Stephen Leonard

Lots of people getting sick after holiday gatherings, and definitely seeing more cases in the ER this week, which is usually our busiest time of year. A quick guide on how to manage some of the more common symptoms, and when it is advisable to get checked out: What to do about coughs? Coughs are probably the most annoying part of getting sick. Coughing is a natural reflex to help you clear secretions and phlegm while you're sick. It can annoyingly linger for 3-6 weeks afterwards as a 'post-viral cough produced by throat and lung irritation, and keep you from sleeping and working. What can you do about it? Honey: This can be soothing for the throat, has an antimicrobial effect, and may help reduce coughing. You can take it with a spoon, or with tea or warm water. Combining it with ginger can also help. Hydration: Helps thin secretions, making them easier to cough up Antihistamines: Commonly used for allergy symptoms, they can help for runny noses and sneezing. Use the non-sedating second generation ones (Cetirizine, Loratidine) if you do opt for this. Cough Suppressants and Expectorants: Over-the-counter cough medicines can help. Cough suppressants (like dextromethorphan) reduce the cough reflex, and expectorants (like guaifenesin) help loosen mucus. Lozenges: Throat lozenges or hard candies can help keep the throat moist and reduce coughing. Make sure you don't fall asleep with them in your mouth, to reduce choking risk, as I almost learned the hard way! Steam Humidifiers: Inhaling steam or using a humidifier adds moisture to the air, which can soothe irritated airways and reduce coughing. Asthma inhalers: May be beneficial if you have a history of asthma. Avoiding Certain Activities: those that exacerbate the cough, like vigorous exercise or exposure to cold air, should be avoided. Children: For safety reasons, most cold/flu meds (eg pseudoephedrine, benadryl) are not recommended or approved for kids <6. Reactine (cetirizine) is approved in Canada for children >2 for allergy symptoms. A dry cough with no phlegm, fever, no body aches, no chest pain, no shortness of breath, is harmless in most cases and will resolve after a few weeks. If you have any of these symptoms, or it lasts beyond 6 weeks, get it checked out. What do I do about body aches? Use tylenol (paracetamol) and advil (ibuprofen) for these symptoms. Follow the guidelines listed on the bottle to avoid taking too much. Stay well hydrated as well. What about fever? Meds: High fevers will make you feel miserable, and the effect is especially pronounced in children. Keep ahead of it with Tylenol/Paracetamol and Advil/Ibuprofen What about my appetite? Fluid intake: Appetite loss is normal in most flu-like infections. It's normal for kids to refuse solid food when sick with a fever, but they should still be able to drink fluids; give lots of fluids/electrolytes, especially after you bring down the fever. The appetite will usually recover after a day or two with the more benign viruses. If you stop peeing, or are peeing much less than normal, it's a sign that you are not getting enough fluids. Meds: Some viruses, C19 and Flu included, can cause severe nausea, vomiting and diarrhea. It can be challenging to stay hydrated. Anti-nausea medications like Gravol (dimenhydrinate) can help, as well as Ondansetron (Zofran) which usually requires a prescription. It's fairly routine for us to give IV fluids in the ER to patients with severe flu and C19-like illnesses and that's often enough to help them get over a rough patch of illness, so don't feel bad if you have to come in. When to come to see your physician/come to the hospital(not an exhaustive list) - fever more than 4-5 days - not eating/drinking - lethargic/sleepy even with tylenol/advil - not peeing, or peeing too much - rapid or noisy breathing - Any fever in a child <6 weeks, or in a chemo patient - focal source of possible bacterial infection - ear pain (ear infection), severe sore throat (strep), pain on urination/flank pain (UTI/kidney infection), etc. - confusion, forgetfulness, not able to walk (in the elderly) - if you're worried Plan ahead if you have to go to hospital Wait times can be higher during the holiday season, our busiest time of year. Taken from an article by my colleague Dr. Courtney Spelliscy (link in thread) Bring food, you will get hungry. Hospital cafeterias may not be fully stocked or open during the holidays Bring devices, you will get bored. Bring powerbanks, chargers as well. Bring some essentials, change of clothes, toothbrush, ear plugs, etc. Get organized, bring a list of medications, any paperwork on previous conditions, tests, etc. Be kind, the hospital is a chaotic environment and we try our best. What to do when you recover from C19 Avoid strenuous exercise, until the fatigue and brain fog have fully resolved. There is some suspicion that this could prolong the length of time you'll have these symptoms, through whatever unknown mechanism causes long term symptoms. Look out for secondary infections: it is very common for recovering patients to get bacterial infections (pneumonia, kidney infections, strep, invasive strep) and reactivation of viral infections (shingles, mono). If you are feeling much worse 1-2 months post infection, there probably is a good reason, and get checked out. Look out for blood clots: very common to get DVTs, strokes and heart attacks (mostly in older folks) after an infection. If your leg is swelling and more painful than usual, pay close attention. If you're having some palpitations, chest pain or shortness of breath that's getting worse, don't ignore it. Common Sense Things: Do a Rapid Test - When you get symptoms, it is a big help to your physicians to know if you're C19 positive or not. This could mean faster access to antivirals that could save a vulnerable patient's life, or at least prevent a hospitalization. Many studies showing early use of Paxlovid and Remdesivir can reduce the progression to hospital admission. Metformin may help for preventing Long C19. Knowing if you have it could also mean you're not prescribed unnecessary and possibly harmful antibiotics. It also helps you keep vulnerable babies or older relatives away from infected family members. Prevention - Mask wearing is not popular, but smart, especially when used in poorly ventilated, crowded places (planes, trains, buses, hospitals, malls full of holiday shoppers). This is a high yield activity that might spare you a lot of misery If you're sick, stay home! If you're sick with any cold symptoms, stay home, wear a mask if you absolutely need to go out. Spare someone else a lot of misery. - It's a hard thing to ask, but don't go to the big family dinner and infect everyone if you're sick - It's no longer 'brave' or a sign of a hard worker to show up sick to work. It's a terrible winter present that your colleagues will hate you for. Get boosted (for C19, flu, and RSV if available), when you're feeling better (and when guidelines say you can). Will hopefully prevent some infections in future and ensure a milder course of illness for most.