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Flu Season: Are You Ready?

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Although it is already the end of February, we still have one old threat about to hit us hard – again! Viral illnesses, like the Flu,  are classically quick to spread, and a lot of folks get them in a short period of time. Symptoms are particularly severe for the first 1 to 3 days, so expect high fever, aches and fatigue, sore throat, and congestion among other things. The illness doesn’t respond to antibiotics and may run a course that is 7 to 10 days at a minimum, often with a residual cough. Typically, clinicians use Tamiflu to treat or to try to prevent influenza infection in cases with more than mild symptoms, but otherwise, you do not have to take that medication.  The treatment dose is a 75mg capsule twice daily for five days, with the prevention dose at 75mg once daily for seven to ten days.  However, I am not particularly impressed with this medication, as it may only shorten the course of infection slightly in treatment dosing, and it comes with some nausea on administration for some and at a significant price for all, if uninsured (an average of $150 – 180 per course). Still, it is one of the only commonly used therapies for influenza, a common perennial viral infection. Problematically, to be effective it must be started within a few days of the onset of symptoms; starting later than two days has shown no significant difference in outcomes over the course of the illness. For acute viral illnesses, and influenza (Flu), in particular, I encourage HYDRATION with lots of fluids – I like diluted orange juice even if there is no good proof of vitamin C matters. It’s also important to get plenty of REST and recognize your body is marshaling significant resources to heal you. A REAL BREAK from your overcommitted American lifestyle and the short-term regularly administered (not as needed) use of over-the-counter NSAIDS (Ibuprofen/Motrin/Advil 200mg tablets). Research shows 800mg (four 200mg tablets) every eight hours for headache, fever, aches, and pain, which is safe in short courses for most people.   Another common alternative for pain is naproxen (aka Aleve) 220mg tablets to take as directed on the box. Tylenol is arguably a safer alternative to these, which has fewer side effects, but in my opinion, is not nearly as effective working by a different mechanism.  Adverse effects are seen on the liver with prolonged heavy usage. Again, this illness often runs 7 to 10 days, not infrequently with holdover effects (persistent cough) for weeks beyond the initial illness. If a cough is a predominant symptom, then first recognize it is there for a reason!  This is a core defense mechanism for clearing the deeper tissues (lungs bronchi, trachea, etc.).  Focus on the reason for the cough first and foremost because attempting to suppress it can cause other issues. Antihistamines are effective for drying up drainage (great if you have postnasal drip with cough), but sometimes at the price of thickening mucous and making it more tenacious.  Antihistamines are most helpful if you have relatively clear discharge or expectorant combined with the perception of nasal drainage, which is worse in recumbency, etc. Now is the time to start therapy for seasonal allergies.  I see the oak tree buds out my bedroom window about to explode with pollen.  This is a particular problem in Texas, worse in the months of February and March, then later in September and October, with sneezing, profound nasal congestion without fever, chesty cough (“the crud, “an apparent form of bronchitis), fatigue, and sore throat.  Sometimes skin issues like hives occur as well.  The best ways to prepare are:

  1. Anticipate arrival – mark it on the calendar so you are prepared with the appropriate medications
  2. Avoid Triggers – not always very easy, but
  3. Nasal steroids, if needed – take over-the-counter Flonase, Rhinocort, Nasacort for one or two weeks to be effective
  4. Prescription only, thereafter – notably Montelukast/Singular if your allergies symptoms don’t respond to over-the-counter meds

All that aside, I typically stick with tea and honey… with a heaping dose of patience! So, in summary, take liberal doses of ibuprofen (as outlined above) or an equivalent, rest hydrate, and be patient – this too shall pass.

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