Health Tip: Time For Your Flu Shot

Did you know that up to 56,000 Americans die of the flu each year, and as many as 710,000 are hospitalized because of it? The flu is a dangerous viral illness that can be lethal, or cause complications that range from pneumonia to inflammation of the heart, brain, and muscles. The good news is that flu vaccines can reduce your risk of getting the flu, and now is the time to get your annual flu shot (the flu virus tends to circulate starting in October and peaking in December through March).

What are the most common flu symptoms?

• Fever or chills
• Cough
• Sore throat
• Runny or stuffy nose
• Muscle or body aches
• Headaches
• Fatigue (tiredness)
• Some people may have vomiting and diarrhea, though this is more common in children than adults.

Over the years I've been asked similar questions from my patients, and would like to share my answers with you here:

1. Can I get the flu from the flu shot?
   No, the flu shot does not contain live flu virus, and therefore you cannot get the flu from the flu shot. It takes a couple of weeks for the body to become immune to the flu after the flu shot, so if you are exposed to the real flu virus in that time period, you could mistakenly believe that you got the flu from the flu shot.  In addition, the flu shot stimulates your immune system to react, and some people get a more robust response than others. When your immune system ramps up to fight an infection, it can cause symptoms such as soreness, redness, and/or swelling at the injection site, headache, low grade fever, nausea or muscle aches. These are usually temporary and mild.
   
   
2. I got the flu shot, and then I also got the flu. Why did that happen?
   The flu shot reduces your risk of getting the flu, but it does not prevent it 100%. The flu virus is constantly changing, and each year it takes time to make new vaccines for the most common strains that seem to be emerging. Scientists monitor the virus spread starting in the opposite hemisphere, and try to predict what the U.S. citizens will need when the annual flu strain(s) arrive. Some years their predictions are more accurate than others. The flu shot is about 40-60% effective, which means it reduces your risk of catching the flu by 40-60%. That's certainly not perfect, but it's the best protection we have.
   
   Other strategies to avoid catching the flu remain: hand washing (or use of alcohol-based gels), avoiding contact with infected people, bleaching surfaces that may have flu respiratory droplets on them, keeping infected people home until their fever has been gone for at least 24 hours, and taking anti-viral drugs (your doctor can prescribe them) within 48 hours of developing flu symptoms.
   
   
3. If I do get the flu, are there medicines to make it go away faster?
   Yes, there are are three FDA-approved, anti-viral medications that can reduce the severity of the flu and reduce it's duration by a day or two.
   
   
   • oseltamivir (available as a generic version or under the trade name Tamiflu®),
     
   • zanamivir (trade name Relenza®), and
     
   • peramivir (trade name Rapivab®).
     
     
   If you are in a "high risk group" for flu complications, you should see your doctor about anti-viral medications (they are only available by prescription). But hurry, these medications only help if you take them within 48 hours of symptom onset.
   
   
4. Who is at high risk for flu complications? (Who REALLY needs the vaccine.)
   While almost everyone can benefit from the vaccine (except people who are allergic to it, are already very ill, or who have had Guillain Barre Syndrome in the past), it is extra important for the following folks to get the annual vaccine:
   
   
   • Children younger than 2 and adults over 65
     
   • Pregnant women
     
   • Nursing home residents
     
   • Native Americans
     
   • Those with medical conditions that put them at higher risk for flu complications (including heart disease, lung disease, asthma, and a long list of others.)
     

The Centers for Disease Control and Prevention website is an excellent resource for flu information. I highly recommend that you educate yourself about influenza and the vaccine at the links below.  I hope you don't get the flu this winter ... remember to cover your mouth when you cough or sneeze, and wash your hands frequently!

References
https://www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm
https://www.cdc.gov/flu/about/disease/complications.htm#complications

If you have any questions about flu shots, please log into your account and send us your question. We are here to help.

Dr. Val Jones MD - Health Tip Content Editor

Health Tips: Understanding Autoimmune Disease

The immune system is a complex system of specialized cells, tissues, and organs designed to defend the body from germs and other invaders.  Central to the normal function of the immune system is its ability to distinguish between what is part of our own healthy bodies from a potentially harmful agent.
 
The part of the immune system that is primarily involved in the development of an autoimmune disease is called the "acquired" immune system.  This system develops during our lives as it responds to "attacks" on the body from invaders, such as bacteria and viruses.  One of the most important components of the acquired immune system is a type of white blood cell called lymphocytes.  One type of lymphocyte, the T-cell, scans the body for foreign invaders and can directly kill infected cells or summon help from other disease-fighting cells of the immune system. Another type of lymphocyte, the B-cell, produces antibodies used for fighting infections and can also remind the body of a germ that has been encountered previously. Vaccines use the acquired immune system to prevent infectious diseases by stimulating an immune response in the body in a manner similar to the way the immune system fights off a real infection.

An autoimmune disease occurs when the immune system targets the body's own healthy tissues by mistake, signaling the body to attack them.  For reasons that are not completely understood, the antibodies and lymphocytes that would ordinarily provide protection to the body end up causing a number of autoimmune diseases.  The hallmark of an autoimmune disease is the development of inflammation, which can cause redness, heat, pain, and swelling. Autoimmune diseases can affect most of the organs or systems in the body. The following are some of the most common:

Celiac disease---An autoimmune condition that causes inflammation in the small intestine. When people with celiac disease eat foods containing gluten their immune system reacts by damaging the villi, the finger-like projections protruding from the lining of the intestinal wall. This prevents the absorption of important nutrients, producing symptoms including diarrhea, weight loss and fatigue.

Type 1 Diabetes—In this condition, the immune system attacks and destroys insulin-producing cells of the pancreas.  This makes it impossible for the body to use glucose for energy and can even result in life-threating complication called diabetic ketoacidosis. The more common form of diabetes, Type 2, is not considered to be an autoimmune process.

Multiple Sclerosis (MS) -–In MS, an abnormal immune system response produces inflammation in the central nervous system (brain and spinal cord). The inflammation damages the myelin that "insulates" nerve fibers, resulting in slowing or stopping of nerve conduction.  Symptoms of MS include blindness, weakness, poor coordination, and muscle spasms.

Graves' disease---An autoimmune disease that affects the thyroid gland causing an overproduction of thyroid hormone. Symptoms of Graves' disease include heat intolerance, heart racing, weight loss and nervousness.

Rheumatoid Arthritis---In RA, the immune system produces antibodies that attach to the linings of joints. The immune system cells then attack the joints, causing inflammation, swelling, and pain. If untreated, rheumatoid arthritis can eventually cause permanent joint damage.

Psoriasis--- A disease that causes new skin cells to grow too fast and pile up on the skin surface. It is a life-long disease of the immune system that, in addition to causing skin lesions, is associated with a number of other health issues including arthritis, depression, and an increased risk of heart disease and diabetes. People with psoriasis develop thick red patches, covered with scales, usually appearing on the head, elbows, and knees.

Systemic Lupus Erythematosus (lupus)---In lupus, multiple systems including the joints, lungs, nerves and kidneys may be attacked by the immune system. Although the exact cause is not known, it appears that there are hereditary as well as environmental factors in it development. Symptoms of lupus can include fever, fatigue, joint pain, a rash on the face over the cheeks and nose, headaches, memory loss, shortness of breath and chest pain.

The immune system does an amazing job of protecting the body from infections and even cancer, often without us knowing it.  In the case of autoimmune diseases, however, the immune system is also capable of producing a variety of conditions that can be challenging both to diagnose as well as to treat.

If you have any questions about autoimmune diseases, please log into your account and send us your question. We are here to help.

Health Tips: Flood Water Dangers

"Water, water, everywhere,
And all the boards did shrink;
Water, water, everywhere,
Nor any drop to drink."

― Samuel Taylor Coleridge, The Rime of the Ancient Mariner

Hurricanes Harvey and Irma have recently flooded Texas, Florida and surrounding states, causing an estimated $200 billion in damage (similar to the costs of Katrina in 2005). Images of people wading, swimming and boating through city streets are all over the news. But flood waters are not just damaging to property, they are a potential health hazard as well.

Flood water mixes with everything it covers, including sewage, animal waste, pesticides, and a host of chemicals normally carefully contained. Bacterial counts in flood water are often extremely high, and this poses a risk for skin infections and digestive issues if the water is swallowed. Mosquitoes thrive in stagnant water, and the viruses that they carry (such as West Nile or Zika) can blossom after a flood. Wet carpets, floors, and wood promote mold growth which can lead to respiratory problems for those living in homes damaged by flood waters.

If you are living in a flooded region, there are some things you can do to protect your health:

1. Stay out of moving water. Did you know that just 6 inches of moving water can cause you to lose your footing, and two feet of it can carry you (or your car) away? People often over-estimate their abilities in navigating through flood waters (both in cars and on foot).
2. Wash your hands - if you have been exposed to contaminated water, keep your hands as clean as possible.
3. Avoid injury when walking through flood water. Brown water may conceal sharp objects that can cause injury. Sturdy boots may help prevent cuts, while waterproof gear like fishing waders can protect open skin.
4. Beware of downed power lines or chemical spills. When live electrical wires or power lines contact water, there is a risk of electrocution for those in contact with the water. Take caution and treat all electrical lines, wires, equipment and fixtures as if they are energized until proven otherwise.
5. Beware of gas leaks. Immediately evacuate buildings if a gas leak or odor is detected.
6. Keep wounds dry - Try not to get flood water in existing wounds, cuts, or scrapes. If the water is in contact with an open sore, wash it right away with soap and water and see a doctor immediately if it shows signs of infection such as increasing redness, warmth, pain, or pus.
7. Keep kids out of the water - make sure they don't play with toys that may have been in contact with the water, nor play in it.
8. Extra vaccines aren't really necessary. Although dirty water can spread cholera, malaria, and Hepatitis A, these are essentially non-existent in the United States. Tetanus lives on dry surfaces (not flood zones), so contrary to popular belief, vaccines are not urgently helpful post Irma and Harvey.
9. Get out of wet clothes quickly. Rinse your body entirely after exposure to flood water to reduce your risk of infection or chemical injury.
10. Seek medical attention immediately for any infections or unusual symptoms such as upset stomach or diarrhea. Flood waters may contain bacteria including E. coli, Vibrio species, Salmonella, or Shigella. Unfortunately, there are no vaccines for these infections.
11. Mold proof your house. When you return home to a flood water damaged house, remove items that can promote mold growth (carpeting, wall paper, and clothing). Be sure to wear equipment like shoes, gloves, and an N95 dust mask when removing material that may contain mold.
12. Check your pets. Dogs and cats don't realize that flood water is contaminated and and are at high risk for infection. If your pet looks sick, take them to the vet as soon as possible for treatment.

I hope you're not dealing with the aftermath of Irma or Harvey, but if so, please take good care of yourself! Feel free to email your health tip suggestions to me at: weeklyhtblog@yahoo.com
If you have any questions about flood water dangers, please log into your account and send us your question. We are here to help.

P.S. How to help Irma victims: https://www.nytimes.com/2017/09/08/us/hurricane-irma-help-donate.html

References
http://time.com/4919355/can-flood-water-make-you-sick/
https://www.dhs.wisconsin.gov/immunization/flood-vaccinate-adults.pdf
http://www.lni.wa.gov/Safety/Topics/AtoZ/floods/TenFloodHazards.asp

Dr. Val Jones MD - Health Tip Content Editor
Reviewed and Approved by Charles W. Smith MD, Medical Director on 9-13-2017

Health Tip: What To Do When The Air Quality Is Poor

I'm interrupting our skin tips to discuss air quality. I live in Washington state, near the Oregon forest fires, and my city is covered in an ash cloud right now. So I suppose this topic is top-of-mind for me… and any of you in California, Oregon, or Washington state are probably reading this with burning eyes, sore throat and a cough. You may wonder why we are having all these fires when we just had such a wet winter… well, the extra rain caused an explosion in forest and grass growth, providing lots of tinder when the summer dryness came.

How Do We Define Air Quality?
In the United States, air quality is a measure of the amount of 5 pollutants in the air on a given day. The Environmental Protection Agency (EPA) has developed an air quality index which gives us a quick sense of how polluted the air is. The values range from 0-500.

0-50 Good
51-100 Moderate
101-150 Unhealthy for Sensitive Groups
151-200 Unhealthy
201-300 Very Unhealthy
301-500 Hazardous

The five pollutants include: 1) ground-level ozone, 2) particulate matter, 3) carbon monoxide, 4) sulfur dioxide, and 5) nitrogen dioxide.

Right now in my city the air is in the "very unhealthy" range!

What Should You Do If The AQI Is Unhealthy?
The most important thing is to avoid going outdoors, and to limit how much outdoor air you breathe. This means no exertion (heavy exercise increases your breathing rate) or prolonged time outside.  In the case of particulate matter (from burning trees and grass) a face mask may reduce some of the particles being inhaled into the lungs. Face masks are often sold at hardware stores. It's important to choose the right kind (they have "N95" or "P100" or "NIOSH" printed on them) to protect from particles.

People at special risk for injury from poor air quality are those with heart or lung disease (including COPD and asthma), the very young and very old. It's probably obvious that dirty air can trigger asthma attacks and injure delicate lung tissue. Inflammation from irritating particles may cause shortness of breath requiring more inhaled medication or even a trip to the Emergency Department. But what may not be obvious is that poor air quality can increase the risk of heart attacks and irregular heart rates!

If you are in an "at risk" population (significant heart or lung disease) and you can get out of the area if the air quality is very unhealthy, that may be the best thing. A short vacation to an unaffected city could save your life.

Tips To Be More Comfortable In Bad Air
If you can't get away from the pollution, here are some tips to reduce your symptoms:
Dry Eyes - flush the eyes with artificial tears as frequently as you like. If you have an allergic reaction to the particles, try an over-the-counter anti-histamine eye drop.

Cough - if you're coughing, this indicates that you have irritation in your respiratory tree from the particles. Try wearing a face mask (described above) to reduce your exposure. Cough drops or cough syrup may reduce the irritation.

Difficulty Breathing - this is an ominous sign that probably should be treated by a physician. If you have asthma or COPD, it's ok to use your rescue inhaler more frequently but ultimately you need to find a way to get out of the triggering pollution.

Chest Pain - if you experience chest pain when the air quality is bad, you should see a physician at once to make sure you are not having a heart attack. Heart attacks and irregular heart rhythms can be triggered by pollution.

I hope the fires end soon, and that you all are staying safe... Take good care of yourselves!
References

https://www3.epa.gov/airnow/aqi_brochure_02_14.pdf
http://www.bepreparedcalifornia.ca.gov/Documents/Protect Your Lungs Respirator.pdf

If you have any questions about air pollution, please log into your account and send us your question. We are here to help.

Dr. Val Jones MD - Health Tip Content Editor
Reviewed and Approved by Charles W. Smith MD, Medical Director on 9-6-2017