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Enoch Choi, MD  
Male, 39
Palo Alto, CA

Specialties: Family Medicine

Interests: sinusitis, Migraine, Low back pain
Palo Alto Medical Foundation
Urgent Care
Palo Alto, CA
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Do I have Swine Flu?

Apr 26, 2009 - 158 comments
Tags:

swine flu

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Flu

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test

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treatment

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virus

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Tamiflu

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relenza

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epidemic

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pandemic



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

Comments
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by GreatBird, Apr 26, 2009
Thanks so much for the Twitter link. I did not know they were there. I am now following  . . .

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by swampcritter, Apr 26, 2009
Thanks! Useful post.

Is there something unique about this particular gentype that would prevent the development of a vaccine? Or should we expect one will be available in 5-6 months? (Not sure what the lead time is on vaccine development)

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by Enoch Choi, MDBlank, Apr 26, 2009
swampcritter, can't say how difficult.

do consider the historical context tho:

http://bit.ly/K8pxu which provides interesting historical perspective on swine flu vaccines...

thanks for the props GreatBird

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by SassyLassie, Apr 26, 2009
Thank you for posting the Twitter Link. I have saved it so I will be able to check it daily. I live in Washington State, so far, no reports, but, one never knows. This is sort of scaring me, but, I will do all I can do prevent myself or my dad from getting it.

Susie

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by khassounah, Apr 26, 2009
After I read your Journal I couldn't help but think that the flu I had last week might have been swine flu. It was more difficult and lasted longer than any flu I had in the past.

Whether it was or not, I am glad that I managed to go through it without infecting anyone around me. Always coughed into a napkin, washed my hands very often, and didn't share food or drink with anyone.

I wish everyone good health.

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by Enoch Choi, MDBlank, Apr 26, 2009
khassounah, glad you followed good hygiene.  Had you been to the border or to Mexico in the week up to getting sick?  Most folks in USA with swine flu have had mild illness, so you may just have had a bad cold.  Most everyone with swine flu have gotten better without antiviral pills.

Enoch

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by ginger899, Apr 26, 2009
I had a terrible long-lasting (nearly 2 weeks in all) flu-like illness around Christmastime. I felt dreadful with it. This was well before this recent swine flu outbreak, and I had NOT been to any places mentioned. I live in the UK and don't travel abroad recently.

So what I'm saying is you can feel very very bad with flu, but it doesn't have to be swine flu. There probably is no need to get scared.  The best thing is to do what the doc. here said, and if you feel you do have flu, and it's worse than a cold, go and get yourself tested.

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by Enoch Choi, MDBlank, Apr 26, 2009
ginger899, you're right, it doesn't have to be swine flu.  If you feel worse than a cold, and visited Mexico or the border, I acutally wrote that you should call your doctor.  They can decide if you need to get tested over the phone.  We're getting over-run with folks that don't need to be tested.

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by ireneo, Apr 26, 2009
Interesting contradiction of information in today's newspaper. There was a column of FAQ's. One asked how do humans contract the virus? The answer included this: " People usually become infected through contact with pigs, though some cases of limited human-to-human transmissions have been reported." That led me to believe that human-to-human is not the primary mode of transmission yet the photos in the paper show everyone wearing masks and the text says to avoid crowded areas, shaking hands, etc. Any idea what is true?

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by Lulu54, Apr 26, 2009
Dr. Choi,
You mention the connection with visiting Mexico or those border states, but I live in Ohio, where there are also reported cases. The last I checked, we don't share a border with Mexico :-)


I would hope that everyone here will not over react to their possible illnesses, but be vigilant in tracking their symptoms and call their medical providers if necessary.  I know that's a fine line to walk, especially since so many of us here on MedHelp already have other health concerns.

Thanks for the updates
Lulu
MS forum


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by Enoch Choi, MDBlank, Apr 26, 2009
ireneo, historically, that's correct, most swine flu is from direct contact or within 6' of an infected pig.  What's concerning with this outbreak is that a mutation has caused a human-to-human transmission to occur.  Masks help folks who are sick keep from spreading to others, but N95 masks may be required to keep the well from getting sick.  and you need to be "fit tested".  I'd stay away from folks who are coughing who just came from affected areas (mexico and border states)

LGK54, those Ohio'ans had just returned from Mexico is what I read.

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by mv1910, Apr 26, 2009
we spent 4 days in Mexico and returned to NY on April 12th?
We don't have any symptoms. If we could be contaminated?
How long is the incubation period?
Thanks

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by PastorDan, Apr 26, 2009
I read that too, that the 9 year old northern Ohio boy who reportedly was treated for what has proven a match for the problem swine flu strain had visited several places in Mexico with his family before becoming ill back in the States.  Still, he's only 100 miles from me, and many of the people I met this weekend (including handshakes and hugs) were coughing and sneezing.  Makes me want to wash up well before bedtime.

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by Enoch Choi, MDBlank, Apr 26, 2009
mv1910, http://www.cdc.gov/swineflu/swineflu_you.htm?s_cid=tw_epr_69 explains that you'd typically get it within a week.

PastorDan, general cleanliness is all that's needed.  100 miles is a long way away.  What I'd be more concerned about is if any of the folks you met this weekend came from mexico or border states in the last week.

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by Quixotic1, Apr 26, 2009
Dr. Choi, Thank you very much for the head's up and the info!!

Quix

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by Enoch Choi, MDBlank, Apr 26, 2009
Quix, you're welcome!  no swine flu in WA state yet, eh?

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by Terri627, Apr 26, 2009
Hello,

Well, l will be watching closely. 5 members of my family just got back from a Mexican cruise today! Not only that,
but I work in a pharmacy, and unfortunately there seems to be an unspoken assumption that health care
providers are somehow immune to illness. Please everyone, if you have a cough, cough into the inside
bend of your elbow. If you use your hand, please wash BEFORE handing over any insurance cards or
any forms of payment, or for that matter, ANYTHING to anybody. I love my job, but I am at high risk
and that endangers my family if I contract anything. That goes for anyone working in healthcare.
Please understand that we are just as susceptible as the next guy to all illnesses, and are in fact
at a higher risk being exposed on a daily basis.

Keep washing your hands!

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by SassyLassie, Apr 26, 2009
Dr. Choi~So far no cases have been reported in Washington State. I would not be surprised though if it does not happen soon, I know that British Columbia has reported some cases. I live in a very small town, have never been to Mexico, so, I feel fairly safe, plus, I am doing all I can to prevent it such as the hand washing, etc.

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by polly22, Apr 27, 2009
Dr. Choi, this is good information; thank you. Two questions. (1) Can 5-year-old Tamiflu be of use if one gets exposed to this (or starts to get symptoms ff. exposure)? (2) You say the pneumonia that seems to have caused (some of?) the deaths from this flu "sounds like ARDS to me"; I am sorry, but what is ARDS?  Now, I asked one very good journalist whether the pneumonia vaccines given to older people could perhaps protect against this flu's pneumonia potential, and learned that the flu's ravages on the lungs can open the way to many bacteria--so that even this vaccine would have limited, if any use, and this is very frightening. I have to travel a week from today and shall then, for two or three days, be sharing a bathroom with, and eating meals with, three or more persons from many places; how do I know whether/when to cancel this trip if necessary?

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by polly22, Apr 27, 2009
p.s. Dr. Choi, my conference is in Washington State.

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by GrannyJo6, Apr 27, 2009
Thanks for the good info. I was especially interested in the incubation period. Our oldest son lives near San Antonio and was in Mexico City last week for a conference. Yikes!  He is a little bit of a germaphobe, so suspect he was very cautious, but still!  We just had a teen from our church get back from a mission trip to Mexico and she was sneezing and coughing yesterday. She has been back for two weeks, so we steered clear!  So far, so good in Washington State, polly22!

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by Enoch Choi, MDBlank, Apr 27, 2009
Terri627, all the pharmacies around here are out of tamiflu, how about where u are?

SassyLassie, you're doing the right thing.  Do you have 2 weeks of supplies?  If a pandemic breaks out you'll need it.

Polly22, 5 year old Tamiflu is likely expired, check the bottle.  ARDS is when your lungs break down and fluid from your blood floods the alveoli so oxygen can't be absorbed.  You basically drown.  Pneumovax doesn't protect against swine flu, but if you're of age to need that, it's a good idea regardless of swine flu.  No travel restrictions have been announced by USA, but if it were me -- personally -- i wouldn't be travelling to mexico city.  Washington sounds ok to me, i just came back from Boston for Health2.0 conference.

GrannyJo6, yikes is right!  I'd stay clear of sneezing & coughing folks frmo Mexico.  Bless the teen for volunteering, my church has plenty who do that, but tell the teen to stay home!  If your son has symptoms, have him call his doctor.

Enoch

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by SassyLassie, Apr 27, 2009
Dr Choi~I am working now on the two weeks of supplies. I sure do not want to be caught un-prepared.

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by zodiacqueen, Apr 27, 2009
Dr. Choi, great post!!!  This Swine flu is going to cause sooooo much paranoia that the hospitals are going to be filled with patients with simple colds or allergies.  Being a student in the radiography field, I fear this is going to be a complete nightmare.  I will probably be taking a million chest x-rays a day now-like, I don't already!  UGGGHHHH!

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by Enoch Choi, MDBlank, Apr 27, 2009
updated numbers: 40 confirmed cases.  http://www.cdc.gov/swineflu/?s_cid=tw_epr_74

Europe's Health Commissioner recommends against travel to USA and Mexico, which CDC says isn't warranted (one of my nurses just returned from Germany and is sad she couldn't have had this as a reason to stay ;)

SassyLassie, good job

zodiacqueen, I'm seeign them all this morning.  over-run with folks with colds.  2 folks matching the symptoms and travel areas though.  Look forward to a lot more xrays!

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by itsallwaves, Apr 27, 2009
Great post!

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by GreatBird, Apr 27, 2009
Here's a Google map with the cases noted: http://tinyurl.com/cosuzr

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by Enoch Choi, MDBlank, Apr 27, 2009
thanks, itsallwaves!

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by Barbarella, Apr 27, 2009
Dear Dr. Choi,

I got the swine flu vaccination in 1976.  How long is that good?  For life?  Years?  Months?.  I searched the Internet and cannot find an answer.  

Thank you!

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by Enoch Choi, MDBlank, Apr 27, 2009
Barbarella, that's not known yet.  CDC will likely answer that question if they decide to immunize the US population.

Many vaccinations are good for life, some require boosters.  I don't believe they know how the 1976 vaccination behaves, at least i haven't read anything about that.  I'm glad you didn't get Guillane Barre.

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by missy222, Apr 27, 2009
Hi Dr. Choi,

I have a question regarding my 15 year old daughter and swine flu.  My daughter's boyfriend's parents are currently on vacation in Mexico.  They will be back in one week and I am afraid that may come in contact with this flu and spread it to their son.  How do I prevent my daughter from getting it?  As with teenagers, even if I tell her no physical contact (kissing or holding hands is allowed for awhile) she will probably have contact anyway with him at school.  What is the incubation period for this flu?  Should I keep her away from him during this time by taking her out of school?  Please advise.

Thanks

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by Med Help, Apr 27, 2009
Hi,

Due to the great interest in this topic, Dr. Enoch Choi will be hosting a Health Chat about the swine flu, this Wednesday, April 29th at 1:00 EST. To learn more or register, go to http://www.medhelp.org/health_chats/register/17.

MedHelp

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by fvf147, Apr 27, 2009
We had the regular flu vaccine back in Oct, will that not provide any protection at all?  I understand it's a different strain, but i'd heard it had some human flu in it too along with swine and avian.

Do you have any thoughts on why it's more severe in the 20 to 40 yr old age group?

I definitely think everyone needs to go about orderly and calm preparations, like the two week supplies you've suggested.  Don't wait till your state or community has several cases to run out to the store and stock pile.  I'm in TN and so far we have no known cases, but I'm going to go ahead and set aside water, food and basic meds.

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by April2, Apr 27, 2009
What are your recommendations for anyone planning to travel to Mexico at this time? Is it best to reschedule or just take precautions?

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by Enoch Choi, MDBlank, Apr 27, 2009
missy222, if your daughter's boyfriend's parents have fever and an influenza like illness (and/or vomiting/diarrhea) then tell them to stay home and call their doctor.  If that were the case, I'd tell your daughter to stay away from the parents.  If the boyfriend got sick, ditto, have him stay home and not go to school.

fvf147, regular flu vaccine gives no protection.  It's a novel (new) virus.  Possibly ARDS in immune competent 20-40 year olds.

WHO has raised the alert for pandemic to phase 4 which documents sustained person to person spread in 1 country.  This is the step before a pandemic is announced, phase 5.

Even if we get to a pandemic, so far, patients in USA have recovered without treatment which is a good sign.

April2, this morning, CDC and European Union announced travel advisories to not travel to Mexico & affected areas except for very urgent essential business.

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by princesa77, Apr 27, 2009
hello,


just a question
i have been having a sore throat for 2 days now and now its followed by and itchy throat is there any  need for concern?
should I go to the doctors??

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by Enoch Choi, MDBlank, Apr 27, 2009
princesa77,

you should contact your provider by telephone or e-mail instead of coming directly to a clinic if all three of the following apply to you:

A fever (temperature of 100 degrees or greater);

AND respiratory symptoms (such as cough, sore throat or shortness of breath);

AND travel within the last 7 days to Mexico or a U.S. county that borders Mexico (such as San Diego County).

In the meantime, the U.S. Centers for Disease Control and Prevention have recommended that we take the usual precautions for an ordinary flu season such as:
Frequent hand washing;

Covering your mouth when you cough;

Staying home when you are ill with a respiratory illness.

http://www.pamf.org/news/health/0409swineflu.html

Enoch

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by princesa77, Apr 27, 2009
thank you for your info
I had a small fever last week some body ache and sneezing but now its just a sore itchy throat and I feel just fine NO coughing.... I will take all precautions and call my health provider.
I work at an electronics store and every day we get people who travel from mexico city and come shop at our store, but I have been careful not to shake hands and be aware of people who seem sick,  but it still scares me....

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by Purple11, Apr 27, 2009
Thank you for the info i don't know but my dad might have it.I also live in Indiana but if i tell him he'll think i'm overacting.How long do you think this will go on i'm kind of scared.My friend keeps saying it's the end of the world or something.I don't like this. :-(

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by Enoch Choi, MDBlank, Apr 27, 2009
Purple11, not the end of the world.  If you meet criteria, there's an antiviral that can help: Tamiflu or Relenza.

If your dad has A fever (temperature of 100 degrees or greater); AND respiratory symptoms (such as cough, sore throat or shortness of breath); AND travel within the last 7 days to Mexico or a U.S. county that borders Mexico (such as San Diego County) then have him call his doctor

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by Christian77, Apr 27, 2009
Dr. Choi:

Thank you for taking the time to answer questions.

I have experienced two rather sever cases of the flu over the past two years. With the first one I was sick for about 2 months. Symptoms still lingered for quite a while after the first two weeks or so. And with the second I was sick for nearly 4 months - I didn't feel 100% healthy on a daily basis until the end of this January. It started around early October 2008.

I normally don't get sick, and these were odd cases. Work wasn't disrupted that much, but during the second illness I had to take a short medical leave. I took no medication nor was I prescribed any.

My question is: since I've battled through both of these illnesses (both of which were labelled as "viral"), do I know have something a stronger immunity to the flu in general, at least so close to my most recent illness?

Probably a silly question, but psychologically I feel that if I made it through the last one, my immune system *must* be stronger, at least for now.

Thank you.

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by Enoch Choi, MDBlank, Apr 27, 2009
Christian77, nope, this is an entirely new virus noone in the whole world has ever experienced and we are all at equal risk and no stronger or weaker based on past exposure to flu.

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by Christian77, Apr 27, 2009
Thank you, Dr. Choi.

I'll be extra-vigilant, then. I might just look into our household supplies as well . . .

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by Enoch Choi, MDBlank, Apr 27, 2009
Christian77, 2 weeks of supplies, food & water for a pandemic.

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by ginger899, Apr 27, 2009
I don't think it's just a Mexico thing anymore, is it? If someone travels with this, infects someone en-route, then they infect someone in their home town...etc it's an 'anywhere' problem by now I would think. As this has mutated, it is now transmitted human-to-human. Just someone sneezing on you who has been sneezed on by someone else who passed by someone infected on their way back from Mexico would be enough to pass this on......etc etc.

The only thing I can get from this is that it has been described as a 'mild' illness. So by this I am thinking it may be no great danger to anyone with normal health, and could be shaken off the same way ordinary flu strains are eventually shaken off.  But is this true?

With the 1918 flu outbreak, apparently it was the younger, fitter people who came down worse with it, not, as you'd suspect, the most vulnerable (children, old people etc)

Also, does anyone know if someone who contracted the 1957 (think it was 1957?)Asian flu would have any natural immunity to this new outbreak? Or as this is a new mutation, wouldn't anything like that count, and it's a whole new ball-game?

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by Enoch Choi, MDBlank, Apr 27, 2009
ginger899, WHO alert for pandemic was raised today to phase 4 which documents sustained person to person spread in 1 country.  This is the step before a pandemic is announced, phase 5. It's likely too late to contain it within 1 country.

We don't know about it's severity.  US cases have resolved without treatment.  Can't say the mexico cases are truly swine flu or the deaths that would happen without swine flu around.

Young fit people have a more vigorous immune response and can have more ARDS.

No past natural immunity protects from this new outbreak.  We're all in this together, on the same level playing field of NO ANTIBODIES anywhere in anyone.


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by Gabu, Apr 27, 2009
Hi Dr Choi. I am in Monterrey Mexico, and just keep wondering if people die each year from the common flu (let's say mexican official reports are true) in maybe even higher numbers, (or I got the stadistics wrong) why would this scenario be so alarming? I am being cautious, staying home with my kids,period,, but what I am really afraid is that the actual victims might be way over those "officially" disclose as to make our governors paralyse the whole country...my brother works at a hospital and they had gotten reports from hospitals in mexico city that there are many more victims than what we are being told, can this be true? Should I really be scared to go to the supermarket and get some groceries? I will eventually  have to go!
THanks, Gaby

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by Enoch Choi, MDBlank, Apr 27, 2009
Gabu, follow your local public health officials' recommendations.  Here in USA, the CDC has given guidelines for those in affected areas:
http://www.cdc.gov/swineflu/masks.htm
They advise avoiding meeting groups of people, and if absolutely necessary, wear a mask or respirator (N95)

I'm sad to hear that the Mexico City numbers may be under-reported.

I would go get supplies for 2 weeks, that's what's recommended in a pandemic, you won't want to leave home for 2 weeks.

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by astrid12, Apr 27, 2009
Thank you for posting the info.  I am sharing with my daughter.  She is a special education teacher for Berkeley Unified School District.  Sadly, BUSD does not have school nurses and no proactive practices for swine flu are currently in place although many of the children are from families who visit Mexico or have Mexican visitors in the home.  One of her students is visiting in Mexico this week.  I am advising that my daughter continue to work with her students on handwashing and keep the alcohol cleaners available for the children.  Fortunately for San Jose and Santa Clara county, they are in full surveillance and prevention mode and working with the parents to educate them as well as the students.

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by Gabu, Apr 27, 2009
Thanks, I will print the cdc guidelines to have at hand.
What about my husband who is the only one going out,needs to work? He is by himself in his office but still has his employees come and go from it...when is it that he should skip work? considering just one death in my area so far...
thanks so much!

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by Enoch Choi, MDBlank, Apr 27, 2009
astrid12, good ideas.  the CDC has advisories available to schools that they share when there's a confirmed case.

Gabu, local health authorities will tell him when he should stay home too.

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by MMMommy, Apr 27, 2009
Thanks for posting the info.
I have a one year old and a three year old with flu like symptoms. 3 year old,started out with vomiting, fever of 102 and excessive sleepiness. Still with a fever and sleepy with a cough started yesterday, 5 days now. Doc said it was a virus. My one year old started a fever 102, cough and became lethargic today. We do not live in an effected state, but plan to travel within the US later this week.
I am taking them both to the doctor tomorrow, do you think they will test them for swine flu?

Do you think I have reason for concern?

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by Enoch Choi, MDBlank, Apr 27, 2009
MMMommy, the fever and lethargy and excessive sleepiness are concerning, regardless of swine flu.  If they're worse before then go to the ER if they can't keep fluids down.  Unless they've been to mexico or a border state in the last week, don't think they'll be tested for swine flu.

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by Barbarella, Apr 27, 2009
Dr. Choi,

Thanks for the information.  

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by Enoch Choi, MDBlank, Apr 28, 2009
Barbarella, you're welcome!

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by hannah1505, Apr 28, 2009
hello doctor i no this is of the subject but i had a look what u specialise in a wondered if you could help i had a lump in my neck nr my collor bone for 2 yrs maybe more my doc looked at it today she said it was nothing to worry about maybe just a swole gland or infected somthing like that bu i am having ain around my collor bone and in my backk it is really not nice have you any advice please x

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by coley423, Apr 28, 2009
Hello doctor, I just went to the doctor i have had a sore throat and fever.. Would this have anything to do with this flu?? I have not but out of the states.. My doctor put me on AZITHROMYCIN. I know that this med is a macrolide antibiotic used to treat bacterial infections.. Just a little worried I have to small childeren that are around me 24/7.. Thank You

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by raseel, Apr 28, 2009
Nice news and advice brother thanks keep it up.

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by PurpleL, Apr 28, 2009
Dr. Choi,
  Thank you for this public service and your personal efforts to educate people about this recent health crisis.  I am an RN and had no information about the outbreak thru official channels, but found out thru a son attending UC San Diego.  As a healthcare worker, I already know the basics of the prevention of transmission - handwashing, etc.  Is there any other guidance you can share regarding preparedness and prevention geared specifically toward the healthcare workers that might help?  I do have a two college-age children, one who is in San Diego county.  Other than the guidelines you have mentioned, is there anything you would recommend they do or not do? I agree with an earlier post that as panic sets in, the healthcare system could easily be overrun just trying to deal with everyday colds and allergy sniffles.  How can we ensure that if our loved ones feel they could possibly be infected that they get the attention they need?

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by Curioustoknow44, Apr 28, 2009
I am traveling to San Diego on Wednesday, from Las Vegas (driving).  We will stay for 3 nights in a hotel and then head to Los Angeles.  Should I cancel this trip?  Thank you for any recommendations!

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by sunset555, Apr 28, 2009
Dr. Choi, Hi, I'm from Ireland and both my parents are in Tenessee at the moment, they went on holidays last week to see Elvis Presleys house, not too sure how far they travelled around when they went over, but they are due back home to Ireland this weekend, and Im meant to take my two kids to visit them! Do you think anyone was infected in the above area? as I really dont know American states that well??

Sunset

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by ChitChatNine, Apr 28, 2009
Dr. Choi,  thank you so much for keeping us updated.  I'll be at the health chat.

Everybody, please tell your familhy and friends to register for Dr. Choi's Health Chat scheduled for tomorrow @ 1:00PM -2:00PM.  It's going to have tons of great info with live questions and answers.  

            http://www.medhelp.org/health_chats/register/17

Register (if you are logged in all you have to do is click on one button) here to attend and you'll get an e-mail reminder or you can get to it via "My Shortcuts".   I've gone to a few of these health chats and they really are simple to attend!

We are going to keep the 2 weeks food, water, meds supply on hand.    Not to panic, but this is a good safety measure to have on-hand year round in case it's needed for any reason outside our control.

C~

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by heartfluttersflyawayplz, Apr 28, 2009
DR if they say its a pandemic , will we all have to stay in our homes for 2 -weeks? and where is the supplie list, can we buy the mask and where i live in Georgia.

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by fvf147, Apr 28, 2009
Sunset555, I live in TN and we have no reported cases in the entire state.  Of course that could change.  As far as I know the closest case of swine flu to TN right now is in Ohio which is 2 states away to the North of us.  

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by pippylongstocking, Apr 28, 2009
Dr Choi ,

Hi , and thank you for this thread and your most helpful information .
My relative works in our local hospital , if the swine flu reached here would I be at
risk of him carrying it home to me ? I am a severe asthmatic with COPD and have
Motor Neurone Disease . I fear if I became infected I wouldn't fair well at all .
Thank you for your time x

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by daleoverseas, Apr 28, 2009
This is a government induced panic just like 1976. In the U.S., only 1 person died from swine flu but 25 died from the vaccine. The one that died had direct contact with infected pigs.
We had 16,000 people with TB in 2006 and over 500 died from it. I didn't hear about pandemics then or now about TB. What about the thousands of people who die each year from misdiagnosis or allergic reactions to medications. I don't hear anything from the CDC on that.
I think it is just a smoke screen to get the public's attention away from what the politicians are doing in D.C. to our money and all the problems with the bailouts. Remember, the President's lackey that said, "Never waste a good crisis", well now they are creating them.
But just as a precaution, wash your hands and don't cough on each other. There are worse things out there than the swine flu.

Dr Dale

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by honey1601, Apr 28, 2009
Hi Dr, Thank you for this information... My concern is, my son's girlfriend has recently been to spain, there is one reported case there I believe? I live in the UK, she has had a cold, with a cough, that will not shift, my son has now caught this,   he has had 5 nosebleeds in the last couple of day's they both visited our home yesterday, I am housebound, with crohns disease and other medical problems.. so have very low immune system.. today I have started having symptoms, being cold, a headache, last night I had really bad nausea, now I feel achy allover... I have had diarrohea which is completely unusual for me, as I have a slow transit and suffer with constant blockages, the last time Ihad diarrohea was a year ago?? Also a friend has been back from north africa for 2 weeks now, he has visited and has a cold/flu like illness and still has it, I have felt unwell, more than usual, with different symptoms, since he visited, getting worse over the last 24 hrs.. I have been really sleepy, sleeping for 16hrs in one go, when usually I never sleep for more than an hour or two tops in one go?? I know I probably just have a normal cold, just a little concerned as I catch everything!! should I tell my son to get checked out at the dr's?? thank you for your time.

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by Enoch Choi, MDBlank, Apr 28, 2009
hannah1505, see your doctor

coley423, you haven't traveled, you don't have swine flu

raseel, thanks for the props!

PurpleL, if they get a fever, call their doctor.  if there's a pandemic, they're in an affected area and may receive tamiflu without examination as prophilaxis or if they're diagnosed, treatment while quarrantined at home

Curioustoknow44, las vegas & LA haven't been affected.

sunset555, incubation period is a few days to more than a week.  TN has not been affected.  watch for temperature over 100 and flu symptoms

ChitChatNine, glad you're ready, and thanks for the props!

heartfluttersflyawayplz, food & water for 2 weeks.  plus any drugs if you have chronic illness

fvf147, that's true

pippylongstocking, if he became infected, household members with chronic respiratory illnesses like yours would be eligible for prophilaxis with tamiflu

daleoverseas, we understand TB very well.  we understand swine flu very poorly.  plenty of folks die from other diseases that are well understood.  Swine flu is a risk since we don't know.  I agree, practice good hygiene.


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by Enoch Choi, MDBlank, Apr 28, 2009
honey1601, if you or your son or your friend from north africa have a temperature of 100 degrees or more, and flu symptoms (including vomiting&diarrhea) then call your doctor.  don't go, call.  we're over-run.

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by sunset555, Apr 28, 2009
Dr. Choi, thank you for your advice, If you dont mind I just have another question, my nephew lives in Spain, and he comes over to visit every three weeks, he stays with my kids, would they be affected by him???? Also I have holidays booked in Spain for me and my children for the beginning of June for a week, should I cancell just in case???  Final question, I have to go into hospital and put under anasthetic to get a camera down throat procedure in a couple weeks time, would my immune system by lower then in catching anything??? so sorry for all the questions. But really appreciate your time. Many thanks, Sharon (Sunset) X
P.S. fvf147 thank you very much for your reply, it was very well appreciated.

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by sunset555, Apr 28, 2009
P.S. my nine year old son has just finished an antibiotic for his sore throat, would he be at risk with contact with my nephew coming over from Spain??? Both my kids also suffer with asthma and are in the process of being weaned off their inhalers. Sharon X

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by Enoch Choi, MDBlank, Apr 28, 2009
sunset555, if he has a fever of 100 degrees or more, ask him to stay there and don't visit.  Who knows how it will be in June.  it's changing by the hour.  The camera down throat procedure in a couple weeks time, would not impair your immune system.  your 9 year old son would be at risk just as anyone would be if your nephew has swine flu.  if your nephew has a fever of 100 degrees or more and flu sympoms tell him to stay away.

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by cgriffin5, Apr 28, 2009
Dr. Choi, how serious is this flu comparable to the typical influenza? i.e. Is the attention to this flu due to it's uniqueness?  Additionally, I live in San Diego; approximately 15 miles from the border. Am I at a higher risk for infection?  

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by fantomas, Apr 28, 2009
hello doctor, i have 2 questions. which is the most strong symptom to take care
the fever above 39c or the sore throat, and also please tell me  the dose of the tamiflu to prevention
thanks

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by Enoch Choi, MDBlank, Apr 28, 2009
cgriffin5, san diego has cases of swine flu.  It is unique and never has been seen before in humans, so we don't know how serious it will be.  We don't know.  Although folks may have died in Mexico (who knows if they really had swine flu) here in the USA we have seen every case get better without treatment and the one hospitalization was not due to swine flu (i think precautionary).  You do live in an area that the CDC has determined that you should not go meet in groups and  practice social distancing: http://www.cdc.gov/swineflu/mitigation.htm


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by Burt600, Apr 28, 2009
35,000 people die of the flu every year in the United States alone.  I wouldn't worry about the flu.  Scientists can study the strain and learn about it - yes, but you are more likely to get in a car accident and die then get a flu that kills you or to die from the H1N1.  And don't take tamiflu whatever you do!  Eat your vegetables and fruits, take Capcaisin (Cayenne Pepper), Lycine and Vitamin C (anything to boost your immune system) --- Tamiflu inhibits the immune system -- talk about "trying to kill off more people - geez.

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by peterg2000, Apr 28, 2009
Dr Choi ,  what supplements and/or vitamins would you recommend to help boost our immune systems in preparation for this flu ?  We have a trip planned to Vegas( wedding )in early May and there are no more cases there than here in Quebec .
We will be more careful traveling however, especially at the very busy connecting Chicago Ohare airport !  

Thanks

Pete

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by pippylongstocking, Apr 28, 2009
Dr Choi

Thank you x

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by memysha, Apr 28, 2009
Dr Choi,

I have a 1 year old son who has never been immunized.  What can I do to help boost his immune system from Swine Flu?  Also, what are the potential risk for babies and children that come in contact with Swine Flu?

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by lunaglow, Apr 28, 2009
Thank you Dr. Choi for your blog!

I'm wondering if it's possible that the reason we are seeing lethal outcomes from cases in Mexico, however much more mild pathogenesis from this flu in individuals outside of Mexico, is perhaps a result of the virus becoming less virulent with each passage/transmission to a new host, and importantly since the spread of the virus is outside of the virus natural 'niche' in a swine background?

Thank you,
Postdoctoral fellow, University in the NW

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by Enoch Choi, MDBlank, Apr 28, 2009
Burt600, yup, we don't know the risk yet, so i'd worry more about those other possible injuries.  The supplements you list don't have good scientific evidence to support their use.

peterg2000, supplements aren't proven to prevent it.  Watch CDC travel advisories to see what they say about travel then.

pippylongstocking, you're welcome!

memysha, there is no immunization for swine flu yet, and previous immunization for seasonal influenza doesn't protect.  Babies and children and elderly have been most affected in the past from influenza since they have less reserve, less strength to draw from.  In Mexico it has been the young adults who've been most affected, possibly from the vigorous immmune response

Enoch



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by fvf147, Apr 28, 2009
I have to say I am thoroughly enjoying this blog and can't wait for your chat tomorrow.

I went to the store today to load up on some extra water, jugs and bottles are so big and take up so much space in the shopping cart that I wanted to go a seperate trip than my regular grocery shopping day, so all I was getting today was the water and juice and gatorade.  I have to say I got several strange looks.  I live in TN and we've not had any cases here yet.  I know a lot of people are feeling like this whole thing has been blown out of purportion.  But I feel like the worse thing to do is wait until your community is overrun with cases then run out to an overly crowded grocery store.  A guy stocking the Coke shelves said, "That's quite a lot of water."  And I smiled and say "Yep."  Then wheeled off.  I didn't get anything that we won't use eventually should the flu fade out.  I just felt a little scrutinized.  I hope and pray the flu doesn't get worse and that it doesn't come to my state, but I just told myself as I went to the check out that anyone who thinks me silly will wish they'd done the same if it does "get bad".  

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by Enoch Choi, MDBlank, Apr 28, 2009
fvf147, it's better to be prepared then you don't have to go out.  good work!  who cares about their stares.

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by stenosis_31, Apr 28, 2009
What's also "lovely" about this decision not to close the border is right now dieticians from all over the world are at a conference in Mexico.  Then of course they return to work in our hospitals.  Real smart.

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by Enoch Choi, MDBlank, Apr 28, 2009
stenosis_31, it's probably already in your hospital.  I think there are many cases of mild illness.  closing borders like Cuba just did to Mexico doesn't make sense.

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by terrlee, Apr 28, 2009
We did not have flu vaccines (or use antibiotics) when I was younger and we got the flu and got over it after a few days in bed.  What's different about this strain?  I know that people with compromised health will be at greater risk for complications, but is this a super bug that will put even the healthy in danger?

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by memysha, Apr 28, 2009
If I were to purchased poly surgical masks, to wear outside, for me and my family.  How effective would this be from catching the Swine Virus?

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by Enoch Choi, MDBlank, Apr 28, 2009
terrlee, noone in the world has any antibodies against this since it's a new strain.  we can't say how bad it will be.  in Mexico it looks bad.  in USA it hasn't been.  don't know why, since the strains are identical.  Can't say if this will be a super bug.  it hasn't been so far.

memysha, poly surgical masks would be great to wear for those who are sick to keep the particles away from healthy folks.  They won't keep healthy folks from breathing in the particles.  You need an N95 mask that is properly fit tested (make sure it seals out around the edge).  Even that isn't proven to work but it has a chance of helping.


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by Gigi4647, Apr 28, 2009
I have been following all advice on the Swine Flu situation. I live in Colorado and so far we have no suspected cases.
What is the recommendation for people (children, adults,and geriatic populations) that have compromised respiratory systems (severe allergies, asthma, chronic lung disease etc...) regarding flu in general and for Swine flu if it becomes an issue in our state?

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by leah1503, Apr 28, 2009
what are the syptoms because i have a cough (a bad one sort of and have had a stuffy nose for almost a month plus cough)

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by sunset555, Apr 28, 2009
Dr. Choi, just wanted to say a big thank you for all your replies. Much appreciated.  Sharon (Sunset) X

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by mitzi2987, Apr 28, 2009
I have a chance to travel to Addison, Texas next week and am now scared due to the Swine Flu, do I need to be concerned about flying there? I live in Kansas and don't want to risk my kids or myself catching anything..

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by sunset555, Apr 28, 2009
Dr. Choi, my kids Dad works in Hewlett Packard, which holds thousands of different nationalities working for the company, with people travelling to and from the States, and all over the world. Me and there Dad are seperated from last year, and they still get to see him every second weekend, would he be a candidate of carrying this flu, or am I just being over the top paranoid at this stage? I just want to protect my kids just like anyone else would.  Sunset.

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by April2, Apr 28, 2009
Dr. Choi, I know this is probably a dumb question but does bottled water ever go bad? I loaded up on bottled water a year or two ago, I can't remember, just to keep in case of emergencies. Does bottled water ever go bad? I don't see how it could but I just didn't know.
Thanks!

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by LisaLo6, Apr 28, 2009
My husband and I received a swine flu vaccine shot in 1976...probably a bad idea, but we did not have adverse reactions to it like some people did.  Now I am wondering if we were guinea pigs and what good it did.  Will there be a vaccine for it now that it is widespread?

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by Enoch Choi, MDBlank, Apr 28, 2009
Gigi4647, for everyone, with chronic respiratory conditions or not, it's recommended to practice good hygiene.  Encourage others to cough/sneeze into their elbow, and wash hands and don't touch your face.  If a person with compromised respiratory condition had contact with a confirmed swine flu case, they would be eligible for prophilaxis with tamiflu.

leah1503, your symptoms for a month don't fit.  The symptoms are fever of 100+ degrees, flu-like symptoms (cough, sore throat, runny nose, muscle aches, and possibly vomiting or diarrhea), and travel to Mexico or an adjoining US state.

sunset555, you're welcome!

mitzi2987, practice good hygiene and check CDC travel advisories at that time.  No CDC travel advisories prohibiting against USA travel, only to mexico.  But it changes often.

sunset555, over the top paranoid.  if he has a fever of 100+ and flulike symptoms, i woudln't send your kids to see him.

April2, not dumb. bottled water can "go bad" since there is less regulation of bottled water than tap.  It's safer to drink tap.  Bottled water is required to be sterilized so it could be ok for a while, but even if bacteria doesn't grow in the water, it can absorb chemicals from the bottle or thru the bottle of whatever the bottle is sitting on.  For emergency preparedness it's best to buy a 55 gallon drum, fill it with tap water, add the bleach needed to keep it clean (can buy this in a packet) and cover it.

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by Enoch Choi, MDBlank, Apr 28, 2009
LisaLo6, different virus this time around.  Not known if you are immune from this swine flu.  They're already working on a vaccine for this new virus.

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by sunset555, Apr 28, 2009
Dr. Choi, it was just on the Irish news tonight, that there are/were 4 suspected swine flu carriers that arrived home from Mexico travelling, it turned out to be negative on three of the cases so far! scary or what!  Sunset.


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by Enoch Choi, MDBlank, Apr 28, 2009
sunset555, don't be scared, be prepared...  gee that rhymes ;)

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by coley423, Apr 28, 2009
Dr.Choi, Thank You very much!!

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by Adria72, Apr 28, 2009
Hi, I live in Mexico City and everybody are really scared.  We don´t know if the infection is really dangerous, I am sure that a lot of people won´t be treated so I would like to know what will happen if you just stay at home and behave like you have another kind of flu?
I have 3 boys, we received the vaccine 5 days ago and we have mild symptoms, one only with caugh, other only with mild fever and I have some joint pain, I talk to my doctor and he said It is a normal response.  What do you think?

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by Enoch Choi, MDBlank, Apr 28, 2009
Adria72, i'll answer your question 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

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by Adria72, Apr 28, 2009
Thak you Dr., I will be on line tomorrow.  I am a Nutritionist from a mexican hospital so I am really interested in this.  I just registered for the chat.


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by kaber7, Apr 28, 2009
Hello Dr. Choi, I was curious about the dynamics of this unique flu and since I had a Swine Flu vaccine back in 1973 -75. (I'm not sure of the year I got it but I do know it was the year the Swine Flu was expected to hit the U.S.) would I be protected from it? I remember feeling like I had the flu for atleast 3 days after I received the injection.

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by Fluffysmom, Apr 28, 2009
Dr. Choi,

Thank you for your patience and persistance with keeping us informed and answering all these questions!  I'm in Oregon, and have a friend's 88 year old mother that is afraid to go anywhere because of all the news reports.  She had already stopped going to church because they always shake hands at the beginning of services, and now she's calling the whole family and warning them.
I just got back from a trip to North Carolina.  I know that there haven't been any cases there, but my flight was cancelled, so I was crammed in crowded planes, one where a sick and coughing woman was two seats behind me.  I had a 3 hour layover in Nashville, stopped to pick up more passengers in Denver; loads of fun.  
I carry disinfecting wipes for tray tables and other stuff that people touch, and try not to use the "outhouse in the sky" unless absolutely necessary.
I was my hands until they're so dry that I need lotion, which I carry, too.  I use paper towels or the sleeve of my jacket to open doors.  I'm a wee bit germaphobic, I guess, but I really don't want to get sick; I don't feel well most of the time anyway.  I feel safe about my travels, but I am curious as to what you think about flu transmission in airplanes where they move people in and out like cattle, without much in the way of cleaning, and being so close to all those coughing, sneezing people?  
Thanks again!

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by lalapple, Apr 28, 2009
Dear Doctor,

Thank you for this gracious post.  

Personally, I have to tell you that I am very nervous about this situation with the swine flu.  You see, I'm currently a full-time 2nd year college student undergoing Interferon/ RIbavirin Chemotherapy.  I have been on therapy for 45/48 weeks already, but treating also dropped my neutrophils to the point where I have to take Neupogen weekly for the past 41 weeks.  

The reason for my stubborn concern is that in the last 3 weeks of school I have left, I will be stressing over final exams and pulling all-nighters.  Not only must I go to school everyday of the next 3 weeks, I also feel VERY uncomfortable sitting in classrooms with at least 80 other individuals for each of my courses with low WBC defense.  I am in a border state, and so far, 6 cases have already been confirmed.  The only schools shut down are the ones already confirmed or are currently being tested.  I feel that if my school does not close soon, it will be too late for the public, their staff members, and students.  I want to avoid school as much as possible, but that would be very detrimental to my GPA, college is not a walk in the park afterall.  

I would very much appreciate hearing your response about this situation I am currently in.

Thank you again,
L

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by zfaith, Apr 28, 2009
I teach school & I have a little boy in my class that has been in Mexico.  He will be back tomorrow  & I am worried.  I have asked about him coming to school & I was told that there was nothing we could do.  If we ask how he is feeling, we might make them mad.  If this child has a cough, do you think we should send him home?  

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by Enoch Choi, MDBlank, Apr 28, 2009
kaber7, fluffysmom, lalapple, zfaith, i'll answer your question 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

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by lea1976, Apr 28, 2009
Dear Dr. Choi,
I am concerned about catvhing Swine Flu because I teach in a public school in the Bronx, NY. I come into contact with over sixty students a day, and many of the students in my school are Mexican. We just recently had Spring Break, and I know that several students in my Middle School may either have traveled to Mexico in the last 2 weeks or have had family visiting them. Also, I speculate that many of the families associated with the Mexican students are either low-income or illigal aliens, and may not have health insurance, or be able to go to the doctor due to financial reasons, therefore if they contracted the virus it is undocumented.

I have a young son at home and do not want to transmit this virus to him. I am practicing all of the reccommended hygene precautions, but I am still very concerned as a teacher and a parent. Given this situation, what do you think the chances are that I (or one of my collegues) might catch Swine flu? I noticed that the # of confirmed cases in NYC more than doubled in 24 hours. I am kinda scared!
Please ease my fears!
Thanks,
Lea

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by Enoch Choi, MDBlank, Apr 28, 2009
lea1976,  i'll answer your question 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

I believe 2 schools in NYC have been closed due to swine flu.

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by Alikonahc2, Apr 28, 2009
Dear Dr Choi,

   I am trying not to be utterly stressed about the swine flu, but I live in NYC and I am currently 36 weeks pregnant. I have read that pregnant women cant take anti-viral drugs, so I feel the need to be even more cautious. I could leave the city for a while and go to a friend's or parents' house. Am I being too paranoid or should pregnant women be even more cautious? I appreciate your thoughts....Thank you very much!

ps. I cannot register for the chat because I will be away tomorrow, otherwise I would.

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by slapperman, Apr 28, 2009
On 23 rd April 2009 the world began to become aware of a very strange new version of swine flu H1N1 in Mexico with limited cases in Texas and California. By the morning of the 24th of April, we began hear that there were hundreds of sick and 20 or so dead. By late in the day, we have learned that over 1,000 are now reported ill and over 60 are reported dead.
There are solid reasons to suspect that this new Mexican Swine Flu is NOT a naturally occurring event but instead is an Advanced Biological Warfare recombination DNA genetically engineered virus.

Here is what we know of the virus so far. This virus has already gone international having crossed the border from Mexico to America. All schools in Mexico City have been canceled, millions of students told to stay home due to Mexican Swine Flu. Sick victims of this strange new virus are currently reported in California and Texas. Over 60 deaths reported in Mexico (could be substantially higher considering the state of Mexican health care and reporting).

Young healthy adults seem to be the most at risk. This is similar to the deadest killer flu in history, Spanish Flu in 1918. Most if not all nations with advanced biological warfare programs have been interested in recreating the Spanish Flu DNA sequence and several are reported to have done so.

The new Mexican Swine Flu has elements of DNA from the following: avian flu, human flu Type A, human flu Type B, Asian swine flu, and European swine flu. A strange combination never seen before and having less than 1/10% chance of being a natural event. Human and animal viruses from four or more continents suddenly recombine in a new flu during a non-flu season that spreads from human-to-human with a 10% fatality rating.

Over 1,000 reported infected in Mexico; true rate may be much higher. Mexico City seems to be the epicenter of the new virus. Mexico City has 20 million citizens, most terribly poor. Mexico City is notorious for its poor sanitation and public health. "Don't drink the water" has been the byword in Mexico City for decades. It is the perfect breading ground for an explosive growth of this new killer virus. Mexico City has closed all schools, public gatherings, public buildings. People are wearing medical masks on the streets. The government has announced a massive new emergency swine flu vaccination program that will be, at best, either totally non-effective or of very limited effect, and could be, at worst, a deadly option for patients. It is thought that the authorities are trying to contain public panic by announcing the vaccination program.

Both the World Health Organization and the US CDC (Center for Disease Control) have announced, today/24th April, that they are 'very concerned' about a global pandemic developing out of this new disease. Based on advanced biowargaming projections, it is already too late to stop the global spread of this new killer disease. Based on the three waves of Spanish Flu, the latter ones being more lethal, fatality rates may range from approximately 10% to 40% or so in later waves. More people could die in America, Mexico, Canada, Europe, and globally from Mexican Swine Flu than died in World War II.

This new flu is likely a lab-created, genetically engineered virus that either: (1) Escaped accidentally from a lab; or (2) was deliberately released by a nation or non-state organization or a well-trained individual. Click here for several news items.

If there is a positive side to this coming global disaster, it may force governments to quickly come to grips with containing advanced biowar attacks. This is of considerable short term importance as Israel is apt to attack Iran by no later than mid-July 2009. The Iranians, having hired a large number of key ex-Soviet advanced biowar scientists 18 years ago and having spent billions on their asymmetrical MAD (mutually assured destruction) counter-force, are expected to respond to any significant attack on Iran with a biowar attack on Israel, North America, and Europe using in-place agents and dozens of genetically engineered viruses, many with very high projected kill rates.


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by Enoch Choi, MDBlank, Apr 28, 2009
Alikonahc2, you can read an answer to your question in the archives of my 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

slapperman,  your article looks like it was copied from somewhere else ('Click here for several news items'), what's the source of this information?  if you have a question (i didn't find one in your comment), you can ask it tomorrow in my 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



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by Curioustoknow44, Apr 29, 2009
I'm actually just wondering if you'd advise against the trip to San Diego.  Thanks so much!

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by Enoch Choi, MDBlank, Apr 29, 2009
Curioustoknow44, you ask me your question at my 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

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by ChitChatNine, Apr 29, 2009
Looking forward to the live chat today.  The schools in my NJ District (K-12) have communicated safe coughing and hand washing reminders to all the students & parents, as well as explaining to them what the Swine Flu is, etc. and have even gone as far as to let the parents know how classes would be made up "if" they had to close the schools in an emergent situation (utilzing Saturdays or days between June 24 and 30, etc.)

C~

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by Enoch Choi, MDBlank, Apr 29, 2009
ChitChatNine, that's what our local schools have shared with students as well.

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by TBOO990, Apr 29, 2009
What is the best kind of mask to get for adults and for children ages 3?

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by TBOO990, Apr 29, 2009
From tboo990 again, where is the best place to get these mask at stores or online.  I live in Denver, Colorado?

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by Enoch Choi, MDBlank, Apr 29, 2009
TBOO990, ask me your question in an hour at my 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

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by April2, Apr 29, 2009
TBOO990, I don't believe there's any cases in Colorado yet. I live in Colorado too. I'm going to be careful, of course, but don't want to get paranoid. Seems we have enough things to worry about in this day, lol.

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by HelpinUtah, Apr 29, 2009
Just visited the CDC website and here's what they have posted:

Arizona: 1
California: 14
Indiana: 1
Kansas: 2
Massachusetts: 2
Mighigan:  2
Nevada: 1
NYC: 51
Ohio:  1
Texas: 16

For a total of 91 cases in the U.S. with 1 death in Texas (a child under 2)

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by StefaniR, Apr 29, 2009
I hear your supposed to stay away from sick people, but I have a 2 1/2 year old son who has been very sick with fever, loss of appetite, and a horrible cough for 4 days now. I find it hard to stay out of his face. He is constanlty coughing on me. I don't think he has swine flu but I'm getting worried now that it's been reported in the state we live in. We haven't been anywhere except where we live in Bloomington, IN.

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by Enoch Choi, MDBlank, Apr 29, 2009
StefaniR, ask me your question in 13 minutes at my 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

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by lalapple, Apr 29, 2009
will patients on Interferon/ Ribavirin treatment have an advantage to counteract the swine flu virus since their main purpose serve as strong anti-viral against viruses such as hepatitis?

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by lunaglow, Apr 29, 2009
What about some sort of protective effect for those individuals who take other antiviral medications for chronic treatment of HSV1 or HSV2, any chance these antivirals could decrease the effects should swine flu be acquired in these folks?

Thank you for your blog!

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by Enoch Choi, MDBlank, Apr 29, 2009
great chat, folks!  I answered many of your questions over at the chat, check it out.  I'll be answering more of your questions there later today: http://www.medhelp.org/health_chats/register/17    There were hundreds of you there and I've got another hundred questions i couldn't get to that i'll answer in that chat window later...  gotta go work out now before clinic starts for me at noon...

come join me again at next week, same bat-time, at this bat-place:

http://www.medhelp.org/health_chats/register/18


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by Curioustoknow44, Apr 29, 2009
I wasn't able to make the chat, as I am on vacation, so I suppose I will continue to be unsure as to whether or not it is safe to travel to San Diego.  Wish me luck, as we are about to leave :-/

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by Med Help, Apr 29, 2009
Hi,

Dr. Enoch Choi just completed his Health Chat regarding Swine Flu. If you were unable to attend, you can view the archives of the chat at http://www.medhelp.org/health_chats/archive/17.

In addition, due to the demand for this chat, we have just scheduled a follow-up chat on Swine Flu for Wednesday May 06, 2009 at 01:00PM - 02:00PM (EST). To register for this chat, go to http://www.medhelp.org/health_chats/register/18

MedHelp

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by cinbug, Apr 29, 2009
Two of my friends came back from Mexico on the April 13. One had been feeling sick with a sore throat and generally not feeling well. I now have a cold.  I don't think that it is the flu but I have heart failure. When should I get worried.

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by farraway, Apr 29, 2009
Dr Choi
There is obviously a lot of panic developing around the planet.
It seems to me that if any person that has contracted this infection DEVELOPS ANTIBODIES (which are detected), it's all over very soon.
Do you agree?

farraway

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by LisaLo6, Apr 29, 2009
Dr. Choi, thank you for the information.  I suspect our '76 vaccine shot won't have any effect should my husband and I get the swine flu--it's been so long since we got it.  I have four grandchildren, two under the age of 2,  and it is scary to think they could catch this deadly flu.  Keep up the good work on getting information out there to folks.

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by Terri627, Apr 30, 2009
Hi Dr. Choi,

I haven't been back on this site for a couple of days. I attempted to order Tamiflu yesterday,
no luck. I am in the Los Angeles County area. I work for a large HMO, so the supply comes
directly from our warehouse. But the restrictions, as you can imagine are pretty tough
right now. We have had a few questions from patients about the virus, but really so far
not a lot of people here seem to be overly concerned. Purell has been a big ticket item,
so has Hibiclens. So, we have people who are listening to the advice and taking
precautions. Best of luck and wishes to everyone here!

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by ChitChatNine, Apr 30, 2009

Here's some info I found on the different phase levels:
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WHO Pandemic Levels

Here is a quick look at the WHO's pandemic alert phases:

Phase 1: A virus in animals has caused no known infections in humans.

Phase 2: An animal flu virus has caused infection in humans.

Phase 3: Sporadic cases or small clusters of disease occur in humans. Human-to-human transmission, if any, is insufficient to cause community-level outbreaks.

Phase 4: The risk for a pandemic is greatly increased but not certain. The disease-causing virus is able to cause community-level outbreaks.

Phase 5: Still not a pandemic, but spread of disease between humans is occurring in more than one country of one WHO region.

Phase 6: This is the pandemic level. Community-level outbreaks are in at least one additional country in a different WHO region from phase 5. A global pandemic is under way.

Note that all of those phases are about how the virus is (or isn't) spreading -- they're not about the severity of the disease.


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by RHONDAARTMAN, Apr 30, 2009
Dr Choi,

I am very worried about this flu for my son. H is 13 and has had pancreatitis a few months ago and also is on flonas for asthma. How bad is it for him if he was to get this??? We live in ILL and hear about 17 unconfermed cases here and Chicago closing schools. I keep him in the house and he is also home schooled for his health. I just worry as he has been sick enough this year for being so young. We live about 120 miles from the City and in north-western IL no cases have been talked about. Thanks for the help.
Rhonda

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by R Glass, Apr 30, 2009
The odds are probably better for you to win the Power Ball, Struck by lightning, Eaten by a Shark and Probed by an Alien, etc., than to be related to someone that dies from Swine Flu.

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by RHONDAARTMAN, Apr 30, 2009
Dr Choi,

Just a update on the news here just now they are saying 40+ cases of swine flu in IL and the cdc has nothing who do you believe with the numbers??? Now very worried about my son.
Rhonda

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by alisa827, Apr 30, 2009
Hi Dr. Choi,

I think its great your taking the time out to answer all these questions for us on here, very much appreciated!  
I live in the Pasadena, CA area.  I haven't heard of any cases in this area, is it true most of the cases in CA are in San Diego area mainly?  Also, I was wondering do you suggest we start wearing masks like how they are in Mexico?  I was at Walgreens today, and I saw up at the front near the cashier a shelf of masks.  

In regards to what RHONDAARTMAN just wrote bout 40+ cases in IL (Chicago my hometown), I am traveling to Chicago end of next month to visit my family.  I am worried for my family there now, their all fine.  Do you think I should reconsider now?  Or should we just go there wearing masks the whole trip?  

Thanks.

-Alisa

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by Teddybear09, May 01, 2009
Dr Choi

My husband and I were in Hawaii from 3/15/09 - 4/1/09 and during that time he had bronchitis/fluid on the lungs and I got an URTI.  We have been home in Australia since 4/2/09.  Now I have a very sore top of my back - across my shoulders and neck.  I know I read somewhere that pain can be a symptom.  I don't have any other flu like symptoms and wondering if this can be related to the URTI or something else.  The thermal imaging has only started here from midnight today so prior to that anyone could have come in with the flu and no one would have known you were sick with swine flu.  Should I be worried about it or not?  Hubby has no symptoms of anything at all.  We practise good hygeine at home and as much as possible out in the public.

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by Teddybear09, May 01, 2009
my other question Dr Choi, is the information that is being fed to the average Joe public across the world right about swine flu - catch it from pigs and from human contamination.  Is this a beat up to scare the public or is it a real threat to developed countries or more likely less developed countries like mexico.

Thanks

Robyn

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by polly22, May 01, 2009
Thank you, Dr. Choi, for answering me re tamiflu purchased five years ago. Its expiration date was for 3 years ago; however, I have read, and been told by a doctor, that tamiflu can be good up to five years. Do you know why the disparity in the answers? Does it steadily decay in effectiveness over five years? Or after five years (or 3 years)?  I ask because apparently this is all one's likely to get out here--I live in the Oregon countryside, hardly a national priority area, so if they have to start giving out stockpiled antivirals, we're not likely to get the nice fresh newer ones, and my own prescription is useless since the pharmacies are out. How are people going to manage if this epidemic gets more severe, in fact?

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by Terri627, May 01, 2009
Polly22

I'd like to help you out with your question. The expiration date on any medication is the date the
manufacturer has decided through testing that it is no longer going to serve its purpose. Working
in a pharmacy, I can say that there are many medications that sit on our shelves for long periods
of time, and with Tamiflu being more of a seasonal item, it's possible it can be there for a
year or longer. As long as it is kept at the proper temperature and under the right conditions,
we hold it on the shelf until approximately 3 months before it expires. If a doctor states that
the medication can be good for up to 5 years, that must mean from the date it was
manufactured, not the date the patient purchased it in the pharmacy. So, even if you purchased
a medication 5 years ago, there really is no way of telling when it was actually produced. I suppose
you can try contacting the manufacturer if you have the original lot number of the medicine. Then
they may be able to confirm the date of production. Short of that, working in the field for over 20 years,
I would not recommend taking a medication that has expired, especially that long ago. Besides, if
someone does suggest you rely on this medication, it may do more harm than good, as you would
be under a false assumption or hope that you are protected. I hope this helps! Take care.

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by John23a, May 02, 2009
From 2 days ago i started having this stomach discomfort and i felt very gassy at times. I thought its just a stomach problem but from yesterday i started having a low grade fever (which i dont have today) and a chest pain. It feels like someone is pouring hot water on my chest when i breath. Its not really a sharp pain i dont really know how to explain the feeling. From today i started feeling like i have diarrhea too but every time i go to bathroom nothing comes out. I just feel like i need to go. Yesterday i also went to a walkin clinic and he said that my chest sounds clear and its probably a virus. I wanted to know if a virus could cause this kind of chest discomfort with stomach symptoms?

I dont have any other cold or flu symptoms like runny nose, watery eyes, sore throat...

could this be the early symptoms of the swine flu? and i havent been to Mexico recently

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by peekawho, May 02, 2009
Enoch, good information.

But here are my questions:  I work in a health care capacity with at LEAST 50% of our clientele either from Mexico, or have relatives visiting the hospital who are frequently traveling back and forth from Mexico to the US.   What is my risk, if I become ill?  I'd have to answer "No" if I were asked if I had been to Mexico recently.  But I certainly feel as though I'm frequently exposed to people who go back and forth across the border all the time.

My husband recently had severe flu like symptoms after traveling across country by air....and he was seated directly in front of a family of Mexicans, and all of the children were coughing and obviously ill.  
His doctor did ask him "have you been to Mexico recently", and of course the answer was no.  So he was not tested.  

I feel like these scenarios are not being taken into account.  You can't merely ask "Have you been to Mexico recently" and feel reassured that your patient hasn't been exposed.   People travel all the time.  Many people work with a largely migrant population, especially in California and the southern states.  Migrant workers can be found though, everywhere in the US.  

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by Enoch Choi, MDBlank, May 02, 2009
Everyone (including Peek)

the situation changes quickly and you should check with your local health authorities to see if there is a confirmed or probable case of H1N1 in your area.

When there is a confirmed case, social distancing is instituted, and the part in the definition about travel to Mexico is moot.  It's local to you then.

Look forward to more school closings and other social distancing measures to be instituted in a community near yours in the near future.

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by peekawho, May 02, 2009
Thank you for including me with "everyone"!

People are not being tested very often, at least not here, and I'm pretty close to the border.  If you say you haven't been to Mexico, thats it as far as patient screening is concerned.  

We have actually been directly told NOT to "waste resources" and we do not test people who have not recently been in Mexico.  

I feel there are cases in the community, and we are not discovering them b/c of the "Have you been to Mexico" question.   Many immigrants do not present for health care even when ill.  Yet they live and work in our community.  



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by peekawho, May 02, 2009
And my last point (you know I love a good discussion!) is this:

If you are basically only testing those who have recently been to Mexico, by default the only positives you get for H1N1 are in those who have recently been to Mexico.

If you tested a broader spectrum of the flu community, I think you might see it as a more widespread issue, occuring even in those who have not traveled to Mexico.  

How is my husband to know if he had it or not?  He wasn't tested.  The vast, vast, vast majority of people with flu like symptoms are NEVER tested for any type of flu.  They are treated symptomatically and streeted.  

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by Enoch Choi, MDBlank, May 02, 2009
Peek,

You're right, I believe we were missing many cases as well until on Thursday we changed the criteria for swabbing to include
- sick contacts of folks who had been to Mexico
- anyone living in a community documented to have probable or confirmed H1N1
- anyone with exposure to group setting, e.g. school, daycare, hospital

the criteria change daily, your community should come in line with cdc's definitions...

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by fvf147, May 02, 2009
I totally agree with Peek.  I was watching my local news last night and a Dr was being interviewed from Vanderbilt hospital and he was saying they were seeing an astounding amount of patients in the ER, some terribly upset, some there just because they'd eaten pork.  But he said that if they've not had any travel to Mexico and/or interaction with someone who had they weren't testing them.  He didn't say it that straight forward but that's what it amounts to.

I also feel being a part of the unknowing public... there's been some kind of break down in communication.  My state of TN has a confirmed case and 2 more suspected, it was confirmed or at least on the news (local) Tuesday.  At first CNN and the like were reporting TN among others as states H1N1 had spread to, then some where after that they stopped reporting it.  TN is not on the list at cdc.gov and it's not on the maps provided by cnn, the only map I could find that seems the most accurate was one done by google, flutracker.rizalabs.com.  

And they no longer report the 150+ deaths in mexico they only report somewhere between 7 - 16 "confirmed" deaths, depending on which cable news channel you watch, what time you watch and who's anchoring the information is totally confusing and sometimes downright contradicting.

The refusal to report states until confirmation is misleading to the public.  It's taking WAY too long to get these confirmations, by the time the first one is announced on CNN the local news is already saying there's two or three times as many cases.  At first the cable news channels seemed to really be on top of things and reporting as things happened, now it seems as if someone has stepped in and said, stop saying this, don't say that, say it this way, not that way.  I'm just irritated that there's miscommunication, misleading information and as said in the other posts patients not being screen properly.  

Just wanted to vent, thanks!

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by Enoch Choi, MDBlank, May 02, 2009
CDC won't post to their official list until they have confirmation via PCR that it truly is H1N1

But local public health departments have to act based on initial testing showing Influenza A "untypeable" meaning it doesn't match any past known isolates, and is presumptively H1N1.

There's the difference.

I'd act just based on Influenza A "untypeable" found in your community, and consider your community is affected if you have Influenza A "untypeable".

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by peekawho, May 02, 2009
But Enoch, that's not feasible for John Q Public.  He/she has no way of knowing about untypeable influenza.

He/she just knows that the Urgent Care doc says "You probably have the flu, here's some Phenergan w/ Codeine for your cough".  NO ONE IS BEING TESTED.  NO ONE IS BEING TESTED.

I don't want to make more of this than what it is.  I'm more worried about the future.  Some day, there will be a virulent flu and we are not ready.  We do not test efficiently or effectively.  We do not test everyone.  We have no database.  We will not be ready if/when it comes.

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by Neecholay, May 03, 2009
I have been told recently that there has been very few confirmed deaths in the world due to swine flu, and that it is not airborne. How true is this, because if that is the case why is everyone so scared? Over 100,000 people are hospitalized and over 35,000 people die in the US alone from just regular flu and noone freaks out over that.

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by swampcritter, May 03, 2009
No rocket scientist is needed to know that if you scare the daylights out of the public -- which is what the news coverage has done -- people are going to demand to be tested. Americans spend more than every other country in the world on health care -- a lot more.

What do we get for our money? A medical profession that believes that they can frighten people and then ignore them? Come on, that isn't service.



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by Sunshine5664, May 04, 2009
I am not sure that this flu is as deadly as first broadcasted.  I don't deny it's excistince but the press and others are more or less causing a "mob" effect while our state and country leaders are making policy and law changes that will all come to light when the flu subsides. We have dangerous panademic illnesses all the time... aides, lyme disease, flu, etc. I like the things you have to say, Dr. Enoch Choi. The facts are put out there and the suggestions for not spreading nor contracting this flu is excellent fact of life year around, day by day!!

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by Enoch Choi, MDBlank, May 08, 2009
I've done 2 more chats yesterday and today: http://www.medhelp.org/health_chats/archive/18 and http://www.medhelp.org/health_chats/archive/19 for more of your questions answered!

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by Enoch Choi, MDBlank, May 08, 2009
1/3 of the world could catch it.  2 billion people: http://news.yahoo.com/s/ap/20090508/ap_on_he_me/med_swine_flu

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by mamabland, May 14, 2009
Well, for myself, I agree with Bill Maher, What does the regular flu have to do to get a little attention? He said, among a few more "profane" suggestions, that perhaps the "flu" flu should make a sex tape, or go to rehab or something to get a little attention.  This year 13,000 people have died from the traditional flu with over 36,000 ill from it.  The swine flu?  3 people dead and less than 5,000 cases of the illness.  
On the other hand, according to a worst case scenario study done by two separate research teams whose numbers were very close indeed, the max cases of swine flu to develop from May 1st over the next four weeks was quoted at only 1700.  Wow, I don't usually put much faith in research studies and now I see why.  
At any rate, my point is this, the flu can be deadly regardless of strain.  This new strain so far is very mild, no need for panic when you consider the numbers involved with the regular flu.  Wash your hands folks, stay away from sick people, if you or your children are sick, stay home.  And don't go to the ER unless it is life or limb threatening.  Don't go to the doctor or urgent care unless you cannot ease the symptoms any longer at home, call them for advice instead.  First of all the medical system is being overwhelmed by unnecessary visits, second, and most important, with the ER, Urgent Care, and Doctor's offices filled to capacity with all kinds of people, you are more likely to contract 1 or 2 things that could end up being way worse than any flu bug.  Wow, go in with a cold that should have been treated at home, and come out with Strep throat, TB or MRSA, or swine flu, or scabies, or, or, or, or......  And finally, go directly to CDC or WHO websites for updates and try your hardest to ignore the media feeding frenzy.  Often times the media feeds on our fear and in turn loves to feed us more crap to induce that fear.  DON"T buy into it.  Use common sense.  And if you have underlying health problems?  Definitely stay out of those places if at all possible and stay in contact with your family physician or specialists via phone.  
I am very impressed with your patience Dr. Choi, as well as your medical expertise.  It has to have been very trying answering the same questions over, and over, and over, and over, well, you get it.  Very few doctor's nowadays understand the value of listening and simply easing a person's fears (because of course we ALL feel our individual situation is just that "little bit" different and therefore you MUST have different instructions for me, type thing going on.)  The doctor that can simply understand this quite normal human condition and use people skills rather than treating the patient harshly, with impatience and superiority (that deity complex thing) is a physician that is worth his weight in gold.  And I have to say that this also makes you about as rare as one of those "blue" diamonds that they auctioned off last week.  Keep up the good work Doc.  I hope other's in the profession follow your lead.  

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by houdy1111, Nov 01, 2009
i dont think this is a big deal i had all the systems except 3 and i was home for 2 weeks then i felt fine i still dont have a appetite and i still have a little cough and i feel fine so i think this swine flu is being exaggerated but thats my opinion and yes i know people been hospitalized but people also been in the hospital for the regular flu so the h1n1  to me is like the regular flu  

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