ASK DR. BAUGHAN February 6, 1998
FLU SEASON IS HERE
I was on call last weekend and received over 60 phone calls, most of them with the same list of symptoms - fever, sore throat, congestion, aching muscles “as though a truck ran over me.” Quite a few had nausea, vomiting and diarrhea for 1-3 days. So I guess it might be worthwhile for an annual review of the repeated questions: What can we do? When should we be seen?
Several viruses are actually in operation here. True influenza may not give much in the way of congestion or nausea and vomiting. It primarily gives the fever and myalgias (“run over by truck” feeling) and headache. Other viruses may give the other syndromes that every other person in the valley seems to have.
When is the fever itself dangerous? It surprises many people when I tell them not to worry about the fever itself unless it is over 105.5 degrees orally or rectally. Axillary (armpit) or ear temperatures can clue you in that there is a fever, but they do not correspond accurately to severity of illness. What if it does not come down with Tylenol or ibuprofen? Again, this is not a sign of a serious complication, it just means that the body is still fighting the infection, not that it is losing the fight. A fever, 101 or 104, means you are sick, but not how sick. The only groups that we generally want to examine more readily with a fever over 103 degrees are those less than one year old or over 65 years old. Even then, key questions to assess severity are: How is the person doing? What other symptoms do they have?
When does a cough need to be seen? Cough can indicate croup, bronchitis, post-nasal drip, pneumonia or lots of conditions. More crucial, however, is how is the person breathing when they are not coughing? Count the breaths per minute. If a child is breathing more than 40 breaths per minute or an adult more than 30 breaths per minute, then a lung infection is more likely. If the breathing is OK but the cough is distressing, then dextromethorphan (found in cough medicines with a DM after the brand name) is as strong a cough suppresant as anything by prescription. Persistent coughing spasms may indicate bronchial airway spasms, for which a bronchodilator spray or syrup may help more than an antibiotic.
How much vomiting is too much? Fortunately, we can go without fluid intake for 24 hours without getting dangerously dehydrated if we do not have chronic problems with our kidneys or other chronic diseases. Therefore, resting the stomach and not trying to replace fluids lost by vomiting for 12-24 hours is possible. Giving tiny sips of fluid frequently can effectively replace a lot of fluid. That is essentially what is done with intravenous fluid. Think: drip, drip, drip. Persistent diarrhea of 10-12 watery movements per day for 1-2 days is more worrisome for dehydration than vomiting. Again: drip, drip, drip, sip, sip, sip.
How about zinc lozenges? There was considerable enthusiasm for zinc after an article published in the Annals of Internal Medicine in 1996. In November 1997, J.L. Jackson published an article in the Archives of Internal Medicine summarizing the results of eight different studies of zinc and the common cold. The total of patients in all the studies was 540, and the author could not show a clear benefit for particular symptoms or duration of illness in those who took it and those who did not. No evidence it hurt; just inconclusive evidence that it helps.
Finally, old sayings die hard, but DO NOT “take two aspirin” with a viral illness. Reye’s Syndrome is a rare complication of viral illness and aspirin that causes liver damage. Acetomenophen (Tylenol) or Ibuprofen (Motrin, Advil) are OK, but not aspirin. Rest, fluids, chicken soup, and lots of tender loving care are still the best prescription.