WellCommons

Google Flu Trends: United States, As of Jan 11, 2013. by Ryan Neuhofel, DO, MPH

If you've been hiding under a rock for the past week, you may have missed that influenza season is in full effect. We had historically low flu seasons the past 2 years, so this flu epidemic is undoubtedly worse than in recent years. More cases and possibly more severe illness are being reported coast to coast. According to Google trends, Kansas is just now in the midst of it's "spike". It has not yet peaked, but many experts are predicting the worst season in the past decade. In any case the flu is going to be with us well into February.

Is it time to panic? No, but you do need to take some common sense precautions when dealing with the flu.

How can I prevent the flu? Is it too late for the vaccine?

• If you haven't done so already, get your vaccine NOW. It takes 1-2 weeks for the vaccine to take effect, so if there is any chance it will be helpful it needs to be done yesterday - or preferably October! As I wrote previously, the flu vaccine is not 100% effective but it's safe and the best thing available to lower your risk or severity of illness. Preliminary data shows this year's flu vaccine to be a 99% match for Type A (which account for 80% of the circulating strains), but only 67% for Type B (20% of circulating strains).
• Your mom was right. Washing your hands frequently and thoroughly can help prevent the spread of germs, including the flu. Alcohol-based hand sanitizer works fine and is convenient, but soap and water may be even better.
• If a family member has the flu should I start Tamiflu? It depends! See below.
• Staying at home when reasonable (see below for who should see a doc) will lessen the chances you infect others.

If I get sick should I see the doctor? or the ER?

• Most people whom get flu-like symptoms do NOT need to rush to the doctor. Otherwise healthy, young to middle age people will typically fight off the flu virus without complication or the need for prescription medications.
• Several high high risk groups that are more susceptible to severe illness with the flu are the very young (less than age 2), older people (age 60+) and those with chronic diseases (especially lung diseases, low immune states, uncontrolled diabetes.).
• Although any case of the flu is miserable, "severe" worrisome symptoms would include shortness of breath, wheezing, fever lasting longer than 3 days, not tolerating any liquids by mouth for 24+ hours or passing out.
• If you do decide to see a doctor most patients can be handled in a primary care physician's office, but more severe cases may require an ER visit or hospitalization.

Do I need to take anti-viral medications (ie. Tamiflu)?

• FOR TREATMENT: The effectiveness of anti-viral medication in treatment of influenza is a controversial issue. At best it decreases the duration of symptoms by 1-2 days. Also, it must be started within the first 24-48 hours of symptoms to have any measurable effect. I think it’s a reasonable medication to try, but I only strongly recommend it to those at high-risk.
• FOR PREVENTION: If you have close contact with known, proven influenza, the Rx treatment for flu can also be used to lower risk of transmission (in theory at least). Not everyone whom is exposed needs preventive Tamiflu, but it should be considered in high risk groups.

W. Ryan Neuhofel, DO, MPH is the physician and owner of NeuCare Family Medicine; a Direct Primary Care medical practice. He is a board-certified Family Physician (American Board of Family Medicine) and Fellow-candidate in Wilderness Medicine.

For more information about NeuCare, visit their website or Facebook or Twitter.

Information contained here is intended for general health education only. All personal health and medical issues should be managed by a health professional.

NeuCare Family Medicine is a paid sponsor and advertisor of Wellcommons.com and Lawrencemarketplace.com

Early indications are that we are set to have an unusually early (and possible severe) flu season. Kansas has not yet seen widespread cases reported but the eastern US is already seeing a spike. If you have not yet received your flu shot, it needs to be done as soon as possible - as it takes about 2 weeks to provide protection. However, it's not too late and sometimes good things come to those who wait - like $10 flu shots!

Get a $10 flu shot IF you wear an ugly Christmas sweater AND bring a donation for Just Food. by Ryan Neuhofel, DO, MPH

If you'd still like to get your flu shot and enjoy some hot cocoa and old-fashioned Holiday jingles, please join us this Saturday morning. The fee is $10 cash IF you wear an ugly Christmas sweater AND bring a donation for Just Food (details below).

• Saturday, Dec 15, 9a - noon
• NeuCare Family Medicine in Medical Arts Building at 346 Maine St. (across from LMH)
• Public welcome. Ages 3 years & up. Not required to be a NeuCare member. No insurance required.
• RSVP appreciated (info@neucare.net), but not required

Fee (details)

• Grinch = $20 each

• $5 discount for wearing an appreciably ugly Christmas sweater (Dr. Neu to judge)

• $5 discount for donating 3 canned items or $5 cash to Just Food

• Cash only. Supplies limited.

• Please print and complete a CONSENT FORM prior to arrival. Forms will be available on-site as well.

W. Ryan Neuhofel, DO, MPH (Dr. Neu) is the physician and owner of NeuCare Family Medicine. He is a board-certified Family Physician (American Board of Family Medicine) and Fellow-candidate in Wilderness Medicine.

For more information about NeuCare, visit them online or Facebook.

Information contained here is intended for general health education only. All personal health and medical issues should be managed by a health professional.

NeuCare Family Medicine is a paid sponsor and advertisor of Wellcommons.com and Lawrencemarketplace.com

As flu season arrives (it’s officially here now) I am urging procrastinators to get vaccinated ASAP. People often cite negative personal experiences with the flu shot as a reason for declining my recommendation. The most common concerns I hear about the flu shot are “it gave me the flu” or “doesn't work for me.” Is that possible? And why does it not work sometimes?

Influenza A Virus. by Ryan Neuhofel, DO, MPH

Let’s tackle the first issue because it’s a much simpler topic. Is it possible for the shot to give you the flu? The short answer is ‘no.' Flu vaccines are either “dead” or “inactive” viruses so they cannot replicate, infect or spread through the body. However, stories of people getting sick (including actual influenza) after getting the flu vaccine are not crazy talk. So what’s the deal? There are several plausible explanations for getting “sick” despite getting a flu shot. (in no particular order)

1) Strong immune response following vaccine. The flu vaccine does cause a low-grade immune response by design. That’s how all immunizations work. The degree of the response can vary from mild to more severe. A more severe immune (inflammatory) response can give flu-like symptoms, including fatigue, low-grade fevers and body aches last for several days (48-72 hours) following your shot.

2) Poor immune response. Some people whom get the flu shot do not gain “immunity” because of a variety of factors. This issue is most common in the very young or old, so guidelines now recommend giving young children 2 doses for their first time and possibly “high dose” vaccines to the elderly. In fact there is still plenty of legitimate debate about the vaccines effectiveness in these high-risk populations (ironically the ones whom will most benefit from the vaccine).

3) Immunity lag time. Your immune system will require approximately 2 weeks to fully gain immunity from the vaccine. So, the vaccine is not immediately protective. During that lag time, it is very possible to get infected with a live flu virus.

4) Not 100% flu strain coverage. This is probably the biggest “downfall” I hear from well-read patients, but it’s a complex and evolving issue. There are 2 main subtypes of flu but dozens of strains circle the globe each year and are constantly mutating in to new forms. Each year’s North American vaccine is based on a carefully planned study of which flu viruses are most likely to be common here based on international trends. This process has markedly improved over the years and the 2010-2011 vaccine was a 94-99% match for the strains that eventually became common in the U.S.

5) Not 100% preventive against infection. Even if you have full immunity to the circulating viruses, you can still become infected with those viruses. In theory, your immune response will be much quicker and stronger (lessening the severity and length of the flu), but you may still become sick.

6) Other viral illness. A whole host of other viruses exist that can cause flu-like illness. The flu shot does not protect against these “common cold” viruses (adeno, rhino, etc.). They are less severe than influenza, but can make you feel pretty crummy and in bed for several days.

Given all of these potential pitfalls of the flu vaccine, why should you get one at all?

For all the reasons listed above, the current flu vaccine is not close to being 100% protective. Our public health marketing effort has probably oversold the effectiveness of the flu shot in many ways. It’s nowhere near as effective as other vaccines (measles, tetanus, etc.) at preventing illness or death. However, it’s the best available way to lower your risk of contracting the flu, becoming very ill from influenza and passing the virus to family and friends. Exercising regularly and eating a well balanced diet does not guarantee avoidance of cardiovascular disease or cancer (or contracting the flu), but I’m not afraid to recommend them either.

W. Ryan Neuhofel, DO, MPH (Dr. Neu) is the physician and owner of NeuCare Family Medicine. He is a board-certified Family Physician (American Board of Family Medicine) and Fellow-candidate in Wilderness Medicine.

For more information about NeuCare, visit them online or Facebook.

Information contained here is intended for general health education only. All personal health and medical issues should be managed by a health professional.

NeuCare Family Medicine is a paid sponsor and advertisor of Wellcommons.com and Lawrencemarketplace.com