good evening and welcome to doctors on call I'm Dr Mary Owen associate dean of Native American Health and director of the center for American Indian and minority Health at the University of Minnesota medical school I'm also a family physician for the Fondulac band of Lake Superior chipa and I'm your host tonight for our program on influenza pneumonia and empyema the success of the this program is very dependent on you the viewer so please call in your questions tonight or send them in ahead of time to our email address the telephone numbers can be found at the bottom of your screen our panelists this evening include Dr Jane Rudd a family medicine physician with asena Health West duth Clinic Dr Sandy Stover a family medicine physician and faculty member at the medical school duth Dr Andrew Thompson an infectious disease specialist with St Luke's infectious disease Associates our medical students answering the phones tonight are Kayla edin sorry Kayla Al from Alexandria Minnesota Mary Jane Evans Big Lake Minnesota and Logan hooker from Sandstone Minnesota and now on to tonight's program on influenza pneumonia and empyema thanks for being here this evening good to be here and good timing for this show so we were just talking ahead of time about until we get some questions from our audience we'll ask some few questions amongst ourselves or talk a little bit amongst ourselves um influenza are we starting to see it are we are we just now seeing it has it been going on where are we at yeah i' say was a little bit of a late start this year so we are starting to see it we're seeing more influenza A um and um it's pretty typical year so influenza most of the time comes in really hard so you feel pretty good and then all of a sudden within hour or two you have a bad headache you hurt all over and you start to get a a cold or a cough um so it's pretty typical influenza year I would say Okay anything to add uh I've seen an increase in hospitalizations due to influenza at St Luke's okay um and when we look at the numbers nationally uh influen activity usually starts first in the southern us and moves North and we are starting to see that we've we've seen it move northward and I would expect in the next few weeks we'll be seeing more cases Dr Stover what do we when we say influenza are we talk is that like pneumonia what's the difference between influenza and pneumonia and that's a good question because the term flu or influ fluza can be used for other for many things but true influenza is a viral infection a specific virus that infects our lungs and creates an entire body reaction because it's it has that kind of a stimulation or a shock to the system so for particularly for people who already have something in their lungs or in their other otherwise in their health it can be even more problematic because it tends to sort of be that shock wave across the body can you have pneumonia and influenza then you can uh the influenza that so pneumonia is a a term that's used when when the lung tissue itself is infected uh and there's fluid often as a reaction from the body to the invading organism and it can be a viral pneumonia like an influenza pneumonia could be a bacterial pneumonia and some viruses tend to create enough of problem in the lung that bacteria take advantage and you can have a bacteria on top of a of a viral pneumonia uh and of our our immune systems are are you know the the Warriors that help to keep that at Bay so you know keeping your immune system as healthy as possible is a is a great way way to minimize how how hard the food might hit you Dr Rd do you um should doctors always be expected when you go in to see your doctor should they always be expected to treat you for influenza it's a really good question when you get the flu you often feel really really sick and you'll come to the doctor and one of the things that surprises me is how sick people feel and how normal their exam can be so their lungs can sound clear their ears can look fine their throats don't look that bad but the patient feels terrible so it's not uncommon for us to not treat other than symptomatically on the Other Extreme people that have underlying conditions can get really really sick and need to go to the hospital so it isn't uncommon that we see them in the hospital as well um there aren't a lot of treatments for the flu if you have high risk condition asthma you're a smoker you have other um lung problems we sometimes will give an antiviral medicine but it has to be given in the first two or 3 days and often people are so sick that they don't come in until the or fifth day and then it's kind of too late for those antivirals to work M Dr thomp that they do make it to the hospital are they usually treated uh with an antiviral at that point or what other things are why would they what what do they go into the hospital for right so people sick enough to be hospitalized for influenza might be there just because they need support they need oxygen um they need other medications uh if it's early in their disease course they would usually be treated with an antiviral medicine um uh sometimes they're there because they have complications and they need uh treatment for that bacterial pneumonia that they got after the flu okay uh so it really depends on their underlying health conditions uh how we would treat them in the hospital so it sounds like one of the things we're watching for when they get that influenza as a secondary complications like pneumonia yeah possible now we hear about pandemics we know we just all experienced one how about influenza can it cause an EP can it cause a pandemic there have been a number of pandemics across the well Humanity as long as the influence has been around and there's the there's a sequence of influences amongst many other organisms can sort of change its coat so that what even though people may have been exposed to influen or had influenza it can it can change into something that's less recognizable by your own immune system and so those Peaks will happen as as the populations um you know um don't have the the right reaction to the right way to recognize the flu viral proteins and so about every 15 to 20 years it's not unusual to see a wave um that come through uh in terms of a little higher Peak and sometimes we call them pandemics when it reaches across broad areas multiple countries anything to add to that Dr Thompson no I agree that's a that's a very good description it's when there's usually it's a new pathogen or a new variant of a pathogen that spreads widely across the the world pan pandemic and I just read that it's only influenza A that we can get pandemics from it's not influenza B I just saw that in the CDC today I thought that was interesting I hadn't known that so little T tidbit for you yeah hopefully it stays that way yeah no kidding I just gsed us knock on wood Dr Rudd um you wanted to talk about public health so is the RSV vaccine recommended for those over the age of 60 and what are the side effects of the RSV vaccine yes they are now recommending it we've been giving it to babies for a long time we're now also recommending it to pregnant women so that they can help protect their babies and we're um just this year offering it to our seniors so uh highly recommended vaccine to help reduce the chance of getting one more respiratory virus um we've seen more hospitalizations we were just asking each other I think it might be because we're testing more than we used to um but uh we are definitely seeing more in our seniors and how about side effects I have not seen a lot of side effects from That vaccine so I don't know if uh others have but it's relatively new so we're just starting to use it in seniors again we've been giving it to infants for a long time and it's been well tolerated okay nothing else to add friends um and it also seems to last for a while you know we have to get a flu shot every year updated the RSV vaccine time will tell but it seems to have a a longer life so you won't need it every year that'd be great huh yeah exactly all right Dr Stover uh Am Scott from embarass wants to know what causes my nose to run more in the winter time is there anything I can take for it that's actually a good question because uh because the runny nose uh sometimes we think of that as an illness and sometimes um it you also have to think about it that it's your body's reaction to trying to keep itself moist so the way the nose is built and and this is a this is one of those fun facts I I read a bunch of years ago we put about a liter of fluid from our sinuses um that are created to help moisturize and warm the air that we breathe in catch all the stuff that we don't want to put in our lungs but about a liter a day that is produced most of it goes down the back of your throat you never notice it because it's flowing helping that stuff flow yeah but on on cold days there's changes in the you know kind of the the moisture need in the nose there's also changes over our lifetime and so our noses get U this the little hairs that supposed are helping us beat it backwards get changed a little bit and um I'm at that age I'll admit it that when there's even foods that will stimulate my nose toon a little bit and I was Dripping a little bit when I first came in not because of an illness but because my nose was responding to being out in the cold air and trying to help protect me from the extra dryness that's hard on tissue oh I'm glad I asked you that question that's far more than I would have expected or answered the only other thing I would add to that is allergies are not uncommon in the winter too we think of them in the spring and in the fall but in the winter we turn on the the airflow Vents and we're putting dust in the air and so it could be allergies as well and we close the windows and keep the keep things in the house y right all right Dr red I want to ask you this one again can you get empyema from asbestosis exposure and I guess let's just go back a step and talk with the audience about what empyema is first right we use a lot of big words and empyema is really um when they end of the airway those little tiny air sacks uh kind of stop uh working they fall apart and we get bigger air air sacks and so there's not as much room for the the air exchange with the blood blood so we we breathe in oxygen and the oxygen gets circulated through our bloodstream at those little air sects as they break down and we get bigger areas and pockets it's that exchange doesn't happen as well and so uh lots of things can cause osma the most common being smoking other inhalations um you know whether you breathe fumes from paints or other things through through your life can also lead to that and there are a few other conditions that can cause empyema but it's kind of an inst stage disorder of the lungs we see it both on x-ray you can kind of see instead of um you know good air circulation you can see that it's um not moving as well is it the same as COPD well COPD can lead to osma but it's not the same okay thank you for that all right Dr Thompson Andrew asks who should receive the new mle vaccine this is a good question it's trickier than we think so um seniors should receive a new umle vaccine um kids should receive a new mle vaccine and other people who H might have some underlying health conditions uh that affect their immune system or if they have chronic heart or lung uh disease some of those people should receive an extra numac vaccine so there are a lot of people there and it's a little bit complicated so uh I would say talk to your doctor about which vaccine and if you meet criteria for for some of them but it's um it's a really good vaccine in the sense that it protects against a lot of different strains of of pneumonia um specifically num maal pneumonia but um so there are a lot of different people to answer the question who would who would uh qualify I'm glad that you brought that up against the strains because that's a question often we get around uh the vaccine for the flu right there can you explain the flu vaccine and why there's some question around it so flu vaccine uh unfortunately we have to get one every year we have to get an updated one because flu is always changing um it flu virus can live in people and in chickens and in pigs and it likes to jump between uh uh species and it's always mutating um so for that reason we have to get an updated vaccine every year um so that and our flu vaccine typically covers four different strains each year um there's a lot of work that goes into predicting that which is the right which are the right ones to put in um and the track record is actually pretty good at matching those up occasionally it's not and the vaccine isn't as effective it's it's not quite as effective as we want but it doesn't do any harm no there's no harm to the vaccine okay great thanks this is definitely for you Dr Stover Tom from duth wants to to know what might make it difficult to take a deep breath after a prolonged cold and that is a good question because you get that that that extra time where you have that little cough or when or you go and exercise you want to go back into your running routine and you end up coughing from it and and um you know there's there's kind of the the I always think of the whatever infection gets you is sort of like an invading armony and then there's the body's response and then there's the the battle happens and the immune system wins it off you know and and and gets rid of the the bacteria the virus whatever but there debris left over and so some of the the cells some of the the the byproducts of that healing process have to also leave that area so that the lung can work effectively um Dr R was talking about how the Alvi work they're very stretchable and flex very stretchy and flexible when they're in their best state but in a state when they're recovering from a cold they're still a little stiff and so you had to cough that moisture out of there anybody want to add to that that was pretty thank you are you Bo on your side side routine I think the other thing to add is that um shortness of breath and and not being able to get a big breath can be infection it can also be a symptom of other things so if you're experiencing shortness of breath or if you find that you're just not moving as much as you used to you may be sort of compensating for not be able being able to get a good breath of air so those are things to definitely take to your doctor to talk about right so that one time when you walk out in the cold and you get it is one thing but if you continue to have those symptoms whether in other conditions or if they just don't go away right right and I think a lot of people don't understand that you're your breathing can be affected by your heart and your lungs so it could be a problem in either system all right you asked for the next question then oh no Dr red jo and duth wants to know what's the life expectancy for someone with mild empyema and Mild large Airway thickening yeah it's a good question and it's not something that I always say in medical school they didn't give us the crystal ball to tell you that um and I think there are a lot of things you can do to extend your life to make sure that you have the best quality of life um and so again working with your doctor on uh what we call pulmonary rehab we think about cardiac rehab after you have a heart attack but there are things you can do to help your lungs to stay as healthy as possible even if they have some damage early on so early osma does not have to be a death sentence does not mean you're dying in the next six months by any stretch so definitely encourage you to talk with your doctor about op that can help improve your quality of life and um and extend your life anything to add good all right Dr Thompson this is a good question Miranda and Mingo and I might get the I'm not from here Wisconsin wants to know are there side effects with statins such as increased risk of infection or leg muscle pain how about the infection piece yeah Statin um definitely have side effects of muscle pain occasion you know that that's a well-known side effect um as far as a risk for infection uh no um and in fact sometimes when people have serious infections statins have actually been shown to maybe help so I would not um have concerned that a Statin would increase a risk for infection okay agree okay everybody agrees all right I'm GNA ask you again can you get influenza twice in a season uh it is possible and in part because there are multiple circulating strains of influenza you could get influenza A in the fall and influenza B in the spring um so it's certainly possible Dr Stover why would a healthy Teresa and Deluth wants to know why would a healthy senior need to get vaccinations for influenza pneumonia Etc um you know it's it's one of those things that we all want to stay as healthy as possible and each time that we do have something that makes our immune system have to work over time to fix something it's it's a a drain and a strain on the system and to be as active and and engage in all the things that keep us healthy it it helps to avoid those kind of infections and as Dr R talked about earlier the flu can knock you down hard for the first week and often for a couple weeks after you're not back to your full level of activity that you'd want to be and so to stay healthy is to avoid those times when you have to have those setbacks um and you know potentially sometimes we'll FLW more than just a mild setback and I'd say in general immune systems aren't as potent as we get older and so um what you might have tolerated well as a 40s something you don't tolerate as well as you get older so again anything we can do to help ourselves stay as active as we can I'd recommend it right it's our folks who are oftentimes our F elderly folks who are more likely to be hospitalized for influence and pneumonia right or complications from them right right all right thank you for that um Dr Thompson uh what can you explain anybody can you explain linear atelectasis you have to ask the hard on so uh so that's a a a reading on an X-ray so when we talk about lungs we often will get an x-ray and sometimes we can see what linear meaning a line we can see a line of thickening um and ectasis means sort of collapse of lung TI is so it's just a description of something we see on an X-ray and it can happen after pneumonia sometimes because the the tissue has doesn't have a chance there's an injury doesn't have a attach to re-expand um there's ways with pulmonary therapy and stuff where you can help improve that sometimes yeah this a very serious one Dr Thompson is it dangerous to hold in a sneeze oh that is a great question yeah um in general no I don't think it's dangerous to hold in a sneeze unless you've recently had some sort of sinus surgery or um you know some sort of ENT procedure then uh I would talk to your surgeon anything else to add because it's increasing your inter thoracic yep pressure and the nasal pressure yeah yeah good all right Dr Stover mentioned the benefit of hair follicles in your nose is it bad to shavee those hairs in your nose I was thinking of the little cyia which are tiny hairs that that are kind of work in there but we do have hair hair for a reason in our nose and the you know the it's amazing how you know as we breathe in if you ever look at a like a Sunbeam sideways and you see how much stuff is in the air we breathe the that's part of what our nose and our sinuses do is there're our Muffler to kind of get rid of some of that stuff and keep our lungs clean and so trimming the hair isn't going to change that big that that function as much as if as other things we breathe in as Dr reded said earlier that can damage some of the tissue on the way down that toxins and um so you can certainly trim nasal hair but I wouldn't be aggressive in trying to get back in and you know potentially again your nose and throat people would would crown on on too much going up in the nose Dr Thompson how often can I get the new mle vaccine can I get it annually um it it wouldn't be recommended annually um actually for most uh people like seniors you only need it once there's a new updated numac vaccine and you only need it once some people might need every five or 10 years but it's not an annual shot and I'll clarify so we had an older version and so if you haven't had the new one even though it's only been a year we might recommend a new one now um so it is a little complicated correct right that's why your doctors will know you schedule sometimes they have to look it up exactly exactly um what's the likelihood of COPD progressing to empyema it can it certainly can and it depends on the severity and it depends on if you continue to damage your lungs through whatever it was you were doing like smoking so I think we would be remiss to not talk about um importance of quitting smoking and trying and trying again to quit smoking um because it would affect all of the things we've talked about today COPD pneumonia flu all of those are worsened by things that you can do to insult your lungs further so um if you're a smoker and uh you are interested in quitting I strongly encourage you to talk to your doctor there are lots of things we can do to help you quit and people should remember it can take several attempts before you're successful at stopping smoking right one of the things with smoking that happens those little hair cells she talked about that are deep down in the lungs get kind of paralyzed so they don't keep moving all the stuff up and out of your lungs and so people that smoke will tell you they often have a very productive cough every day um and that just is a great breathing ground for all of these bugs that we come in contact with so smokers are at higher risk for infection good all right we have a few minutes left what else do we want to share with our audience about public health you know I think um we know we talk a lot about it right now to masking and things like that that we can use when we have had an illness ourself and but we want to go out in public and do something it's not a bad idea to have that opportunity to protect the um people were going to be nearby for a while does we luckily don't have to mask continuously but when you're ill that can be a helpful thing or when you're in uh crowded places especially crowded places like in schools and right right I think all the the general precautions handwashing wearing a mask if you're going to be in a crowded place or if you're not feeling well yourself are are good and then getting your vaccinations for sure I think hand washing is one of those things that is underrated and we should be doing more of it yeah just regularly sure Dr Thompson Sarah wants to know is there a difference and how adults and children are vaccinated for influenza um there's not much of a difference no um it's the same shot the same components are in the shot uh really young kids get it a different dose and they their first time they would actually get two shots in that first year but it's the same vaccine older folks will actually get a higher dose vaccine and that works better because their immune system needs that stimulation to uh form a good response we talked before the show how one of the things that we're seeing as Physicians that's a little bit hard is that we know that our um patients don't always trust the covid vaccine and we're trying to talk with them about that but now we're also seeing a mistrust of the flu vaccine so um a little carryover are there ways that we should counter that or we can think about that and well I think even more importantly we saw real um um uh fall behind on immunizations during covid because parents couldn't bring their kids out um and so we have a lot of catching up to do so a lot of our kids are behind on vaccines and really need support to get those caught up um and then yeah we still have a little bit of hesitancy around um all vaccines I think that the the covid vaccine just got parents really questioning things so strongly encourage you to talk to your doctor I think all of these vaccines are very safe and proven and and can help prevent some serious complications and hospitalizations it's interesting with the covid vaccine because there were such large numbers during the epidemic it's the best studied vaccine in the shortest amount of time that we ever had and and so it's prettyy well understood intense amount of science behind that one and it saved many lives it saved millions of Liv lives across the globe uh it's hard when something works when something's successful sometimes to see how well it works for instance measles uh there are measles there's a measles outbreak in the country right now because uh people have been reluctant to get vaccinated so when something works well like a public health inter vention we really have to work hard to convince people that everyone should do it and that we don't get any extra money for all those vaccines we're really concerned about our our patients right try to promote them correct okay last words of wisdom anyone wash your hands take good care of your found foundationally take care of your health and talk to your doctor about the right vaccinations for you it's not too late to get your flu shot or a covid vaccine we are seeing a lot of activity now that means there's still weeks more of that Co too Co and flu okay and RSV okay good anything else Dr I was just goingon to say and if you're a smoker Reach Out we'd like to help quit so they're all gonna be calling your clinic there we go all right I want to thank our panelists Dr Jane Rudd Dr Sandy Stover and Dr Andrew Thompson and our medical student volunteers Kayla eens Mary Jane Evans and Logan hooker please join me again next week for a program on upper extremity shoulder neck and back problems my panelists will be Dr Matthew Davies Dr Billy hog and Dr Dino Turing thank you for watching and good [Music] night