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The Informed Parent

The Flu…Or Not The Flu?

by Louis P. Theriot, M.D., F.A.A.P.
Published on Nov. 14, 2005

On a Monday morning in early October, a group of employees gather around the water cooler to discuss their weekend endeavors. Bob approaches the group and says what a miserable weekend he had. "I was so sick this weekend. I had the stomach flu," he lamented. "We had big plans. We were going to have people over to watch the football games, but we had to cancel. I had diarrhea, vomiting and cramps all day Saturday and Sunday. I virtually lived on Gatorade and chicken soup. I'm just starting to feel like a human being once again," he went on. Bob did NOT have the flu.

It is Thursday morning and Mrs. Jones is writing a note for her son's school. She is explaining why Jake missed school on Tuesday and Wednesday. She writes that her son came home from school on Monday not feeling well. By dinnertime he had a fever up to 101.2 degrees and had terrible chills. The next day brought on a sore throat, horrible headache, and aching all over. His eyes were somewhat bloodshot. Even the muscles in his eyes hurt when he looked to the right or to the left. By Wednesday the fever broke and he felt a little better. He slept around 11 hours that night, and when he got up on Thursday he felt pretty good. In her note to the school she asked that Jake be allowed to return to class because he had had the flu. Wrong again!

The Smiths brought their 13-month-old daughter to the office because she has had a runny nose and cough for the past week. At first she seemed to do all right, but over the past couple of days she has been fussy and irritable. The mucus draining from her nose had been clear, but then it turned a yellow-green color and was much thicker. The cough had taken a turn for the worse becoming much deeper and more productive. It was so bad that the cough kept her up all night. Mr. Smith added, "I've been reading a lot about the flu lately, and I could just kick myself for not bringing Anna in for the flu shot sooner...we might have been able to prevent this." Not even a chance!

We have all heard stories like these in many different venues. And I am sure that at one time or another we, too, have come down with an illness and have been quick to blame it on the flu. The reality is that in the majority of cases the flu had nothing to do with our illness. We know what people are referring to when they claim "to have the flu", but from a technical standpoint it is not accurate. It might be semantics, but as we approach the winter months, (and flu season), a simple discussion would be worthwhile.

Influenza is a viral infection that is caused by a single stranded RNA virus classified as Orthomyxoviridae. There are three types of Influenza viruses: A, B and C. Types A and B are primarily responsible for the seasonal outbreaks of the flu that occur during the winter months. Influenza is a virus that causes an array of respiratory symptoms. The onset is usually abrupt after an incubation period that may be as short as 48-72 hours. It is spread through the respiratory tract (coughing and sneezing) and it is highly contagious. The first signs include conjunctivitis (blood-shot eyes), sore throat and dry cough. This is soon followed by a high fever, muscle aches, headache, malaise and fatigue and a general feeling like one was hit by a truck. The fever lasts for three-to-four days but the symptoms may last longer. The cough may persist for a much longer period of time. Many patients report that it took days after the symptoms resolved before they felt back to normal as far as strength and energy.

In the Northern Hemisphere Influenza is present during the winter months. Different strains of Influenza A and B circulate around the globe, and it is the variations in individual strains that cause the yearly endemics that occur. It is different each winter. The vaccine manufacturers can predict which strain SHOULD be prevalent for the upcoming winter and thus prepare a vaccine that contains the three most likely strains. Every winter the flu vaccine that we receive is unique for that particular winter. There is both science and guesswork involved, but they are pretty accurate in their predictions. The Public Health Department usually recommends getting the vaccine in late October.

Bob, by the water cooler, did not have the flu. He had a viral gastroenteritis which people commonly refer to as "the stomach flu". But it is really an intestinal virus that causes vomiting and diarrhea, may cause a slight fever, has absolutely no respiratory symptoms, and usually resolves in a few days.

Because of the short course of Jake's illness and the specific symptoms that he had, in no way did he have the flu. He probably had one out of a hundred different non-specific viruses that were out in the community. If he truly had the flu, it would be very unlikely that he would be back to school in two days.

It is equally unlikely that the Smith's daughter had the flu. Undoubtedly she had a cold (another non-specific virus) that lingered, and then became secondarily infected with a bacteria. Given the progression of her symptoms and fussiness, it most likely was caused by an ear infection, which she did in fact have. After being placed on antibiotics she was dramatically better in 48 hours. This would not have been the case if it had been the flu.

It seems that throughout the year we always are running into someone who is getting over the flu. We all understand what they are referring to, and I'm sure that we all have had the same symptoms at one time or another. But for the sake of accuracy, the flu occurs only in the winter months, is NOT a trivial illness that lasts a day or two, has very specific symptoms that affect the respiratory tract, and will not get better with antibiotics.

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