My husband and I took our two young sons to Disney World for a week back in October. It was a fun, fast-paced trip that unfortunately left me exhausted and feeling the most ill I’ve been in years. For me and my personal health, I’ve found that a lack of sleep is the biggest detriment to my overall health. I try to do a pretty good job of strengthening my immunity all year round, but none of those efforts matter if I haven’t been keeping up with my sleep.
I started feeling pretty bad within a few days of us returning home. By day 3, I was in such bad shape that I thought it may be one of the most severe illnesses I’ve ever contracted. The fevers were relentless and the overall malaise and lack of energy had hit me hard. A quick visit to urgent care confirmed that I had influenza Type A – the more severe strain – and that I was exposed in mid-October, before I even had a chance to consider obtaining the flu shot.
The CDC has been saying that the 2017/2018 flu season has been one of the worst since the H1N1 disaster of 2009. Below are some of my thoughts on the influenza vaccine, other ways of prevention, and the best symptom management.
The Flu Vaccine
Ah, the flu shot. To obtain vaccination or not – that is the question that perplexes many people. Even as a healthcare professional whose job is to advocate the flu vaccine, I even question it for my family and myself on a yearly basis. In years past, I’ve either worked from home or worked in a closed-door pharmacy where it was never mandated by superiors. The decision to vaccinate lay more in my hands than someone else’s, and it has forced me to research and gather as much factual information on my own accord as I could. This research is something I do every year, as the influenza virus is constantly mutating and the risks are never quite the same. My thoughts on the flu shot blend these 3 factors: my personal preferences as an individual; my concerns as a mother, wife, and daughter; and my overall duties as a pharmacist.
The complexity is that nothing we do in healthcare – the procedures we undergo, the medications we take, or the vaccines we have administered to us – is 100% void of risk or complications. Everything we do has a certain benefit and a certain risk that must be weighed against each other. In every clinician’s head lies an imaginary scale. Our goal is to choose the option in which there are clear weighted benefits.
The difficulty is that – when it comes to a certain treatment – my particular set of “risk vs. benefit” is probably a little different from yours. No two individuals are alike, and we all have certain preferences, tolerances, lifestyles, genetics, and other factors that make us unique. Those of you who have read my book or other pieces of work know that I am a strong proponent of individualized healthcare.
Trust me, as a healthcare professional, it is much easier to say, “Everyone needs a flu shot,” and jab you in the arm with a needle. Yet, blanket statements don’t jibe with what I consider to be my ultimate responsibilities: to perform your requests as ethically and to the best of my ability as possible and to ensure that any pharmaceutical intervention (including the flu shot) is appropriate for YOU.
I will start by saying that I am not “anti-vax.” In fact, I have chosen to utilize the majority of vaccinations for my children and am very grateful to be raising them in a world where most major diseases have been profoundly eradicated. My job is to consider all factual information and try to find a clear benefit, whenever possible.
Speaking of “facts,” here is one taken directly from the CDC website.
The flu vaccine for this year has anywhere from a 10% to a 39% chance of being effective.*
*Recent reports in Australia show that the vaccine had a 10% efficacy rate. Australia experiences winter before the US and is often indicative of how Americans will fare. However, the CDC also draws data from years past, and the rate in America last year was upwards of 39%.
If I were cite this fact to a group of people, undeniably I would get a multitude of different responses. Here are some different scenarios that I’ve often encountered.
Scenario 1:
“Those chances seem awfully low that the vaccine will actually work for me. I won’t be getting the flu shot. I’m a relatively healthy person and will choose other ways of preventing flu transmission, such as washing my hands.”
Scenario 2:
“The flu shot isn’t perfect, but neither am I. I (or a loved one) have some health issues in which it could be very detrimental if I wind up with the flu. I (or a loved one) could be hospitalized or suffer other complications. I’m getting the flu shot because a 10% to 39% chance is a lot better than nothing.
Scenario 3:
“I lead a very busy, active, and fast-paced lifestyle. I have young children at home that depend solely on me for care. I can’t afford to be sick, and I’m hoping that if I do get sick with the flu shot, it won’t be nearly as bad as the actual flu. I’m getting it for peace of mind.”
Scenario 4:
“The flu shot is just another agenda on Big Pharma’s to-do list. Pharmaceutical companies and government are corrupt and full of lies. I won’t be getting the flu shot.”
These and many other scenarios are just a few that I encounter frequently. No concern presented to me is too big or too big small. No personal worries are invalid, unjustified, or discredited.
So, with all this being said, do I recommend the flu shot or not? In general, I tend to be more in favor of the older flu guidelines which reserve the flu shot for those who are high risk and leave it optional for the rest of the population who are relatively healthy and have minimal exposure to immunocompromised or geriatric patients. The benefit of the flu shot is clear in high-risk populations which include those with diabetes, heart disease, asthma, obesity, immune-compromised conditions, and those over the age of 65. If you have a loved one who is high risk, then yes, I recommend getting the flu shot even if you happen to be healthy. For those who have decided to opt out of receiving the flu shot, this year’s flu season is severe enough that we must be making every other effort to ensure that transmission is reduced. These practices are listed later in the article.
If you have a very personal reason for choosing not to obtain the flu shot for your own peace of mind, then the current scientific data available cannot sway me in disfavor of your decision. In other words, I realize the challenges in advocating something in which the data is unclear and somewhat unconvincing at times.
And vice versa, I also fully support obtaining the flu shot if only for the fact that you sleep better at night knowing you did what you could. I never discredit “peace of mind” as a viable reason for doing the things we do.
You may be asking what I have decided to do with my children. They, unfortunately, were sick along with me so they have already been exposed to and developed antibodies to the flu virus this year. I’m aware that there could be other strains circulating, yet I have opted out of vaccinating them. With a 10% to 39% chance of efficacy, I am betting that the odds will not be in their favor that the shot will be beneficial to them, especially considering their baseline immunity this year.
Now, children are a difficult population because it is the caretaker’s responsibility to make appropriate decisions for them. There is no greater misery than seeing your child sick. The CDC says that children, especially those under 5 years old, are high risk. I advocate vaccinating children who attend daycare/school or have a condition that would potentially cause the flu to be detrimental, such as asthma, chronic lung disease, heart problems, or weakened immune systems. Each individual child needs to be assessed.
Now, my own children do not attend school or daycare and are primarily in the care of myself and other caregivers who have received their flu shot and do not care for any other children. They are relatively healthy children with no food allergies or underlying conditions. If they attend any special classes or are in contact with other children, we enforce a very strong habit of washing hands and making sure that baths are taken and clothes are changed later that day. Because of our hygiene and minimal to moderate contact with other children, I have opted out of flu vaccinations and will most likely do so until they enter preschool. Again, every child needs to be assessed on an individual basis, and all caregivers have an ethical responsibility to keep them as safe as possible.
I talk a lot about individualized healthcare. You may have heard of a term called “herd immunity” and wonder how individualized healthcare fares with an ethical responsibility to the community. I’ll present my thoughts on herd immunity with regards to the influenza virus only. Herd immunity is only evident if the vaccination is effective. Let’s take a look at the best case scenario: the majority of people receive the flu shot that is 39% effective. Since the flu shot is not accessible to everyone, I will assume that roughly 10% to 20% of the population will not receive one. Even at the flu shot’s best odds, there is still a 61% chance that it won’t be as effective – or effective at all – to the circulating strains. Now we have to consider the unknown antibodies of the 10% to 20% of the population who did not receive the vaccine at all. That’s a relatively large gap to fill in. Now, there are multiple opinions with regards to herd immunity in this instance. You may still want to get the shot to feel like you’re doing your part. Or you may feel that the data is too unclear to see any real benefit. With regards to the influenza virus only, it is difficult to get a firm grasp on herd immunity when a virus is constantly mutating from year to year. For this reason only, I do not place a large emphasis on herd immunity.
Other Ways to Prevent Flu Transmission
Whether you choose to get vaccinated or not, there are other ways to protect yourself and prevent flu transmission.
Hand washing: This is by far the most important practice we should be doing. Antibacterial soaps are no more effective than regular mild soap and warm water. My hands tend to get chapped in the winter months, so I like using a creamy soap such as Jergens Moisturizing Hand Wash or Bath and Body Works Creamy Hand Wash. I also like to keep to a pump bottle of hand cream near the sink so I can moisturize after cleansing. Children’s hands need to be washed frequently. Try to make it fun for them by using character soaps and giving them stickers, etc.
Focus on food: Try to avoid sugary, processed foods as much as possible. I know this is easier said than done. “Bad” bacteria and viruses find it harder to thrive in a healthy environment. Focus on seasonal vegetables, good quality meats, and other whole, unprocessed foods. Alcohol also weakens our immune system. Opt for the occasional glass of red wine and limit overindulging.
Take vitamin D3 – Vitamin D is a powerhouse nutrient that strengthens our immune system. We also happen to be incredibly deficient in this nutrient during the winter months due to lack of sunlight and outdoor exposure. Too much vitamin D can be toxic in those with kidney disorders, so be sure to consult your doctor or pharmacist for the best dose. I personally take 2000 IUs a day.
Take a probiotic – Much of our immunity lies in our gut, so it makes sense to strengthen our digestive system with “good” bacteria. Try adding yogurt or kefir to your diet. Apple cider vinegar can also help. While apple cider vinegar is not a probiotic, it can promote pH levels in your gut that are suitable for good bacteria.
Stay home – I like being active and productive as much as the next person, but it’s important to stay home if you have the flu or any flu-like symptoms.
What to do if you have the flu:
My doctor offered me Tamiflu when I was diagnosed with the flu, however I respectfully declined. Here’s why:
Tamiflu is an antiviral agent that has been riddled with controversy ever since it made headlines during the H1N1 influenza pandemic in 2009. Roche, the manufacturer of Tamiflu, was accused of misleading government and other public institutions with claims that the drug could reduce serious complications and hospitalizations from the flu. Putting such hope into these claims, the drug was then “stockpiled,” contributing to roughly half of Tamiflu’s $18 billion in sales. When clinicians gathered results from all the clinical trials studying Tamiflu, they found that it only shortened flu symptoms by about a day – but the evidence in reduced hospitalizations and other complications was rather limited.
It’s not that the drug is ineffective; it is just difficult to use it correctly. The problem is with timing. Tamiflu is most effective within the first 48 hours of the flu, while the virus is still replicating. However, most people are like me and wait the 2 or 3 days to “ride it out” before making an appointment with the doctor. At this point, symptoms are severe and viral replication has already peaked. Tamiflu is not as effective when the virus has already “done its job,” so to speak. This reasoning could explain why Tamiflu works better in a preventative fashion, before people even get a chance to catch the flu virus – such as during a major flu pandemic.
With that being said, you may be wondering why many doctors – including my own – even offer Tamiflu as an option. As mentioned before, Tamiflu can shorten flu symptoms by about day. To most people – including myself – a day doesn’t seem like a whole lot. At the time, an extra day of being “down and out” didn’t pose any significant concerns. However, to other people, a day could be a world of difference. I knew a man who was diagnosed with the flu and had to leave for a mandatory business trip. He would’ve done anything for an extra day, including grin and bear Tamiflu’s high copay and some of the side effects, which mainly include stomach upset, headaches, nose bleeds, psychiatric- type phenomenon (hallucinations, weird dreams), and rare skin reactions. This extra day is something that has to be personally considered according to your lifestyle, severity of symptoms, and other comorbidities you may have. Clinicians want to make sure they are giving you every option. Just remember with viruses, time is of the essence. If you choose to take Tamiflu, the sooner you do so, the better it will work.
So how is the flu effectively treated? Unfortunately, symptom management is still the best option we have.
For fevers, sore throats, headaches, and other aches: Acetaminophen (Tylenol) and NSAIDS (such as ibuprofen and naproxen) are still the mainstays of therapy. You might find that you need max doses, and that is okay for several days – just be sure to check with your doctor or pharmacist that this won’t interact with any other drugs you may be taking or other conditions you have. The max dose of acetaminophen is 4,000mg per day (some conservative clinicians recommend 3,000mg per day). This is equivalent to 650mg every 4 to 6 hours. The max dose of ibuprofen is 3200mg per day. This is equivalent to 400mg every 4 to 6 hours. Again, if you have certain conditions or other medications you are taking, check with your pharmacist or doctor to make sure these doses are suitable for you. You can also alternate between the 2 agents to avoid maxing out on doses.
For sore throats and general well-being: I like using a peppermint, Echinacea, or chamomile tea mixed with honey, fresh ginger root, and cloves. Many herbalists suggest the use of peppermint and Echinacea for alleviating flu symptoms. Honey helps to coat and sooth the throat, and the active ingredient in cloves (eugenol) has been proven to have anesthetic and antiviral properties.
For cough: The most important thing is to distinguish whether your cough is productive or nonproductive. Productive coughs generate sputum from the chest in which an expectorant, like guaifenesin (Mucinex, Robitussin), can be helpful. These help to break up sputum and make it easier to expectorate. Be sure to take guaifenesin with plenty of water. If your cough is nonproductive (dry, hacky) a cough suppressant can be useful. I like the use of Delsym as a cough suppressant, because of the convenient, 12 hour dosing.
Other supportive measures such as rest, plenty of hydration, and warm baths can also help to alleviate the discomforts of the flu.
Here’s hoping you get through the flu season relatively unscathed, and, as always, I’m open to your thoughts and ideas!
