Posted by AskNurseLinda on Feb 5, 2018 11:48 am

The flu is at a second peak this winter. It is not unusual to have a dip in the number of flu cases midseason as we are experiencing this year. Typically, flu season begins in December and ends in March. In the southern hemisphere, flu appears in the ‘summer months’ when it is winter there.

Flu enjoys the winter time as the virus survives better in colder temperatures with decreased humidity. The virus can survive any weather but it certainly is more viable in cold, dry weather. So is it the weather or the virus that perpetuates the flu? Actually, the virus survives but thrives in a cold and dry environment.  No one really knows the right situation for the flu because you can have it in the summer as well but it appears less often.

Some people think the flu is more common in the winter due to the change in people’s behavior. In the winter people stay indoors, have the furnace on which produces dry heat in the house. Usually people spend less time outdoors in the sunlight which helps individuals produce vitamin D increasing our immune system ability to fight illness. The flu virus is always around us. It is less potent in warmer, wetter temperatures as a general rule but sometimes these rules are broken by the flu virus.

Symptoms of the flu can range from mild to severe. Some people get the flu with symptoms of being tired or feeling weak. Sometimes, they just do not ‘feel themselves’.  This is a very mild case of the flu. Usually, flu develops in a much more severe manner. Typical signs of the flu are listed below. You could have one symptom, just a few symptoms or all of the symptoms listed:

Fever, with or without chills, lasting 3-5 days
Sore throat
Runny or stuffy nose
Muscle or body aches
Vomiting or diarrhea
Flu can be confused with a heavy cold. Flu appears quickly. Colds take a few days to appear. With colds, there are less body aches and tiredness. Headaches are less frequent unless a sinus infection appears with the cold. Sneezing, stuffy nose and sore throat are more common with a cold.

There are many diagnosis that have been linked to being more susceptible to the flu. Spinal cord injury is on the increased risk list mostly due to the decreased ability for the body to fight infection. In addition, flu complications can be greater if you have secondary complications of spinal cord injury such as diabetes, kidney or liver problems, heart disease, have a diagnosed or undiagnosed head injury, are overweight (body mass index of greater than 40), are under age 19 or over age 65. Other risk factors for increased complications of flu are asthma or taking low dose aspirin. Interestingly, individuals who are of Native American or Alaskan descent, are noted to have a higher risk of flu complications.

Individuals with spinal cord injury have this higher risk of flu complications due to immune suppression complications and respiratory issues. SCI can lead to an increase number of infections due to catheterizations and breathing issues among others. The more infections you have, the more the bacteria learns to live in your body. The more antibiotics you take, the more the bacteria mutate to avoid being destroyed by the medication. If you develop a bacterial infection, you should take the prescribed antibiotics to rid your body of it. However, the continual ingestion of antibiotics makes bacteria stronger and smarter. The best treatment is to carefully perform intermittent catheterization as cleanly as possible to avoid getting the infection in the first place. This might not always be possible even using the best technique but it is the best route to take. Bacterial infections can weaken your immune system making it easier for viruses such as the flu to enter and thrive in your body.

The same is true for respiratory bacterial infections such as pneumonia. Treatment is needed but avoiding respiratory infection is the best treatment. The respiratory system depends on three sets of muscles for function, the diaphragm, the intercostal muscles (the muscles between the ribs), and the abdominal muscles. Any or all of these muscle groups can have decreased function with spinal cord injury.

To keep you respiratory system clean and clear, deep breathe and cough frequently throughout the day. Deep breathing will stimulate a cough. Try for four times a day. Perhaps after meals especially if you have swallowing difficulty to try to remove any residue from your throat. If you were given an incentive spirometer, use it. If you are unable to breathe on your own, use the sigh button on your mechanical ventilator. Suction as necessary. See if you can obtain an Insufflator/Exsufflator prescription if suctioning is a challenge for you.

For everyone, keep your mouth clean by using oral hygiene twice daily and after meals. If your mouth is clean and you should happen to swallow or choke, the particles will be less apt to contaminate your lungs.

Complications of the flu include sinus and ear infections, pneumonia, worsening of existing heart conditions, or infections that are virus and bacteria combinations. Other complications include inflammation of the heart, brain or muscles and multi-organ failure. As the body fights infection, it can get out of control leading to sepsis or when the infection spreads throughout the body. Sepsis and septic shock is a severe drop in blood pressure and organ failure. It is life threatening. Information about sepsis is available in a wallet card along with other topics for individuals with SCI from the Christopher & Dana Reeve Foundation.

There are signs that the flu is becoming critical and you need emergency attention. These include:
Difficulty breathing, bluish color to nails
Pain or pressure in the chest or abdomen
Sudden dizziness, confusion, not waking or interacting, irritability
Severe or persistent vomiting or diarrhea
Not drinking enough for hydration, lack of tears or decreased urine output
High fever or fever with a rash
Flu that appears to improve and then worsens
Be sure to notify your health professional should you feel uncomfortable with your health status. Let them assist you in making the decision for emergency or acute care. If you feel you are in need of immediate assistance phone 911.

As an individual with SCI, there are actions you can take to help yourself to stay healthy and avoid the flu. It is not too late to get a flu shot. While getting your flu shot, ask about a pneumonia vaccination if you don’t already have one.

Drink plenty of fluids especially water. Remember caffeine and alcohol dehydrates. Sugary drinks can increase your blood sugar and risk of urinary tract infection. You can still enjoy these in moderation but water works the best. Don’t wildly just drink. Think of your bladder routine. Increase your fluid intake by just an extra quarter to half a cup of water at meals or even less if you have a heart condition or edema. Check with your healthcare provider for a water increasing plan.

Cough and deep breath as indicated above or use the sigh button on your ventilator. This will help to keep your airway clear. Keep your mouth and airway clean. Cover your nose and mouth when sneezing and then throw the tissue away. Do not save it in your sleeve or side of your chair. Stop smoking.

Avoid people who are ill. Individuals with the flu will be contagious one day before symptoms appear and up to seven days after the flu starts. If your caretaker has the flu, use a backup assistant. If you have the flu, let your caretaker know. Avoid situations where you might be exposed to the flu such as gatherings of people and airline flights.

Preheat your vehicle so you will not be out in the cold too long breathing in the cold air which can quickly lower your body temperature. Dress appropriately for the weather.  Even if you do not feel the cold, your body will react to it, lowering body temperature and even leading to frostbite.

Activity will help your body produce heat. Moving, performing pressure releases for skin health, or even rolling from side to side will change the position of your lungs which will move any collected fluid in them reducing the chance for bacteria to grow. The same is true for your bladder.

If your healthcare professional recommends antivirals for the flu, take them according to the instructions. Read the package insert so you can be aware of side effects.

The number one prevention for everyone is to wash your hands thoroughly and frequently. Your caretaker should do the same. Clean surfaces that you touch frequently such as joysticks, mouth sticks, wheelchair rims, steering wheels, toilet flushing knobs, door knobs and your own face, including mouth, nose and eyes. Look around your environment for frequently touched items. Yikes, I am looking at my own environment and seeing my computer keyboard. Time for a wipe and a hand wash.

Nurse LindaI'm online in this community every Wednesday from 8-9 PM ET to answer your SCI and paralysis related questions.

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