Antiviral medications safe treatment for influenza
Dear Doctors: I thought I had a bad summer cold, but it turned out to be the flu. I didn’t know that can happen in the summer. Urgent care offered me an antiviral medication, but since I’m not familiar with those, I said no. I would like to know more about antiviral treatment for the flu.
Dear Reader: While it’s possible to get infected with the influenza virus at any time of year, a case of summer flu is somewhat rare. That’s because influenza tends to be a cyclical virus. Infection rates begin rising in the fall, peak in the winter months and subside again with the return of longer days and warmer weather. Interestingly, this pattern occurs worldwide. In the United States, flu season runs from roughly October through April. In the Southern Hemisphere, where the seasons are reversed, the flu surges from roughly April through October. Why the influenza virus emerges as the days begin to shorten is a subject of study and debate, and the answer is not yet clear. What we do know is that indoor living during the colder months creates the ideal breeding ground for this highly transmissible virus.
For anyone lucky enough not to be familiar with the symptoms of the flu, they include fever, body and muscle aches, headache, cough, congestion and a stuffy or runny nose. While these can strongly suggest an influenza infection, a definitive diagnosis requires a test. That’s because different respiratory viruses can produce similar symptoms.
Once the flu is confirmed, choices regarding treatment can be made. Among them are the antiviral medications you are asking about. This is a class of prescription drugs that can reduce the severity of the disease by making the virus less efficient at replicating and invading the cells. Antiviral medications can slightly shorten the length of someone’s illness. More important, they can prevent flu symptoms from escalating.
Complications from the flu can include ear infection, bronchitis, pneumonia and systemic inflammation that can involve the organs. Antivirals are an important option for people with health conditions such as diabetes, asthma and heart disease who are at higher risk of hospitalization. Antiviral drugs are most effective when taken as soon as possible after exposure to the influenza virus, or as soon as symptoms begin to appear.
Influenza isn’t the only disease for which antiviral drugs are available. Others include COVID-19, swine flu, hepatitis B and C, Ebola and HIV. However, it’s important to understand that antiviral drugs are not interchangeable. Each medication is specific to one type of virus. For example, if you take an antiviral for the flu but it turns out you have COVID-19, you won’t get the benefits of the drug. That’s why if someone is a candidate to receive an antiviral medication for a respiratory illness, a test is needed to be sure the correct drug will be prescribed.
Antivirals are a safe and effective treatment option. Potential side effects include nausea, vomiting and diarrhea. Meanwhile, with flu activity on the rise, we urge everyone who is eligible to please get their flu vaccine.
WEIGHTED BLANKETS CAN HELP WITH SLEEP
Dear Doctors: My niece got me a weighted blanket for my birthday, which she says helps you sleep. I admit I was skeptical, but I used it for a month, and she may be right. Instead of waking up a few times at night, I sleep right through. Is it the power of suggestion, or is there a reason this is working?
Dear Reader: Weighted blankets have become increasingly popular in recent years. They were originally developed as a therapeutic tool to help people with conditions such as autism, in which anxiety can be a persistent symptom.
Unlike an ordinary comforter, which is made entirely of fabric, the interior of a weighted blanket is lined with a heavy material of some kind. Depending on the manufacturer, this may be tiny spheres made of glass, plastic or metal, or natural fillers such as rice, grain, beans or sand. These fillers are sewn into pockets or channels and arranged so that their weight is distributed evenly throughout the blanket.
Someone lying under a weighted blanket feels a sensation of gentle pressure evenly distributed across their entire body. Occupational therapists refer to this as deep touch pressure. Research has found that this type of compression activates the centers of the brain that oversee involuntary processes such as heart rate, blood pressure, respiration and digestion. It has long been used, often to beneficial effect, on individuals with a wide range of sensory disorders.
Studies looking into weighted blankets over the years have observed a range of potential benefits. These include easing insomnia in adults living with depression, anxiety and attention deficit disorders; lowering anxiety in some children with mental health disorders; and improving sleep in older adults living in a nursing home. The researchers noted that while using a weighted blanket, the participants in their studies were able to fall asleep more easily, woke less frequently during the night and felt an increased sense of calm during the day.
A new study in Sweden has potentially linked the use of weighted blankets to increased melatonin production. Melatonin is a hormone that plays an important role in the sleepwake cycle. Researchers found that when a group of 26 young adults with no previous sleep problems used a weighted blanket at night, their bodies produced more melatonin than when sleeping with a conventional blanket. It’s a small and short study — just two days — but the results take the weighted blanket conversation in an intriguing direction.
The accepted guidance regarding weighted blankets is to select a product that is 10% or less of the person’s total body weight. The specific material used in the filling is a matter of personal preference. However, weighted blankets are not for everyone. They should never be used by or on someone who would not be able to remove the covering themselves. This includes infants, young children and older or frail adults. They also may be unsuitable for people living with certain medical conditions, such as Type 2 diabetes, asthma, sleep apnea, low blood pressure and circulatory problems.
COLONOSCOPY PREP IS UNPLEASANT, BUT NECESSARY
Dear Doctors: I’m having my first colonoscopy in a few months. My friends say it’s unpleasant, and I’m already dreading it. I think it would help if I knew what’s going to happen. How often do you need to get a colonoscopy? And is there any way around having to use that prep drink?
Dear Reader: A colonoscopy is an exam that allows a doctor to see the inside of the large intestine. It may be used to identify the cause of certain bowelrelated symptoms, such as rectal bleeding, abdominal pain or chronic diarrhea.
It is also used to look for signs of colon cancer. With colon cancer on the rise in younger adults, screening guidelines have been recently updated. It is now recommended that someone of average risk begin screenings at age 45. For those with risk factors, such as family history of the disease, earlier screening is advised. Colonoscopies continue once per decade until age 75. Between the ages of 76 through 85, continued colon cancer screening is based on risk, medical history and overall life expectancy.
Some people may choose a stool-based colon cancer screening test. However, it is not yet clear if these are as effective as a colonoscopy. If stool-based tests are used, they must be performed at more frequent intervals than a colonoscopy. Depending on the specific test, they must be repeated annually or every three years.
A colonoscopy includes a few days of preparation, during which patients cleanse their bowels. This begins by eating a low-fiber diet for several days, followed by a day of clear liquids. The final step is using a specially formulated liquid laxative, which is the prep solution you asked about. Talk to your doctor about using one of the newer products. They use smaller volumes of liquid than in the past and are better tolerated. A sodium sulfate-based tablet for colon cleansing, which the FDA approved two years ago, may also be an option. You and your doctor will also discuss any medications or dietary supplements you may be using and whether or not these should be adjusted or discontinued prior to the procedure.
The test takes place with the patient lying prone on a table. In most cases, sedation is used. A long, flexible tube, known as a colonoscope, is introduced into the colon via the anus. It has a light and a tiny camera, which allow the doctor to see the interior of the colon. A colonoscopy takes between 30 and 60 minutes. If polyps or other growths are found, they may be removed and sent to a lab for testing.
After the exam, it takes about an hour to recover from the sedation. Cramping and bloating may occur, but are temporary. If tissue has been removed, there may be light bleeding. A follow-up appointment is typically scheduled to go over the findings.
It’s true a colonoscopy takes time, and the screening can be uncomfortable. But early-stage colon cancer, which a colonoscopy can identify, is highly treatable. In making this appointment, you have made an investment in your health and well-being.
LONG COVID REMAINS A MYSTERY TO PROVIDERS AND PATIENTS
Dear Doctors: I had COVID-19, and now I’ve got long COVID. I have neuropathy and brain fog, and when I try to exercise, I get exhausted right away. My doctor said it just takes a while to get back on your feet, like after you’ve had the flu, but this feels different. What is the latest news on long COVID?
Dear Reader: As we enter the fourth year of living with COVID-19, it’s clear the initial illness isn’t the only health risk for those who contract the disease. They also face the chance of developing long
COVID, the constellation of symptoms that can continue long after the initial illness has ended.
Symptoms include the physical and neurological effects that you have described. The condition can also adversely affect the heart, respiratory and circulatory systems, stamina, endurance, cognition and mental and emotional health. Long COVID does not appear to be linked to the severity of a case of COVID-19. And to make things even more complex, the symptoms can take a few weeks, or even months, to appear.
The newest data shows that 1 in 5 people who recovered from COVID-19 later develop long COVID. With more than 100 million cases of COVID-19 in the U.S. to date, that puts the number of long COVID patients well into the millions. Because the condition is so new, doctors are still struggling to understand what is happening to their patients. And, as with all new diseases, the learning curve is steep. This puts a burden on both patients seeking help and the medical workers trying to treat them. Here at UCLA, as is occurring in medical centers and hospitals throughout the U.S., long COVID treatment is rapidly emerging as a subspecialty of its own.
When it comes to physical activity, a new study backs up your experience — that is, long COVID can severely reduce the ability to exercise, no matter the person’s prior level of fitness. It also offers clues into the mechanics of what is happening. Researchers at the University of California,
San Francisco, analyzed data from studies that compared the exercise performance of about 800 adults who have had COVID-19. Roughly half recovered completely, while the others developed long COVID. While running or cycling, the long COVID group had a diminished ability to use oxygen in the blood to fuel muscles. Additionally, their cardiac function, including heart rate, wasn’t able to meet the needs of the exercise. Why this happens is not yet clear, but each new bit of information suggests new paths forward.
At this time, the guidance for long COVID patients is to take a modulated return to exercise. This can mean adding as little as a few extra steps to a walk or run or a few extra strokes of a swim every few days or weeks. Research shows that pushing yourself can delay progress. Physical therapy is also emerging as an important tool for recovery. Long COVID continues to be the subject of many of the letters we receive. We’re keeping an eye on new developments and will continue to share them in future columns.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.