Flu update

There have been many developments on the 'swine flu' front, so I thought I'd give my readers an update... I guess we are now calling it H1N1 to start off...


I'll be honest and admit that there was a much more significant outbreak this summer than I expected. It is still about equivalent to the regular flu for your average healthy individual. Here are some numbers you may be interested in: H1N1 deaths in the US = about 300. Number of deaths of regular flu per year in the US = 36,000.

We have learned a few things about this new strain of flu: It seems to be harder on pregnant women than previous strains of flu. There seem to be some concerns that it is easier to develop secondary infections (like pneumonia) from this strain than the average American strain. This risk seems to be increased in the teenage/20-something age group than 'regular' flu.

Things to do to protect yourself now, and during flu season
1) Get vaccinated (more on this later)
2) Be free with the hand sanitizer/hand washing especially before touching your eyes, nose or mouth (they both work!)
3) DO NOT wear a mask. There are very few masks (which are currently in low supply) that work for more than a few minutes against flu particles. In fact, wearing a mask in public may increase your risk of getting it, because it may make the flu particles get lodged between the mask and your face, increasing exposure time. You can wear a mask if you think you have swine flu to keep it from spreading to others, but do yourself and others a favor and just stay home (the CDC recommends staying home until your fever is gone for more than 24 hours).
4) Take antiviral medication. One of the antiviral medications appears to be more affective against this strain than others, but it is in short supply, so you may not be able to get it unless you are at high risk of developing severe disease. Ask your doctor if you are concerned.

5) Get plenty of rest, exercise and a healthy diet while you are well to keep your immune system up. Always good advice!

Should I vaccinate my family?
Unfortunately the regular flu shot isn't very affective against H1N1, and as of this year, the H1N1 strain is too new to be added to this year's flu shot. They are, however, feverishly working on developing an H1N1 flu shot. Which means this: you will have to get multiple shots to be protected from all strains of flu this year. It will likely be combined in the future, but not now.

Some people feel it isn't worthwhile to get vaccinated against something that probably won't kill you, since you are healthy. In fact, there's a good chance you won't even catch it. You may be right, unfortunately, your kids don't fit in that group. I highly recommend getting the flu shot (flu shot's' this year) if you are a kid or have kids. ESPECIALLY if you are pregnant or want to become pregnant. 6% of the swine flu deaths have been pregnant women. Here are the target groups the CDC gives for those who should be vaccinated this year:

- Pregnant women
- People who live with/provide care for infants besides being a pediatrician - and everyone knows pediatricians love to torture children with needles): kids are the vectors! Studies have shown that just vaccinating school age children signficantly decreases the load on ALL OTHER demographics. Kids spread germs. That's the reality. You decrease the germs amongst the kids, and everyone is better off.


For more info, see the CDC webpage on H1N1
http://www.cdc.gov/h1n1flu/

I will try to fix you

Annoying complaint #2: Doctor, you have to help me. My son got a runny nose and cough three days ago, and he STILL HAS IT! What do I do?!?!? Please FIX HIM.

What the doctor hears: "I'm not leaving here until I have a prescription for antibiotics in my hot little hand." I have to admit, this type of response on the doctors part is annoying, too. Almost as annoying as the complainer. Education is much better than a reluctant antibiotic prescription.



News Flash: There is still no cure for the common cold. And no, antibiotics still don't work.

What can I give my child to make them better? Sorry. Turns out, lots of fluid and lots of rest work the best. I know THAT'S SOOOO BORING. Most studies of cold formulations show that these medications do absolutely nothing for children under the age of 6. Most studies also show they do nothing for children over 6, either, even 35 year old children. I know there is a place for sudafed in adult care, and I personally am a HUGE fan of Nyquil when I am sick. But most groups who have a statement on is (American Academy of Pediatrics, American College of Chest Physicians) say you should avoid cold medications in children under 6 (ACCP goes as far as to set the age at 14). I know what you are thinking.. these medications work great for me, why not my kids? The answer: Kids are different. Imagine that.

Okay, there's more to do than just fluids and rest, but those are the only 'cure' we have. Here's some other things that can help:



Mom: A ton of good old fashioned TLC helps anyone feel a little better when they are sick. I try to convince my wife this is what I need when I am sick, but she says she will never be my mom. Apparently, I already have on of those.

Saline water: Nose drops for the babies. Full-fledged lavages for older kids. It's uncomforable, but it works like a charm. Even better than sudafed. Your at home recipe for a nice salt water lavage: 1 tsp of salt and 1 tsp baking soda to 2 cups water. Some recommend pickling/canning salt over table salt and distilled water to tap, but if you aren't going to do it because you don't have those things, just do it with table salt and tap water. They sell bottles to (gently) shoot the stuff up your nose at the store, or you can just use a bulb syringe.

Cool mist: Cool mist humidifier in the room tends to improve symptoms and help with more restful sleep.

Honey: Yes, honey.

No, not THAT honey, this honey:

There's actually good evidence to show that honey helps coughs much more than cough syrup (which should be no surprise, since cough syrup does nothing). There are some good studies to back it up, also. 1/2 tsp for age 2-6yo, 1 tsp 6-11yo, 2 tsp 12yo and over. DO NOT give this to babies Unless the baby is a terrorist and/or poses immediate danger to the safety of all Americans (in other words: unless you want to kill them).

Cough drops: My favorite when I am sick. Only for older than 4 years due to choking danger.

Medicines: Yes, there are some medicines I recommend to my patients. Of course you can use tylenol/motrin for fevers. Also I'm a big fan of using Benadryl/diphenhydramine at night before bed, and maybe again in the day if your child is still taking naps. Remember, I said rest was very important to recovery, and while benadryl may produce very marginal results with the symptoms, they have the perfect side effect for this situation: sleepiness. I am pretty free with it (but do not endorse benadryl use to put annoying kids to sleep).

What should I expect?

Cold and the flu can last a long time. Usually the first few days are the worst and include runny nose, cough, sore throat, and fever. After that, its totally unpredictable. The fever typically subsides, but the runny nose and cough can go on for weeks! I am personally sporting a mild cough that's been with me for 4 weeks.

What about this green snot?

No it, in and of itself, does not mean there is an infection present. It is the natural course of a viral illness to produce thicker/darker mucous as the body fights the illness. Many times is it a sign that you are almost over your illness. But if the dark thick stuff persists for a long time or is accompanied with a new fever (remember your original one went away), I would see a doc to evaluate for infection. Actually, I think any new fever after the initial one has been gone for 2 or more days should probably be evaluated as it could signify an early pneumonia/sinusitis/ear infection.