Episode 11: August 26, 2009
by Rob Lamberts, MD
Today’s topic comes from a Facebook friend named Marvin, who was actually one of my camp counselors when I was in junior high. I am actually pretty nervous about some of the stories he could tell.
Marvin wanted me to talk about influenza, specifically the H1N1 variety – the one that’s being called: “swine flu.” Now let me clear up a little confusion: first, you don’t get the swine flu from eating pork. Second, it is not called the “Hieney Virus” – you know, the H1N1. A friend of mine heard someone say this. Don’t call it this, unless you want people laughing and pointing.
This is a hot topic now. It’s all over the news, and just last week in my office we diagnosed a bunch of people with influenza. This is very unusual for this time of year, and probably represents the H1N1 virus. I think it’s going to be a very busy fall.
My patients have a lot of questions and some of them are pretty scared. As I thought about this topic, I realized that there was no way I could cover this in a single podcast. So this week I am covering influenza in general, and next week I’ll talk specifically about the H1N1 virus and the threat it poses.
Have I mentioned that this podcast is for informational purposes only? My goal is to add to your medical knowledge and translate some of the weird medical stuff you hear, so when you do go to your doctor, your visits will be more fruitful. I am sure I’ve told you that I don’t intend to replace your doctor; he or she is the one you should always consult about your own medical condition.
I have? Well good for me.
What is Influenza?
So what about the influenza virus? Should people be scared? I took a poll on Facebook about this and many people indicated that they thought the H1N1 situation was being blown out of proportion. This doesn’t totally surprise me. People have never taken the influenza virus seriously, so warnings about a worse kind of flu ring kind of hollow. It’s like being warned about a killer hamster attack. It’s hard to take seriously, right? I think this is a big mistake.
Influenza goes around every year causing serious illness and death. The typical flu season runs from November to April, and each year more than 30,000 people die and over 200,000 are hospitalized from influenza-related illnesses in the US alone. Let me repeat that: each year over 30,000 people in the US die from illness related to influenza.
I don’t think most people appreciate just how sick you can get with this virus. I’ve heard people say, “I had a case of the flu” describing an ordinary viral illness. But influenza is anything but ordinary.
What are Symptoms of the Flu?
When I walk into the exam room of someone with a typical case of the flu, I am met with someone who looks like they’ve been hit by a truck. Seriously, they are usually lying on the exam table, semi-conscious, shaking, and moaning. This is because of the extreme symptoms the virus can cause, including:
Fever (which commonly gets to 103 F or higher)
Body aches (not anything subtle; more like the morning after you’ve been beaten up with a baseball bat)
Chills and sweats
Shortness of breath
Less common symptoms include nausea, vomiting, and diarrhea, and even more rarely, neurologic symptoms like seizures and dramatic mental status changes can occur.
It is definitely not your “routine sickness,” and it’s not hard to see how an infection with symptoms this bad could threaten the lives of people who are frail.
Why the Flu is Dangerous
Influenza’s real danger comes from complications caused both by the virus itself and from bacterial infections that can take advantage of the person’s weakened state. Pneumonia, which is an infection to the lungs, is the most common complication. This pneumonia can come from the virus or from the bacteria called Staph. Aureus -- which causes a deadly form of pneumonia in people with influenza.
Influenza can also cause serious and even life-threatening complications by damaging the heart, kidneys, and central nervous system. It’s a really dangerous infection.
Fortunately, most people who get it don’t get these complications.
There are two main types of influenza viruses, given the clever names influenza A and influenza B. Of the two, the bad actor is influenza A, which is the one that causes pandemics. Influenza B will still make you feel lousy, and can even be lethal, but this doesn’t happen nearly as much as with A.
Each year, we have epidemics of both A and B. People can get the infection year after year because the virus changes. There are proteins that coat the outside of the viruses -- called antigens. Viruses of differing antigens are called strains. When the antigens change enough, they can fool the immune system. The larger the change, the more the immune system is fooled, and the more severe the disease. Influenza A antigens change more rapidly and dramatically than those of influenza B, which is why it is the deadlier of the two.
What Can Be Done to Prevent the Flu
Every fall, people have the opportunity to do something to keep from getting the flu or at least lessen its severity; and each year far too many people pass up this opportunity. I am, of course, talking about flu shots.
The yearly influenza vaccine is made based on predictions as to what virus strains will show up in the coming year. One B and two A strains are included in each year’s vaccine. The immunization comes in two forms: a nasal spray, which contains a weakened form of the viruses, and an injection, which contains only killed virus. The nasal spray can only be given to people between ages 2 and 49, and should be avoided by people with a weakened immune system, since the virus in it is not killed. Everyone else should get the injection.
Who Should Get the Flu Vaccine?
Here’s who should get a flu shot every year:
Everyone 50 years and up
Children from 6 months to their 19th birthday
People with chronic illnesses, such as diabetes, lung, heart, or kidney disease
Those having contact with infants under 6 months of age, since children this age can’t get flu shots
Anyone who is around any of these other at-risk people.
So you see that this pretty much includes everyone. Getting a yearly flu shot is almost never a bad idea. In fact, our office started giving them early this year. I’ve already had mine. Check with your doctor or health department to see if you can get yours.
Let me dispel a myth: you don’t get the flu from a flu shot. Many studies have shown this, but still people insist they do. I think this is because people don’t realize how bad the actual flu is. They are probably exposed to sick people when they are at the doctor’s office getting their flu shot (doctors’ offices are full of sick people) and get infected with another virus. They get sick and assume it was the shot that did it. But they don’t get the high fever, body aches, and other symptoms of the flu. In the 15 years I have been in practice, not one of my employees, who are required to get the vaccine, have ever missed work because they got sick from a flu shot.
What Should You Do If You Do Get the Flu?
If you are one of the unlucky ones who do get the flu, including the H1N1 virus, here’s what you should do:
Stay home; don’t go into work or school sick and spread it to others.
If you are healthy and young and want to tough it out, drink lots of liquids, take Tylenol or Ibuprofen for the fever and aches, and get lots of rest.
If you are at risk for complications, see your doctor right away, as there are anti-viral medications to make your infection less severe. But these medications have to be given in the first 48 hours of the illness for them to work. Normally, these medications should be reserved for the very young, the elderly, and those with chronic diseases. During this H1N1 outbreak, however, young and healthy people are actually at higher risk and so should get anti-viral medications if possible.
See your doctor for any signs of complications, including significant cough, shortness of breath, or mental status changes.
Don’t give aspirin to children with influenza, as this is a suspected cause of the serious condition, Reye’s syndrome.
That’s all for this episode. Tune in next time for a discussion about the H1N1 virus and the risk of pandemics.
Remember, Influenza is a bad infection that kills thousands each year. Take it seriously, and do what you can to protect yourself and your loved ones. I hope you stay well, and I hope this podcast keeps Marvin quiet about that wedgie incident.
If you have topics you want me to cover, send them to firstname.lastname@example.org. You can tweet me at @houscalldoc and find me on Facebook.
Catch you next time. Stay healthy!