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 V.21 No.48 | November 29 - December 5, 2012 

Miss Diagnosis

Know Thy Virus

How to avoid a snot-filled winter

Miss D
Miss D
From my perch at a busy primary care clinic, the waning daylight is an ominous harbinger of abundant infectious nastiness.

Every year, millions of us catch at least one virus. Though viruses offer a dazzling array of symptoms, most entail some unsavory buffet of coughing, fever and boogers.

While I personally find all of the body’s slimy byproducts fascinating, my patients, who sit in feverish, congested misery on my exam table, seem less enthused. But it’s so fun figuring out the culprit behind a bizarre rash (pink nipple splotches, anyone?) or whopper-sized lymph nodes on the back of someone’s head (true story!).

Unfortunately, there isn’t much your health care provider can do about many run-of-the-mill viruses, like colds or stomach bugs. Antibiotics don’t work against these tiny jerks, and most treatments are supportive (think lozenges and fluids) rather than curative.

When you or your kiddos start spewing sputum this fall, sorting the sniffles from the scary can be daunting. Before you freak yourself out by consulting Dr. Interwebs, here’s the skinny on two cold-weather criminals.

When you or your kiddos start spewing sputum this fall, sorting the sniffles from the scary can be daunting.

RSV (Respiratory Syncytial Virus)

I don’t often pee my pants, but the first time I saw an infant with a full-blown case of RSV (a viral illness of the airways), I definitely tinkled a little in fear. In most children, RSV’s bark is worse than its bite. But when a tiny critter falls ill, mega badness can ensue. Sadly, there’s not a vaccine for RSV yet.

Most everyone gets RSV before the age of 2, usually when the weather turns cold. The majority of kids have mild cold-like symptoms (think runny nose, loss of appetite and coughing). But this bully can cause serious respiratory distress in a small percentage of kids, especially little babies and children with chronic health or immune problems. A kid struggling to breathe always requires immediate attention (as in, calling 911).

True to their sadistic nature, children delight in freaking their parents out with scary fevers, wacky rashes and awesome amounts of barf or poop when they’re sick. It’s hard for parents to distinguish these normal sick kid symptoms from red flags, such as trouble breathing, somnolence or significant dehydration. Because of this, I typically advise parents to seek care if there’s any doubt at all. The vast majority of RSVers will recover after nothing more then some tender parental care.

I’ve written about the flu before, and I’m going to keep writing about it until I never hear a patient complain that the flu shot gives them the flu again.

RSV isn’t the only virus to strike kids come fall. In fact, healthy children normally get between six and 12 cold viruses, like the tamer rhinovirus, every year. Clinics face an onslaught of coughing kids in the cold months, so don’t be surprised if your pediatrician asks you a few questions about your little one, glances at his vital signs, peers into his mouth, listens carefully to his lungs and recommends fluids before being torn away by a beeping pager and 30 other sniffling munchkins. Try not to be disappointed if your child doesn’t get a prescription for antibiotics. Antibiotics can't kill viruses, and kids can get serious side effects from inappropriate antibiotics.

Influenza

I’ve written about the flu before, and I’m going to keep writing about it until I never hear a patient complain that the flu shot gives them the flu again. Before I get a bunch of inflammatory comments at alibi.com for this, allow me to remind you that flu kills tens of thousands of Americans annually. Even if you’re a robust lad of 20 who never gets sick, your granny and nephews and pregnant girlfriend really don’t need you passing on a potentially deadly virus.

Flu virus
Flu virus
By October, the flu virus is single and seriously ready to mingle. It enjoys nestling into the airways of young and old equally. Of course youngsters, the elderly and sick folks are at higher risk of experiencing complications such as pneumonia or death. The rest of us huddle in our beds for a week or so, AWOL from work, school, that amazing skiing trip or whatever else was on your calendar. This costs the economy (which I hear isn’t doing so hot) billions each year.

Many cases of flu are preventable. The flu shot contains inactivated virus, and, though some folks feel a little blah for a day or so after, there’s no way it can give you the flu. Yes, flu shots have risks. No, those risks don’t outweigh the benefits for the majority of people, not by a long shot. There’s this newfangled thing called Google, and you can use it to search for a flu shot clinic near you.

Vaccines

Hey! While we’re on the subject of vaccines, I’d like to give a shout out to the Pertussis vaccine, which protects against whooping cough. All adults need a booster, so make a date with a sexy TDaP vaccine and get boosted. Second shout out goes to the pneumococcal vaccine, which wards off common pneumonia-causing thugs. Ask if you need one. Inquire about the shingles vaccine while you're at it.

Last shout out goes to the HPV vaccine. I’ve been thinking a lot about this because apparently people like this whole “free preventive care” thing and, as a result, my clinic schedule has been full of appointments for pap tests. HPV is a pervy little virus that causes genital warts and cancers of the cervix and other private bits. It’s not just a women’s health issue, since men don’t particularly enjoy losing their penises to penile cancer or their wives, sisters and mothers to cervical cancer. Consider getting your kids (or yourself) vaccinated.

In addition to vaccination, the best way to enjoy a healthy season is to wash your hands and get plenty of fresh air. Hopefully that will keep you out of the clinic, delighting infectious disease geeks like me with your neon blue phlegm and butt rash.

Despite its brilliant name, this column is not intended to prevent, diagnose or treat awesomeness. Or any other diseases, for that matter.

Whitny Doyle is a family nurse practitioner.

The opinions expressed are solely those of the author.
 
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