If you now have the flu you know how terrible you feel. Your fever, fatigue, muscle aches, body ache, headache, sore throat, cough, and nasal discharge make you feel awful. Your sore throat feels like you've got glass in there and even water is hard to swallow. You have my sympathy. But it's important that you handle your illness in the right way to get better as quickly as possible.
Is my sore throat viral or bacteria?
This is a very important distinction to make because it may save you from an unnecessary medical visit, possibly leading to the prescription of an antibiotic which won't help and which could possibly harm you.
- if your sore throat is centered around your larynx; where your "Adam's apple" is (it goes up and down when you swallow) and the pain possibly goes down into your chest, then it usually is viral.
- if your sore throat is centered around the sides of your neck (your neck under your jaw close to your ears, possibly going up into your ears), then it could be bacterial and thus respond to an antibiotic.
If you have a virus, going to the doctor for an antibiotic in the hopes that it will fix your 'strep throat' can have one of two outcomes. Either the doctor may agree with you and give you the prescription, in which case you will have dragged yourself out of bed and exhausted yourself further as well as spreading the virus to others. Or the doctor may tell you that you have a virus, that they can't do much for you and send you home to bed, hopefully not angry with the doctor.
Your doctor and you may decide that an antiviral medication like Tamiflu™ will help although studies have shown that the benefits are a very small reduction in the length of time you are ill.
If you got the antibiotic, you'll take it and still feel terrible. You may feel you got the wrong antibiotic. If the doctor told you that you have the flu or a virus, then you're better off. At least then you can go back to bed and slowly get better. So let's have a look at the different common virus scenarios.
When we get a 'cold', usually a rhinovirus, our body responds with a sore throat (virus attaching itself to the epithelium in the throat), a fever (the immune system kicking in and activating its defenses), and sneezing and coughing (mucus going to work to rid us of the virus). We get tired (our body asking for some time to deal with the invader). If we answer this challenge with rest, increased fluids and a reduction in mucus forming foods (dairy and baked flour products), we usually get better quickly.
With a flu, the same situation applies except the flu viruses are much stronger and the need for rest is greater.
The flu virus makes a deep impact on the lining of the lungs. The cilia which line the airway are most affected. The illustration below is of healthy cilia (on the left) compared with viral infected cilia (on the right). It is clear how much the healthy cilia are affected by the flu. Compare the healthy cilia (on the left) which the virus has invaded and which have been altered (the bag-like, ineffective cilia an the right) by the infection. These damaged cilia are virtually unable to clear any mucus, so our body responds with coughing to help.
The flu typically lasts seven to ten days. During this time it is important to rest. Physical activity delays healing. You may get some relief with an NSAID (ASA, ibuprofen, acetaminophen etc.) which may have the effect of lowering your fever and getting you more comfortable. However, the body uses the fever to boost our immune responses. I usually ask people not to suppress a fever of less than 102° Fahrenheit or 38.5° centigrade. The body creates the fever as part of its strategy to overcome the virus so suppressing a low-grade fever likely means you will be sick for longer.
If you are so uncomfortable you can't sleep, you may get some relief from the NSAID. The danger is that you may feel well enough that you go to work, or do some other physical activity, which impairs recovery, and then are sick for longer.
Treatment Suggestions for 'Sinusitis'
Some of the things we do to get some relief from the symptoms of our illness can make the situation worse. Not resting is one of the worst of these. Medications to dry out the respiratory secretions (decongestants) cause our body to lock in the mucus and slow down healing.
One of the frequent complaints I see in the clinic is what patients often call "sinusitis." Their symptoms are facial pain and headache, without fever. These symptoms are caused by locked in mucus. Often they have been taking a decongestant in the hopes of getting rid of the secretions. But the decongestants cause the secretions to dry up. Dry, hardened, mucus blocks the exit from the sinuses and the pressure builds, causing pain; headache, facial pain, pain in the teeth, pain which increases when you bend over to tie up your shoes. Patients often feel this pain will be fixed by an antibiotic, which is not usually required.
The fix is to stop the antihistamines and decongestants which have dried the secretions. Blocked secretions cause the pressure to build, creating pain. The best treatment, in my opinion, is to inhale steam, perhaps containing a little camphor (Vicks™). It also helps to apply hot wet compresses to the face, take a hot drink and snort salt water up the nose. You can purchase this as a saline spray or make it yourself.
Saline water is made by adding 1/8 teaspoon of salt in 1/4 cup of good quality water. Salt water for inhalation should taste salty but not be as strong as sea water, which stings if inhaled. Sinus congestion can almost always be helped without requiring an antibiotic.
If you have rested and were slowly getting better, then your symptoms began getting worse again, it's time to get seen by a physician. Further information will be found on the page about sinuses.
Could you have Pneumonia?
If you have a fever and are coughing green or bloodstained mucus and especially if you feel exhausted and short of breath and have been ill for a number of days, then you might have pneumonia. One of the clinical challenges that doctors face is to decide if your symptoms are from a bacterial cause (and could be helped by an antibiotic), or are viral (you could have a viral pneumonia).
Influenza causes symptoms which last for many days. It is unusual for the flu symptoms of fatigue, fever, cough, and sore throat to be better in less than a week. Some people are still ill at the two week mark. In some cases, especially when people have been forced to keep working despite being ill, the flu can last three weeks, or in some cases, come back. Almost every patient wonders, when symptoms are not improving, if an antibiotic would help.
A chest X-ray is an easy way to answer this question but is not practical in many cases and, is not desirable because of radiation exposure. So it usually falls on the clinician to make the decision. It's sometimes a tough call.
What's the problem with just giving antibiotics to everyone with flu-like symptoms?
There are many reasons why not to do this.
Antibiotic use encourages the emergence of drug resistant super bugs
A patient who gets an antibiotic may have a false sense of security and not rest enough to really get better.
The patient may get one of the negative reactions to the antibiotic:
- allergic reaction
- Clostridium dificile ( a very troubling intestinal infection)
If the patient is not responding to the antibiotic, a physician may feel pressure to prescribe a second (and presumably stronger) antibiotic.
What reason should an antibiotic be used?
Patients with a suspected bacterial infection will usually require an antibiotic. Bacterial infections commonly follow a viral infection and tend to occur when a patient should be getting better and then appears to relapse. There are a number of pre-existing medical conditions which make it more likely that an antibiotic will be needed:
COPD (chronic obstructive pulmonary disease)
cardiac issues like valvular damage or congestive heart failure
sinus symptoms with a fever
patients who are immune compromised
In these cases an antibiotic will usually help. I usually prescribe azithromycin (Zithromax®) because it usually works, and between the once daily doses, one can take probiotics.
Some people may develop a wheezy cough during or after a viral infection. A physician may opt to treat this wheeze with an inhaled steroid/bronchodilator (asthma puffer). This can have the effect of relieving the dry wheezy cough. The problem with the puffers, usually containing steroids, is that they blunt immune responses. I feel that they may be responsible for delayed healing. Herbal teas and a change of diet can also help.
This won't work for children nor for the faint of heart! Garlic - the super anti-viral and anti-bacterial is amazing if fresh raw garlic juice can trickle down your throat. To do it, peel a clove of garlic and pop it whole into your mouth. Then suck on it. When you need to release more juice, touch it with your teeth. A clove should last about i/2 hour. If you space this out and alternate with salt water gargles you should get good relief of your sore throat. With any luck, you may manage to avoid getting ill.
Some people with the flu seem to respond well to natural remedies including herbal teas and compounded herbal preparations as well as homeopathic ones like Oscillococcinum®. There are a wide range of natural cough remedies which do not contain potentially harmful ingredients. Kroeger Herbs has a very powerful preparation called "Influ" which many people report as useful in dealing with the fever and feelings of general debility with the flu.
It has, in my experience, been a great help in helping people deal with the flu. With the onset of symptoms, one capsule twice daily seems to speed recovery. It has been used by healthy athletes in a trial which showed a significant reduction in the number of colds and flu encountered by the athletes who took it regularly. Pease see the page on WGP™ Beta-glucan for more information.
AFA has also helped people boost their immunity. People who take these products every day tell me that often they avoid getting seriously ill, or if they get the flu, it passes quickly and easily.
The evidence is in that Vitamin D3 can make you more able to resist many diseases including viral ones. There are a number of physicians who now feel that even in the middle of a flu, taking extra Vitamin D can help reduce the impact of the virus.
For adults, this would be taking 4000 to 8,000 IU of Vitamin D3 daily. For children, drops are available. They take a lesser amount - usually two to four times the amount indicated on the bottle. These amounts should be reduced after the illness subsides. Please see for more information on Vitamin D.
North American Ginseng
This is available from a number of sources but has been patented in a standardized formulation, Cold Fx. Trials done with this particular product have shown a reduction in sick days when taken during either a cold or influenza. It may safely be taken by almost everyone over the age of 12 years. Its daily use during the winter has been shown to decrease the number of viral events.
Garlic is a powerful immune stimulant. One of the best uses for garlic is to help deal with a sore throat. By peeling open a clove of fresh, raw garlic and sucking on it, the juice runs down the throat and helps deal with the pain - speeding healing. When the juice is depleted, just biting down gently can release more juice. A gargle with salt water provides some relief from the taste.
Frequently referred to as promoting healing and are found by some people to be effective are:
- zinc lozenges
- Vitamin C
- echinacea may be of benefit but should only be used for a maximum of two weeks
- homeopathic remedies, i.e. Oscillococcimum™
Herbal remedies like Kroger Herbs, 'Influ' or other herbal or homeopathic remedies like Oscillococcinum™can also help with the symptoms of fever and colds. Drinking lots of hot teas and soups supports mucus elimination. See also a healing, cooling diet for more ideas.
This wonderful form of treatment will, if given by a skilled practitioner, often be a great help.
Also see Strengthen Your Immunity