Join me on a free Health Chat to discuss swine flu on Wednesday April 29th at 1PM EST. To register, go to: http://www.medhelp.org/health_chats/register/17

Due to the swine flu, the US has declared a public health emergency.  

We're early in the outbreak of this new virus, with most all patients in the US having mild illness who have recovered without treatment.  Only 1 of the 20 cases have been hospitalized.  Since the US strain is a genetic match to the Mexico strain, officials are concerned about the potential of deaths in America from swine flu.  In Mexico there have been many deaths from pneumonia that sounds like ARDS to me.

You can protect yourself by avoiding those who cough, ask those who do to cover their cough (not with their hands, eg. with a mask), practice good hygiene with hand washing and don't touch your own eyes, nose and mouth.

What's important is that if in the last week you have been to Mexico, San Diego, Imperial County or Texas, and come back with a flu like illness with fever, sore throat, cough, runny nose, and possibly vomiting and diarrhea, call your doctor.  You may benefit from Tamiflu or Relenza pills.  What your doctor will do is test you for flu and if you have an untypeable flu (one that we doesn't match those we've seen before) it could be swine flu.

I've been following the CDC on twitter at http://www.twitter.com/CDCemergency and at http://www.cdc.gov/swineflu/ which CDC has promised to update at 3pm EST daily.

To be prepared, make a plan for your family to consider how you would manage if your community was disrupted for 2 weeks:
- do you have food & water stored?
- if you have chronic illness, do you have enough for 2 weeks?
- how would you manage your children if they couldn't go to school for 2 weeks?
- do you have a communications plan with your family?  e.g. where to meet in case of disaster.

The American Public Health Assn has a great site at http://www.getreadyforflu.org/ with these and other good suggestions.

Expect daily changes, as this epidemic spreads, so far, touching San Diego, Imperial County, Texas (san antonio), Iowa, Ohio, New York (Queens), and many other countries.  It's scary, but you can get prepared!

Enoch Choi, MD

For more read my last post, "is this a cold or something more serious?" http://www.medhelp.org/user_journals/show/70703

On Tuesday Mar 17, 2009, 03:00PM (EST) I'll be on a webchat answering questions about colds and flu:

http://www.medhelp.org/health_chats/register/2

Can you tell the difference between the common cold and the flu? How about bacterial infections such as bronchitis or pneumonia? According to the CDC, flu activity is just starting to pick up in the U.S. and could continue into April or May. As an Urgent Care physician at Palo Alto Medical Foundation, I see dozens of these viral and bacterial illnesses every day and I'll be available to answer your questions live at March 17, 2009 3:00PM EST. Join me to learn about the flu vaccine, antivirals, antibiotics, and alternative preventative measures such as humidifiers, saline drops and sprays, herbal supplements, and honey and find out whether these treatments are suitable for children, the elderly and other high-risk groups.

This has been an unusual year in that the flu has been picking up in the last few weeks, and will last into early summer.  The symptoms of influenza include cough, sore throat, runny or stuffy nose, and fever. Other common symptoms are chills, headache, muscle aches, fatigue (a tired feeling), and loss of appetite.   Fortunately, this year, there's plenty of vaccine and you'll have protection as soon as a week after getting your shot.  They flu shot covers the flu virus strain very well this year.  The shot is a better choice, since it's been hard to find Relenza, the antiviral medication that this year's strain is sensitive to.  Tamiflu has been so overused that this year's flu strain is resistant to it - meaning it won't help you if you took it.  This is important because in a minority of cases, the flu can lead to death from complications of pneumonia.

The common cold has less severe symptoms than the flu.  It's more likely to have the the symptoms of cough, sore throat, runny or stuffy nose, and fever without the chills, headache, muscle aches, extreme fatigue (a tired feeling), and loss of appetite.  It gets better with time.

A bacterial infection such as bronchitis, sinusitis, or pneumonia is suspected when you have a persistent fever (>100.4 deg F), and copious pus in your bronchi, sinuses, or lungs, which can be heard by a doctor on examination.  Other signs such as facial pain radiating to your teeth or rapid breathing with shortness of breath can help with diagnosis.

No matter if viral or bacterial, there are over the counter remedies that help: humidifiers, saline drops and sprays, nasal rinses, and herbal remedies.

I'll be happy to chat more about this with you!

Three separate federal cases denied any association between vaccines and autism, according to rulings on Feb 12, 2009.  I pray that these rulings reassure parents who limit vaccination of their children, since decreasing rates of vaccination have led to U.S. outbreaks and preventable deaths from measles and Haemophilus influenzae type b.

http://www.uscfc.uscourts.gov/node/5026

These were 3 test cases for 5,500 others against the National Vaccine Injury Compensation Program claiming one of these means of causation:
-  measles, mumps and rubella, or MMR, vaccine and thimerosal-containing vaccines can combine to cause autism;
- thimerosal-containing vaccines alone can cause autism; and
- MMR vaccine without thimerosal can cause autism.

The U.S. Court of Federal Claims Office of Special Masters ruled out the first and third theories since "the evidence was overwhelmingly contrary to the petitioners' contentions" on each issue, according to Special Master George Hastings.  "The expert witnesses presented by the respondent were far better qualified, far more experienced and far more persuasive than the petitioners' experts concerning most of the key points," he wrote.  Plaintiffs have 30 days to seek reviews: ftp://autism.uscfc.uscourts.gov/autism/vaccine/Background_on_the_autism_proceedings.pdf

The second theory will be addressed by the Special Masters this summer.

I'll be chatting about this on KGO810AM radio in the SF Bay area at 4:13pm today ( http://bayradio.com/kgo_archives/61700.mp3 will have the recording sometime after they upload it at 5pm (it's the archive of 4pm-5pm):

http://www.medhelp.org/medical-information/show/1516/Salmonella-enterocolitis

Since September 2008, 388 across 42 states have become sick with Salmonella typhimurium and 18% (around 70 folks) have had to go to the hospital.   The CDC has yet to track down the cause, and has pulled staff from other work to devote to looking for it.  You may remember the peppers from Mexico that caused the last outbreak.

Salmonella usually causes an illness with nausea, vomiting, diarrhea, fever and cramping, within 8 to 72 hours of eating the contaminated food.  In most cases it goes away by itself, but if you're really sick for more than 2 days with more than 6 stools a day with high fever you may need to see your doctor, especially if the stools are bloody, you're dehydrated, or have abdominal pain.

The fortunate thing for you is that by good habits and wise eating you can avoid the risk of catching this illness.  Carefully wash hands and cooking utensils & use alcohol-based hand rubs frequently when preparing raw eggs, poultry or other meats.  Cook meats and eggs thoroughly.  Do not eat raw milk products (such as raw milk or raw cheeses).  Wash raw fruits and vegetables before consuming.  Keep raw foods in a separate part of your refrigerator.  Cook raw food from animal sources to a safe internal temperature: ground beef 160ºF (71ºC); chicken 170ºF (77ºC); turkey 180ºF (82ºC); pork 160ºF (71ºC). Don't leave cooked foods at room temperature for more than two hours (one hour if the room temperature is above 90ºF/32ºC).

Probiotics can be helpful if taken in the first 2 days of being sick.  Antibiotics are usually not needed and can make things worse.

Antidiarrheal medications
Medications to reduce diarrhea can help if there is no fever (temperature greater than 100.3ºF or 38ºC) and the stools are not bloody. These medications do not cure diarrhea, but decrease your frequency of bowel movements.

Loperamide (Imodium®) is available over the counter; the dose is two tablets (4 mg) initially, then 1 tablet (2 mg) after each unformed stool. No more than 16 mg is recommended per day.

Diphenoxylate (Lomotil®) requires a prescription; its benefit is similar to loperamide, although it can cause constipation since it's so strong.

Bismuth subsalicylate (Pepto-Bismol®, Kaopectate®) is not as effective as loperamide. Bismuth subsalicylate can help patients with fever and bloody diarrhea. However, women who are pregnant should not take bismuth subsalicylate. The dose of bismuth subsalicylate is 30 mL or two tablets every 30 minutes for up to eight doses.


for more:
http://news.google.com/news?sourceid=gmail&oe=UTF-8&ie=UTF-8&tab=wn&resnum=0&cd=1&ncl=1287622770&hl=en