Cold and Flu Season Coming

As we head into fall and winter we see an increase in the number of viral respiratory illnesses in the community. Most of these are simple self-limited infections that healthy individuals can weather after a period of a few days to a week of being uncomfortable from runny noses, sinus congestion, sore throats, coughs, aches and pains and sometimes fever. There are studies out of Scandinavia conducted in extreme cold temperature environments that show that taking an extra gram of Vitamin C per day reduces the number of these infections and the severity and duration in elite athletes and Special Forces military troops. Starting extra vitamin C once you develop symptoms does little to shorten the duration or lessen the intensity of the illness. Vigorous hand washing and avoidance of sick individuals helps as well. Flu shots prevent viral influenza and should be taken by all adults unless they have a specific contraindication to influenza. A cold is not the flu or influenza. Whooping cough or pertussis vaccination with TDap should be taken by all middle aged and senior adults as well to update their pertussis immunity. We often see pictures of individuals wearing cloth surgical masks in crowded areas to prevent being exposed to a viral illness. Those cloth surgical masks keep the wearers secretions and “germs” contained from others but do nothing to prevent infectious agents others are emitting from getting through the pores of the mask and infecting them. If you wish to wear a mask that is effective in keeping infectious agents out then you need to be using an N95 respirator mask.

Once you exhibit viral upper respiratory tract symptoms care is supportive. If you are a running a fever of 101 degrees or higher taking Tylenol or a NSAID will bring the fever down. Staying hydrated with warm fluids, soups and broths helps. Resting when tired helps. Most adults do not “catch” strep throat unless they are exposed to young children usually ages 2-7 that have strep throat. Sore throats feel better with warm fluids, throat lozenges and rest.

You need to see your doctor if you have a chronic illness such as asthma , COPD, heart failure or an immunosuppressive disease which impairs your immune system and you develop a viral illness with a fever of 100.8 or higher. If your fever is 101 or greater for more than 24 hours it is the time to contact your doctor. Breathing difficulty is a red flag for the need to contact your physician immediately.

Most of these viral illnesses will make you feel miserable but will resolve on their own with rest, common sense and plenty of fluids.

Advertisements

Adult Sore Throats 2015 – 2016 Flu Season

Robert Centor, M.D., of the University of Alabama at Birmingham, performed the definitive study on adult sore throats showing that 10% or less of adult sore throats are caused by bacteria particularly Group A Streptococcus . He went on to prove that bacterial Strep throats were accompanied by a cough, large swollen and tender lymph nodes, a temperature greater than 100.4 and an exudate on your tonsils. The disease is primarily seen in children age 2-7 and those who care for them and play with them. In adults who did not meet the criteria of having a cough, swollen and enlarged lymph nodes, a temperature of 100.4 and a tonsillar exudate, a rapid streptococcus throat swab was accurate 100 % of the time. If the quick strep analysis is negative you do not have a strep throat and do not require an antibiotic. We had two patients this past fall who did not meet the criteria of Dr. Centor, did not have the physical findings consistent with a strep throat, had a negative quick strep throat swab but upon performing a traditional throat culture were found to be positive for Group a Beta Hemolytic Streptococcus requiring antibiotics. Why did the discrepancy occur? According to the manufacturer they had to recall a batch of diagnostic material that was ineffective. Both patients were placed on antibiotics soon after their clinical course did not follow the path of a viral infection and both did well.

Most adult sore throats and colds do not require antibiotics. We reserve them for patient with debilitating chronic illnesses especially advanced pulmonary, cardiac and neurologic disease patients. With influenza season on the horizon we will continue to assess patient’s clinically using history, exam, quick strep throat swabs and traditional microbiological throat cultures where appropriate. I will continue to prescribe antibiotics where necessary but must admit, last years’ experience opened my eyes to a more liberal approach with the prescribing of antibiotics for simple sore throats.

Cold and Flu Season Coming

SneezeAs we head into fall and winter we see an increase in the number of viral respiratory illnesses in the community. Most of these are simple self-limited infections that healthy individuals can weather after a period of a few days to a week of being uncomfortable from runny noses, sinus congestion, sore throats, coughs, aches and pains and sometimes fever. There are studies out of Scandinavia conducted in extreme cold temperature environments that show that taking an extra gram of Vitamin C per day reduces the number of these infections and the severity and duration in elite athletes and Special Forces military troops. Starting extra vitamin C once you develop symptoms does little to shorten the duration or lessen the intensity of the illness. Vigorous hand washing and avoidance of sick individuals helps as well. Flu shots prevent viral influenza and should be taken by all adults unless they have a specific contraindication to influenza. A cold is not the flu or influenza. Whooping cough or pertussis vaccination with TDap should be taken by all middle aged and senior adults as well to update their pertussis immunity. We often see pictures of individuals wearing cloth surgical masks in crowded areas to prevent being exposed to a viral illness. Those cloth surgical masks keep the wearers secretions and “germs” contained from others but do nothing to prevent infectious agents others are emitting from getting through the pores of the mask and infecting them. If you wish to wear a mask that is effective in keeping infectious agents out then you need to be using an N95 respirator mask.

Once you exhibit viral upper respiratory tract symptoms care is supportive. If you are a running a fever of 101 degrees or higher taking Tylenol or a NSAID will bring the fever down. Staying hydrated with warm fluids, soups and broths helps. Resting when tired helps. Most adults do not “catch” strep throat unless they are exposed to young children usually ages 2-7 that have strep throat. Sore throats feel better with warm fluids, throat lozenges and rest.

You need to see your doctor if you have a chronic illness such as asthma , COPD, heart failure or an immunosuppressive disease which impairs your immune system and you develop a viral illness with a fever of 100.8 or higher. . If your fever is 101 or greater for more than 24 hours it is the time to contact your doctor. Breathing difficulty is a red flag for the need to contact your physician immediately.

Most of these viral illnesses will make you feel miserable but will resolve on their own with rest, common sense and plenty of fluids.

Electrical Stimulation May Improve Sleep Apnea

Sleep Apnea v2Patrick Strollo Jr., MD of the University of Pittsburgh Medical Center presented preliminary data on the use of a surgically implanted neurostimulator to improve sleep apnea symptoms. The device was implanted to stimulate the hypoglossal nerve. The participants in the study were 124 patients who could not tolerate the CPAP mask treatment or who were never before treated. After implantation they were treated and followed for one year. The participants were mostly men (83%) in their mid-fifties (mean age 54.5 years old), Caucasian and overweight (mean BMI 28.4 kg/m2). Thirty eight percent of the participants had hypertension, 9% were diabetic, and 5% had COPD. Interestingly, 18% had undergone previous surgery on the uvula called uvulopalatopharyngoplasty which was felt to be an effective alternative to wearing a CPAP mask for sleep.

At 12 months all the parameters to assess the effects of sleep apnea had improved dramatically. Interestingly enough, some of the study participants were allowed to continue treatment while others were randomized to stop the neurostimulation. Those who stopped the treatment were followed and their scores regressed.

Like all treatments there were some adverse effects such as tongue pain and mild to moderate infection in 1%.

This is very preliminary data. The study must be presented to a peer review journal, evaluated and published before this treatment becomes acceptable. We recognize sleep apnea as a dangerous disease that leads to pulmonary hypertension and right heart failure if not treated. CPAP masks work well but are cumbersome, awkward and difficult to travel with. The epidemic of sleep apnea is being fueled by a worldwide epidemic of obesity. The current preliminary work at the University of Pittsburgh holds out hope for a future solution that may be easier to live with.

Soda – Does it Cause Asthma and COPD?

With the USA dealing with a youth epidemic of obesity we have been educated as to the large amount of sugar and calories we get from drinking a can of  carbonated soda pop or pouring a glass of soda.   Vending machines for soda as well as fountain service have been removed from schools and school cafeterias in an effort to stop the youth intake of cheap inefficient calories.  Nobody criticizes the occasional use of soda pop in moderation but the continued use at 250-500 calories per 8 ounce serving will cause anyone to gain weight easily.

We now have another disease entity to think about. Australian researchers, in a pulmonary journal named  Respirology, have published the results of a “cross sectional study” that seems to link drinking at least a half liter of soda per day with the development of asthma and chronic obstructive lung disease.   By design, cross sectional studies will not show that drinking a half liter of soda a day is a cause of asthma or COPD, but it certainly can establish a relationship.

US researchers looking at the preliminary data seem to feel that individuals who consume that much soda a day probably have a poor overall diet and pay poor attention to their overall health putting themselves at risk for many types of diseases.  Additional research is needed on the subject but the message is clear, keep your soda intake to occasional use at moderate levels until more is known.