Back to School

It’s that time of year in NYC (I know other parts of the country already started) when buses are filled with children sporting back packs, tales of summer vacation are told and germs are spread.
In my office, it is also the time of year in which adults get re-exposed to germs they haven’t seen in years – the kids get a sniffle at best, and the adults (especially new teachers) feel like they’ve been hit by a Mack truck! Why is this?  What is it about “kid germs” that affect adults so severely?
The reason for this comes from our immune systems. The fevers we get and the aches we feel are a result of our bodies response to the infection. The more our immune systems get activated – the worse we feel!
Our immune systems develop memory. That’s why you only get certain diseases once. If you are exposed again later in life – the memory of the infection may have faded – and your body responds in full force.  When you are exposed to similar infections multiple times – or if you are vaccinated against a disease you body can respond faster and with less inflammation – and you don’t feel sick!  An MMR – measles, mumps, rubella – vaccine given in childhood and an adult booster gives enough immune memory to last a lifetime.
To help stop the spread of these infections basic hygiene is our best defense – HAND WASHING with soap and water or hand sanitizer.  Covering our mouths when we cough and sneeze; and taking our FLU SHOTS.
I wrote about flu shots last year.  Recent politics aside, there is no danger of getting the flu from the flu shot.  There can be side effects, depending on if you have an infection brewing or how strongly your immune system reacts to the shot, but there is no live virus in the vaccine to transmit disease.
The strains in this years flu shot are different from last year, and early reports show a good match between flu strains we are starting to see in the public and what is in the shot.  So get your flu shot, and feel better through the season!

Flu shots – Don’t Believe the Hype

It’s that time of year again – just after Labor Day when Flu Season begins! Flu shots are in stock in my office, most chain pharmacies and starting to make the rounds at companies that offer them to their employees. It is also the time of year when I explain to many a worried patient that you CAN NOT get the flu from the flu shot.

There are several myths about flu shots and vaccines in general – that persist because people with loud voices propagate falsehoods despite overwhelming evidence to the contrary. Perhaps it is, as was recently written in the Wall Street Journal  that people today, especially parents of young children, have never seen the consequences of the diseases vaccines prevent.

Some facts about the flu

  • Influenza is a virus spread like any other cold
  • You can be contagious about 1 day before you get sick, and for 4-7 days after
  • Anywhere from 5-20% of the US population gets the flu each year
  • About 200,000 people are hospitalized each year from the flu
  • In 2009, we saw the first new flu virus without a vaccine – H1N1 or “Swine Flu”
    • 60.8 million people in the US were infected
    • Almost 275,000 people were hospitalized
    • 12,469 people died from H1N1 flu that year – when no vaccine was available
    • Those most severely affected were pregnant women and children
    • When the vaccine was introduced the following year, rates returned to normal

Some facts about the flu shot:

  • You can not get the flu from the flu shot
  • Flu vaccines do not contain dangerous preservatives
  • Flu shots (or other vaccines) do not cause autism
  • Flu shots decrease hospitalization due to the flu by 70%

So where did the myths come from?

  • The flu shot is made from killed flu virus, and a mix of 3 or 4 different strains of the viral components
  • Because the viral components are killed, they can not cause an infection
  • The vaccine stimulates the immune system which can cause a mild fever, congestion and body aches
  • If you have a cold when you get the vaccine, this reaction can be stronger
  • Vaccines used to contain a preservative called thimerosal, but have not for years, which contained mercury, although the quantity was much less than your average can of tuna
  • No study of any vaccine has been linked to autism – the only study that showed that position was retracted for falsifying data and the physician who wrote the study stripped of his medical license.  I reviewed this information in an early post about the HPV vaccine

What do I advise my patients?

I offer the flu shot to all my patients. I highly recommend it for all my patients over 65, pregnancy women and those with young children in the house. In addition, anyone with a weaker immune system, such as diabetics, or asthmatics who are at higher risk of lung complications should get a flu shot every year.

The flu causes people to miss work (this is why employers have flu shots in the office), children to miss school, and unnecessary misery.  The flu feels worse than any cold – with fever, cough and severe body aches.  It feels like you’ve been hit by a Mack truck – and it can be prevented.

Don’t believe the hype, get your flu shot – I’m getting mine – and its much more pleasant in the office when you get your shot than when you come to see me because you are sicker than you’ve ever felt!  

The path to wellness begins with a proper diagnosis

Cold, Flu, Allergies or worse – what’s my diagnosis?

I’ve been sick for 2 weeks, nothing is helping!

It is the peak of cold and flu season and it is likely that you and at least 3 people you know have probably said this.  Regardless of the climate you live in, it’s cold and flu season, not to mention allergies.
Do I need antibiotics?  Am I contagious?  Can I fly?
How do we figure out what is the cause of your suffering?  What is your diagnosis?
For these seemingly simple symptoms and problems a proper diagnosis is key.
  • A cold will get better on its own
  • The flu can be treated with specific medication
  • A bacterial infection such as strep throat should be treated with antibiotics
  • Allergies can be treated with specific medications
So calling your doctor for a “z-pak” will only work at best 25% of the time – the rest of the time you may improve around the same time as you finish the antibiotics – not because of it.

What in a history can clue the doctor into your diagnosis?

Some key questions will guide the doctor toward the answer.
  • How long have you had symptoms
  • Fever? Chills? Night sweats?
  • Type of cough?  Nasal congestion
  • Body aches?
  • Are the symptoms worse at night or first thing in the morning?
  • Anyone else sick at home?
Based on the answers to these and other questions, the likely diagnoses can be ranked.  After examining you, the doctor can see if there are other specific signs of infection like an ear infection or pus in the throat, giving more or less support to the diagnoses on their list.  Tests like a strep or flu test can be ordered and a diagnosis made, treatment given, and you can start to feel better and get well!
If you are given the wrong treatment, such as unnecessary antibiotics, you are exposing yourself to medications with side effects, perhaps creating resistant bacteria in your system and NOT improving your health.
Determining the cause of your symptoms, getting the right diagnosis, is essential to giving proper treatment.

How does this affect MY practice?

The key to determining the need for antibiotics is a good history.  There are several factors that lead me to decide what treatment is best for you.

  • How long have you had symptoms?
    • sick for a month or longer suggests allergies as opposed to an infection
    • cold symptoms for more than 10 days may need antibiotics
    • very sudden onset of symptoms should be seen sooner rather than later
  • Were you getting better and then seemed to relapse – this may indicate a second infection
  • Body aches with cold symptoms suggest the flu
  • Do you have a weakened immune system due to other illnesses or medications?

Combining this type of information with the findings on a physical exam and quick office lab tests for strep and flu make the diagnosis and treatment plan one that hopefully helps you feel better with a low risk of side effects!

The path to Wellness begins with a proper Diagnosis.