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If you are planning to travel over the holiday season be sure to:

• Pack your medications – all of them – even those you use only occasionally. This applies to your kids too – make sure they have an inhaler with them if they occasionally use one for asthma. If you forget something you can get new meds at your destination (by calling your pharmacy or visiting the emergency room) but is that how you want to spend your holiday time?
• Carry an emergency fact sheet with you. Go to this link for a template to create an emergency fact sheet. Fill in all of the sections, print two copies and pack the form to take along on your trip. If you need medical care while traveling present this form to the care providers you see. They will appreciate this information. It is all essential: medications (name, dose, and frequency), allergies, current health issues, recent procedures, health care provider names and phone numbers, insurance information.
• You never know when something will come up; don’t be caught off guard.

1. Ask your relatives (especially your aging parents) to make out an emergency fact sheet too (or you can do it for them).
2. Complete and accurate information is critical for good health care. A physician recently told me that he spends ¾ of his time with patients trying to get accurate information. If you walk in with complete information you get faster, more complete, and better care. It’s satisfying for you and for the doctor.

Report on Swine Flu, October 1, 2009:

We’re at the beginning of the 2009-2010 flu season. This year we will be dealing with the “normal” or expected “seasonal flu” and a variety that emerged in the spring, H1N1 influenza.

There is much misunderstanding about the flu in general and about H1N1 in particular. This report will address many of those misunderstandings.

Influenza is the most unpredictable of contagious diseases. Influenza mutates at an alarming rate. The H1N1 virus in its present form is rather mild. People should not expect this to necessarily be the case as the flu season progresses. If this virus mutates to a more dangerous form, which it could do at any time, the worst case scenarios will become our reality.

• In a typical year 5-20% of the population of the US are infected with the seasonal flu (that’s about 61,400,000). Health experts are predicting that up to 50% of the population will contract H1N1, that’s 150,000,000 people. That will be in addition to the 61,000,000 with seasonal flu. Therefore we should expect to see 3x more flu this year than in a typical year.
• Most people recover from the flu within one to two weeks. Serious complications occur in others such as pneumonia, ear infections, sinus infections, dehydration, and worsening of chronic medical conditions such as CHF, asthma or diabetes.
• More than 200,000 people are hospitalized in a typical flu season and seasonal influenza kills 36,000 people/year.  H1N1 is expected to send up to 1.8 million people to the hospital. 200,000 people may die from this strain of virus. Many people requiring hospitalization will have severe respiratory complications and will need ICU and mechanical ventilation. It is expected that there will be a significant national shortage of ICU beds and mechanical ventilators to treat these people.
• People over 65, young children, and those with underlying medical conditions have always been at highest risk of serious complications and death from the flu virus. H1N1 rates and complications are different. (chart) Those over 65 are NOT in a particularly high risk group. Indeed, younger people (especially those 25-49) are far more likely to suffer severe and even fatal outcomes from this virus.
• Symptoms of the flu include sudden onset of fever, headache, body aches, chills, extreme exhaustion, dry cough, and weakness. Symptoms of H1N1 are essentially the same although there is a higher incidence of vomiting and diarrhea with H1N1.
• Influenza is spread by respiratory droplets. Coughing, sneezing, touching object which have been infected with the droplets from another person are the three most prevalent means by which the virus is spread.
• The flu virus is active in a human host and can be spread one full day before symptoms occur in the individual.  Anyone you see – indeed, even any one of us here in this room today, could be carrying and could spread the flu. Thus, hand washing and personal hygiene become key strategies to control the spread of influenza of all types. Even after symptoms subside the virus remains active for at least 24 hours, sometimes longer.
• Controlling the spread of the seasonal flu is an objective of public health efforts. Those efforts are two fold and include public education programs and immunization programs.

1. public education

• to teach people how to keep from spreading the virus from person to person
• to teach people when to seek medical care (when does the flu become life threatening/dangerous),

1. immunization programs involve vaccinating large segments of the population. Vaccines work by stimulating the immune system in the recipient so that the recipient develops antibodies to the virus – without having to undergo illness. Immunization programs do more than protect individuals, they slow and can even stop the spread of the disease. Immunization programs have a proven track record.

The “Seasonal Flu” vaccine is ready now. These people should get vaccinated:

• Children aged 6 months through age 18
• Pregnant women
• People 50 years of age and older
• People of any age with certain chronic medical conditions
• People who live in nursing homes and other long-term care facilities
• People who live with or care for those at high risk for complications from flu, including:

1. Health care workers
2. Household contacts of persons at high risk for complications from the flu
3. Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)

• The H1N1 vaccine is due to be released next week.
• The Center for Disease Control (the CDC), a federal public health agency, is responsible for setting public health policy, their Advisory Committee on Immunization Practices (ACIP) has recommended that certain groups of the population receive the 2009 H1N1 vaccine when it first becomes available:

1. pregnant women,
2. people who live with or care for children younger than 6 months of age,
3. healthcare and emergency medical services personnel,
4. persons between the ages of 6 months and 24 years 
5. people ages of 25 through 64 years of age who are at higher risk for 2009 H1N1 because of chronic health disorders or compromised immune systems.
6. After this first population is served those from 25-64 will be advised to receive the vaccine
7. then finally those over 65.

Take these everyday steps to protect your health:

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners* are also effective.
• Avoid touching your eyes, nose or mouth. Germs spread this way.
• Try to avoid close contact with sick people. If you must care for sick people you may use a face mask. They do offer some protection.
• If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Keep away from others as much as possible to keep from making others sick. If you must go out – cover your face with a mask and wash your hands.

If we are lucky, and if enough people are vaccinated and practice effective infection control, we may see fewer infections, fewer complications, and fewer deaths than epidemiologists are predicting.

Additional Information:

Illness from H1N1 is expected to peak in the middle of the normal flu season. Distinguishing the varieties of flu will be difficult to nearly impossible. In practice, the important consideration is how sick the individual becomes. Those with severe illness will need help. Here are the danger signs:

Children:

• Fast breathing or trouble breathing
• Bluish or gray skin color
• Not drinking enough fluids
• Severe or persistent vomiting
• Not waking up or not interacting
• Being so irritable that the child does not want to be held
• Flu-like symptoms improve but then return with fever and worse cough

In adults, emergency warning signs that need urgent medical attention include:

• Difficulty breathing or shortness of breath
• Pain or pressure in the chest or abdomen
• Sudden dizziness
• Confusion
• Severe or persistent vomiting
• Flu-like symptoms improve but then return with fever and worse cough