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Saturday, 8 November 2014

Autumn is coming to a close



Autumn is coming to a close. Yes, that's a boring topic but hey! I can't always be fun ;)
But you know my favourite part of Winter? Christmas lights. I love them! They twinkle and reflect off all the windows and in the eyes of children and adults and humans and animals and black and white and gay and bi and straight and trans alike. They don't care who you are, they just shine. Put some light in your day.
So how about my worst part of Winter?
Cold and Flu season. And the fact that people cannot seem to differentiate between them. So, how do you know what you've got? How do you know when to stay away from people? And do you know when things aren't as straightforward as they could be?

What is a Cold?
A cold is an infection of the upper respiratory tract, characterised by a sore throat, runny nose and coughing, and a generally slow onset of symptoms over a couple of days. The symptoms are:
- cough
- runny nose
- blocked nose
- tiredness
- sore throat
- sneezing

A cold can be treated for most people with rest, fluids, paracetamol and some good food.

What is Flu?
Flu hits you like a train. All the symptoms may come on at the same time, and you might not get all the symptoms, but if it doesn't hit you suddenly, you're not suffering from flu. The symptoms usually associate with flu are:
- aching bones
- cough
- sneezing a lot
- temperature
- extreme tiredness
- sometimes feeling sick 
- sudden severe sore throat
- headache
- swollen glands (eg in your neck)

Flu is treated with rest, sleep, fluids, and time off from work or school until the worst of the symptoms have died down. Paracetamol can help ease aches and headaches caused by flu, and things like Dequadin or Tyrozets can be used to soothe a sore throat.

What's normal?
Any of the symptoms listed above. The symptoms will go away on their own as the virus is fought off by your immune system.

What precautions can I take?
Everyone can do their bit by washing or sanitising their hands, sneezing or coughing into a tissue or the crook of your elbow and unless you're having more serious problems (see below) then stay away from the doctor's surgery.
Some people choose to get a flu jab which they must pay for at a pharmacy it supermarket. These are safe and given by trained nurses, but aren't necessary unless you fall into one of the risk groups below.
If you:
- work with young children or in a school
- sing for a living
- live with young pets or children
then you should probably pay for a flu shot.

The risk categories, which entitle you to free shots on the NHS, are as follows:
- health care personnel
- those with asthma, COPD, eosinophilic bronchitis or any other chronic lung disease
- cancer patients 
- those with diabetes 
- those on treatments which suppress the immune system 
- babies and very young children
- the elderly 
- pregnant people

If you fit into any of those categories, talk to your doctor or nurse about getting a flu shot.

What is NOT normal?
It depends on who you are sometimes, but the things that are red flags in anyone are:
- coughing up blood
- coughing up thick, yellow/yellow-green sputum (phlegm)
- symptoms that persist for longer than a week
- difficulty breathing
- vomiting after coughing

If you experience any of the above, even if you aren't in a risk category, you should see your doctor as soon as you can. These can all be signs that something other than a cold or flu is causing your symptoms, such as pneumonia (most commonly numbers 1 and 2), other lower respiratory infections, and infections such as bronchiolitis (especially number 1).

If you have asthma, COPD or another lung condition, and you are:
- quite short of breath (as in much more than normal)
- coughing a lot 
- working harder than usual to breathe 
- using your reliever inhaler more than 4 times with no effect 
- having a cough which is accompanied by wheezing
- breathing very fast and having a rapid heart rate

Then you should see your doctor immediately or go to an out-of-hours centre.
However, if you fit into the lung disease category and you:
- are very short of breath
- having a cough accompanied by harsh wheezing 
- have any chest pain, especially if it is worse on breathing in
- have a bluish tint to the skin, dark lips, or pale skin 
- have a cough that won't stop
- cannot speak in full sentences
- have a very fast breathing rate
- are coughing up any kind of thick or yellow or green phlegm
- are not able to relieve your symptoms even after using your reliever 6 times 

then you must call an ambulance, or get to an Emergency Department immediately. You could have a lower respiratory tract infection such as pneumonia which must be treated with antibiotics, or even a pneumothorax (especially number 3) or pleural effusion. You could also be having a severe asthma attack which could be life-threatening if not treated immediately. You may need a course of Prednisolone or another steroid to help you breathe.

If you have a suppressed immune system and you have any cold or flu symptoms, you must go to the ED ASAP as you could have serious complications.

What to expect at the GP
If you are going to see your GP, you should expect to be thoroughly examined with a stethoscope, have your blood pressure and heart rate checked, as well as your oxygen levels (Sats). You may have a blood test ordered to look for infection, or a chest x-ray. 

What NOT to expect at the GP
Don't expect to get antibiotics. Over-prescribing of antibiotics is the reason for MRSA and other treatment-resistant bacteria. These are especially severe in people with suppressed immune systems.
Don't expect that the doctor will prescribe you anything, really. He or she may just advise you on how to keep comfortable and get better soon.

What to expect at the ED
If you have to go to the ED, you should expect a thorough examination with a stethoscope. All of your vitals should be taken regularly, and you can expect to have bloods taken, a cannula inserted and be taken straight to a cubicle. 
If your oxygen levels aren't satisfactory for your age and underlying condition, then you should expect to be given oxygen via a facemask (although a nasal cannula may be used instead).
If you are coughing up phlegm then you may expect to have a chest x-ray taken, although you may not need one. If your doctor does not order a chest x-ray and you are concerned, just ask the doctor if he or she is going to order one. This gives them a chance to tell you why they haven't, or to reconsider their decision.

If you have asthma, you can expect to have your peak flow measured at least twice. You may also be given a nebuliser treatment, although inhalers with spacers have been shown to be just as effective in most patients, and can also be used with a mask for young children and babies or people in distress.

If you are a cancer, HIV or AIDS patient you should be admitted, although thus does not necessarily mean you will have to stay in.

What NOT to expect at the ED
Don't expect that you will be seen first unless you came in by emergency ambulance or you cannot breathe. You must accept that other people may well be in far greater need than you, and EDs have to prioritise patients.

Don't expect that you will be given antibiotics. This is for the same reason as for GPs, and is especially important in hospitals. You may well be given antibiotics, especially if you have asthma or other lung disease, or HIV/AIDS. 

What you should take to the ED
Everyone should take all and any medications they are currently on, including homeopathic medications, creams, ointments, suppositories and herbal remedies. For people with diabetes, it is important to take your diabetes kit, and for people with asthma it is important to take your inhalers with you. If you have a spacer, nebuliser or peak flow meter then you should being those too.

When I go to hospital, even if it is not necessarily to stay, I always take a small bag containing:
- all my medications in a cosmetics pouch
- my phone, iPod and earphones
- deodorant
- a sleeping mask
- a pair of pyjamas
- a spare t-shirt
- toothbrush and toothpaste
- something to do, such as homework, class notes to read, a book, pen and notepad, pencil and sketchpad, small travel game, or iPad

It might be a good idea to take:
- sanitary towels
- wet wipes
- a bit of money
- an extra layer

If you are bringing in a child, either as the patient or with you, then it might be an idea to take:
- small, versatile toys such as a couple of Playmobil or Lego figures, a Barbie doll or an action figure
- colouring books and crayons (taping some crayons onto string and taping that to a book can help prevent losing them)
- picture books or drawing paper
- a camera for children mature enough to understand others' privacy; this can be a way for a child to understand what is happening, and can also give you an idea of their perspective
- a warm blanket
- a bit of food, or money for snacks from vending machines
- any formula milk you are using if applicable

Playmobil are especially good, as you can get hospital-related sets for children who might be scared or worried, or just curious and interested in playing out what is going on. Teddies can have 'breathing treatments' or 'oxygen' and also provide comfort if the child is separated from you or you have to leave your child for a bit.

***

I hope I've given you some good information and remember, if you have any concerns, then seek medical advice. I'm not a doctor or nurse!

Keep safe and keep others safe.

~Liz