A cold, the flu, or sinusitis? Part 3: Myths

The Pediatric Insider

© 2015 Roy Benaroch, MD

You might not like to hear it, but the truth is….

 

Nothing really works well to treat these things

Colds, flus, and sinusitis all share some things in common—and the most important one is that just about all of us get these, and they make us miserable, and we want them to go away. Billions are spent on all sorts of things to treat these conditions, both from pharmaceutical companies and from companies that make supplements and other alternative-health nostrums. We’ll try just about anything. But if clinical studies reliably show that just about nothing really helps, why do we keep buying them?

I think the most important factor is simple human nature, and the way that symptoms change. If you have a cold, the symptoms get better and worse throughout the day—so if you take medicine or supplement XX when you feel really bad, the natural ups and downs average out, and you’ll feel better. But: you would have felt better anyway! Still, human nature, you took the magic beans (that you paid for), then you felt better, so there must be a connection, right?

That happens at the end of an illness, too. Let’s say you’ve had a cold for 6 days, and you go to the local get-me-some-drugs at the QuickieClinic. You get some antibiotics, and a few days later you start to feel better. Boom, QED, there’s all the proof you need. (BTW, docs are pretty much just as bad about giving out unnecessary antibiotics, too.) But: you were going to get better anyway.

Think about this, it’s really important: many symptoms occur like a mountain, with an up and a down. If you try therapy at the top, when you’re feeling bad, you will feel better. But that doesn’t mean that the therapy was why the mountain went downhill.

 

Flu shots work

The effectiveness of flu vaccines varies from year to year, but typically runs ~ 50-75% — that’s pretty good, really, for a health intervention (it’s much better than, say, the effectiveness of taking a cholesterol-lowering drug to prevent a heart attack. And some people take those every day for years.) It does mean, though, that in a family with say four people who’ve gotten flu vaccine, one child may not be well protected. That’s why it’s important for the whole family to get it.

Also: flu vaccines only prevent the flu. They don’t prevent colds. And they take 3 weeks or so to “kick in” – you don’t get instant protection.

 

Flu shots cannot cause the flu

MythsNo. They can’t, and they don’t. They can sometimes cause a little fever or achiness, but that is not the flu—and anyone who’s actually had the flu will tell you that these mild symptoms after a flu vaccine are pretty much nothing. Sometimes, right after a flu vaccine, someone does get the flu—that’s because we’re giving flu vaccines during flu season, and if you don’t get it in advance it can’t protect you. The vaccines take about 3 weeks to work. If you catch influenza right after getting the flu vaccine that’s called “bad luck” or “bad planning”, not “bad vaccine.”

 

Green snot means sinusitis

No, green snot means it’s been sitting around up your nose (you’ll often notice this overnight), and your white cells are busy fighting off the viral infection. Good for your white cells. Go blow your nose, and stop looking at the color—it doesn’t matter what shade it is.

 

Flu tests are needed to diagnose flu

Commercially available flu tests aren’t very good—they give a lot of false negatives (a negative test even in the setting of flu), and some false positives (a positive test in a person without flu.) Many health care facilities don’t even use them. A flu test can be helpful, sometimes, if I’m on the fence about a diagnosis, but they’re really just not very reliable to help make decisions about treatment.

 

Cold weather causes colds

Colds are caused by viruses, one of many from families called “rhinovirus” and “coronavirus” and others. They’re not caused by cold weather. BUT there is a germ of truth here: cold air in the nose can make it more likely that these viruses can be transmitted. Grandma may have been right!

 

I’m sure there are other myths, feel free to add your own in the comments!

 

The whole series:

A cold, the flu, or sinusitis? Part 1: Symptoms and Diagnosis

A cold, the flu, or sinusitis? Part 2: Treatment

A cold, the flu, or sinusitis? Part 3: Myths

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5 Comments on “A cold, the flu, or sinusitis? Part 3: Myths”

  1. Frank Camma Says:

    You should add the myth that the flu shot had never hurt anyone. Oh wait there are a bunch of people that now have incurable narcolepsy that would feel differently.

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  2. Dr. Roy Says:

    Frank, I don’t know anyone who says “The flu shot never hurt anyone.” Real side effects from vaccines occur, and neither I nor any medical authority I know of disputes or denies that.

    Serious side effects from flu vaccine are rare. Frank is referring to narcolepsy associated with the Pandemrix brand of flu vaccine distributed in many European countries in 2009-2010. It was never sold in the USA. An association has been found between that vaccine and narcolepsy, with an estimated ~ 1200 excess cases occurring that year that mathematically could be linked to the excess risk after vaccination. To put that in perspective, 30 million doses of vaccine were given. The baseline rate of narcolepsy among Europeans is 1 in 3000– meaning that by chance alone, 10,000 people who received the vaccine would have narcolepsy (they would have had it anyway, that’s the incidence.) far more details here: http://ecdc.europa.eu/en/publications/Publications/Vaesco%20report%20FINAL%20with%20cover.pdf

    We’ve been able to learn far more about narcolepsy and the connection with this specific formulation of vaccine: http://news.sciencemag.org/health/2015/07/why-pandemic-flu-shot-caused-narcolepsy

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  3. Maria W Says:

    How about leaving home (on a cold day) with your hair wet? I know you can get a headache, but my mother used to believe I would actually “catch my death of cold”.

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  4. Dawn the Mom Says:

    What do you think about cultures for ear infections before prescribing an antibiotic? Last year my 5 year old son had several colds turn to “ear infections,” sometimes very suddenly, and was prescribed antibiotics. Each time he got DRASTICALLY worse, often leading to severe viral symptoms – fever that wouldn’t break, skin peeling, body aches, etc. Sinxe school started three weeks ago we’ve started back in the cycle. I’m refusing to take him back to our pediatrician because I know the routine. But he’s crying complaining of ear “pain.” I also have pretty intense pressure right now, so I have a feeling he’s interpreting that sinus pressure as pain, but I can’t be sure. And of I take him in he’ll give him another antibiotic. Would a culture confirm whether that was necessary or not? And if so why aren’t they routine in these situations? Thanks!

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  5. Dr. Roy Says:

    Dawn, in theory culturing a potential infection is a great idea — you can then objectively see if there are bacteria. BUT to culture a potential ear infection, you have to puncture the eardrum with a needle and collect the fluid. General peds like myself typically haven’t been trained to do that (at least not in the last 20 years). Could be done by an ENT, but might require sedation, or at least some serious holding-kid-still. And how many parents want their child’s eardrum poked?

    Still, thew way we’re going, this may be the wave of the future. Hold still, Junior!

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