Chances are falling leaves, picking apples, and lighting bonfires all bring to mind one thing: fall. But with the seasonal change from summer to fall coming, less pleasant things like the flu, allergies, and the symptoms of conditions like rheumatoid arthritis (RA), Raynaud syndrome, and seasonal affective disorder (SAD) may soon cause a flurry of patient visits to your office.
When that happens—and it will—here are some tips for identifying and managing these five common fall illnesses:
Influenza. Although the timing of flu season varies year to year, it typically gets rolling in October, when activity begins to increase. The season usually peaks from December through February, but activity can last until May.
The 2017-2018 flu season was classified by the CDC as one of high severity across all age groups. During this time, influenza-like-illness (ILI) peaked at 7.5%, the highest it’s been nationally since the 2009 flu pandemic, which peaked at 7.7%. ILI was at or above the national baseline for a full 19 weeks. Thus, the 2017-2018 flu season was one of the longest in recent times.
According to the Advisory Committee on Immunization Practices (ACIP), the efficacy of the 2017-2018 flu vaccine—against both influenza A and B—was estimated to be 40%, and by subtype and virus type, was 25% effective against A(H3N2), 65% against A(H1N1), and 49% against influenza B viruses.
For the 2019-2020 flu season, the CDC recommends the administration of trivalent vaccines containing the following:
- A/Brisbane/02/2018 (H1N1)pdm09-like virus (updated)
- A/Kansas/14/2017 (H3N2)-like virus (updated)
- B/Colorado/06/2017-like (Victoria lineage) virus
For quadrivalent vaccines, the recommendation is for the three viruses above plus B/Phuket/3073/2013-like (Yamagata lineage) virus.
- Management tips: Recommend patients be vigilant throughout the whole flu season—from October through the spring. Counsel them on the importance of washing their hands, engaging in disease control measures, and—perhaps most importantly—getting the flu vaccine as early as possible. The CDC recommends annual flu shots for everyone 6 months and older. Patient education and reminders, sent via patient portals or email, can help improve vaccination rates.
Seasonal allergies/asthma. In the fall, ragweed is the greatest trigger for allergies. The 2019 ragweed season is predicted to be one of the worst yet, due largely to high temperatures and heavy rains across the country. This past July, the United States experienced some of the highest temperatures on record, according to the National Oceanic and Atmospheric Administration (NOAA), and most states had above-average recorded rainfall.
Ragweed allergies usually kick in around August 15 in the Upper Midwest and Northeast, and in the South, after Labor Day. The worst of it occurs in late August and early September across the Mid-Atlantic and Midwest.
- Management tips: Tell patients who live in the city to avoid going outside between 10 a.m. and 3 p.m., when pollen amounts are at their peak. Counsel them to come in for a doctor’s visit early in the season. Allergy shots, nasal steroid sprays, and over-the-counter antihistamines are all viable options. Talk to your patients and decide which one—or combination of—these is most effective for them.
Rheumatoid arthritis pain. RA is a chronic, idiopathic, autoimmune disease that affects over 1.3 million Americans and up to 1% of the world’s population. For these individuals, falling temperatures are bad news. Patients with RA typically report an increase in their arthritis pain as the seasonal temperatures start to fall. Whereas warmer temperatures during the spring and summer tend to ease pain, the seasonal changes—especially the transitional times from warm weather to times of colder temperatures (summer to fall, and fall to winter)—can exacerbate their symptoms and pain.
- Management tips: Tell your patients to stay warm, especially in cold and damp conditions. Counsel them to wear extra layers, keep a blanket handy in every room of the house, and invest in a space heater. Many times, a warm shower or a 20-minute soak in the bathtub can help increase their blood flow and ease joint pain. Massages also help increase circulation and decrease pain, especially when warmed lotions or essential oils are used. Exercise and daily stretching are also important in warding off pain and stiffness. Help patients find what options work best for them.
Raynaud syndrome (or Raynaud phenomenon). Fall is the peak time for pain and discomfort in patients with Raynaud syndrome. This rare disorder of the vasculature that affects 3% to 5% of the general population causes extreme narrowing of the blood vessels in the fingers and toes. Affected areas may turn blue or white. When the circulation returns, the area turns red, and may throb or tingle. In severe cases, the loss of circulation may cause sores or even tissue necrosis.
Common symptoms include numbness, poor circulation, and swelling, and these are exacerbated by cold temperatures and stress. Raynaud syndrome is idiopathic, but can also be caused by trauma or certain medications (secondary Raynaud). It is more common in those with a family history, and in those aged ≥ 30 years, women, and those living in colder climes. The peak time for pain and discomfort is autumn, although symptoms usually continue through winter.
- Management tips: Identify patients at risk for Raynaud syndrome using EHRs and other data collection tools. Counsel them to soak their hands in warm water at the first sign of an attack, and to keep their fingers and toes warm when temperatures drop. Some patients fare well with alpha blocker or calcium channel blocker treatment.
Seasonal affective disorder. SAD is a type of depression that comes and goes with the seasons. SAD is rare—but possible—in the summer months, and most common in the winter. Symptoms typically start up in late fall or early winter, and then resolve with the onset of spring.
SAD is not considered its own disorder. Risk factors include a family history, concomitant depression or bipolar disorder, younger age, being a woman, and living far from the equator. Lower serotonin and vitamin D levels and overproduction of melatonin have been implicated in SAD, but its causes are unknown.
- Management tips: Diagnosis is dependent on meeting the full criteria for major depression that coincides with the specific season for at least 2 years. Treatment options include selective serotonin reuptake inhibitors and bupropion, light therapy, psychotherapy, and vitamin D supplements. Educate patients not just about symptoms, but about treatment as well.
Be ready for patients presenting with any of these complaints. And remember that flu shots and patient education can go a long way toward mitigating symptoms and perhaps even preventing some of these illnesses. Finally, consider SAD in your patients who may present with depression in the coming months.