What is Influenza (The Flu)?
Influenza is a virus spread via the respiratory tract causing runny nose, cough, fever, congestion and general body aches.
One difficulty is that it is contagious BEFORE symptoms even start. A person can be spreading a disease that they don’t even know that they have.
The most commonly tested flu bugs are Influenza A and Influenza B.
Quickcare or ER?
You should go to the ER if the following red flags are present:
- Shortness of breath
- Difficulty swallowing
- Severe throat pain
- Stiff neck
What will you doctor ask?Your doctor will want to know your SYMPTOMS. Remember, a symptom is your description of your condition. It is YOUR STORY.
Most doctors will ask:
- When did it start?
- Are you short of breath?
- Do you have a cough?
- Do you have a sore throat?
- Are you able to swallow?
- What medications have you been taking?
- What makes your symptoms better?
- What makes your symptoms worse?
What will your doctor look for?Your doctor will look for SIGNS. Remember, a SIGN is an objective finding that a doctor sees during the examination.
- Fever. Characteristically, fever can zoom up to 101-103 degrees (Farenheit)
- Cry cough
- Swollen tonsils
- Wheezing or shortness of breath
- Cervical lymph node enlargement
- Many children may have associated stomach issues such as pain, vomiting and diarrhea
What is your doctor thinking?
Your doctor will create a mental list of possible reasons for your SIGNS and SYMPTOMS. This list is called the DIFFERENTIAL DIAGNOSIS.
Your doctor may consider strep throat as a cause. Mononucleosis needs to be considered especially if the glands on the back of the neck are swollen. Strep throat may look like the flu. A quick bedside Strep test will confirm the diagnosis.
In children, your doctor may consider pertussis as a cause should the immunizations be incomplete.
Recently, in my hometown of Hollister, I have seen cases of Valley Fever which mimic many of the symptoms of the flu. To make this diagnosis, special sputum cultures testing for fungus are required.
What is the treatment of Influenza?
For the cough, I prescribe Robitussin with codeine. For the nasal congestion, I like to use Flonase. It has a steroid component that decreases the swelling of the nasal passages.
If the cough goes into the chest, then I will have my patients use an inhaler such as Albuterol.
Flu medications such as Tamiflu (Oseltamivir) may help but they must be given within 1-2 days after onset of symptoms. So if a person has had symptoms for a one week, antiviral medications will not help shorten their illness. Should Tamiflu be given, a typical dosage for an an adult is a 75 mg tablet twice a day for 5 days. Physicians may prescribe Tamiflu to children. The dosage is based on their weight. The FDA did approve Tamiflu for children between 9-11 months. The typical dosage is 3 mg per kilogram per dose. (So a 10 kilogram child will take 30 mg twice a day). Tamiflu liquid comes in 6mg/ml. In the aforementioned example, 5 ml (one teaspoon ) will be given twice a day.
An alternative to Tamiflu, amantadine or rimantidine is a treatment for influenza A only.
For a true viral illness, antibiotics do not help.
As a prevention, I recommend a flu vaccine. Each year, the CDC presents the flu vaccine that they predict will be effective.
How long will you be sick with the Flu?
The worst part of the flu virus generally lasts for one week. A patient may have prolonged symptoms such as cough or congestion that lasts weeks. So many will present for a nagging cough that will not quickly go away.
Let me tell you a story
Right when I walked into the room, I took a short look at Joshua and knew he was as sick as a dog. Joshua is a small man in overalls. Probably just 5 feet 4 inches tall. His plump and pleasant wife stood over him like a giant. She held his forearm gently. Lovingly. Keeping him in his place.
His eyes were red and goopy. His cough was hacking. During the short wait time, he had already created a stack of used Kleenex which he kept by his side. He was miserable.
Even without looking at the chart, I knew I was going to keep him out of work for a few days and my inclination was to start him on antibiotics. Those decisions were made instantaneously. Now was a time to be “doctorly” Comforting. He needed someone who cared.
I noticed that he was wearing the uniform of the local energy company. I asked,” So how long have you worked there.”
“Twenty years there as an electrician, doc” responded Joshua.
He was so small. I could not help but noticing his hands as we greeted each other.
“My God. You have such small hands! Look at these little fingers. They are so small and thin, ” I said. I then went on,” I bet there are a lot of jobs that other guys cannot do and so they call on you for help.”
The little guy got a huge smile. He went from “sick as a dog” to “healthy as horse” His eyes widened and his chest puffed out. “As a matter of fact, doc, we have to deal with some delicate and fine wire. No one else can do like me. Right in the middle of the job, some guys have to stop and call me to finish the work.” His wife wearing the extra large house dress held him tighter as if saying,”That’s my man!”
His flu test was positive and she refused to have him take antibiotics or anti-virals. A few days of bedrest and chicken soup made by “the little Mrs” was enough to cure him.
I hope this helps
David Reyes MD