Questions

• Flu season is approaching. What exactly is the flu, and what can I do to keep from getting it?
• What vitamins or supplements can I take to help my heart?
• Why are immunizations important for children and what do I need to know before I take my child to get them?
• My doctor recently  told me that I have  pre-diabetes. What does that mean and is there anything that I can do to control the condition?

Charlita R. Mangrum, M.D.
Family MedicineSandhills Medical Group
(910) 582-5166

Influenza, or “the flu,” is a viral infection in the nose, throat and lungs. About 10 to 20 percent of Americans get it each year. Some people get very sick. Each year, about 130,000 people go to a hospital with the flu and 20,000 people die because of the flu and complications.

Flu can cause fever, chills, headache, dry cough, runny or stuffy nose, sore throat and muscle aches. Unlike other common respiratory infections, such as the common cold, flu can cause extreme fatigue that lasts several days to more than a week. Although nausea, vomiting and diarrhea sometimes accompany influenza infection, these symptoms are rarely prominent. The illness people often call “stomach flu” is not influenza.

The flu virus spreads easily from person to person, primarily when an infected person coughs or sneezes. Symptoms usually appear within two to four days, and the infection is considered contagious for another three to four days after the symptoms appear.

Most people feel better after a week or two. In some people, however, the flu leads to serious, even life-threatening diseases such as pneumonia. People who might have a higher risk of influenza complications include children ages 6 to 23 months, adults ages 65 and older, residents of nursing homes or long-term-care facilities, anyone ages 2 to 64 years with long-term health problems and children ages 6 months to 18 years on chronic aspirin therapy.

The best way to avoid getting the flu is to get the influenza vaccine each fall. Although the flu season lasts from November to April, most cases occur between late December and early March. The vaccine is usually offered between September and mid-November.

Some people who get the vaccine will still get the flu, but they will usually get a milder case than people who aren’t vaccinated. The vaccine reduces the average person’s chances of catching the flu by up to 80 percent during the season.

Getting the vaccine isn’t a guarantee that you won’t get sick, however, because the vaccine prevents infection by only a few of the viruses that can cause flu-like symptoms.

A common myth about the flu shot is that it can actually cause the flu. But the vaccine used in the United States is made from killed influenza viruses, which means that it’s impossible to catch the flu by getting this vaccine. However, because the nasal spray flu vaccine is made from live viruses, it may cause mild flu-like symptoms, including runny nose, headache, muscle aches and fever, which may last a day or two. Most people do not experience any side effects from either flu vaccine.

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Joseph F. Hakas Jr., M.D.
Cardiology
Pinehurst Medical Clinic
(910) 295-9211

This is an excellent question, but also one that is difficult to answer. Six or seven years ago, cardiologists often recommended anti-oxidant vitamins such as E, C and beta-carotene based on scientific theory. Now, based on large clinical studies in humans, we actually caution against regular use of all three supplements. Vitamin E and beta-carotene appear to increase the rate of cardiovascular complications when taken regularly as supplements. Vitamin E has also been linked to an increased risk of heart failure (a buildup of fluid in the lungs). Vitamin C appears, at best, to have no effect on heart disease risk and may increase the risk of rhythm problems in some people.

We had high hopes for B vitamins, as well, particularly folic acid. Unfortunately, well-designed studies have convincingly shown no benefit. At this time, we have no proof of benefit to any supplemental vitamins.

On the other hand, fish oil supplements may have some benefit. There is strong evidence of cardiovascular benefit to eating fish, particularly those high in omega-3 fatty acids (e.g. salmon, tuna, mackerel, swordfish, herring and sardines). The American Heart Association recommends two servings of such fish per week for the general population and perhaps more for those with known coronary disease. Fish oil supplements may be helpful, particularly in those people who do not regularly consume fish.

Fish oil supplements lower triglycerides and have anti-inflammatory effects that may lower heart attack risk. The risk may outweigh benefit in people on blood thinners since fish oil may increase their risk of bleeding. Also, fish oils have recently been shown to increase the risk of rhythm problems in those with severe heart weakness.

It is important to remember that vitamins and supplements are medications even though a prescription is not required. They may cause side effects and/or interact with prescription medications. Before starting any vitamin, supplement or herbal product, it is important to discuss it with your health care provider.

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Nancy Keeler, P.A.-C
Family Medicine
FirstHealth Family Care Center-Ellerbe
(910) 652-2663

Immunizations help protect your child from disease, and they help prevent the spread of disease to other children. When children are given an immunization, they receive a small amount of a disease. While this does not completely prevent the disease, it greatly reduces the likelihood that a child will have the disease. If he or she does, the severity is typically reduced.

Most schools and day cares require that children be vaccinated. Immunizations also cost less than treating the disease they protect against. That means you not only help keep your child well and in school, but you also save money by having your child immunized.

After a vaccine is given, some children may have mild reactions to the small amount of disease given through the immunization. Your doctor will likely recommend some home remedies for these side effects. Being sure your child is well rested and physically comfortable before the immunization is one way you can help prevent some of these side effects.

If your child has a severe reaction to any immunizations, you should call 911 immediately. Examples of severe reactions are significant changes in your child’s alertness within seven days of getting the vaccine, a seizure, collapsing or a major allergic reaction. Call your doctor immediately if you notice a severe reaction within two to three days after an immunization, if you notice any other type of unusual reaction, such as redness or swelling at the site of the shot that lasts more than 48 hours, or if your child has a fever that lasts more than 48 hours.

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Phyllis Simmons, R.N.
Nurse Educator
FirstHealth Diabetes Self-Management Program
(800) 364-0499A

Pre-diabetes is a relatively new term that replaces the old terminology of “borderline diabetes.” Pre-diabetes describes the condition when a person’s glucose (blood sugar) levels are higher than normal, increasing the risk for diabetes and other conditions, such as stroke and heart disease. A fasting blood sugar level between 100 and 125 mg/dL or an impaired glucose tolerance test result greater than or equal to 140-199 mg/dL qualifies as pre-diabetes. Diabetes is diagnosed if the fasting blood sugar level is 126 mg/dL or above, or if the glucose tolerance test is above 200 mg/dL.

There are many steps you can take to delay and even prevent pre-diabetes from becoming diabetes. One of the most important steps is to consult a registered dietitian who can help design an individualized meal plan with the correct servings of carbohydrates and fats. Often Medicare, Medicaid and many private insurance companies will cover this service.

You should also exercise five to seven times a week for about 30 minutes. Take a brisk walk, ride a stationary bicycle or go to a water aerobics class. If 30 minutes at one time is too long, you can also substitute two 15-minute or three 10-minute intervals of exercise.

For those who are overweight, weight loss is extremely helpful in treating pre-diabetes. As little as a 5-pound weight reduction can help. Work with your doctor and registered dietitian to set and achieve your weight-loss goals. Self-monitoring of glucose levels at regular intervals may also help you assess the progress you are making to manage pre-diabetes.

Most importantly, continue to work with your doctor and obtain the necessary diabetes self-management education.

A recent national diabetes prevention study showed that the patient is the most important part of the health care team and that the steps the patient takes to manage his or her condition can make all the difference.