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What You Need to Know About Stomach Flu

The main difference between a “stomach flu” and “food poisoning” is duration. Both usually have vomiting and diarrhea, fever and chills to varying degrees, and abdominal cramps, but food poisoning should not last more than 24 hours, while a stomach flu may last up to 3-4 days. Also, food poisoning usually has a more abrupt onset with all of the above symptoms occurring almost simultaneously, within 1/2 hour to 24 hours after ingesting tainted food, while the symptoms of viral gastroenteritis may occur more gradually with vomiting or diarrhea occurring before the other begins.

The cause of food poisoning is usually an exotoxin (liquid) produced by staphylococcus bacteria very frequently, or an endotoxin (on the bacteria itself) such as from shigella, salmonella, campylobacter, or E. Coli. Ingesting food that has not been cooked thoroughly, or reheated, or improperly stored, or made from fresh vegetables/fruits that weren’t washed before preparation, is the main culprit. Use of antibiotics for treating some of these bacteria is controversial, since it is felt that they can cause the germs to become invasive into the walls of the intestines, and thus prolong illness.

Viral gastroenteritis, or “stomach flu”, occurs from the “fecal/oral” route, i.e. someone who has the virus does not properly wash their hands after using the toilet, and a healthy person touches a surface that the infected person touched, or their soiled clothing, or shakes hands with him/her, and then touches their own face or mouth. It has no cure.

Treatment of both is similar, except for the decision whether or not to use antibiotics. Only clear liquids in sips (no more than 1 oz every 3-5 minutes—that’s only 2 tablespoons!!) to start if vomiting/ nauseous. This lets liquids slide by the stomach. If one is thirsty and ingests a large quantity of liquid rapidly, the distention of an already irritated stomach causes reflex regurgitation. Thus, small amounts, frequently is indicated. However, if one also has diarrhea, then constantly ingesting liquids slides by the stomach, but keeps stimulating the bowels and thus propagates the diarrhea. So, if one has both vomiting and diarrhea: take clear liquids in small amounts frequently until thirst is slacked, but then wait 1-2 hours before repeating.

Also, it is important to not drink only water. One loses sodium, potassium, and other chemicals in the emesis and diarrhea that are important to maintain a normal heart rhythm. Drinking only water will further dilute them in the bloodstream, with potential life-threatening consequences. While Gatorade, Powerade, and other “sport” drinks have electrolytes, they are made to replace sweat, not emesis or diarrhea. Coconut Water, on the other hand, has almost the same concentration of electrolytes as human serum, although slightly more potassium (which is good when having both vomiting and diarrhea) and glucose. “Pedialyte” is good for children, but pretty much intolerable to take for anyone older. (Holding one’s nose while drinking/eating unpleasant substances greatly improves the process, since we really “taste” with our sense of smell – the tongue has limited sensations.)

The World Health Organization/UNICEF and others have looked at ORT (Oral Replacement Therapy) because of the unavailability of enough i.v. fluids in Third World countries when Cholera or Rotavirus epidemics occur to replace the massive fluid losses of these diseases. There are many different products of electrolyte powders that can be added to 1 qt of clean water. In general they contain: 1 tsp of salt, 1/2 tsp. of baking soda, and 2-4 tblsp of sugar or honey at a minimum. One can make the same if in a pinch. It is also now recommended to restart regular feedings in children after 6-8 hours if possible. Bananas, applesauce (apple juice can cause diarrhea), rice, and toast are binding. Keep away from caffeine drinks that will stimulate the bowels.

We use injectable, “ODT”s (oral dissolving tablets), or suppository medications to stop the vomiting, and “OTC” (over the counter) Kaopectate or Imodium AD to stop diarrhea in viral gastroenteritis, along with i.v. fluid replacement if needed. I prefer Acetaminophen to control fever and aches, since NSAIDs like Ibuprofen (Advil, etc.) or Naprosyn ( Aleve, etc.) are irritating on the stomach. Also, taking a non-milk-product-containing ProBiotic (at least 9 billion cfus/dose) 3x/day, will replace the normal good bacteria in your intestines that are lost from either of these diseases causing increased diarrhea. ProBiotics have no side effects, and are tasteless. If you cannot control symptoms by yourself, please call us before becoming dangerously dehydrated, or go to the nearest E.R.!!

Please share this email with the link below if you think that you can help someone you know to prevent or treat the stomach flu this season.

Updated 1/19/2020
STEVEN J. LIPSKY MD, FACEP


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The cancer fatality rate in the USA fell 2.2 percent from 2016 to 2017– the largest single-year decrease in cancer rate mortality ever reported, The American Cancer Society reported on Wednesday. Starting from 1991 the rate has gone down 29 percent, which equates to about 2.9 million fewer cancer fatalities than would certainly have occurred if the mortality rate had actually remained constant.

“Each year that we see a decline in cancer cells mortality price, it’s excellent news,” said Rebecca Siegel, director of surveillance study at the American Cancer Culture and also the lead author of the organization’s report, which was released online in CA: A Cancer Cells Journal for Clinicians.

Experts associated the decline to reduced smoking rates as well as advancements in lung cancer treatment. New therapies for cancer malignancy of the skin have likewise aided in extending life for people with metastatic disease, or cancer cells that have spread to other parts of the body.

Progression in treatment has actually slowed down for colon, breast as well as prostate cancer cells, unfortunately.

The rising rate of weight problems amongst Americans, along with considerable racial as well as geographic differences, most likely indicates why the decrease in breast and colon cancer has actually begun to lessen, and also why the decline in cases of prostate cancer has halted completely.

Cancer remains the 2nd leading cause of death after heart problems in both males and females nationwide. The American Cancer Society anticipates that in 2020 there will be about 1,806,590 brand-new cancer cases as well as 606,520 cancer fatalities. Lung cancer kills more people than breast, prostate, colon and brain cancers combined.

“We are still managing the effects of cigarette smoking from the 1960s and 70s in today’s population,” stated Dr. Otis Brawley, an oncologist at Johns Hopkins College as well as a previous chief clinical officer at the American Cancer Society. Due to the fact that there is a lag in between exposure as well as cancer medical diagnosis, people that stopped smoking cigarettes might establish lung cancer cells years later. However these rates should continue to decrease, Dr. Brawley claimed.

Thanks to advancements in technology there have been numerous vital advances in diagnosing as well as treating lung cancer resulting in significantly fewer cancer fatalities. New imaging innovations have permitted doctors to accurately examine the stage of the cancer and its prognosis. Less invasive surgical approaches have accelerated recovery times. Since 2015 immunotherapy has assisted some patients by using their own T cells to kill their tumors.

Similar treatment advancements have actually entirely reversed fads in cancer malignancy. In 2011, the Food and Drug Administration approved two new treatments, ipilimumab as well as vemurafenib, for metastatic cancer malignancy. Ultimately, the melanoma mortality rate began decreasing by 7 percent annually amongst males and females aged 20 to 64, and also by 5 to 6 percent annually in individuals 65 and older.

“That was the largest decline in cancer cells mortality that we saw,” Ms. Siegel said. “And also what made it so significant is that for individuals 65 and older, melanoma mortality rates were actually climbing in the 2000s.”

However as more Americans packed on excess extra pounds, the increase of obesity-related cancers has risen. These include malignancies of the liver, kidneys, pancreas and also womb, cancers of the breast and postmenopausal women, and also colon and also anal cancers in adults younger than 55.

“What we’re seeing with excessive weight is really sort of parallel to what we saw with cigarette smoking,” said Timothy Rebbeck, an epidemiologist at Harvard and also the Dana-Farber Cancer Cells Institute.

Studies have actually discovered that obesity, unhealthy diets and also an absence of physical activity are associated with metabolic as well as hormone problems and with chronic inflammation, which might help attribute the link to cancer. Controlling these factors can aid jump-start declines in cancer incidence as well as mortality rates once again, Dr. Rebbeck stated.

However, not all the population benefits from prevention and advancements in cancer therapy. Although racial differences in cancer treatment are narrowing, The American Cancer Society reported that black males were still two times as most likely to pass away of cancer as Asian/Pacific Islander men as well as 20 percent more likely to die than white men.

Men and women residing in particular states are additionally more likely to contract as well as succumb to possibly avoidable cancers, such as lung cancer, cervical cancer, and cancer malignancy. The reason lies in historical distinctions in smoking prevalence, obesity, other cancer risk variables and the ability to afford and access high-quality cancer treatment, Ms. Siegel said.

The incidence of cervical cancer is much greater in Arkansas than in Vermont or New Hampshire. As some states embrace inoculations against human papillomavirus more frequently than others, the distinction in prices of HPV-linked cervical cancer could become more noticeable.

“Making sure equal access to recognized cancer prevention and very early detection approaches would go far to speed up the progression of agaisnt cancer overall,” Ms. Siegel said.



This article was updated on January 15th, 2020.

With flu season upon us, it is important that you learn everything there is to know about this illness. While the flu is fairly common, every year it claims numerous lives throughout the U.S.

The Centers for Disease Control (CDC) estimates that over 2.5 million people will be affected this year alone. They also predict that over 20,000 people will be hospitalized with upwards of 1,000 flu-related deaths.

So far flu season is off to an early start, a total of six children in Texas have died from the flu this year.  Maricopa County reported the first death of an infant as well. Children along with the elderly are two of the most vulnerable groups of people due to their relatively weak immune systems.

We have been seeing 3 viral syndromes lately:

1) Flu-Like: consisting of low-grade fever, malaise, weakness, headache, runny/stuffy nose with post-nasal drip causing coughing (especially during sleep), and nausea.

2) Influenza (it started as type B, but now is type A H1N3): like #1 but with higher fever, severe muscle aches, and some diarrhea and nausea as well

3) Norovirus: which causes fever (often high), and only extreme vomiting and diarrhea (no URI symptoms), lasting about 3 days, and often requiring i.v. hydration (it’s the “stomach flu” virus that causes huge outbreaks on cruise ships, etc.).

As always, public health officials have been urging people across the country to get inoculated against the flu. This seasonal illness can quickly worsen, causing health complications that can be fatal, even for healthy adults.

Current Flu Activity

This map provided by the CDC shows the overall influenza activity throughout the United States. Alaska, The Virgin Islands, and The District of Columbia are the only ones to report sporadic levels of flu activity.
An infographic showing where the flu is currently in the United States

States with the most widespread influenza activity include Alabama, Arizona, California, Connecticut, Georgia, Idaho, Indiana, Kentucky, Louisiana, Maryland, Massachusetts, Nebraska, Nevada, New Mexico, New York, North Carolina, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, and Washington.

Beginning of Flu Season

In the United States, cases of influenza-related illnesses typically start around October, continuing on through early spring. February has pretty much always been the worst month in terms of the sheer number of people getting sick.

Who Should Get a Flu Shot?

It is a good idea for just about anyone who is over the age of six months to get inoculated against the flu. Getting this shot early on in flu season significantly decreases one’s chances of becoming seriously ill. These shots are typically made available as early as September in most places throughout the U.S. However, many folks say: “I don’t get a Flu Shot because it gives me the flu!”. This is impossible! The injectable immunization consists of completely dead viruses that act only as a template for your body to make antibodies to them. However, it takes about 2 weeks to make these antibodies, and if one is exposed to the Influenza Virus during (or shortly before) the immunization, then one can come down with the flu before you have enough time to mount a resistance. Also, some people do not make enough antibodies to ward off a subsequent infection. Getting a Flu Shot in Sept. – Oct. should protect for the entire flu season, which hit earlier than normal this year and is still rampant in the West. However, it is still advisable to get one now if you have not already!
Flu myths vs flu facts infographic

Will The Current Vaccine be Effective?

There are many different factors that ultimately determine the efficacy of a flu vaccine, including the current strains that are going around. It is ultimately up to health officials as to which strains of the fly to cover in each year’s vaccine. The fact that these strains are capable of changing rapidly can make determining this quite difficult.

Scott Epperson, a spokesperson for the CDC, stated that he believes the current vaccine will be highly effective. It was formulated to prevent illness due to the H1N1 and H3N2 strains, which have been widespread in numerous states.

All indications suggest that this new vaccine is also going to be effective at combating the B strains that were identified earlier this year. The CDC has acknowledged that even effective vaccines can only work so well.

Effectiveness of the flu shot from 2008 to 2016

Where are Flu Shots Available?

There are many different drugstores, schools, public health departments, and other places across the country that offers flu shots.

A vast majority of medical insurance policies cover these shots for children and adults. Those who have Medicare Part B will be able to get one of these shots without having to pay anything.

If you are looking for a flu shot near me check the map below


Is the Nasal Spray Vaccine Effective?

Those who are not a fan of needles will find that the nasal spray vaccine is a viable alternative to consider.

The young child Nose Spray Immunization is a weakened virus, and although the CDC says it is too weak to cause the flu in healthy patients, this is a possibility in immunocompromised ones (e.g. those with leukemias/other cancers, HIV, insulin-dependent diabetes, etc.).

Although, as our readers have previously been explained, antibiotics won’t kill a virus (it’s like trying to use weedkiller to kill a gopher!)

This vaccine offers protection for children and adults. There have been some changes made to this spray in the last year that have supposedly made it more effective than ever.

Many parents have started opting for the nasal spray option when it comes to protecting their children from the flu. It is not painful at all and only takes a matter of seconds to administer. This makes it an ideal choice for kids who don’t do well with needles.

This nasal spray did not protect against the H1N1 virus, but it offers protection from other viruses that were going around at the time.

How is the Flu Vaccine Created?

There are a few factors that are considered when creating a vaccine for each new flu season. Doctors and scientists thoroughly research cases of viral infections that are occurring within the U.S. They use this information to determine which strains should be included in the upcoming vaccine.

While this ultimately comes down to a guessing game, the estimates are based on actual data and years of experience among medical professionals. This data is compiled to come up with a final decision for the strains that the vaccine should protect against.

This year’s vaccine has been formulated to protect against H1N1 and H3N2 viruses, as well as two different B strains. Experts have been saying that this new flu shot is more comprehensive than before, which could mean more lives saved across the country.

There is never any guarantee that the flu vaccine will be completely effective for any person who gets it. It does, however, drastically reduce the chances of getting sick by up to sixty percent for most people.

Will We Have a Universal Flu Vaccine in the Near Future?

A recent endowment of $8 million by the National Institutes of Health was given to the University of Georgia. The sole purpose of this large grant was to create a vaccine that can protect against numerous strains of the flu virus in one dose.

The University of Georgia has collaborated with numerous other schools to come up with a universal flu vaccine. While officials are still saying that such a vaccine is still a little way off, it might be available to the public sooner than most of us think.

Human testing of the vaccine could begin as early as 2020, which is exciting news in the health and medical communities. There are other institutions that have been working towards a universal flu vaccine with varying degrees of success.

Who is Most at Risk?

There are certain groups of people who are more at risk of becoming seriously ill from the flu than others. Those who work around children on a regular basis are among these groups. It is also common among doctors and other people in the healthcare community who have direct contact with patients.

Many of the cases of flu-related death in the U.S. each year consist of children who are under the age of two. Elderly people who are over the age of 65 also make up a significant number of these cases each year. Any person with a weak immune system is particularly vulnerable.

Women who are either pregnant or recently gave birth to a child in the past couple of weeks can develop severe symptoms as well.

Any person who has asthma, diabetes or heart disease is also at a higher risk level for serious illness or death from the flu. People who are already in poor health are always the ones who are most likely to experience health complications when getting sick.

Infographic showing the most at risk ages for getting the flu

Is There a “Best” Flu Vaccine?

The fact is that there isn’t any single vaccine that is universally better than all of the others. The best thing that anyone can do is to ask their doctor which vaccine to get. Certain vaccines can be more effective than others for people of certain ages. A majority of the vaccines that are given out this year are going to be quadrivalent, which means they protect against four unique flu strains.

Types of Flu Shots

There are a number of different flu shots that you can get in 2019 through 2020, including:

  • High dose vaccine: These shots are best for older people who are at least 65 years of age.
  • Standard dose vaccine: These vaccines are administered using a needle.
  • Adjuvant vaccine: Vaccines with adjuvant in them are particularly effective for older people and children.
  • Cell culture vaccine: A small percentage of flu vaccines this year will be made using cell cultures as opposed to eggs. These shots are best for those who have allergies.
  • Nasal spray: There is also the nasal spray flu vaccine, which is not recommended for women who are pregnant or those who are in poor overall health.

Is There Anyone Who Shouldn’t Receive a Flu Shot?

Any person who has a known allergy to any of the ingredients that are used in a certain vaccine should not receive it. Those who contracted Guillain-Barre syndrome six weeks leading up to their last vaccination should not get the shot.

When Does the Flu Vaccination Take Effect?

These shots become effective at protecting against various strains of the flu within 10 to 14 days after they are administered.

Pregnant Women and the Flu Vaccine

Most types of flu vaccines are perfectly safe for pregnant women, with the exception of the nasal spray option. The Centers for Disease Control makes a point of telling pregnant women to get vaccinated. Taking this measure can serve to protect themselves and their unborn child at the same time.

The risk of health complications from getting the flu is far more worrisome than the potential reactions to the shot itself. One study conducted in 2018 showed that pregnant women who received a flu vaccine were far less likely to end up in the hospital from influenza. It made a difference of about 40%, which is impressive, to say the least.

Pregnant women are statistically more likely to develop health complications when getting the flu than women who aren’t pregnant. This is why anyone woman who is pregnant should get vaccinated early on in the year.

Which Symptoms are Associated with the Flu?

It is important that you are aware of the various symptoms that are associated with the flu. While it does not present the exact same way in everyone, there are common signs to watch out for.

Some of the symptoms of the flu include:

  • Sore throat
  • Headaches
  • Clogged sinuses
  • Fatigue/lethargy
  • Vomiting
  • Diarrhea
  • Fever
  • Chills

The symptoms of the flu tend to be more dramatic in children. It is a misconception that the flu is always accompanied by a fever, which may not be the case for some people. Most people who get the flu have a general “sick feeling” or malaise, as well as headache and stuffy nose.

infographic that shows the difference between the cold and the flu

What Should I do if I Exhibit Flu Symptoms?

The best thing that you can do if you think you have the flu is to relax at home for a minimum of one day. Once you are no longer running a fever, you won’t have to worry about giving the flu to anyone else.

There are more severe symptoms that you’ll want to be aware of as well, including:

  • Difficulty breathing
  • Irregular heartbeat
  • Changes in skin color
  • General disorientation
  • Vomiting that does not stop
  • Chest or stomach pain
  • Severe muscle aches and pains
  • Mental confusion

If you notice any of these symptoms, you should get yourself to an urgent care clinic right away. The sooner you seek treatment, the better your chances will be of coming through your illness without any major issues or complications. These are not the kinds of symptoms that you should simply ignore, as they are incredibly serious. Pregnant women in particular need to be aware of these symptoms due to their increased overall risk.

Other Ways to Keep from Getting Sick

There are other ways of avoiding the flu in addition to getting the shot that you should consider.

We have been having success treating the symptoms of  Flu Type#1 and  Flu Type#2 with:

Tylenol for fever, headache and muscle aches (Ibuprofen and Naprosyn–ie. Advil and Aleve–can further upset a tender stomach)

Pseudoephedrine (the “Sudafed” you have to show your driver’s license for) and prescription Fluticasone Nasal Spray for runny/stuffy nose/post-nasal drip

Prescription Hydrocodone Cough Syrup ( e.g. Hydromet or Tussionex – all Walgreen’s are currently out of Hydromet in the Valley!) and Pro-Air HFA (i.e. Albuterol Metered Dose Inhalers) for cough and chest congestion

Prescription Ondansetron for nausea/vomiting (along with Phenergan or Compazine Suppositories if uncontrollable)

OTC (i.e. “Over The Counter”) loperamide (e.g.Imodium AD) along with an OTC Probiotic powder or capsule of at least 9 billion cfus (i.e.”colony forming units”) 3x/day for diarrhea.

For those who truly appear to have Influenza (the nasal swab test is only about 50% accurate, and thus worthless in our opinion), and did not get a Flu Shot, we are adding prescription Oseltamivir (e.g. Tamiflu) that is very effective at ameliorating the symptoms of Influenza Type A & B if taken within 48hrs of onset (their literature says it’s effective up to 96hrs, but in our experience, it’s not!).

Remember to stay home and away from others until you are O.K. if you become ill – one is infectious to others from 1-2 days before you come down with symptoms until at least you’re completely normal (some studies say that you can transmit the virus up the 3-4 days after you’re completely normal!!). Cough into your elbow(not hands!) and wear a disposable surgical mask if you must go out, to prevent transmission. Wash hands with soap (it’s not necessary to use “antibacterial soap”) and warm water, front and back, vigorously for at least 30 seconds, frequently (and especially after being in public places). Bedrest and lots of clear liquids are very beneficial, and I personally like CoQ-10 at least 125mg 1-2x/day, a daily high potency B-Complex Vitamin, and at least 1000mg of Vitamin C daily, as well.

If you start to feel yourself getting sick, you should stay home for a day if possible. It is always better to be safe than sorry when it comes to your own health.

While this is not a definitive method of preventing illness, it is better than doing nothing.

Please share this guide with the link below if you think that you can help someone you know to prevent or treat the stomach flu this season.

Feel free to post questions you may have about the flu below and one of our board-certified emergency physicians will do their best to answer.

 


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Thanksgiving Safety

Thanksgiving is a joyous occasion celebrated in the comfort of home with family and friends. Unfortunately every year countless Americans end up in the hospital or much worse. In 2016, U.S. fire departments responded to an estimated 1,570 home cooking-related fires on Thanksgiving. This makes Thanksgiving the peak day of the year for home cooking fires. Christmas, Superbowl Sunday, and other holidays don’t even compare to Thanksgiving when it comes to danger.

The statistics show an alarming increase in injuries, illness, and death around Thanksgiving. Road-related accidents account for a large number of injuries and deaths, but cooking equipment was involved in almost half of all reported home fires and home fire injuries, and it is the second leading cause of home fire deaths. Other turkey day activities like excessive unhealthy eating, deep frying turkeys and drinking contribute further to Thanksgiving harm. Unfortunately, we can’t help you with rowdy in-laws, or by watching your diet for you, but we can give you some helpful Thanksgiving-related safety tips to keep you out of harm’s way this holiday. Doctor Housecalls of Paradise Valley is available from 10AM-9PM on Thanksgiving if you require urgent medical care due to a Thanksgiving injury like a burn, cut, or turkey overdose.Thanksgiving

Top 10 Safety Tips

  • Stay in the kitchen when you are cooking on the stovetop so you can keep an eye on the food.
  • Stay in the home when cooking your turkey, and check on it frequently.
  • Keep children away from the stove. The stove will be hot and kids should stay three feet away.
  • Make sure kids stay away from hot food and liquids. The steam or splash from vegetables, gravy or coffee could cause serious burns.
  • Keep knives out of the reach of children.
  • Be sure electric cords from an electric knife, coffee maker, plate warmer or mixer are not dangling off the counter within easy reach of a child.
  • Keep matches and utility lighters out of the reach of children — up high in a locked cabinet.
  • Never leave children alone in a room with a lit candle.
  • Keep the floor clear so you don’t trip over kids, toys, pocketbooks or bags.
  • Make sure your smoke alarms are working. Test them by pushing the test button.

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