2017-2018 Seasonal Flu

Flu season is here. The best guard against the flu is to educate yourself about it, how to prevent it, and if you get it, how to take care of yourself, and most importantly get the flu vaccine every season. The flu is caused by a virus that strikes the respiratory system. This is not the same stomach flu (Gastroenteritis), which causes nausea, vomiting, and diarrhea. There are several types and sub types of flu. We often hear most about type A and B. Type A is the flu recognized during the winter months when flu is expected to be most active. Widespread flus occur about every 10 years, and people tend to get sicker than when the usual annual flu comes around.

Transmission is through direct contact from one person to another through coughing, sneezing, or touching someone (handshake) or an object like a tissue used to blow their nose or cough into. You are contagious from the day before you start having symptoms up to 7 days after they develop. Symptoms often develop 1-4 days after your exposure. The flu should pass in 5-7 days, but you may feel tired for several weeks.

Risk factors include those who are very young, elderly, live in nursing homes, those whose immune system is compromised, such as HIV, and cancer patients, those who have respiratory problems already, such as, asthmatics, and COPD, heart problems, pregnant women, and those who are overweight.

Diagnosis of flu is now often made using a rapid test, but it is not 100% accurate, and is usually diagnosed by the provider based on symptoms, exposure history, and community alerts to outbreak by the local department of health.

Symptoms include fever, body muscle aches, runny nose, chills, sweating, headache, cough, fatigue, weakness, nasal congestion, and sore throat. Sometimes vomiting can be seen in children. Smoking worsens symptoms. Complications include Pneumonia, sinus infections, dehydration, Bronchitis, Asthma flare-ups, ear infections, and heart failure for those with heart problems.

Antiviral medication early in illness can shorten the flu, reduce severity, and prevent complications. The antiviral may not work though. The medication must be taken within 48 hours of the first symptom, and does not mean you should not get the flu vaccine. Two medications used are Oseltamivir (Tamiflu), and Zanamivir (Relenza). Antibiotics, Vitamin C, and Echinacea cannot prevent or treat the flu. Other treatments include plenty of rest, and increased fluid intake. Treat aches and pain with Tylenol or Ibuprofen. Cough medicine and nasal decongestants may help those symptoms.

Seek immediate medical care if you have trouble breathing, have a severe headache with a stiff neck, feel confused, or you cannot stay awake. You should see your doctor if you have very high fever that lasts more than 3 days, if your child is less than a year old and has a fever, pain to ears, chest, throat, sinuses, or wheezing.

Prevention includes vaccine against the flu every year, frequent hand washing, cough and sneeze in a tissue and then dispose of the tissue in a garbage container, and avoiding crowded areas. The CDC currently recommends vaccination for children over 6 months of age. Higher dose vaccination is available for those over 65 years of age. There are different types of flu vaccines. Ask your doctor which one is best for you. The most common are made with or without eggs, and have no preservative. Make sure to notify your provider if you are allergic to eggs, have a history of Gillian Beret, or feel sick the day of your vaccination. Wearing a surgical mask is a good idea for caregivers. Sanitizers that contain alcohol may help with cleaning surfaces, such as door knobs, remote controls, and cell phones. Bleach is also effective, but may not be appropriate for cleaning some objects as it may cause damage.

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What You Need to Know About Irritable Bowel Syndrome (IBS)

IBS is a condition affecting the large intestine marked by alternating periods of diarrhea and constipation, abdominal cramping, and straining. It is sometimes called a spastic colon. It is not a disease, and there is no cure for IBS, but it can be managed over one’s lifetime. IBS has a high incidence in women under the age of 40, if there is a family history, and those with anxiety and stress. The same is true for children, but may include a history of gastroenteritis, or food poisoning. The cause is not well-defined. Normally, the muscles of your intestine contract and relax in rhythm, but in IBS the contractions may be stronger and longer, resulting in diarrhea, or weaker and slower, resulting in constipation. Poor communication between your brain and your intestines can lead to a change in reaction time while you are digesting.

Possible causes include anxiety, stress, hormones, laxative abuse, food or drug allergies, and lactose intolerance. Also, diet seems to be a large factor, such as fiber, raw fruit, coffee, alcohol, spicy or highly seasoned foods, and cold foods. Additional symptoms include abdominal pain, stools that are very thin and pencil like, heart burn, mucus on stool, bloating, gas, fatigue, and weakness. Tests include checking stool for blood, parasites, or bacteria, blood tests, lower GI test, where you swallow a liquid barium and have x-rays, and a sigmoidoscopy. Complications of IBS includes inflammation of hemorrhoids, and malnourishment. In children seek medical attention if growth is poor, rectal bleeding, abdominal pain, difficulty swallowing, or if having vomiting or diarrhea at night.

Immediate treatment includes stress management, and change of lifestyle. Dietary changes which are based on patient’s symptoms. A food log will help identify foods that cause symptoms. List what you ate and symptoms appearing after your meal. Slowly add foods to your diet to allow yourself to adjust. If you have cramps or diarrhea try to stick with a low fat, high carbohydrate diet. Avoiding high gas foods such as cabbage, broccoli, cauliflower, and raw fruit. Fatty foods, chocolate, alcohol, caffeine, and carbonated drinks. Lactose containing foods, such as milk and cheese should be avoided, as well as certain grains. For children avoid foods, and drinks with sugar. Also, do not let your child eat large meals. Increasing dietary bulk with supplements, and fluid intake help manage symptoms. Medications include supplements in high fiber to control constipation, such as, psyllium (Metamucil), methyl cellulose (Citrucel), Milk of Magnesia (MOM), and polyethylene glycol (Miralax). Hyoscyamine (Levsin), and dicyclomine (Bentyl) help stop spasms. Loperamid (Immodium) helps stop diarrhea. Other meds that can be used are laxatives, and meds to treat nausea. For anxiety and stress mild tranquilizers and/or an antidepressant may be prescribed. Aloestron (Lotronex), and Lubiprostone (Amitiza) are new medications on the market and are treatments currently geared towards women. Seek immediate medical care if you have rectal bleeding, continuous abdominal pain, and weight loss.

Resources
http://www.mayoclinic.org/diseases-conditions/irritable-bowel-syndrome/basics/definition/CON-20024578

http://www.webmd.com/ibs/tc/irritable-bowel-syndrome-ibs-treatment-overview

Cold Sores, Herpes, Shingles. Oh My!

Copyright © 2006, John Pozniak

The Web MD reports Cold Sores affect 90% of the world. A cold sore is a Cluster of tiny blisters, usually on the lip, that burst, drain, and then crust over, and is caused by Herpes Simplex Virus I. Symptoms include fever, red, swollen, painful blister, and swollen lymph glands. Healing time usually takes place within 2 weeks. Transmission occurs through contact with a sore through kissing (saliva), sharing eating utensils, razors and tooth brushes from an infected person. There is no cure. Exposure to sunlight or wind, stress, immunocompromised, before onset of menstruation, fatigue, colds, flu, can increase the risk of an outbreak. Prevention techniques include avoid touching, sun-sunscreen, wash hands often. Cold sores can be contagious even if you don’t see them. Treatment options are limited as they can heal on their own, but antivirals can speed up their healing, and NSAID’s can be taken for pain. Seek med care if you have a weak immune system, sore that doesn’t heal within 2 weeks, increased frequency of cold sores, and irritation to eyes.

Genital Herpes is a common STD caused by Genital Herpes II. The Mayo clinic reports they appear as small, red bumps or tiny white blisters that are painful, itch, or sore or you may not have any symptoms. After the first infection, the virus becomes dormant, but can reactivate at any time. There is no cure. Antiviral medication can decrease the symptoms and speed recovery. To prevent transmission from your infection use condoms. Risk factors include having multiple partners, or another STD’s. Genital herpes causes increase risk of transmission to newborns, bladder problems, meningitis, and rectal inflammation. There are three ways to diagnose. One is having your doctor perform a viral culture of the sore itself. Second is having a test called a PCR, which tells you the type of herpes you are infected with. Finally, a blood test can tell you if you have had genital herpes in the past. Treatment includes a prescription for an antiviral medication such as Acyclovir, Famciclovir, Valacyclovir. Pregnant women should discuss a C-section to prevent infection to newborn.

Shingles is a viral infection that results in a painful rash, caused by Varicella Zoster or Herpes Zoster Virus. It is the same virus that causes the Chicken Pox. The virus lies inactive in nerve tissue near your spinal cord and brain. When it reactivates it does so in the form of shingles. Shingles can last 2-6 weeks. Symptoms include pain, burning, numbness, and tingling, sensitivity then red rash, fluid filled blisters that open and drain a clear liquid and then crust over. Other complaints noted are fever, headache, sensitivity to light, and fatigue. Shingles can spread if person has never had the chicken pox and had direct contact with the sore. Shingles is dangerous to those with weak immune system, newborns, pregnant, over 50, HIV, cancer, and organ transplant. Complications are post herpetic neuralgia- damaged nerve fibers, well after blisters have cleared. Vision can be affected if shingles develops in the eye. Brain, facial paralysis, hearing, balance can cause neurological imbalance. Bacterial infections can occur when shingles appears on the skin.
Treatment includes antiviral medication, pain medication, such as capsaicin cream, gabapentin, lidocaine gel or cream, or narcotics.

The CDC reports the Shingles Vaccine reduces shingles 51%, and reduces post herpetic neuroglia by 67%. They
Recommend the vaccine if you are over 60 with or without history of chicken pox to prevent future occurrences. The vaccine protects for 5 years. FDA has approved the vaccine for over 50, but insurances may not cover. Avoid the
vaccine if you are allergic to gelatin, neomycin, weak immune system, or are pregnant. This is a live vaccine.

Throat Infection vs. Strep Throat

A throat infection, also known as pharyngitis, can occur in the throat and tonsils. Throat infections are most commonly caused by the common cold, and do not require an antibiotic to treat.  Another virus that can cause throat infection is Mononucleosis, which is mostly seen in young people. Symptoms include a sore throat, fever, lymph gland tenderness and swelling around your neck and throat.  A blood test, known as a Mono spot, can diagnose.  Antibiotics are not the treatment.  Additional conditions that can cause throat infection is dry air, smoking, post-nasal drip, allergies, singing, yelling, and sexually transmitted diseases such as gonorrhea.

The CDC reports Strep pharyngitis is caused by Group A Strep bacteria. It can be easily transmitted to others, and highly contagious via droplets from cough, sneeze, or sharing personal objects like cups, tooth brushes, etc.  Symptoms include sore throat, painful swallowing, fever, headache, swollen lymph glands, nausea, vomiting and stomach ache.  Redness to the throat and pus on tonsils may be noted upon examination.  Testing can be done via rapid strep test, or a throat culture.

The Mayo Clinic reports the treatment of choice is antibiotics such as penicillin or amoxicillin. If the individual is allergic to penicillin, they can be given Keflex, Zithromax, Biaxin, or Clindamycin.  Warm broth or apple juice, throat lozenges, gargling 1 tablespoon of salt with warm water can provide some comfort.  For pain and fever, Acetaminophen, Ibuprofen, or Naproxen can be bought over the counter.  Additionally, it would help to eat soft foods, drink plenty of fluids, and rest.  Avoid smoking to reduce irritation to the throat.  A humidifier can moisten the air to reduce irritation from dry air. Also, change your toothbrush to prevent re-infection.  Make sure to perform frequent handwashing to prevent spreading, as well as covering your mouth and nose when coughing or sneezing.

Seek immediate medical care if you are struggling to breath, drooling, spitting out saliva because you can’t swallow, unable to open your mouth completely, high fever, severe sore throat (could be tonsil abscess), wide spread rash (rheumatic fever), or ear pain. Strep infections can affect the tonsils, sinuses, skin, blood, middle ear, and kidneys. Complications include tonsil abscess, rheumatic fever, and kidney infection.

You can return to work or school after 24 hours fever free, and on the antibiotics for at least 24 hours.

 

Bursitis vs. Tendinitis

The bursa is a fluid filled sac that provides cushions and protects areas between the joints, muscles and bones of your body from frequent movement. When the bursa is inflamed it is called Bursitis.

Symptoms of bursitis include pain, stiffness, redness, warmth and swelling as fluid builds up in the sac. Pain often continues even at rest, and if the area becomes infected, fever and chills.  The joints of the knees, elbows, hips, and shoulders are most often affected. Bursitis is caused by an injury, such as a direct impact from a fall, or repetitive use of a joint.  Sometimes infection and diseases can cause the bursa to become inflamed, such as gout and rheumatoid arthritis.

Those at greatest risk for getting bursitis are those who have a job or activity that has repetitive movements to the same joint of your body, those who have suppressed immune system (diabetics, cancer), lift their arms over their heads frequently, lean or kneel on hard surfaces often, run, or walk often.

Treatment for mild cases of bursitis is R.I.C.E. or rest, ice, compression, and elevation. Moderate to severe cases may require NSAID’s to treat pain, and inflammation. Corticosteroids may be injected in and around the bursa for inflammation and improve movement.  If there is an infection, an antibiotic is given.  Physical therapy may suggest splinting or a brace to support the injured area.  If the case is severe, surgery may be required to remove the bursa.

If you are prone to getting bursitis, do your best to prevent yourself from another painful episode. Wear knee pads if you kneel often, avoid or take frequent breaks from repetitive activities. Warm up before exercise.  Seek medical attention if you develop fever or chills, or home treatments are not working.

The tendon is a strong rope of tissue that attaches muscle to bone. When the tendon is inflamed it is called Tendinitis.  The most frequent tendons affected are those of the shoulder (rotator cuff), ankle (Achilles tendon), elbow (triceps tendon), and any one of the wrist tendons.

The most common cause of tendinitis is repetitive use of a tendon or muscle. Additional causes include injury, ageing, wear and tear, arthritis, and some medications. Symptoms include pain, swelling, and tenderness. Treatment is the same as for bursitis.  Seek medical attention if you do not improve with home care or if you develop numbness or tingling to the extremity near the injury.