General Wellness

I have had a number of questions regarding the flu vaccine and when to get it.

This year in particular, with the likely uptick in Covid cases as we start spending more time indoors, it is vital to get a flu shot. Remember that the flu still kills. Almost 80,000 in the 2017-2018 season. Getting sick is not only not fun and potentially serious, it significantly raises the risks of catching Covid-19 because of the impact being sick has on your immune system.

I have heard many people say that they have never received a flu shot, and the fact is that they may not have needed one or maybe they were lucky. But in the era of Covid-19, everyone should get one.

It takes about 2 weeks after the shot for protection to kick in. Protection is provided for at least 6 months. The flu season usually starts in October so no later than mid September (ie NOW) is when you should get it. The problem with trying to time the flu vaccination to ensure coverage for the whole season is that you might miss the mark. Get it when you can and as soon as possible.

Egg allergy? NOT AN ISSUE! You can still get a flu shot.

Fear of infection from the shot? Almost impossible. Nothing is impossible, hence the “almost”. Although live, attenuated (killed) virus is used in some forms of vaccination, primarily intranasal sprays used primarily in kids, most are not actual viruses so you can’t possibly get the flu from the flu shot. You can get some side effects like muscle soreness or even a little bit of a fever and fatigue. Remember that it takes 2 weeks to provide full protection so if you got the flu after a recent shot, it’s because you were exposed to the flu. Simple as that.

If you have had a severe reaction to the vaccine, you may not be able to get it however, this is a discussion you need to have with your doctor. “Symptoms” do NOT necessarily mean that you had a reaction to the vaccine. Some symptoms are more common than you might think. Getting the flu after you were properly vaccinated does NOT mean you are “immune to the shot”, just unlucky. They are not perfect. Also keep in mind that even though you may get the fly after a shot, it may not be as severe as it could have been had you not received the shot. Some protection is still provided.

There are a few different types of shot available. You want to make sure you get the “quadrivalent” vaccine. A quadrivalent vaccine is designed to protect against four different flu viruses, including two influenza A viruses and two influenza B viruses.

As far as the difference between Covid-19 and the flu, the major symptoms are the same: fever, cough, breathing difficulties. Add to that other common symptoms like fatigue, muscle and joint aches. Both can cause loss of smell, sneezing, a runny nose and stomach aches. If you’re sick, see your doctor.

Similar to Covid-19, you can also be infected with the flu, have few if any symptoms and you can still spread it.

Just like wearing masks, getting a shot is not only good for you, it is also good for those around you. If you don’t catch the flu, you can’t spread it either.

Stay safe and be well. 

AC 😎✌️🌱❤🐖🏃🏻🧘🏻‍♂️🌎😷

DEXAMETHASONE vs NSAIDS vs HYDROXYCHLOROQUINE

At the start of the pandemic, the term “cytokine storm” was bantered about describing the over exaggerated inflammatory response the body had to being infected with SARS Cov-2. By the way, there is an article floating around describing the “bradykinin theory” of how Covid 19 affects us. I am editorializing the article and will post later this week. 

The cytokine storm is not common but complications from this reaction are the most common reasons for hospital admissions and deaths. Also early on in the pandemic, the combination of Zithromax, an antibiotic, and hydroxychloroquine, an anti-malarial, were touted as the definitive combination treatment for Covid. Since SARS Cov-2 is a virus, why would there be any notable benefit at all from these drugs since neither are antivirals? Well, first of all, they do not work that well regardless of what our fearless leader and even some in the medical community contend. Secondly, they both have anti-inflammatory effects, which is the likely mechanism of what little benefit they may provide.

Many medications have anti-inflammatory effects in the body. This includes many antibiotics, over-the-counter medications and even foods.

Corticosteroids (also known as glucocorticosteroids, glucocorticoids or just steroids) are among the most widely used drugs in the world and are effective in many inflammatory and immune diseases. The most common use of corticosteroids is in the treatment of asthma. I use them all the time to help decrease inflammation in acute infections.  Corticosteroids mimic the effects of hormones your body produces naturally in your adrenal glands, which sit on top of your kidneys. An example is cortisol, our “stress” hormone. Corticosteroids are completely different from the steroids you hear about which make your muscles big or we inject into animals to make them grow bigger and faster. Those are anabolic steroids.

The predominant effect of corticosteroids is to switch off multiple inflammatory genes which encode cytokines, chemokines, adhesion molecules, inflammatory enzymes, receptors and proteins, that have been activated during the chronic or acute inflammatory process. In higher concentrations they have additional effects on the production of anti-inflammatory proteins. They help to reduce swelling by shifting fluids from the tissues back into the intravascular space. The steroid which has been shown to be of benefit in Covid-19 is DEXAMETHASONE, or decadron. There is NO role in prevention of infection and in fact taking steroids regularly actually suppress your healthy immune system making it MORE likely to catch Covid-19 and have a worse outcome. To be clear, steroids dampen the immune response but in doing so, they also increase the risk of catching an infection since they also lower our ability to defend ourselves. This includes defending ourselves against cancerous cells which develop every day in everyone’s bodies. 

NSAIDs (Non-Steroidal Anti-inflammatory Drugs) work by reducing the production of prostaglandins. Prostaglandins are chemicals that promote inflammation, pain, and fever. Examples of NSAIDs are Aspirin (ASA or acetylsalicylic acid), Motrin and Advil (ibuprofen) and Aleve and Naprosyn (naproxen). Although they do decrease inflammation and may help with the symptoms of Covid like fever, headaches and aches and pains, they have no role in the more severe cases treated in hospital.

Hydroxychloroquine, again an anti-parasitic drug first developed to treat malaria, is thought to interfere with the metabolic communication between the body’s immune system cells. If the cells can’t effectively communicate with each other, then the excessive immune response of RA is reduced. The same may occur with Covid-19. It has many side effects however, just like any other drug, including arrhythmias and cardiac death. I have also heard from ICU docs that it actually impairs the beneficial effects of Remdesivir, an antiviral which has also been shown to be effective in some patients when administered early on.

Zithromax, an antibiotic, also has anti-inflammatory effects. It causes increased production of  Interleukin-10 (IL-10), one of the proinflammatory cytokine compounds produced. From personal experience, I see many patients who were placed on this antibiotic for questionable reasons. When I ask patients, they often say that someone prescribed it “just in case” there was an infection. Makes me want to pull my hair out. The anti-inflammatory effect may be the actual cause for improvement in symptoms rather than treating an actual infection and in the meanwhile, you’re destroying up to 1/3rd of your healthy gut microbiome and it can take months to recover. Not a good thing.

When you have an injury, regardless of the kind, there is a normal inflammatory response. Cuts get red. Insect bites swell. Lung infections result in coughing which is a nerve irritation… Too much inflammation in the body is not good. ALL chronic diseases produce additional inflammation we do not need. Extra weight is inflammatory. Foods we eat. Toxins we are exposed to. The air we breathe. The water we drink. Psychological and physical stress. The less inflammation in your body as a baseline, the better off you will be. 

The overwhelming reactions from Covid-19 are to some degree predictable but in some cases, why people who apparently are “healthy” die or get really sick is still unclear. Why some people, like CNNs Chris Cuomo, are having long-term and delayed effects like depression, brain fog and fatigue is equally unclear. 

What is clear is that you don’t want to get sick if you can avoid it.

What is clear is that there are some very basic strategies you can follow which will minimize your chances of getting sick. You’ve read it before and I’ll spell it out again:

WEAR A MASK. Wear and handle it properly.

DISTANCE. Remember, physical, not social distancing. We NEED each other.

WASH YOUR HANDS.

DON’T TOUCH YOUR FACE.

WORK ON YOUR HEALTH. At least drink more water and eat more fruit and vegetables.

VENTILATE. More airflow = more viral dilution.

VACCINATE against the flu.

Stay safe and be well. 

AC 😎✌️🌱❤🐖🏃🏻🧘🏻‍♂️🌎😷