It’s that time of year again!  Cold and flu season lasts from October to May, although we all know you can get sick with influenza or another flu-like illness pretty much anytime.  Upper respiratory infections are well-named: they lead to symptoms in the upper respiratory tract, the throat, nose, and sinuses. Most of the bugs that cause these upper respiratory infections (URIs) are viruses.   Why are these types of viral illnesses more common in the winter? One, people are more likely to be in close spaces indoors together when it is too cold (or rainy) to spend much time outdoors.  This proximity with many people and many germs increases the chances of contracting an illness that is spread through coughing or sneezing such as the cold or influenza. Second, many viruses are more resilient in cold weather: their external shell comprises fat molecules which are heartier in cold temperatures. Another factor is that it is harder to get vitamin D from the sun in the winter due both to its being weaker and that we humans tend to be heavily bundled in the winter – making it impossible for our skin to convert the sun’s rays into that wonderful hormone vitamin D. How can you support yourself during this year’s cold and flu season?  Start with prevention: minimize time spent in crowded indoor spaces, avoid touching your face when in such places, and wash your hands with soap and warm water immediately upon returning home. Wash your hands every time you are going to eat or drink something, or touch your face, including brushing your teeth or taking out your contacts.  Consider supplemental vitamin D during the winter months, or all year-long as directed by your healthcare provider. Vitamin D supports many aspects of your immune system: increasing defensins to destroy virus particles on your skin or mouth, activating macrophages to engulf then extinguish invading virus cells, and modulating T cells.1  If you don’t like swallowing pills, a liquid version can be added directly to food.  Vitamin D is fat-soluble and best absorbed when taken with a fat-containing meal.  Other tools to add to your winter tool kit?  Vitamin C is an accessible and inexpensive vitamin that can help to support your innate immune system.  Vitamin C can increase natural killer cells, immune system cells that destroy pathogenic bugs like viruses.  The evidence for vitamin C and cold and influenza has been mixed, but one study showed that “megadosing” the vitamin helped with both relief and prevention of upper respiratory infection symptoms.2 Intravenous vitamin C is sometimes recommended because the IV route bypasses the gut, meaning your body can use a much higher percentage of the vitamins than if...

October officially marks the start of influenza season, which lasts until May. During these months, doctors’ offices across the world start to see increasing number of runny noses, coughs, sore throats, and fevers. This year, your scratchy throat and congested nose might bring up some more confusion than previous years. You might think it is just the common cold but be worried about influenza or COVID-19. Are there ways for you to tell which upper respiratory infection you might have? The common cold, influenza virus, and SARS-CoV2, the virus that causes the COVID-19 illness, have a lot of symptoms in common. These include feeling run down or tired, sore throat, cough, and a runny nose. Influenza and COVID-19 can both have fever and/or chills, shortness of breath, body aches, a headache, and sometimes gastrointestinal disturbances like nausea, vomiting or diarrhea. Some upper respiratory infections can result in loss of smell or taste, and it seems to be a common complaint in COVID-19. The only way to know which viral illness you are sick with is to go to your doctor’s office to get tested.  If your symptoms are mild and the influenza and COVID-19 swabs are negative, it is probably just the common cold, hurray! Important note: Even if you are tested for influenza and COVID-19 and the tests are negative, it is still important to remain at home for the duration of symptoms or longer as instructed by your provider. There is a significant chance of a false negative for both the influenza and SARS-CoV2 tests. Cold symptoms usually resolve in less than a week but can linger for up to two weeks. If you are still feeling ill after more than two weeks, call your doctor again: you may need to be retested for COVID-19. Both influenza and COVID-19 can result in serious complications or even death, especially in high-risk groups. High risk groups for influenza include children under two years of age, the elderly, pregnant women, those with compromised immune systems, and those with chronic health conditions. High risk groups for COVID-19 include the elderly, those with compromised immune systems, patients with obesity, patients with diabetes, and those with underlying heart and/or lung conditions. You can get the influenza vaccine now through the end of flu season. Pharmacies and many doctors’ offices offer this vaccine and most insurance companies cover it fully. There are medications that can help to shorten the course of influenza. There are currently no FDA approved treatments for COVID-19. And while there are many medications that can help with symptom relief of the common cold, to date there are no cures or vaccines for the common cold.   CDC. Coronavirus Disease 2019...

Wildfires continue to affect much of the West Coast, as we are all aware.  But what exactly is the health impact of these fires?  The biggest culprit – and the one on everyone’s mind – is the smoke and what it does to our air quality.  Portland, Oregon has had the worst air quality in the world this past week, clocking in at an Air Quality Index (AQI) of 516 on September 13, 2020.  The number looks huge, especially considering Oregon is usually home to some of the best air quality in the world with AQI numbers consistently in the lowest bracket possible, below 50.   Due to the smoke and hazardous air quality of the past few weeks, clinics across the state have seen large numbers of acute asthma and COPD (emphysema and chronic bronchitis) exacerbations.  Infants, the elderly, and pregnant women are also at increased risk when air quality gets to be 101-150 on the AQI, or the “Unhealthy for Sensitive Groups” range.  For pregnant women, unhealthy air quality – be in from air pollution or wildfire smoke – increases the risk of low birth weight, premature birth, and stillbirth.  It also increases the risk that the child will later have a learning disability or have respiratory complications in childhood.   Just how bad is an AQI of 500 for a pregnant woman?  I do not have an advanced degree in environmental science, so it was hard to grasp just how bad 500 is (well minus the dizzying smell, low grade headaches, sore throats, and burning eyes that patients have been reporting).  An AQI of 401-500 is equivalent to a PM2.5 of 350.5-500.  And smoking one cigarette a day approximates a PM2.5 of 22μg/m3.  This means an AQI of 500 is roughly equivalent to smoking a pack (20) of cigarettes a day.   So, if you are expecting, or are in another sensitive group: what can you do about these hazardous air quality levels?   You could try to find cleaner air. The AirNow app and the Weather app both list AQI for your location.   Stay inside. Let your pets out to do their business but Fido needs to forgo his walk for the time being. Rinse your pet off with water before bed to get the smoke of her fur. Try to keep doors closed as much as possible and definitely keep windows shut.   If you do need to go outside, wear an N-95 mask or a respirator that can filter out particulate matter such as a P100.  You can find these at hardware stores. Cloth or surgical masks will not filter out the hazardous smoke particles.   Use your central air, mini split, or air conditioning unit all...

HPV of the Cervix and Vaccines Human papilloma virus, HPV, is the most common cause of both sexually transmitted infections and of cervical cancer worldwide. This virus is a particularly tricky one, sometimes evading the immune system for years. In addition to hiding from the immune system, it can cause changes to cells of the cervix, called cervical dysplasia.  Left unchecked, this dysplasia can lead to cancer. In fact, over 99% of cervical cancer cases can be directly linked to specific high-risk strains of this virus.  Annually, approximately 12,000 women in this country are be diagnosed with cervical cancer. In 2006, the United States began offering a vaccine for HPV called Gardasil.   This vaccine immunized against strains 6, 11, 16, and 18.  At first this vaccine was only recommended to girls and women although now it is offered to both sexes starting at age 9.   In the last year, the recommendations were changed to allow women up to age 45 years to get the HPV vaccine.  Now, the US offers Gardasil 9, which immunizes against nine strains of HPV. The HPV vaccine, like all vaccines, works by priming your immune system to mount a response to an infection, in this case to multiple strains of a virus.  Once vaccinated, the spread of HPV will decrease and thus the rates of cervical cancer are predicted to decrease.  The word “predicted” is chosen deliberately, as no studies were conducted long enough to conclude that the HPV vaccination prevents cervical cancer.  Cervical cancer is a slow growing cancer, and typically HPV needs to be present for a decade or more before the cells turn cancerous. The HPV vaccine was studied long enough to deem that it was effective at decreasing dysplastic cells, but it was not studied long enough to determine that it prevents cervical cancer. Fortunately, even before the advent of these vaccinations, we had a way to screen and test for HPV and the cellular changes it can cause: HPV and pap tests. As many of you know, guidelines have changed in the last few years to recommend getting pap and HPV tests less often.  This is because the screening was so frequent, it was causing many women to have unnecessary procedures done for a virus their body might have cleared on its own.  Some estimates are that 90% of HPV infections are transient and will resolve in one to two years. Routine gynecologic exams, testing for HPV and/or pap tests are still an important part in preventing cervical cancer, regardless if you have had the HPV vaccine series or not.  Co-testing with both HPV and the Pap test are considered the most thorough and informative evaluation. Some people are...

Is it Celiac Disease or Non-Celiac Gluten Sensitivity   Gluten-free eating, cooking, and living has been increasing in popularity over the past decade.  Some skeptics consider this a fad, while others swear they feel better eating a strictly gluten-free diet.  Gluten-free bakeries and restaurants speckle metropolitan areas,and now even body-care and cleaning products are hopping on the bandwagon, labeling their lotions and scrubs as “gluten-free”.  So, is it hype, or is there a medical need for eating sans gluten?   It’s definitely not all hype.   Current estimates are that 1% of the US population has celiac disease.  That’s a lot.  That’s one guest at a wedding of a hundred people.  And celiac disease is serious: if a person with celiac continues to be exposed to gluten, they can have chronic diarrhea, malabsorption so severe it can lead to early osteoporosis, chronic rashes, increased risk of developing other autoimmune diseases, and increased risk of many different types of cancer.  And yes, that includes even the gluten in their lotions and scrubs. Celiac disease is an autoimmune reaction to the protein gluten which is found in wheat-derived grains including wheat, rye, and barley.  Genetics can predispose you to celiac disease, but you also need the trigger (gluten) and intestinal hyperpermeability aka “leaky gut” to develop celiac.  (Circle back to my primer on autoimmunity for a refresher on autoimmune disease).   Your doctor can order blood work to determine if you are having an immune response to gluten but you need to be eating one to two pieces of bread (or the equivalent in crackers, whole grains, wheat cereal, etc.) for a good four to eight weeks in order for these blood tests to pick up the immune response.  If your blood work shows you are having a certain type of immune response, your provider will send you to get some biopsy samples taken from your small intestine because celiac disease causes characteristic damage to your small intestine. If you get tested for celiac and there are no signs you have the disease—does that mean you can go back to feasting on glutenous grains?  Maybe, but maybe not.  You might have non-celiac gluten sensitivity (NCGS), meaning you are having a reaction to gluten, but it is not autoimmune in nature.   This condition, unlike other food sensitivities, is recognized conventionally and was first introduced at the International Celiac Disease Symposium in 2011.  Similar to celiac, it can cause symptoms and conditions both related to digestion (such as bloating or diarrhea) and unrelated to digestion.  Other symptoms associated with NCGS are many and can include fatigue, headache, joint pain, generalized pain such as fibromyalgia, anxiety, depression, and rashes. Testing for non-celiac gluten sensitivity is...