Cold and Flu Season - A greater Understanding (Plus Helpful Hints and Tips)
To anyone who may have taken notice of my rather extended blog hiatus and assumed I must have either moved to a remote cabin in the woods or else succumbed to a deadly pathogen, I can now declare with certainty that neither of these plausible scenarios came to pass. There was a moment or two where the former may have seemed like the best idea while the latter was closest to taking place, but despite my household’s unfortunate run-in with the walking death of 2024, I am pleased to be at long last feeling back to normal health.
If you have not been personally afflicted by one of the many terrible upper and lower respiratory infections swirling around Central Ohio this past month or two, I commend you. You should be proud.
I think the timing of my illness calls for a little crash course in cold and flu management. What to do early, what to look out for, when to worry, etc.
Most of you know how this typically goes. Someone in your household comes down with an illness, often after traveling, or at the start of the school year, or following a large family gathering. Soon enough, it seems like everyone is dealing with with some version of it or another. Here is how I tend to think about these infections.
Symptoms are not illnesses, they are your body’s way of attempting to restore normalcy.
Identical illnesses or infections will not always produce identical symptoms.
Many infections will cause the same symptoms as many other, different infections.
Most easily spread infections fall under the virus category. Viral infections, including some nastier ones such as Influenza and COVID 19, share a lot in common with hundreds or thousands of less severe rhino-, parainfluenza, adeno-, entero-, and human corona- viruses (or what we’ve long thought of as “common colds”) and usually begin similarly. Early symptoms are often systemic, meaning they affect the whole body. This is why we often feel sore, achy, and fatigued. We may have fevers or chills. We may experience nausea, upset stomach, or even diarrhea. Onset generally happens fairly quickly, over the course of 1-3 days following exposure. Most viral infections aren’t serious for anyone with a competent immune system, but they may still make us feel pretty miserable. Viral infections typically run their course within 5-10 days.
“Okay, smarty pants, it’s been well over a week now, so why am I still sick??” someone could say.
Well, the short snarky answer is “it depends,” but I am going to try and explain it in a way that’s not overly technical.
Setting aside the fact that patients sometimes aren’t sick from infections at all, but instead are suffering from allergies. (For instance, seasonal allergens, such as grass and tree pollen or ragweed, can persist for months. Remember, symptoms are not illnesses, but the body’s response to something causing a problem.) But, for the sake of this discussion let’s assume they were in fact sick due to a virus. Lingering symptoms may often be continued by what we term secondary infections.
Secondary infections can be viral too, (there’s no rule that says you cannot get 2 separate viral infections in a row) but more likely this is when we get into the realm of bacteria. And the reason this distinction is important is the use of prescription antibiotics. Antibiotics kill bacteria, but they have zero effect against viruses. This comes up a lot in primary care, where is it extremely common to be told by a patient who presents with 2 days of cold symptoms “I get this same illness practically every single year. My old doctor always gave me a Z-pack and it always does the trick.” Maybe you see where I’m going with this, and maybe you feel slightly under attack right now, but it’s okay. This is a learning experience. Human nature is funny, and surprisingly predictable, so when a patient who doesn’t feel well seeks something, ANYTHING, to make it all better, that is just what they’ll do. What they reflexively abhor is to be told to wait. Do this instead. “Be patient, patient.” Especially when they’ve got a foolproof remedy in mind that has never failed, despite it being a simple math equation. Present on day 2 or 3 with a viral illness. Be prescribed a superfluous 5-day antibiotic regimen that cannot possibly address the likely problem at hand. Basically back to normal by the end of a week. Like I said, human nature is funny. But anyway, back to secondary infections.
Unlike more contagious (primary-infection-causing) bacteria, Strep A for example, the majority of secondary infections result from boringly common yet opportunistic bacteria that already live in and on our bodies in relative peace and harmony. When a body is fighting off one thing, the door is often left open a crack, allowing formerly-kept-in-check bugs a chance to make their presence felt in ways they normally cannot. And the reasons for this phenomenon makes sense when you think about it. During a cold, there’s all this inflammation in several key areas of the upper and/or lower airway happening at the same time. Excessive mucus production and plugging, swelling of mucosal surfaces of the nose, throat, ears, sinuses, and bronchioles. Factor in poorer rest quality from spending nights tossing and turning due to all the coughing, sore throats, and stuffy noses. During viral illnesses we are simply weakened a bit. And that weakness presents an opportunity for our neighbors, bacteria.
The three most likely secondary bacterial infections I frequently see in primary care are sinusitis, bronchitis, and, to a lesser extent, pneumonia. The good news is, there are ways to limit the potential to develop these secondary events. Here are my best tips.
Treat your symptoms as your body doing its job, and our goal is to assist it in doing so.
Mucus thinners (“expectorants”) + hydration = more movement and less plugging. Guaifensin (the active ingredient in Mucinex, Robitussin, et al) keeps everything looser and more watery, enabling your body to clear out the infection easier.
Cough suppressants. Coughing is your body’s way of clearing the lungs of debris, and it’s necessary, but excessive, under-productive coughing is not only painful, annoying, and exhausting, it is also a waste of energy. Controlling the cough frequency and allowing the coughs you do experience to be more productive is a win-win. Dextromethorphan (aka “DM” in product preparations) is a very useful tool to employ.
Vitamins. Particularly immune-boosters such as Vitamin C, Vitamin D3, and Zinc, provide your body with a little extra ammunition to bring to the fight.
Saline irrigation. For similar reasons that we discussed the benefits of expectorants, nasal and sinus rinses with OTC saline preparations can make a big difference when dealing with upper respiratory infections. The pipes are clogged? Hose ‘em down. Flushing with saline not only mechanically clears the openings, but osmotic properties of saline helps to also draw excess fluid out of the swollen mucosa, reducing congestion naturally
Pain relievers. Acetaminophen, ibuprofen, naproxen, etc, make you feel less achy. Colds cause pain. Sore throats, headaches, body aches to name a few. By reducing these symptoms with the help of medications you can achieve better sleep, remain more productive during the day, and generally function more normally as you recover.
Decongestants. (Mainly pseudoephedrine and phenylephrine) I’m including them because they are readily available over the counter and are in many multi-symptom preparations on the shelf. In my opinion, they do have a role, but they’re not for everyone. Pros: Less stuffiness. Reduced sinus pressure and headache. Cons: over-drying mucus membranes, (the opposite of what we are trying to achieve with guaifenesin), plus they can disrupt sleep, and may also increase heart rate and blood pressure. My advice? Use these sparingly, and generally for no longer than the first 3 days of the cold symptoms when the stuffiness tends to be at its peak.
If you have gotten sick, and have smartly followed the advice above, and are STILL not improving after a period of 7 to 10 days, I would definitely encourage you to see your direct primary care physician, who can evaluate you and determine whether antibiotics may now be warranted.
