good evening and Welcome to our 43rd season of doctors on call I'm Dr Ray Christensen a faculty member at the department of family medicine and biobehavioral health at the University of Minnesota Medical School Deluth I'm also a family doc at Gateway Family Health Clinic in Moose Lake I'm your host for our season premere tonight on upper and lower airway and respiratory illnesses RSV covid flu pneumonia this season we will again be rotating hosts from the medical school which will include Dr Mary Owen and Dr Peter nen and myself the success of this program is very dependent on you the viewer so please call in your questions tonight or send them ahead of time to our email address ask wdc.org the telephone numbers can be found at the bottom of your screen our panelists this evening include Dr Ken rip a family medicine physician with CMH Raider Family Clinic in clo do Dr Steven Schumacher a family medicine physician at enena Health Hermantown and Dr Ryan Harden a family physician at the Gateway Family Health Clinic in Sandstone also a faculty member at the medical school in duth our medical students answering the phone tonight are Riley Berg from buiji Minnesota willstone from Melrose Minnesota and Wyatt Windor from Alexandria Minnesota and now on to tonight's program on upper and lower respiratory illnesses RSV covid flu and pneumonia it's interesting when you see the um the respiratory illnesses we they talk about upper and lower and I think we need to differentiate between because they don't get treated all the same so Ryan what what is meant by an upper respiratory illness so that's a good question upper respiratory infection is any infection from the nostrils into the naso FX into the fering which is behind the nostrils and behind the mouth down into the larynx where your voice box is and down into the trachea that's the upper respiratory or upper Airway the lower airway or lower respiratory infections affect the lung tissue itself and the major Airways into the lungs the bronchi and bronchioles so anything above the lungs is considered upper Airway Steve is there a difference in the way we treat those um well it all depends upon what is causing the infection I guess and so um uh primarily like if it's a viral infection there are some antivirals that that are being approved mostly for influenza and covid now um but uh and then if it's a bacterial cause then obviously antibiotics would be the the best treatment but it's kind of differentiating what's causing the infection it seems like there's more of a tendency to try to stay away from the antibiotics uh most of these are viral I believe aren't they that yeah yeah the vast majority of the common cold that we all get during the winter months are they're they're viral in nature and sometimes you have a virus long enough you can get a bacteria on top of that but that usually takes weeks of being sick and so we try and be you know judicious in our use of antibiotics and really try and figure out who really needs antibiotics because we're trying to make sure that they're effective when we need them what are some good treatments for upper respiratory infections uh any one of you can jump in on that I that again that would depend on if it's a bacterial infection or a viral infection most upper respiratory infections are viruses and thinking symptomatic treatments um staying well hydrated and taking some Acetaminophen getting plenty of rest eating a healthy diet robotos in sometimes is a good one to go been good for 50 years robotos DM honey as a cough suppressant has good data vix has good da data as a decongestant and then then the the if you want to go behind the counter one you have to ask the pharmacist ped is a potent decongestant and you can can use if you're really congested looking for just a little relief a nasal decongestion can be used but that needs to be used only for a brief period of time a few days because if not it can cause more problems what kind of symptoms show a change from a viral and a simple infection to one that you should be concerned about and we can get into pneumonias and other things here but what kind of changes what I'm an old guy what would I go through that would get me concerned I would say is if if you you can beat me up now right now if you have a a common you're going through the usual common code which would be a sore throat followed by nasal congestion followed by a cough and if you're getting better better better and have a sudden worsening and you have a Redevelopment of fever fatigue shortness of breath and and a change in your mucus that could be a sign that's definitely a sign to go get checked out because you that may be we call a bacterial super infection so um any other thoughts on that uh cough Maybe Chang based on your symptoms so like if you're getting a lot of dizziness a lot of lie headedness or you're feeling like more what we call like orthostatic where you like you're um feeling like that you're generally like just worsening instead of improving like Dr rip said um those would be reasons why I think we want to make sure and especially if you're imuno compromised or based on what medications you're taking we might have like a lower threshold just to make sure that it's not something more serious basically other other symptoms that that somebody might be developing a pneumonia secondary to a upper respiratory viral viral infection would be also if they're having a more productive cough if they're coughing up blood or if they have low oxygen SATs or if they when they take a deep breath if they have chest pain with deep inspiration when should um so you've got a child let's go to Children real brief because the question came in uh when should you take a child to the office for a checkup with an upper respiratory infection uh how do I know it's not just a cold well um speaking well we're all family practice doctors here but uh like uh and you can speak for us oh okay okay thank you uh so taking care of uh like infants primarily under two months like we want to know about it so we don't if like a baby is Feb or anything 100.4 we want to know about it basically so that's a reason why but yeah things that I wouldn't really worry about with kids so much is if they're playful if they're you know if they're still interactive if they're enjoying their playtime with their friends and stuff like that if they have a little bit of a cough running nose maybe low grade fever temp 99 stuff like that they're eating and drinking well I'm I'm not too worried but if they start to be lethargic if they aren't eating and drinking appropriately if they develop a rash or a high fever greater than like 101.5 then I would be more concerned that they should probably be a evaluated in the clinic so let's move into co uh it's still out there I believe and as I heard the numbers there's several I forgot the numbers like 100 a thousand or whatever so many dying each each day in the United States from Co so that's still there um the shot should people get the shot yes yes yeah okay everybody overage six months y so now we're coming into this blastam kind of thing I'm starting to feel like a little kid now where you go to the doctor's office and you get 10 shots so I'm I'm old and all of a sudden there's RSV there's flu and now there's Co also pneumonia shot don't forget your pneumonia shot well how good is well one at a time how long is a how long is a pneumonia shot good for well the the new the if you're over 65 the the the the the two Pneumonia shots so so if you have the RSV is a once in a lifetime and the prear 20 is a once in a lifetime shot so you're done that's what they said about the other well but but so far that's been held true and so we'll wait and and and the reason why we got to the prevenar 20 as I explained to my patients is you know the first shots were so good that they made a sequel because it was that successful and for those of us who are practicing in the hospital we from when we've trained to when we become attendings we just don't admit patients with pneumonia like we used do I mean I remember that was like every second or third admission was someone with pneumonia and we just don't see that anymore because we are we are curing it or preventing it or making people not get sick enough to require hospitalization you can still get pneumonia but you won't be in an ICU or God forbid die so Steve additional comments on that one um yeah I mean uh I guess like with the major or the majority of my older population then I would say uh definitely above like age 65 like I'm highly recommending them to get immunized against with the the PCV 20 uh pneumonia 20 or 20 veent pneumonia vaccine um I think it's a little less contentious compared to I don't know if this is true or not but it seems a little less contentious people are more willing to get the pneumonia vaccine compared to um other viral vaccines it's not saying that they're any less important than the pneumonia vaccine but it seems to be like a little bit more they're they're more willing to get that done at least so maybe it's just that they realize how serious pneumonia can be but flu and Co are both equally can be serious so and right now in parts of United States there's a big outbreak of pusis and they said it's been one the high hold on to that for a minute the one other thing I want to do before we jump off flu as long as that we were there a little bit but I want to come back to pesus Ryan why is why is the over 65 different than the under 65 flu shot what's that all about well the the seeing is how I care now the flu shot the flu shot that we give to people over age 65 is a higher dose of the antigen that provokes an immune response because as as we all get older our immune response diminishes so you want to give a higher dose of the antigen so you get a more robust response from somebody's immune system it's also recommended that some people with chronic illnesses under age 65 get the high dose vaccine and and I'll add to the to the pneumonia vaccine everybody should have the pneumonia vaccine at age 65 but some people under age 65 people who smoke people who have asthma COPD chronic lung disease people have heart disease they should be getting the pneumonia vaccine under age 65 so okay then let's go on now the other one is RSV so what what's our combine knowledge on RSV I think last year was the first year if I remember right that we really pushed it um and that's being pushed again now as a fall shot correct so RSV I mean historically was a disease that we worry about more in kids because little tiny humans have little tiny Airways and when they get inflammation in their airways it can actually interfere with oxygen exchange as people get older they get larger their airways get larger um RSV the virus respir respiratory sensial virus doesn't tend to affect the lungs as much unless people have um chronic disease in their lungs like like COPD asthma but um we are now vaccinating everybody it's recommended that everybody over age 75 get the RSV vaccine because again as we get older your immune response changes and I'm you know RSV infections in in older people can be very serious so a couple of months ago I finally got caught with Co so how long how long when's when do you get your Co shot after you had Co so there questions here people that have recently had Co do they wait a while or can they go ahead and get them now or what's the story you can go ahead and get them anytime after Co immediately after Co you're probably do have an elevated protection against it for a while but you don't know what type you had and so if you came across a different variant of it you could get Co again hopefully your body would have some memory but I tell people you can probably wait a month or two and then get the shot I saw you you had an answer there uh well no I generally age with that too and I mean uh like unofficially like we've always said like like maybe like 90 days or something I find that if I can convince people to be like okay well if you'll get your flu shot now and then I'll get you your covid shot in 90 days then then at least you'll you'll follow up for that and then it's a way to like get people to to make sure that they're following up for their vaccines so and just as we leave RSV one shot it's not one and done it's every year correct RSV I believe so I thought so I don't know one and done done I think that that story is still evolving right I we don't we don't really know yet but your immunity after the RSV vaccine wanes more quickly than it does with like the pneumonia vaccine so Jim from Hibbing would like an honest answer from all three of you are you in favor of the co shot this year absolutely already had mine I'm going to have mine there you go Jim all are we seeing increased heart damage from viral infections and the person that's asking is from here in duth specifically RSV and covid and where are we with some of the long Co if you want to venture and I'm not calling on each of you just jump into this it's kind of a discussion well any I mean many viruses can infect the heart and cause something called myocarditis which can be very signif serious condition um there was some data originally in when young younger males would get the covid vaccine that they would develop a myocarditis from the vaccine but the um the incidence of myocarditis from the covid infection was much higher much higher much higher so um it's not common to have a viral infection affect the heart but when it does it can be serious and that's why we try to get people vaccinated against those viruses so it it they can't be exposed to the virus which can move into the heart have any of you dealt with the loss of smell with covid with patients and are there any treatments for that yes and yes um so it is one of the most frustrating parts of getting over covid is if your sense of taste doesn't return because it makes eating difficult and uncomfortable and unpleasant it takes one of the enjoyments of Life Away there are things you can do there are special there's different um odors that you can smell to try and stimulate your nasal passages to start to get those nerves going again and they can actually go in and do a block uh certain of the the Interventional pain people go and actually block some of the nerves that will stimulate it and that's been found to be helpful for some people I have had patients who've had success with that block and I think we're still trying to get a feel for the long Co and we did bring it up and I'm not sure just exactly where that's going and what percentage of people that get Co get long co uh and I sometimes wonder if we overread that sometimes too as we see patients it's it's a book yet to be written because we're just we're still learning about it and and I think that the effect of once a virus clears your body does not mean that it it hasn't left a scar behind on the body I I use polio so people had polio and then years later develop post polio syndrome it's not that they have polio again but that virus that affected them ear early on is coming back to wreak some Havoc now unlike shingles you get Chickenpox as a kid and or get exposed to the chickenpox virus when you're young and then when you're older you get a rash and which can be devastating for people they don't you know that is a virus that sort of a second life of it so so that kind of leads us into zoster MH uh talk about the herpes the herpes zoster shot um zostavax uh what are your what's your feelings on that well it's Shangri now it's sh was what was it before sorry but yes shingrix um yeah so everyone over age 50 uh we recommend uh getting its a two do series basically and then um I think it's four months apart so yeah um best way to prevent either a getting shingles or B having severe shingles that could be permanently disabling so um people can have postoptic neuralgia we call it which is nerve sensitivity that can affect them for years after having shingles so and a question that comes up in my practice a lot if I've had shingles do I need the shingles vaccine yes yes yes is the right is the answer I knew that answer it took us a long time to figure that one out though yeah just thinking back over the years um one just to finish off Co I thought I was going to do that before but how often do they need a shot and basically that's just kind of comes up government or whoever puts CDC put sees together again I think that's that story is we're still learning I looks like yearly don't it I think it's believe yearly going forward if we had a predict did they uh last year have it separate they came out with a new vaccine towards the end of when they started offering and so then that was kind of split but I believe I cut you off on the what was yeah so so protestas you know is so one of the other vaccines that I'm a big fan of is is that they they I don't know how many years ago they allowed us to continue to give the tetna shot with proasus and it we give that to kids and then for a while we're just giving adults just the tetanus shot they add the protestas back in to try and pre prevent adults from getting protestas and so right now there's a big outbreak and they're blaming it on two things is they're blaming it on um decreased vaccination rates and then um some other factors but they uh they have had two deaths and so if you haven't had your tetanus shot you should consider making sure that's up to date we're dealing with measles measles coming back too we're dealing with measles in certain parts of the country thankfully not so much in Minnesota did they have like one case down in the cities or two cases so so we we we in Minnesota are very fortunate that we have high vaccination rates and and one of the things that we talk about in medicine we talk about herd immunity so if you go in and you vaccinate 80 or 90% of a population the whole population gets the protection cuz a virus that can't that gets in can't move around at all and a prime example was they had a a case of uh of measles hit New York and California at the same time and in New York it went nowhere because the vaccination rates in New York City are very high but in California where the rates had gone down for numerous reasons it spread and they had a big a big outbreak and a big problem big problems How likely is it to get guon Beret from vaccines it's a question that's been around for a long time I don't personally have an answer I think that the question is there and I I don't know do you fellas any any insight it would be rare and and I bet you none of us have seen it vaccine caused we've seen G gon ber but I've seen it twice never not related to vaccinations and I've seen it twice and not related to vaccines I think the correlation between guon Beret and vaccines is strongest with the flu vaccine but um there was some preliminary data that it was associated with the RSV vaccine but that has you know that's been debunked is Vitamin C helpful respiratory infections it's not going to hurt but uh I don't think like mega dosing on vitamin C is necessarily going to help you out any more than just having a glass of orange juice a day unless you have diabetes but never mind uh uh but uh yeah I mean I think like just make sure like you're getting like like like 100% of the vitamin C so mega dosing on any any any vitamin I don't really recommend to people but yeah good health good diet yep yeah no smoking hydration hydration should re so great yeah we haven't mentioned that yet yes great that's a way to get over your uppr piure so we talked about the viral infections how do you get a bacterial infection lower or upper respiratory well I mean you you get exposed to the bacteria you you can contract a bacterial upper respiratory or lower respiratory infection like a pneumonia the same way you contract a viral infection but usually what happens is people will get a viral infection that'll suppress their immune system and then they'll start to get better and their immune system is suppressed and then bacteria will move into their lungs and cause a secondary infection and those can be quite serious the other question that comes up is autism and vaccines um I don't have any personal knowledge except that I'm not sure that there's a correlation between vaccination and autism but uh you're the experts that that the link has been quite clearly proven not to exist if you go into countries where they don't vaccinate or don't have access to vaccines the rates are the same there there has been a increased rate of autism in the United States without a doubt but to blame it on one thing like vaccines is not there's not the data there there's so many other environmental changes the change in our food sources and what's in our food so we've not been able to link to say what has caused this change but vaccines is not it yeah the other thing that I've uh been told is that I mean that I've been taught um uh is that we're we're identifying autism more basically like it's just that it's been there and then now we're we're kind of putting a label on it basically and so then and then it it it happened at the same time that we started being like okay we're going to start vaccinating against all these preval preventative illnesses both things like it's just it's a correlation not causation basically just I think you hit on Ste you hit on something that's important across Society because it's not just autism we have a lot more practitioners we have a lot a lot of newer knowledge and so on so we're making diagnoses that we hadn't been making much before right or we we've also changed maybe some of the criteria for some of those diagnosis too if someone had mild chickenpox around 10 years old do they need a vaccination if it is if you are sure that you had chickenpox then technically you do not you can safely receive the vaccine and it's probably safe because then you get you will get a more complete protection against you know and the people gets vaccinated actually more protection against shingles later on but you should still get the shingles vaccine even if you have the chicken pox when you're younger so and if there's any question if somebody had chickenpox you can do an antibody tighter to see if they have antibodies if they do then they probably had chicken box a quick this is bad you're going to throw me out somebody just a quicky on pulmonary fibrosis well that's for another show no uh so pom fibrosis is is it can but it makes them susceptible to a lot of stuff well well what what pom fibrosis you have one minute a gradual stiffening of the lungs over time and so lungs are not able to move air across is a it can be a rapidly Progressive disease that leads to death those people if they get any infection can be tragic so vaccination is going to be critical to keep them healthy try and preserve their lung function as long as they can because that is a tough one and the other place I guess would be the respiratory infections uh the copds and the asthmas and all of the rest I want to thank our panelists Dr Ken rip Dr Steven Schumacher and Dr Ryan Harden and our medical student volunteers Riley Berg will Stone and Wyatt uh Windor for their for their help and assistance tonight please join Dr Mary Owen next week for a program on women's health and female cancers when our pan panelists will be Dr Michael cassing Dr Sandy Stover and Dr Addie vitorio thank you so much for watching and panel thank you so much for some great interchange this is fun thank you thank you for