FALL 2008 NEWSLETTER
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Rules of Thumb for When to See your Doctor
Well, fall is back again. As kids have started back to school, many viruses are already causing respiratory and gastrointestinal problems as well as sore throats. Most of these illnesses are viral, and have no specific treatment, so there are a few rules of thumb for knowing when to go see your doctor. Strep throat can never be ruled out without doing a culture (I can attest by personal experience), so I always recommend that a sore throat be evaluated. The main reason to treat strep throat, besides alleviating symptoms (most symptoms subside within a few days despite treatment) is to prevent rheumatic heart disease, which used to be a severe complication of strep throat before the modern antibiotic era. Rheumatic heart disease can lead to severe valvular damage to the heart which can lead to heart failure and the need to replace heart valves due to damage.
Some patients are surprised by the fact that most upper respiratory infections (URIs or commonly colds) are more effectively treated by over-the-counter (OTC) medications than they are by prescription medications, especially antibiotics. This is because most URIs are viral and most antibiotics only work against bacterial pathogens. In fact, the most effective medications for URIs are zinc-containing OTC medications such as Cold-Eze lozenges and Zicam nasal spray. Zinc binds to the sites that the cold viruses bind to in the nasal passages and prevents the cold virus from causing such severe symptoms, often shortening the course of the cold dramatically. If a cold lasts more than a few days or if discolored (yellow, green, brown, bloody) discharge is noted, the cold may have progressed to a sinus infection and you should be evaluated by your doctor.
Most cases of “stomach flu” or cases of vomiting/nausea with or without diarrhea are viral as well. Usually the symptoms can be controlled by trying to maintain good fluid intake, especially with fluid and electrolyte replenishing solutions such as Gatorade or Pedialyte. I recommend sticking to starchy foods and light soups (not creamy or tomato based) for solid food, although replacement of lost body fluids from vomiting and diarrhea are much more important than caloric replacement at these times. Those most susceptible to complications from vomiting and diarrhea include very young children, elderly individuals, and people with chronic medical problems, especially cardiac and respiratory conditions, diabetes, and people who may be immunosuppressed because of cancer treatments or medications which suppress the immune system like prednisone. Other agents, such as those used to prevent rejection of transplanted organs or to treat chronic conditions such as rheumatoid arthritis can put people at increased risk. By far the greatest threat from these viruses is dehydration, so fluid replacement is critical. In infants, signs to watch for to indicate dehydration include listlessness, lack of tears when crying, and loss of more than 10 percent of body weight. Signs of dehydration in the elderly may be more subtle, and change in level of consciousness or confusion should be watched for closely.
Flu shots are available beginning October 1. Many people ask me when the best time to get flu shot is. My response is usually “Get out your crystal ball, find out when the big flu season will begin, and take your flu shot two weeks before it hits.” Since that is very impractical, I recommend getting your flu shot as soon as they become available. Most individuals should get all the immunity from the flu shot that they will get at that point, and it should last throughout the flu season. People who are at highest risk from complications from the flu, such as pneumonia, again, are the very young and elderly and infirmed individuals. I also recommend all persons who work in the health care field get yearly flu shots as well as college students (who should also receive meningococcal vaccine) because of their high exposure.
Many people come in complaining of the flu, when in reality they have a common cold (URI) or stomach virus. How can you tell if you may have the flu? Generally the flu comes on rapidly with high fever (greater than 101 degrees F), dry cough, severe headache, muscle aches and fatigue. This is opposed to the gradual onset, rare fever and lack of headache and generally milder symptoms of a cold. Stuffy nose, sneezing, and sore throat are also more common with a cold than they are with the flu. The distinction is important, because there are medications such as Tamiflu which can be used to treat the flu which are ineffective against colds. In addition, these medications should be started within the first day or two of onset of flu symptoms to have their greatest effect. The makers of Tamiflu maintain a website, www.igotflu.com, which outlines many of the differences between the flu and colds.
Treatment of colds and flu is generally more difficult than prevention. Flu shots are an important means of prevention of the flu, but one measure everyone can take to try to stay as healthy as possible during the cold and flu season is simply to wash your hands frequently, especially when you think you may have been exposed to a sick individual. Waterless hand sanitizers are both effective and convenient when traveling or when water is not readily available.
With soaring gas prices, and many of our Medicare patients reaching the “doughnut hole,” everyone is concerned about costs. Our staff will do all we can to help alleviate the high cost of medications by helping with sample medications, using generic medications where appropriate, and in some instances helping those of you who qualify for assistance from pharmaceutical companies apply for those benefits.
Have a safe and healthy fall!
