, even this year, if you are in a high risk group. This includes:
- People 50 years old or above
- Anyone who lives or works in a college, nursing or long-term care home, assisted living residence, or similar facility
- Adults and children (6 months of age or older) who have chronic heart or lung conditions, including asthma
- Adults and children (6 months of age or older) who need regular or follow-up treatment for a kidney, immune, blood, or metabolic disorder (like diabetes), and anyone else who lives in the same household
- Children (6 months to 18 years) who are on aspirin therapy, because a viral infection like the flu puts them at risk for Reye's syndrome
- Pregnant women who will be in their second or third trimester during flu season
- Doctors, nurses, hospital employees, home caregivers, and
- household members of people in high-risk groups
What If I Can't Get a Flu Shot?
In the absence of a flu shot, common sense works almost as well. Statistically, two things work almost as well as the flu shot:
1. Cover your mouth if you cough and ask others to do the same. Virus are spread by droplets of fluid which are propelled through the air by coughing. Avoiding these droplets is one way of avoiding the flu.
2. Washing your hands frequently. Viruses can survive on the skin for several hours. With a virus on your hands from hand shaking or other physical contact, you can infect yourself by touching your mouth or nose. We'll discuss more about handing washing later.
Other common sense measures
1. Get plenty of rest. Your own immune system can often defeat a virus, attempt to invade your body, but not when you are fatigued. Fatigue diminishes the effectiveness of your own immune responses. So, a good night's sleep is one excellent anti-viral method.
2. Physical activity stimulates the blood flow in your body, the clearing of your lungs and the mobilization of many other factors in your body which improves your chances of not getting the flu. Stay active. Get exercise. It's better than the flu shot.
3. Hydration is important. Drinking your 64 ounces of water a day will help your body's immune system fight off the flu. Don't forget to get plenty of fluids before you are ill and if you get sick.
4. Nutrition is important. Eating a well balanced diet, which includes vegetables and fruits is critical to avoiding the flu. Your immune system is dependent upon your diet. Junk food, fast food, fried foods and fatty foods, all impair your ability to fend off viruses.
5. Avoiding stress will help you avoid the flu. Stress impairs your immune response. While it is not possible to control the things which happen to us, it is possible to control our responses. Learn to live with what you can't change and change what you can't live with.
Of course, these strategies for avoiding the flu are important all year long, not just in the flu season.
Medications for the Flu
If you can not get a flu shot and you are exposed to someone with the flu, you might ask your doctor about prescribing an antiviral drug to help prevent you from getting sick. These flu drugs include:
- amantadine (Symmetrel)
- rimantadine (Flumadine)
- oseltamivir (Tamiflu)
Although usually only prescribed for seven days after your flu exposure, they can also be used long-term for the whole flu season if you are considered high risk for getting seriously ill from the flu and you did not get a flu shot.
These flu medicines, along with zanamivir (Relenza), can also be used as treatment if you get sick with the flu. As a flu treatment, they can shorten the time a person infected with influenza feels ill by approximately 1 day, if treatment is started during the first 2 days of illness.
The drugs aren't perfect, though. Up to 10 percent of people taking amantadine experience side effects including:
- nausea
- dizziness
- insomnia
These problems are less common with rimantadine. People with kidney disorders and certain psychiatric conditions may have a serious reaction to these drugs. In addition, they aren't foolproof, because the type A virus can develop drug-resistant strains.
In 1999, a new class of flu drugs called neuraminidase inhibitors came on the market, zanamivir (Relenza) and osteltamivir (Tamiflu). The newer drugs have some advantages over the previous ones:
- they suppress both types of influenza (A and B), and
- they inhibit most strains, not just the strains of the season.
Like the other antivirals, neurmaninidase inhibitors only work if you take them within the first 48 hours, and they generally shorten the length of a flu by about a day.
They also have side effects to watch for: People with chronic lung conditions such as asthma and chronic obstructive pulmonary disease may have trouble breathing or feel like their lung capacity is reduced while on zanamivir, and should keep a fast-acting inhaler handy. Osteltamivir produces nausea and vomiting in about 10 percent of people, and some of the less common effects include vertigo and insomnia. The FDA also recommends that osteltamivir not be given to infants less than a year old.
Echinacea and the Flu
Finally, Echinacea has been reported to boost the immune system, and some studies show it can reduce the severity and length of cold and flu symptoms. In one study, a daily 900-milligram Echinacea supplement during a bout with the flu significantly reduced patients' symptoms, including weakness, fatigue, chills, sweating, sore throat, muscle and joint aches, and headaches, when compared to both a placebo and a lower dosage (450 mg).
Other Tips to Avoid the Flu
Whether or not you got a flu shot, since it isn't 100% effective, you should follow these steps to help prevent you and your family from getting sick with the flu.
Wash Your Hands
One of the most important thing that you can do to keep from getting sick is to wash your hands often. Unfortunately, many people, especially kids, either do not wash their hands often enough or don't do it correctly. You should wash your hands often. Probably more often than you do now because you can't see germs with the naked eye or smell the, so you do not really know where they are hiding.
When should you wash your hands?
One of the most common ways people catch colds and the flu is by rubbing their nose or their eyes after their hands have been contaminated with a virus. By washing your hands often, especially:
- before, during, and after you prepare food
- before you eat, and
- after you use the bathroom
- after handling animals or animal waste
- when your hands are dirty, and
- more frequently when someone in your home is sick
you may avoid getting sick yourself and keep your kids from getting sick too.
What is the correct way to wash your hands?
- First wet your hands and apply liquid or clean bar soap.
- Place the bar soap on a rack and allow it to drain.
- Next rub your hands vigorously together and scrub all surfaces.
- Continue for 10 - 15 seconds or about the length of a little tune. It is the soap combined with the scrubbing action that helps dislodge and remove germs.
Protecting Children
Routinely clean, with soap and water, and disinfect surfaces, toys, and objects that younger children may put in their mouths. It may also help to wipe surfaces with paper towels that can be thrown away or cloth towels that can be washed afterwards.
- Use disposable tissues to wipe or blow your child's nose.
- Teach your children 'cough etiquette', which the American Academy of Pediatrics describes as teaching 'your children to turn their heads and cough or sneeze into a disposable tissue or the inside of their elbow if a tissue is unavailable'.
- Avoid close contact with people when you are sick.
It isn't really possible to completely avoid people who are sick, so it is likely better if you just avoid exposing other people to your germs when you or your kids are sick. So don't go to school, daycare, work, etc., if you are sick with the flu.
Avoid unnecessary contact with a lot of people for your younger children. It isn't easy to always tell when people are sick and some people are contagious even before they start to have symptoms, so don't expose your younger kids to large crowds of people if you don't have to.
Since the virus can survive on surfaces for hours -- wash your hands as often as possible. If you can't get to soap and water use a commercial hand washing preparation. Studies show these are highly effective at killing influenza and other viruses.
Airplanes and the Air in the Plane
What about the air you breathe on planes? It passes though the same type of filters used in operating rooms - highly effective at keeping viruses from circulating. But the filtration does not protect you from nearby passengers, rude enough to not cover their mouths when they cough or sneeze. Your greatest risk is going to be in very close proximity with somebody that, if you will, kind of showers your airspace with their virus.
The expert advice is try to change seats and don't be shy about complaining if you can't. It might allow you to end your trip as healthy as you were when you started.
Conclusion
The good news is that we will survive the flu season and you will too. If you get sick, contact your physician immediately. Few people, aggressively treated early, will succumb to the flu virus. Remember, it is your life and it is your health.
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