October 24, 2013

This Is Why I Get the Flu Shot. ~ Lauren Grantz, PharmD

“A bit of science distances one from God, but much science nears one to him. The more I study nature the more I am amazed at the work of the Creator.”

~ Louis Pasteur

In the late winter of 2006 I had both the fortunate and unfortunate opportunity to be part of a medical team in the Intensive Care Unit of Albert Einstein Hospital. Every morning for five weeks I would wake up before the rest of the city, scrape the frost off my car and get to the hospital before dawn to monitor the medication profiles of the patients assigned to me.

Many times I would get there and at least three would have passed away over night. It was the most mentally, physically and emotionally exhausting time of pharmacy school.

There was one patient that was in the ICU for the entire five weeks that I was on that medical team. He was a 55-year-old guy a year and a half out from a successful kidney transplant. After a transplant, in order for your body to be able to keep the organ, you must take medications that suppress your immune system (immunosuppressants). This makes you more susceptible to all kinds of illnesses.

This particular fellow was in the ICU on a ventilator from complications of Influenza A- mainly pneumonia. The added stress on his body was making the transplanted kidney reject—he was screwed. This was an eye opener for me to realize how detrimental the flu can be on a person’s health. Although, at the time, it wasn’t enough to convince me to get an annual flu shot. After all, I was in my mid-twenties and healthy so why should I?

Before I go on, I think it’s important that you know a little bit of background about moi (that’s French for me).

First off, I’m sort of a science geek. Don’t let my cool disposition fool you. Inside I am bleeding Amy Farah Fowler. I took every science class that my high school offered. Even though I was accepted into college before my senior year I still maxed out my credits with genetics, advanced chemistry and intro to microbiology.

After what seemed like a never ending onslaught of information, classes and labs, I obtained my doctorate of pharmacy in 2007. During those years I studied the human body and it’s chemistry incessantly. While not required, I furthered my education to be able to administer vaccines, biologicals and other injectables in the state of Pennsylvania.

My area of expertise is Herpes Zoster (Shingles). The continuing education requirements that I complete every two years are almost entirely related to infectious disease and I’m a participant in the Merck adult vaccination program.

I put all of my knowledge to use on a daily basis at an outpatient pharmacy for a very large local health system. I also manage a team of seven pharmacists, fourteen pharmacy technicians and three medical supply specialists. Every day I am in contact with newborn babies, children, the elderly, those with cancer, those with HIV, pre and post-transplant patients, those that just had major surgeries, and others.

I also am a practitioner and student of yoga. I’ve kept up with a daily, well almost daily, Ashtanga practice for nearly five years. While furthering my study of yoga my philosophy towards my pharmacy practice has changed for the better.

I’ve been independently studying alternative forms of medicine for the past few years. I now believe that pain can be controlled through various non-pharmacologic modalities, diabetes can be eliminated with modifications of the diet, heart disease can be eradicated with exercise and a grain based diet, and blood pressure can decrease with a few safe-breathing techniques.

Now don’t get me wrong, medications are obviously still needed, but they are often a short-term fix for a long-term problem. Studying yoga has also encouraged me to think about why I’m really here, as in on this Earth, and what I can be doing for the so-called “greater good” of humanity.

Whatever major contribution I’ll make is still undetermined. Maybe I’ll have a daughter that finds the cure of Cancer or HIV. But until then, I’ll reduce, reuse and recycle as much as I can, give to charity, and as the pharmacist’s oath says, “I will consider the welfare of humanity and relief of suffering my primary concerns.”

This is going somewhere, I promise.

Yoga practitioners have their own Code of Conduct, a set of morals and ethics, which eerily resembles that of pharmacists, doctors and nurses. We all strive to abide by these rules, which are wide open to self-interpretation.

The first moral quality we learn about in Yoga is Ahimsa. It is a Sanskrit word meaning non-violence. To further it’s definition one can say that Ahimsa is a quality that develops out of love for all living things. Without going deeper into the cosmic hippy fluff, after all this is a blog post not a dissertation, this is why I choose to get a flu shot.

I’m a healthy person. I eat well and I’m in excellent shape. I have no diseases or illnesses. I have an immune system of steel. If I were to get an infection or a virus my body will most likely be able to fight it off on it’s own. However, I’m in constant contact with those not as fortunate in the health department as I am.

In my own opinion, for me not to get a flu shot is one of the most selfish things I can do as a pharmacist. The other is to not donate blood.

I don’t get the shot for me, I get it for you.

I think that there are a lot of misconceptions about vaccinations, especially the flu vaccine. One that isn’t really spoken about anywhere is that there is this automatic assumption that just because a needle is being jabbed into your arm that you’re protecting yourself from getting sick. While this may or may not be true, it’s in the numbers.

There is a concept called “herd immunity” which applies to both animals and humans. Essentially it means that there is strength in numbers. The more people that get vaccinated the less of a chance the virus or other pathogen can infect a community. This is how life-threatening diseases are eradicated. Small pox anyone?

There are high-risk populations out there that rely on other people to get vaccinated to protect them since they either can’t get vaccinated or the protection is extremely limited from their own compromised immune system. I’m not talking about those that choose to be unhealthy. I’m talking about those with cancer, HIV, organ transplants, other immunocompromised disease states, allergies to the vaccine, newborns and the elderly.

I’m probably not going to die from the flu if I get it, but they can. This is a very difficult message to deliver.

Then there are the safety concerns. “But vaccines contain this that and the other thing.” I can confidently tell you that the amounts of these trace additives used to purify and make the vaccine safe are so small that you probably are at more risk for exposure to carcinogens at the nail salon or the bedding department at Macy’s. Not to mention the single-dose vaccines are preservative-free, so your woes about Thimerosal can be kicked to the curb.

It takes your body almost three weeks to develop a full response to the flu vaccine. This is why it’s important to get your shot as early as you can in the season. This is also why there is a fallacy that the flu vaccine causes the flu.

Most people wait to get their shot until the flu season is in full swing. There is exposure to the virus before the vaccine and your immune system have had a chance to do their dance. The vaccine covers three types of influenza “strains.” Because the flu is a virus, it is constantly changing (antigenic shift) which is the main reason the vaccine’s efficacy is around 60%—which is very good considering it’s a virus.

There is always going to be a surgence of a strain that wasn’t included in the annual vaccine, but it’s not common. However this contributes to the lower percentage of its efficacy.

Healthy adults can possibly infect others beginning 1 day before flu symptoms develop and up to 7 days after becoming symptomatic. Children can pass along the virus even after 7 days. Flu symptoms usually start 1 to 3 days after the virus infects the body. This means that you may be contagious and can infect someone else without even knowing you are sick.

According to the CDC these populations should be vaccinated first: kiddos 6 months-5 years old, anyone 50 years old or older, adults and kids with asthma, lung, heart, kidney, liver, brain, blood, or metabolic disorders, those who are immunosuppressed, pregnant women, children on long-term aspirin therapy, nursing home residents, Native Americans, the morbidly obese, all health-care personnel, and household contacts with any of the afore mentioned groups.

According to me I think the recommendations should extend to anyone in the service industry such as food service, hospitality and any other professions that could potentially be in contact with a high-risk person as well as the school system and those who travel internationally.

There are lots of vaccines available this season. I’m not an expert on all of them, but I can tell you that I recommend Afluria pre-fill for adults (that’s what I got and give out), and Fluzone pre-fill for the kiddos. I have not had a chance to study FluBlok yet. FluBlok is a new formulation that is not made with eggs or antibiotics.

Choosing to vaccinate or not to vaccinate is a completely personal decision and should only be made by you. Everything in life has risks and benefits. It’s up to you to determine and evaluate them. Many of you sought out my opinion on the subject since I’m a unique blend of western and eastern medical philosophies. I’m fairly certain my opinion may not have been what you wanted to hear. But you know what they say about opinions…

Regardless of what you decide to do this flu season, wash your hands often, drink lots of water, take Vitamin C, wash your hands often, get lots of rest, cover your mouth when you sneeze or cough, wash your hands often, stay home from work or school if you get sick and eat as much pumpkin flavored things as you can get your washed hands on! (because they are delicious)

Be Well and Wash Your Hands. ♥

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Assist Ed: Dana Gornall/Ed: Sara Crolick

Photo Credit: Pixoto

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