Dear Doc: Fighting the flu in Eagle County
Eagle County CO, Colorado
EAGLE COUNTY, Colorado ” This week I am bringing you some good news and some bad news, and then a bit more bad news. Ever the optimist, first the good news.
The flu shot works, and is “on target” for the strains of Influenza A and Influenza B this year. There is still time to get your flu shot, so if you have not received one yet, don’t wait. Now the bad news. First and foremost, the flu is here in our community and believe me, you do not want to catch it. The second part of the bad news is that the Influenza A strain spreading like wildfire is resistant to most prescription anti-flu medications.
If you’ve never had the flu, thank your lucky stars. If you have had it, I’m sure you haven’t forgotten! A week in bed, body aches, a nose that runs worse than a leaky faucet, nausea, fevers, even your hair hurts. Too tired to get up, feeling too miserable to fall asleep, there is nothing to do except watch old re-runs and bad TV.
Is it too late for me? I’ve heard the flu is here. Is there anything I can do?
Dreading the flu in Gypsum
Prevention is often the best medicine. We talked about the flu vaccine last fall, and it is still available. Although especially important for high-risk groups of people including those over age 50, children and anyone with chronic medical problems like diabetes, asthma and emphysema, the flu shot is recommended for almost everyone. There is more to prevention than just a shot though. Keeping your immune system healthy is important. Getting adequate sleep, eating healthy and managing stress are all essential. Beyond that there are some over the counter remedies. Vitamin C in doses of 200 to 6,000 mg daily can help. Dr. Linus Pauling fervently advocated the use of high dose vitamin C. His work showed about 50 percent of those who took large doses of the supplement benefited with fewer colds. The NIH (National Institute of Health) recently increased their recommendation of dietary vitamin C intake to 200 mg daily. Other anti-oxidants like vitamin E may help too. While the scientific data is still limited on any of these treatments, Echinacea and zinc may offer benefits as well. These supplements are safe and early use is probably essential.
Previously we had four prescription medications which have been well shown to decrease both the duration and severity of the flu. These included the older medications amantadine (brand name Symmetrel) and rimantadine (brand name Flumadine), the newer oseltamivir (brand name Tamiflu) as well as the recently introduced zanamivir (brand name Relenza). Beginning in 2006, Influenza A resistance to amantadine and rimantadine began to develop. Since then resistance to Tamiflu has increased as well. In the 2007-2008 flu season nearly 11 percent of influenza A was resistant to it, leaving only Relenza as being reliably effective. While Tamiflu and Relenza work against influenza B strains as well, amantadine and rimantadine do not.
The best choice this flu season is Relenza, unless we have only locally susceptible strains of Influenza A present. CDC recommendations are to try to track exactly which strains of the flu are present in our (or any) area. That is not always easily done, and different strains may be present at the same time. Unless you can be confident you have a susceptible strain of influenza (ask your doctor), the CDC recommendation is to use Relenza or a combination of Tamiflu and either amantadine or rimantadine to cover both Influenza B and resistant A strains.
The key to the use of any of these medications is early treatment. Starting treatment in the first 24 hours is preferred and the benefit rapidly decreases after 48 hours. While early treatment may reduce the severity of flu symptoms, these medications only shorten the course of your illness by one day. It is important to talk to your doctor about which type of flu is in the community before choosing a medication. Relenza is the only medication of the four that is inhaled and should not be used if you have asthma or emphysema. Relenza is also only for adults and children over 7 years of age.
So how do we know it is the flu and not a cold? The following table will help:
Symptom Flu The Common Cold
Onset Rapid (hours) Gradual (many hours to days)
Fever Common (100.5 to 104 F) Uncommon
Muscle Aches Severe Mild or none
Appetite Poor (anorexia) Average
Fatigue Severe for days to weeks Mild for 1 to 2 days
Malaise (run down) Severe for days Mild or none
Chest Discomfort Common, significant Uncommon or mild
Cough (dry) Common, severe Uncommon or mild
Stuffy Nose Uncommon Common, significant
Sneezing Uncommon Common, frequent
Sore Throat Uncommon, mild Common, mild to moderate
My best advice is to stay healthy, exercise, eat right, drink plenty of fluids, wash your hands and get plenty of sleep. If you have not had a flu shot, get one! Prevention is the best medicine. If you are unlucky enough to get the flu, get in to see your doctor because medication might be right for you.
Remember your health is your responsibility! Health is our greatest asset and it doesn’t happen by accident. If something doesn’t seem right, or questions are left unanswered, don’t wait, call your doctor. Please keep your questions coming in! The only bad question is the unanswered one. Let me know what’s on your mind at email@example.com.