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The Influenza Issue

October 2009






About the Newsletter



Flu Shot Clinic

Our annual flu shot clinic will be Friday October 9, from 8-12. We will be scheduling patients every half hour. We anticipate a high demand this year, so please call our office to schedule your shot today!.

This clinic will offer the vaccination for seasonal influenza, which is expected to peak in the winter, as usual. This shot is recommended for everyone over 6 months of age.   The flu shot is especially recommended for anyone with asthma, diabetes, heart disease, pregnancy, or an immunocompromised state.

The vaccine for H1N1 influenza is not yet available to the public, but is expected in late October. We will plan a separate shot clinic when it becomes available. The same recommendations will apply to H1N1 shots as for seasonal influenza.

Unfortunately, the seasonal flu vaccine does not prevent H1N1 flu, and vice-versa.  Therefore, at-risk individuals should plan to get BOTH vaccines.


Office Hours

Our normal office hours are 9-5 Monday through Thursday, and 9-12 on Friday. Our answering service can be reached after hours at 251-4873. When the office is closed, emergency care is available at the Urgent Care Centers, and at Mission/Saint Joseph hospitals ER.  Telephone calls are handled by Dr. Curran’s call partners.

  • Our Flu Shot Clinic will be Friday, October 9th from 8am – 12noon
  • We will be closed November 25-27 for Thanksgiving holiday
  • We will be closed December 24-25 for Christmas holiday
  • We will be closed December 31- January 1 for New Year’s holiday

Office Reminders

Now that cold and flu season is upon us, we have a higher demand for sick appointments. If you are not able to keep your scheduled appointment with Dr Curran, please call our office at least 24 hours in advance so we may have availability for sick patients.

HIPAA law states we can not release any of your information without your written consent. Please let us know if you would like to authorize us to release information to your spouse or family member(s).

Please let Kitty or Julie know when you check in if you have a new mailing address, phone number or new/updated insurance.


Medical News

Swine Flu

We are currently in the midst of an epidemic of Swine Flu (H1N1) in WNC. Every day for 2 weeks we have seen several sick adults and children at our office. The local school systems are experiencing record high absences due to illness. It is important to recognize the signs of influenza, and to know how to prevent the spread of this illness.

If you have a fever (over 100), cough, fatigue, and muscle aches, you almost certainly have influenza. The current strain of influenza is the H1N1, or swine flu. This strain is expected to continue throughout the winter. The H1N1 flu will also be joined by the usual seasonal flu strains in the winter months. If you have these symptoms, please isolate yourself from others, and consider seeking medical attention.

How serious is swine flu infection?

Initially there was concern that the Swine Flu would be more deadly than usual influenza, because of several deaths in Mexico. However, our recent experience has shown the illness to be similar to seasonal influenza. Like all influenza, Swine Flu will make an individual sick for 5-10 days with fever, muscle aches, fatigue, cough, and upper respiratory symptoms. Most people with Swine Flu will recover without complications. There is a higher risk of hospitalization and complications from influenza in people under age 5, over age 65, and with conditions such as asthma, heart disease, diabetes, pregnancy, or immunocompromised states.

Is the Flu virus contagious?

The Swine Flu and the seasonal flu are both highly contagious by coughing, sneezing, and skin contact. Sick individuals are contagious four about a week, from the day before they are sick, to the day after their fever resolves. Because of this, sick individuals should stay home from school and work until their fever has been gone for 24 hours.

What are the signs and symptoms of flu and swine flu?

The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. Severe illness (pneumonia and respiratory failure) and deaths have occurred with swine flu infection in a few people. Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

Are the Flu Shots safe?

In a word, YES. It is much safer to get the vaccine than to get influenza. Flu shots are made with a killed virus, so they cannot cause the flu illness. Like any shot, the most common side effect of the flu vaccine is a sore arm. Some people will have a low-grade fever as a response to the injection, but this is not the same as an illness. Eggs are used in the manufacturing process, so people allergic to eggs or poultry may not be able to get the vaccine. The preservative Thimerisol is used in the initial stages of vaccine production, but is diluted out of the final product. Our vaccine is considered "preservative free."

We are currently giving vaccinations for the seasonal influenza which is expected in the winter.  Unfortunately, this vaccine does not protect against Swine Flu, which is already affecting our community.  We expect Swine Flu vaccine to be available by late October.  The Swine Flu vaccine will not protect against seasonal flu, and vice-versa.  Therefore, at-risk individuals should get BOTH vaccinations.

Are medicines necessary to treat Swine Flu?

Antiviral medications (oseltamivir or zanamivir) can lessen the course of illness with influenza.  They are recommended for treatment of influenza only in severe cases, such as those requiring hospitalization. These medications are useful only if started within the first 3 days of illness. Most people with Swine Flu or seasonal influenza will not need antiviral treatment. Treatment is not recommended for prevention of the illness except in high-risk individuals.

What can I do to protect myself from getting sick?

There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza. Take these everyday steps to protect your health:

  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
  • Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
  • Avoid touching your eyes, nose or mouth. Germs spread this way.
  • Try to avoid close contact with sick people.
  • If you get sick with influenza, stay home from work or school and limit contact with others to keep from infecting them.

What is the best way to keep from spreading the virus?

If you are sick, limit your contact with other people as much as possible. Isolate yourself at home until your fever resolves. Do not go to work or school if ill. Cover your mouth and nose with a tissue when coughing or sneezing,  and put your used tissue in the waste basket. If you do not have a tissue, cover your mouth and nose with your sleeve. Then, wash your hands, and do so every time you cough or sneeze.

What is the best hand washing technique?

Washing your hands often will help protect you from germs. Wash with soap and water, or clean with alcohol-based hand cleaner. Wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers should be used. You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn't need water to work; the alcohol in it kills the germs on your hands.

What should I do if I get sick?

If you are sick, you should stay home and avoid contact with other people as much as possible to keep from spreading your illness to others.   If you become ill and experience any of the following warning signs, seek medical care.

In children emergency warning signs that need urgent medical attention include:

  • Fast breathing or trouble breathing
  • Bluish skin color
  • Not drinking enough fluids
  • Not waking up or not interacting
  • Being so irritable that the child does not want to be held
  • Flu-like symptoms improve but then return with fever and worse cough
  • Fever with a rash

In adults, emergency warning signs that need urgent medical attention include:

  • Difficulty breathing or shortness of breath
  • Pain or pressure in the chest or abdomen
  • Sudden dizziness
  • Confusion
  • Severe or persistent vomiting

More on this from WebMD:

More on this from the CDC:

Influenza - Home Treatment

If you have influenza, you can expect the illness to go away on its own in about 7 to 10 days. In the meantime, you can take these steps to feel better:

  • Get extra rest. Bed rest can help you recover faster. It will also help you avoid spreading the virus to others.
  • Drink plenty of fluids to replace those lost from fever. Fluids ease a scratchy throat and keep nasal mucus thin. Hot tea with lemon, water, fruit juice, and soup are all good choices.
  • If fever is uncomfortable, take acetaminophen or ibuprofen to lower it. You may also sponge your body with lukewarm water to reduce fever. Do not use cold water or ice. Lowering the fever will not make your symptoms go away faster, but it may make you more comfortable.
  • To relieve body aches and headache, take Tylenol or Motrin.
  • Try a decongestant or nasal spray to ease a stuffy nose. Look for a single-ingredient decongestant that contains phenylephrine or pseudoephedrine. If nasal drainage is thick, a decongestant that contains guaifenesin may help keep it thin and draining. Do not use medicated nasal sprays or drops more often than directed, and don't use them for longer than 3 days.
  • To help clear a stuffy nose, breathe moist air from a hot shower or from a sink filled with hot water.
  • Avoid antihistamines. They do not treat flu symptoms and may make nasal drainage thicker.
  • If the skin around your nose and lips becomes sore from repeated rubbing with tissues, apply a bit of petroleum jelly or lip balm to the area. Using disposable tissues that contain lotion also may help.
  • Use cough drops or plain, hard candy to help ease coughing.
  • Take a nonprescription cough medicine that contains dextromethorphan if you develop a dry, hacking cough. Some products contain a high percentage of alcohol - use them with caution.
  • Do not give cough and cold medicines to a child younger than 2 unless your doctor has told you to. Be sure to follow medication directions, and do not mix medications for children.
  • Elevate your head at night with an extra pillow if coughing keeps you awake.
  • Avoid smoking and breathing secondhand smoke. This is good advice any time, but it is especially important when you have a respiratory infection like a cold or the flu.

Call your doctor if:

  • Your symptoms, including fever, do not improve after 5 days.
  • You develop a worsening cough, chest pain, or shortness of breath.
  • You cannot eat or drink.
  • You develop symptoms of a bacterial infection, such as a new or worse cough that produces yellow, green, rust-colored, or bloody mucus; ear pain, sore throat, sinus pain, or nasal drainage that changes from clear to colored after 7 to 10 days.

More on this topic from WebMD:

Medications to ease your illness

Treatment of colds and influenza is mostly aimed at minimizing the symptoms. There are dozens of over-the-counter remedies that may improve your symptoms. However, these medications must be used intelligently. Most these medications contain slight variations of the same several ingredients. It is best to pick medications that contain only one ingredient, so you know what you are taking. Do not take more than one medicine with the same ingredient. Only by reading the list of active ingredients can you identify which medications are right for you.

  • Guaifenesin/Mucinex is a mucolytic. It makes mucus more watery, so you can clear out congestion or sinus pressure. This increases sinus drainage. Guaifenesin is safe in pregnancy, hypertension, diabetes, and for children. The adult dose is 600-1200mg every 8-12 hours. Guaifenesin is in Mucinex and most Robitussin products.
  • Pseudoephedrine and Phenylephrine (D or PE products) are decongestants. They dry out your nose and throat, reducing mucus secretion. Side effects can include elevated blood pressure and heart rate, feeling jittery and wakeful. Avoid pseudoephedrine at bedtime. Pseudoephedrine should not be used by people with hypertension or heart conditions or strokes. The adult dose is 30-60mg of pseudoephedrine every 6 hours. Pseudoephedrine has been moved behind the counter – ask the pharmacist for it.
  • Antihistamines are also decongestants. They dry out your mucus membranes and suppress an allergic response. Antihistamines are very useful for treating allergies, rashes and hives. Antihistamines should not be used by people with glaucoma or urinary retention, and should be used carefully by people with hypertension.  The once-daily antihistamines cause less drowsiness, and include Loratadine (10mg) and Citerizine (10mg). Older antihistamines cause drowsiness, and last 6-8 hours. These include Benadryl/diphenhydramine (25-50mg), chlorpheniramine (2-4mg), Brompheniramine (2-4mg), phenylpropanolamine (12-25mg), and Clemastine (1mg).
  • Dextromethorphan (DM products) is a cough suppressant. It may make some people drowsy or dizzy. It is safe to use in pregnancy, hypertension, diabetes, and for children. The adult dose is 10-30mg every 6 hours. Products with dextromethorphan often have DM in their name.
  • Anti-inflammatories are used for relief of pain and fever. They can irritate the stomach, elevate blood pressure, and cause swelling. They should be avoided by people with ulcers, CHF or renal disease. These include Aspirin (200-650mg every 4 hours), Motrin/Advil/ibuprofen (200-800mg every 8 hours), and Aleve/naproxen (200-400mg every 12 hours.) Children may take Ibuprofen 10mg per pound, every 8 hours (use the dosing schedule on the container). Aspirin should not be used by children.
  • Tylenol/acetaminophen is used for relief of pain and fever. It is safe to use in pregnancy, hypertension, diabetes, and for children. It should not be used by people with liver failure. The adult dose of acetaminophen is 325-650mg every 4-6 hours. Never exceed 4000mg per day. A child’s dose is 5-7mg per pound, every 4-6 hours (use the dosing schedule on the container). This can be used in addition to ibuprofen for fever.
  • Nasal Saline is simply salt water. It is safe for all children and adults. You can make it at home or buy it in a squirt bottle. Saline is useful to clear nasal congestion and reduce nasal dryness. This is particularly useful for recurrent nosebleeds. Nasal saline should be used every hour as needed.
  • Afrin Nasal Spray is a very powerful nasal vasoconstrictor. It reduces runny nose and congestion. Unfortunately, Afrin is rapidly addictive to the nasal membranes. It is safe to use Afrin every 4-6 hours for 2-3 days. If you use it longer, you are likely to develop rebound rhinitis.
  • Eccanacia and Vitamin C are thought to boost the immune system. Some people use them to prevent or treat colds or URIs, however, there is no evidence that they actually work. Both are safe for children and adults.
  • Imodium is used to reduce diarrhea. You can safely take double the amount listed on the box. Adults can use 2mg every 4 hours. If you are having diarrhea, also eat bland foods and simple carbohydrates, and avoid milk products
  • Meclizine/Dramamine 2 is an effective treatment for nausea and dizziness. The adult dose is 25mg every 8 hours. This will usually cause drowsiness. This is an antihistamine, and should be avoided with glaucoma.
  • Alcohol/ethanol is an ingredient in many over-the-counter cold remedies and home remedies. Alcohol increases cellular permeability, allowing viruses to spread easier. Alcohol causes dehydration and drowsiness. Alcohol should be avoided while you are sick.

Influenza Links

Here are several websites with valuable information about influenza and its treatment.

For more local and general health information, check out these links:

About our Newsletter

Dr. Curran and the staff at Pisgah Family Health are proud to publish the Pisgah Family Health News to our patients.  Our goal is to provide regularly updated information about the office and current medical topics.  We plan to publish a new issue each quarter with breaking news.  The newsletters will also be archived on our website,

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