Opened the door and influenza!

It’s that time of year again, the flu season is coming. In Southern California it tends to be strongest from January to March. Primary care offices, urgent care facilities, and emergency departments will see their visits increase on an almost daily basis. So let’s talk about “The Flu.”

Influenza is a respiratory disease caused by infection from the influenza virus. There are several types of influenza viruses, but the most important ones from our perspective are Influenza A and Influenza B. The “swine flu” virus, H1N1, is an Influenza A virus.

The typical presentation of flu includes fevers, fatigue, body aches, cough, runny nose, headaches, sore throats. If you are paying attention you’ll see that these symptoms are very commonly found in a variety of viral illnesses, including colds, pharyngitis, ear infections, and bronchitis. One of the key presenting factors to help us diagnose flu are the severe body aches, or myalgias. These are not usually found to the same degree in other viral illnesses.

When patients present to their doctor with symptoms of flu, the diagnosis is usually called “influenza-like illness.” The only way to diagnose true influenza is with a nasal swab to culture the virus. In 2009, during the early part of the swine flu “epidemic,” the CDC was collecting samples from physicians to help determine the distribution of H1N1 in the population. It took a “Freedom of Information Act” filing to get them to release the data, and here’s what is showed:

In California, out of 13,704 specimens only 2% were positive for H1N1, and only 12% were positive for other flu viruses. This meant that 86% of them were negative for any flu virus.

In the other states the negative findings were similar, ranging from 83% to 97% of samples being negative for flu virus

This becomes important because we are attempting to make sure that we are looking at the body from a holistic, natural perspective. One of the keys to managing flu infections in the medical world is the vaccination program. The vaccine is only modestly effective in most patients, with little data supporting its use in healthy people, including elderly and children. But if 83-96% of influenza-like illnesses are negative for influenza virus, even in the most effective situation the vaccine would not be able to prevent these infections. In people who have pre-existing lung problems such as asthma, emphysema, or cystic fibrosis the vaccine has been shown to reduce pneumonia infections and hospitalizations

So if the vaccine is ineffective, then how do we prevent ourselves from “catching” the flu? One of the most effective strategies is basic hygiene. Hand washing, not coughing on others, and using a mask if necessary are all basic strategies that have been shown to be most effective at preventing spread of the influenza virus, as well as other viruses.

As we recall, the Osteopathic philosophy places an emphasis on the body’s response to an insult, in this case a virus landing on our mucous membranes in the nose or mouth. So our approach is to try to boost the natural response, called the innate immune response, to outside invaders.

One strategy includes watching what you eat/drink and checking your supplements. In a 2010 study in Japan, schoolchildren who took 1200 IU/day of Vitamin D had a 58% relative risk reduction compared to placebo for laboratory confirmed influenza A infections. This compares quite well with the CDC’s stated efficacy of influenza vaccines which is in the range of 50-70%. If you are supplementing your Vitamin D via sunlight this can be a challenge during the winter months. In fact, some have proposed that influenza infections be seen as a symptom of Vitamin D deficiency related to decreased sunlight exposure in the winter months.

Sugars can lead to increased inflammation and decreased immune response, so maintaining your avoidance of simple and added sugars is critical. Vitamin C, found in many citrus fruits as well as most supplemental vitamins, is also effective at boosting the innate immune response to viral invaders.

Finally, if for some reason you are unable to respond to viral exposure and are now “sick” the basic rules of hygiene apply. Lots of fluids, rest, sunlight (Vitamin D), hand washing, masks. OMT can also help to stimulate the lymphatic system and improve overall functioning of the body. During the Spanish Flu epidemic of 1918 (the last big swine flu outbreak, BTW) patients who received Osteopathic treatment had a much greater chance of survival than those who just received allopathic care. Data collected by the AOA at the time showed a death rate for DOs patients of 0.2% compared to the documented rate of 12-15% for standard care.

So, to sum up, I think that it’s important to recognize your risk factors going into “flu season” this year. If you are at risk, including chronic lung disease, then the flu shot may help reduce your chances of pneumonia or hospitalization. If you are otherwise healthy please continue to do those things to keep yourself healthy this year, including supplementing with Vitamin D. If you are going to be around people who are sick, hand washing, and maybe masks if those around you have coughs.

As usual, to find a DO in your area contact the AAO or the Cranial Academy

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