E-Kidney | november 2013

Staying Healthy Through the HolidaysStaying Healthy Through the Holidays

By Leslie Spry, MD, FACP, FASN, FNKF

It may be the season of sharing, but that doesn’t extend to germs. As the weather gets colder and we head into flu season, there are ways share the warmth, love and cheer of the holiday season while keeping germs and sickness at bay.

Kidney patients need to know what they can do and what they should avoid if they become ill. Those at the highest risk for catching the flu are pregnant women, the elderly (age over 65), and nursing home residents. Immune-suppressed individuals such as transplant recipients, cancer patients on chemotherapy and patients being treated with steroids or other immune suppressing drugs are also very prone to coming down with the flu.

For the most part, everyone older than age six months should be vaccinated with the influenza “flu” vaccine. There are some exceptions: if you are allergic to eggs, have experienced prior allergic reactions to the flu vaccine or have had Guillian Barre syndrome as a complication of the flu vaccine, you should not be vaccinated. The flu vaccine comes in two forms – the traditional needle variety and a nasal spray known as FluMist®. Those with suppressed immune systems and children under two years old should not get the nasal vaccine because it is a live virus vaccine. If you are a new transplant recipient (within the first 6 months), check with your transplant coordinator to make sure your transplant team allows flu shots in the first 6 months after transplant.

This year, there will be vaccines that protect against different strains of the flu. One vaccine, the “trivalent” version protects against three strains of the flu. The “quadrivalent” flu vaccine protects against four strains of the flu. Kidney patients can be vaccinated with either one. The more people that get vaccinated, the less likely it is that communities will experience flu epidemics. Even if you are low risk for influenza, your vaccination may prevent someone in a very weakened state from getting a life-threatening case of influenza, this is known as "herd immunity."
Here are some tips on staying healthy and avoiding sharing germs during the season of sharing:

  1. Wash your hands frequently. Carry hand sanitizer with you as a substitute when you don't have access to soap and water, but soap and water are still the best.
  2. Get a flu shot. And don’t just stop there – make sure you are up to date on all of your vaccinations including the pneumonia vaccine and whooping cough vaccine. There are two forms of the pneumonia vaccine now available and both are recommended for kidney patients. All patients with kidney disease, including those with kidney transplants should receive a flu shot. Transplant patients should not receive the nasal mist flu vaccine known as FluMist® due to their compromised immune systems, and instead should obtain the regular injection. Even if you are vaccinated, it is still possible to get influenza and pneumonia. The vaccines don’t protect against all strains, but usually shield you from the most virulent ones, so the disease is usually much milder.
  3. Lend a sleeve and not a hand when it comes to covering your coughs and sneezes. You’re less likely to share your spread your germs because it’s unlikely that anyone will want to shake your sleeve when they meet you.
  4. Avoid crowds if you are sick. Stay home and rest so that you can fight off your infection without spreading it to other people.
  5. Airline travel is the worst. The tray tables are rarely (if ever) disinfected, so play it safe and wipe down your tray, armrests, seat belt buckle and any other surface that many people have touched with anti-bacterial wipes. Because airplanes are filled with dry, re-circulated air, they can also serve as a vacuum for infection. Consider wearing a surgical mask if you travel by plane during the height of flu season. This is common practice in many countries outside the United States.
  6. Down those fluids. Drink plenty of water and eat a balanced diet. Stay well hydrated and give your body proper fuel to help your immune system be the strongest it can be.
  7. Get moving! Keep physically active to maintain your overall health.
  8. Adjust your medication dosing. Make sure you work with your doctor to adjust medication dosing based on your level of kidney function. If the flu virus is spreading in your community, there are medications that you can take to protect against it if you have not been vaccinated, however the dose of these medications may have to be modified for your level of kidney function. This is also true of antibiotics or any medication that you take for colds, bacterial infections or other viral infections. Over-the-counter cold remedies that are safe to take for patients with high blood pressure are generally designated “HBP.” Any over-the-counter medication that you take for a cold or flu should be approved by your doctor.
  9. Beware of daycare. If you are a new transplant recipient or are immunosuppressed, try to avoid young children in daycare during the flu season. Children in daycare bring home many different viral and bacterial infections.
  10. See what you can stomach. Gastrointestinal illness – commonly referred to as the “stomach flu” even though it is not actually influenza – may include nausea, vomiting or diarrhea and you should contact your physician if you are experiencing these symptoms. Immodium® is generally safe for kidney patients to take to control diarrhea. If you become constipated, medications that contain polyethylene glycol, such as Miralax® and Glycolax® are safe to take. You should avoid laxatives that contain magnesium and phosphates. Any medication you take should be reported to your physician. Gastrointestinal illness can lead to dehydration or may keep you from taking your proper medication. If you are on a diuretic, it may not be a good idea to keep taking that diuretic if you are unable to keep liquids down or if you are experiencing diarrhea, so check with your healthcare professional.
  11. Play it safe. You should monitor you temperature and blood pressure carefully and report concerns to your physician. Call your physician if fever is over 100 degrees, if you experience shaking chills, or a productive cough. Call your physician if your symptoms persist for more than 7 days, but avoid showing up in a crowded waiting room unless told to do so by your physician.
  12. Avoid NSAIDs. If you have kidney disease, you should avoid such drugs as ibuprofen (Motrin®/Advil ®) and naproxen (Aleve®) for treating aches and pains. Aspirin and acetaminophen (Tylenol®) are much safer for kidney patients.