Sunday, February 17, 2013

Supportive Treatment of Viral Syndromes

An extra large hot lemon.   (Picture: )


   I can't blame super blogger Lotta Joy.  I have somehow come down with the same respiratory super plague she had.  I would like to blame her, because she is so much fun with which to trade barbs, but the only viral syndromes which come through the computer, afflict only those, not human beings. The computer also apparently has better virus protection than I do.
             Despite my influenza vaccine this year, I am the last person in my household to catch this lengthy plague. When I took one of my sons to the doctor this week, she assured us that this respiratory illness falls squarely "under the viral umbrella".   So. I would imagine, if things continue, that my son will recover but I will expire clutching a giant viral umbrella.  I must remember to thank my son's pediatrician for that mental image, before I go.  I took my seventeen year old son to the adolescent medicine physician because he was experiencing ear pain, and because ear pain and infection are probably one of the few things which really should be treated in anticipation of other complications.  About a day after sitting in the pediatrician's office, I came down with this.  Of course, only 60% of patients who receive an influenza shot are successful in avoiding influenza that year.  Since the day after the pediatrician's office visit, I have been intermittently febrile, which is nurse-speak for "with a fever".  This might explain my last post which attempts to be humorous, rather than informative.   Of course, with asthma and intermittent atrial fibrillation, I expect to have a rougher time than my son, who was able to eat Tombstone pizza today.  (Oh, the irony !)
             In influenza, there is sometimes value in antibiotics.  Some patients benefit from a carefully selected antibiotic in order to prevent superimposed bacterial infections which are more likely in those with chronic illnesses, pre-existing respiratory problems, sinusitis, or heart problems.  Most of the time however, physicians, in an attempt to keep antibiotics effective, and to avoid organism resistance, withhold antibiotics from viral syndrome patients.  This is fine with me, because I would rather that antibiotics work when I need them, rather than upset my stomach, when I really don't.

            For a few of us with viral syndromes, we will move into an infection which requires seeing a physician again, and at that time, she will prescribe the appropriate antibiotic.   However, the bulk of us will suffer and need to be treated with what is known as Supportive Care.

       By far, the most important element to supportive care in influenza is ensuring hydration.
Plain water is very helpful, but most patients take in more fluids if you can vary the fluids for them.  Water, alternated with gatorade, or even a little soda, fizzy or allowed to flatten, can also be helpful as it provides fluid, some sodium, and some phosphorus.   Hot fluids can be helpful too, especially with a sore throat.  I usually make something my family has long called a hot lemon.

It has been made with many variations including honey, but mine is:

One cup hot water
2 tablespoons lemon juice
2 teaspoons sugar                  (or Splenda or Stevia if you are diabetic)

  This is helpful because it is soothing, it supplements vitamin C, and it provides enough sugar to keep the patient moving, but not really enough to coat the throat with sugar that it can use to grow bacteria.

Tea can be soothing, but cannot comprise too much of your daily fluids while ill because tea has a diuretic effect and will actually pull fluids from your body.  This is one of the times in which we wish to keep those fluids !

When most people tolerate fluids and are taking an adequate amount of them, they can progress to a soft diet.  Try not to eat anything which is easily inhaled or chokes upon, because when you have a cough, you are much more prone to accidental inhalation of food.   Some people like toast and soups, or maybe some tomato soup and a grilled cheese sandwich.   Watch the creamed soups because people with fevers sometimes cannot digest milk, and we do not wish to cause nausea or vomiting when you are ill already.
Oatmeal is also good on a soft diet.  You can advance your diet gradually as you see fit.  For children, move more slowly.

People who have the flu, and who are eating and drinking well, can consider using an anti-pyretic for comfort.   Acetaminophen (Tylenol) can be taken by those who are adequately hydrated.   It is probably not absolutely necessary for those with temperatures under 102 F determined orally, but I give it if they are hydrated because it a.) promotes comfort   b.) prevents the vomiting that some people get during fevers, which could furthur contribute to dehydration.       Some patients can use aspirin or ibuprofen, but these are harder on the stomach for some, and enhance bleeding for others and so this is a good time to default to the anti-pyretic or analgesic that your physician has suggested on a prior visit.     Children under 18, should not be given aspirin, unless specifically ordered by a physician for a specific purpose.   It should not be given during viral syndromes because of its association with Reye's Syndrome.

Most people improve very slightly day by day, and some have slight relapses.
If you or your family member deteriorate in the following manner during a viral syndrome, then you need to see your physician immediately or if not immediately possible, go to the nearest emergency room.

Symptoms which should trigger seeing a physician include:

* A change in level of awareness, including confusion or delerium.

* A fever above 102F or one which rapidly returns three or four hours after last dose (as this suggests
  an additional bacterial infection or perhaps even strep infection)

* Diarrhea or vomiting in a baby or a child.

* Dizziness on arising, or a marked increase in pulse between the sitting and standing position.
  (This may signal something called orthostatic or postural hypotension, which can accompany dehydration,.)

* An irregular heart rate in someone who did not have one before, or who is not being treated for one.

* Wheezing in a person who normally doesn't or who is not being treated for it.

* Blue lips in a child.  Crying without tears in a child or baby.  A sunken fontanelle in a baby.

* Dark or brown urine, which is a sign that this person is inadequately hydrated.

* Any other symptom which frightens you, as a parent, spouse, or friend of a person with influenza.

                My son's doctor was of the opinion that the viral infection she is seeing most often, which she believes has afflicted our seventeen year old son, lasts about eighteen days.  Eighteen days. I should live that long !

Prevention is best, if you can do this. ( Graphic: )


Sandy said...


Oh no, you too.
Feel better soon my friend!

JaneofVirginia said...

Thanks Sandy, I am working on it, just like everyone else, I suppose.

Mamma Bear said...

Jane...I've been busy and missed this post. I hope you are feeling better. Mine is almost gone but still have a nasty cough that won't go away. I did finally get the sofa off of my back!

JaneofVirginia said...

Mamma Bear, I hope you are feeling better soon. I still have mine and can barely speak. (My husband is enjoying this, I think. LOL) I hope this passes soon for us both. My doctor said the entire thing takes 18 days !

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