Musings of a Dinosaur

A Family Doctor in solo private practice; I may be going the way of the dinosaur, but I'm not dead yet.

Monday, September 21, 2009

Everything Else You Need to Know About the Flu

After posting this, which ended up being mainly about the H1N1 flu shot, I realized there were a few more things you really ought to know about the flu.

How do I know if I have the flu?

As I said before, it isn't subtle. In addition to a fever, headache, and body aches that make the day after five games to 15 that all went to universe point feel not so bad, the onset is often quite abrupt. You wake up feeling fine that morning and by lunchtime you can't stand up anymore.

You don't need to go to a doctor or health center to "make sure" you have the flu. The diagnosis is usually made on the basis of the medical history (what you tell the doctor about how you're feeling and how it started) anyway, so the best thing you can do is to stay away from other people (as are often found in a doctor's office or health center). There isn't much they can do for you either.

What do I do if I get the flu?

As I also said before, most people who are young and generally healthy get over the flu just fine. The most important thing you can do is REST. This does not mean going to class just to get the notes. It does not mean going to practice just to impress everyone with how dedicated you are. It definitely does not mean having a few brews with your buds because if your head is pounding anyway you may as well get a buzz on as well. It means stay in your room, preferably in your bed. If you live close enough to school, call your parents to come get you and stay in your room at home instead.

You can take acetaminophen (Tylenol) or ibuprofen (Motrin, Advil). It really will make you feel better. Not perfect; not well enough to get up and do stuff anyway; but better. So will drinking lots of fluids like water, juice, and chicken soup. NOT beer.

How can I keep from getting the flu, or spreading it if I have it?

Because the flu is spread by respiratory droplets, containing them is the key. The first thing you have to do is re-learn how to cough. You know how your mom taught you to cover your mouth with your hand when you cough? DON'T DO THAT. It just gets all those flu-virus-filled respiratory droplets all over your hands, which then touch door handles, keyboards, as well as other people and things that other people touch. Unless you're going to wash your hands with soap and water for 20 seconds every single time you cough or sneeze, DON'T COVER YOUR MOUTH WITH YOUR HANDS.

What should you do? You boys are going to love this, because you've been doing it for years and now no one can yell at you for it anymore: cough into your arms, which are hopefully covered with sleeves. If you're wearing just a t-shirt [and what the hell are you doing wearing only a t-shirt in the middle of winter when it's frickin' COLD outside!?!?] then cough into your shoulder.

You should still wash your hands frequently, preferably with soap and water for 20 seconds (the latest thing is to call it the time it takes to sing the "Happy Birthday" song), but those alcohol-based hand sanitizers are better than nothing.

The other really important thing to do is to stay away from sick people if you're healthy, and healthy people if you're sick. It's all about those stinkin' respiratory droplets.

What about school?

Many schools and colleges have developed policies to deal with flu this year. The Pennsylvania State system (includes IUP, Penn State, West Chester, Kutztown, etc.) has a policy encouraging sick students to "self-isolate", ie, stay in their rooms or go home. It looks like they're also going to be pretty liberal about excusing absences and allowing make-up work. For what it's worth, though, this should not be looked at as open season for slackers. I have no doubt that plenty of students will abuse the relative laxity of these policies, and absenteeism will probably be ridiculous even if the flu is really mild. Still, I expect better of the Frisbee team. I'm happy to bring you homemade chicken soup if you get sick, but you know I'll be just as quick to come kick your asses if you start acting like a bunch of lazy slackers.

What's Tamiflu?

Tamiflu is the name of a medicine that can be prescribed for people who get the flu. All it does is shorten the duration of illness by only about a day, on average. It needs to be prescribed within 24 hours of the onset of symptoms to do even that. It has side effects like nausea and vomiting. All in all, it's not much of a trade-off for young, generally healthy people, so I'm probably not going to be using it much for them.

When should I worry?

If you get a really bad cough that's bringing up a ton of stuff (called "sputum") of any color along with a very high fever, trouble breathing and/or bad pains in your chest, you might have pneumonia. Call a doctor or go to the health center.

If you have a really bad headache AND your neck is so stiff that it hurts to move it, call a doctor or go to the health center.

I usually tell people to call me if they feel really really bad, but the problem with the flu is that it can make you feel pretty bad, and people who don't get sick much don't know just how "bad" is bad enough to worry. Leave it at this: If you have anything in addition to fever, headache, body aches, slight sore throat and cough, get them checked out. If that's all you have, suck it up and wait it out.

Anything else?

Not that I can think of. Email me or ask in the comments.


At Mon Sep 21, 04:56:00 PM, Blogger Alpine, R.N. said...

~claps~ I'd add "dont call the campus ambulance service unless you have symptoms THAT WOULD TAKE YOU TO THE HOSPITAL"- we dont want to be infected if we can at all avoid it, so calling us for rides to the health center is really rather unkind.

At this point though, I've pretty much gotten used to the idea that I'm GOING to get the flu this year.

At Mon Sep 21, 10:09:00 PM, Anonymous Anonymous said...

That was great. I would love to cut and paste your two flu posts and use them for some patient education handouts in my office. If that's OK with you, please let me know.

At Mon Sep 21, 10:16:00 PM, Blogger Margaret Polaneczky, MD (aka TBTAM) said...

Excellent info - thanks for this.

At Tue Sep 22, 06:15:00 AM, Blogger #1 Dinosaur said...

Doug (and everyone):

Please feel free to cut, paste, edit to taste and distribute widely. This is obviously aimed at the college age population, and since that describes the demographic of all of my spawn, they are all close to my heart by proxy.

At Tue Sep 22, 06:27:00 AM, Anonymous Anonymous said...

So are any of the spawn actually ill? Here's hoping all are okay.


Kensington MD

At Tue Sep 22, 11:11:00 AM, Anonymous Anonymous said...

Apparently with H1N1, not all cases have a fever.
From the article:
"At the beginning of the outbreak in Mexico, only 30 percent of patients hospitalized with the infection had fever initially," he tells me, "and 15 percent of patients never developed a fever at all." What usually sent them to the hospital was shortness of breath or chest pain. In Chile, he adds, about half of those with confirmed H1N1 had no fever; many just had a headache and runny nose.

So, don't rule out H1N1 if a fever isn't initially present.

At Tue Sep 22, 11:31:00 AM, Blogger #1 Dinosaur said...


These posts are aimed at self-care for the general college population of basically healthy young adults. I am well aware of the nuances of H1N1 diagnosis (ie, that not all cases present with fever), however it is also the case that the overwhelming majority of people with "just a headache and runny nose" do NOT have the flu.

At Tue Sep 22, 12:37:00 PM, Blogger onewhowas said...

This comment has been removed by a blog administrator.

At Wed Sep 23, 11:21:00 PM, Anonymous Anonymous said...

last yr when hubby got seasonal flu, he came home from MD with tamiflu for me and our 2 teenagers to take to "prevent" us from getting the flu (I'm on immune suppresants for MS, but teens both healthy) Is tamiflu given out to prevent "collateral illness" for H1N1 too?

At Wed Oct 14, 02:22:00 PM, Blogger Just a little snarky said...

You know you have the flu because you feel like you WANT TO DIE.

BTW, I am rather flexible and so I cough into my lower back. I hope that's ok.


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