It’s a pharmacist’s job to promote the flu vaccine, not twist a patient’s arm into taking it.

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How many times in the run of a day does a pharmacist make recommendations on medications to a patient, nurse, physician, parent, caregiver, or pet owner? Often we finish the quick interview of medical issues, current medications, allergies, and what have they already tried with a go-to personal recommendation based on a certain intuition called, clinical judgement. Quite often, we do not get any type of follow-up or feedback on how that recommendation went.

With the Infuenza vaccine, most people either recognize the importance of the vaccine and get it or just go ahead and get it anyway, regardless of their level of understanding just because everyone else is. It’s not my intention here to pressure anyone into getting the vaccine or giving a spiel to tell your patients on how they and their family should get the vaccine. I am careful to never twist anyone’s arm in a consultation, even when I know the best therapy for someone is the only therapy.

So, what do you do with a patient who flatly refuses to get the vaccine? Not just that, but they also refuse for their family to get this vaccine. You know the best bet is to keep not only them, but their neighbourhood and community free from the flu. Is there a second line? You need to be aware of it because these patients are out there. Regardless of your beliefs, you need to show that you are a strong clinician and give them an alternative without missing a beat. Nothing brings about a feeling of inferior therapy or lack of confidence on the patient’s behalf than a pharmacist that is stretching for an alternative. Keep in mind that there are other ways to help prevent the flu than the vaccine. My personal number one recommendation is the vaccine, but when a patient insists on no vaccine for whatever reason, you can maintain their confidence by respecting this wish and showing them another way.

Omega 3: has been found that DHA-enriched fish oil enhanced B cell activation and select antibody production. This can actually aid immune responses associated with pathogen clearance, while possibly reducing the inflammatory response.

Zinc: is a trace element essential for cells of the immune system, and zinc deficiency affects the ability of T cells and other immune cells to function as they should. Caution: While it’s important to have sufficient zinc in your diet (15–25 mg per day), too much zinc can inhibit the function of the immune system and over supplementation can reduce copper stores

Probiotics: a large percentage of your immune system originates in the gut. So maintaining gut health and repair of gut tissue with glutamine is helpful. Probiotics that maintain the normal healthy flora of the gut help to maintain this. it is now known that certain bacteria in the gut influence the development of different areas of the immune system, such as correcting deficiencies and increasing the numbers of certain T cells. Prebiotics like FOS help this flora flourish.

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Sleep: the fact that sleep deprivation has an impact on the function of the human immune system is well known. Maintaining good sleep hygiene is important. Go to bed at the same time every night and get up the same time every morning. If you are awake for longer than 15 minutes get up and go to another room, no TV in the bedroom, no reading in the bedroom, and be mindful of the effects of food and exercise to your sleep habits. Caffeine consumed in the morning may still be getting cleared at bedtime due to it’s long half life so be aware that stopping coffee at 2:00 pm may not be early enough.

Muco-coccinum: this post is not directed at sneaking in the promotion of any one particular product; however, there is one product that has a large underground and above ground following that is sworn by the people that take it to completely prevent the flu. A few of my Naturopath friends certainly swear by it as well.Although I do a fair amount in alternative therapies, I haven’t brought in many homeopathic meds. This is one that I endorse and I encourage you to look it up.

Oscillococcinum: the active ingredient is Anas Barbariae Hepatis and Cordis extractum 200C. I have no link to this product, monetary or otherwise, it is just one of those products I go to because it works for my patients. If you are one that thinks that homeopathy is snake oil, you at least can take comfort in the fact that interactions and side effects are pretty much low to non existent in this group of medications.

Vitamin D: I am a huge advocate of this pro-hormone and promote it every chance I get. It’s not always about the dose of the vitamin D but the level of the serum 25-hydroxyvitamin D level in the patient. As most patients are completely unaware of their levels of this in their blood, I have most patients increase their dose from my recommended 2000iu daily to 10,000 IU daily while they have symptoms of the flu.

Nutrition: our absolute first defence against any infection or non-infectious disease is our nutrition. Your GI health is tied in closely with how your food translates into nutrition in your body so avoid refined sugar and refined flour, eat plenty of fibre, do not consume alcohol in excess, drink lots of water, and be aware that some medications can damage the delicate lining of the gut, requiring rebuilding with glutamine and other supplements.

Wash your hands: need I say anything more? However, I could say that there is a proper way to wash your hands to be effective in preventing disease.

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Check out the World Health Organization’s infographic http://www.who.int/gpsc/clean_hands_protection/en/

Green Tea: How many of our patients have at least one coffee per day. Maybe they even drink Tea. Suggest they have at least one drink per day of Green Tea. There are also green tea extracts that are available in capsule form for those that cannot have the Tea. Green tea extract inhibits the growth of influenza virus in vitro. Part of this was due to epigallocatechin in green tea. In fact, one study showed that nursing home patients gargling with this compound had less incidence of influenza.

Vitamin C . Also shown to inactivate influenza virus in vitro, the key here is the dose. The patient is instructed to reach 80-90% of their “bowel tolerance dose” or the dose that causes diarrhea. This dose is higher when the patient has influenza (ie 150 mg/day) than when they are symptom free.

NAC- in a double blind trial, administration of NAC during the flu season reduced the frequency and severity of symptomatic influenza episodes. NAC is an antioxidant and a precursor to glutathione – a major antioxidant in lung tissue. The oxidative stress that results from influenza contributes to pulmonary damage.

Selenium, administration of 100-200mcg/day prophylactically during the flu season and 200-500 mcg/day to treat influenza in adults is reasonable based on the science pointing towards the decreased severity of the influenza virus with selenium and the prevention of the virus from mutating into a more virulent strain.

Finally, stopping smoking, exercising often, and maintaining Adrenal health are also all key in maintaining good health and immune system and will help fight off a flu or reduce the severity of one when it hits.

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