Flu tests- Fact and Fiction

How do you know if your flu is the H1N1 strain? Is there a quick test in the doctor's office?
Well, yes and no. Most primary care offices now have rapid flu tests in their offices that can tell you if you test positive for type A or type B influenza. If indeed you test positive for type A, at this point in the United States, you most likely have H1N1. 99% of samples of known positive type A flu that have been sent to the CDC are testing positive for H1N1. The difficulty is that the rapid flu tests are very specific (meaning if it is positive, you definitely have the flu) but not too sensitive (meaning if you do have the flu, there is a good chance - up to 30%- that the test will not show it.)
So, please understand that flu is primarily a clinical diagnosis. This means if you have high fever, intense headache, sore throat, cough, and body aches, and your doctor doesn't find evidence of any other disease (like strep throat or pneumonia), your doctor will likely conclude that you have influenza- whether or not she has the "proof" of a positive rapid test. It is also no longer necessary to send every positive type A flu test on to the CDC for confirmation that it is H1N1.
The good news is that H1N1 is proving to be primarily more mild than initially feared, and now treatment (meaning antiviral medicines) are only recommended for high risk groups (pregnant women, patients with poor immune systems as in cancer or HIV disease, young children under 5 or adults over 65, people with chronic diseases or people who are hospitalized.)
BOTTOM LINE: See your doctor and get tested if you think you have the flu, but understand the limitations of our current testing. Most importantly, remember GOOD HAND WASHING and STAY HOME if you have a fever!

Is that the FLU??

Picture your child miserably sick, teeth chattering, shaking chills, complaining of a sore throat, body aches, cough and headache. When you touch her forehead, she is burning up- sure enough, her temperature is 104.8*! As your brain is trying to process all this, she suddenly tries to jump out of bed and push past you but starts vomiting before she ever leaves her room. What is this? What should you do??
Well, this is no imaginary scene, but one I simply can recall from a few nights ago in our house, when our 12 year old daughter's flu symptoms first showed up...at 2am (of course ;0) What did I do? Well, with a fever that high, the first thing I did was to give her some liquid ibuprofen. (I picked liquid so it would be absorbed more quickly, and because she was more likely to gag and vomit again if she tried to swallow a pill. And yes, I got the ibuprofen in her before I cleaned up the mess.) We put a cold, wet washcloth on her forehead and I read to her (as a distraction) for the next half hour while the medicine was kicking in. By 3am, her temperature was out of the scary range, and "just" 102*.
What I want to emphasize, though, is not the care of a high fever. I want to make it clear the difference between a common cold and the flu. A cold can cause headache, stuffy/runny nose, and sore throat, but generally does not cause intense body aches and high fevers. The flu is not so subtle! It often comes on suddenly, and the flu victim typically feels (and looks) like they've been hit by a Mack truck, with serious aches and pains in their muscles, bad headache, intense sore throat worse with swallowing, high fever, and often a cough.
So, what did she have? The flu. What type? Presumably H1N1 as 99% of type A influenza being tested right now is H1N1, and she had repeated exposure to friends & classmates with confirmed type A. She became ill on Saturday, missed 3 days of school, and is now 7 days later she is feeling back to normal, although easily fatigued.
BOTTOM LINE: Recognize that a stuffy nose, low grade temperature (99*) and sore throat are uncomfortable but very unlikely to be the flu. High fever, chills, headache, cough, sore throat and body ache at this time is most likely influenza- see your doctor and try to limit your exposure to others to slow the spread of this year's flu!

A BETTER cleansing diet

"So if I don't need colonics to cleanse my body, what can I do to get rid of all the toxins in my body?" Are you sure you are ready for my answer? If you've seen me as a patient or know me personally, you already know my answer...
If you are really ready to work hard to increase your energy levels and improve your health, then the "cleansing" diet you want is simple- stick to fruits, vegetables, and a protein source at every meal and snack. Eliminate processed foods. Skip anything with high fructose corn syrup and every other additive or chemical that you cannot pronounce.
Drink WATER- add a lemon or lime slice for a change of taste now and then. If you are serious about "eliminating toxins", give up caffeine, alcohol and artificial sweeteners, too!
How long do you have to stick to this SUPERCLEANSE diet? Start with one day, and see if you can't last several days. If you really want to jump start a weight loss program, commit to a whole week! This is not a very low calorie diet that requires medical supervision, and it is not dangerous in any way.
Do I think you need to live on this forever? Well, you'd certainly be healthy if you did! I do this periodically, but I love baking cookies and having my occasional Coke too much to commit to it permanently.
Bottom Line: If you're looking to "cleanse" your body, make it simple and stick to water, fruits, veggies, and simple proteins (eggs, beans or meat) for a healthy jump start!

Doc, do I need to stop...?

How much is too much? Well, it depends. Are we talking about alcohol? Tobacco? Cigars? Sweets? The occasional recreational pot use? (For the record, if it’s illegal or tobacco, I think any amount is too much!) There are many definitions of substance abuse, but I have a favorite one that a wise attending physician taught me during medical school. He said that when patients ask him if they need to cut back on something, he would reply, “ If I tell you that you absolutely cannot have it for the next thirty days, what would you say?”
It’s really a great gut check. If your doctor tells you no wine with dinner for the next month, and you feel an immediate panic or protest, perhaps you’ve become too dependent on that habit. Now, before everyone tells me that we believe a glass of red wine per day enhances your health, let me say that as long as you have no medical issues precluding alcohol (liver issues, medications that interact with alcohol, etc.) I happily agree! BUT, what we think is healthy is a 4 oz glass of wine. When is the last time you poured yourself only 4 oz in a lovely red wine glass? And do you stop at one?
The point of this blog entry is not at all to pick on wine at dinner, which happens to be my own favorite vice, but to point out that it’s healthy to occasionally step back and look at our indulgent habits and see if we’re becoming too dependent upon them.
BOTTOM LINE: It’s TOO MUCH if the thought of giving it up for a week produces anxiety!

Normal aging or Alzheimer's?

July 4th evokes deep emotions within Americans, as we reflect on our many freedoms in this great country. This holiday has an additional significance in our family. My mother endured Alzheimer’s for nearly twelve years, and gained her freedom from this physically and emotionally sapping disease on July 4th, 2004. While our family was deeply saddened by our loss, we were relieved that she was no longer suffering the daily frustrations inherent with severe memory loss.
Many people are fearful that they are developing Alzheimer's disease. Do you forget why you walked in a room? Can't find your keys or the tv remote? Couldn't think of an old friend's name when you ran in to them at the store? RELAX- none of these episodes are unusual for a healthy, busy adult. Typically these things happen when you are stressed and simply not paying much attention to your task at hand.
What is concerning, then? Forgetting directions to the grocery store where you always shop; missing multiple appointments because you confused times/dates; being unable make change or figure out tips (when you could before) or not being able to name common objects (like a watch or a shirt.)
If you think you are having significant memory issues, please go and see your doctor! There are many causes of memory loss that are correctable, and even if you do have early Alzheimer's disease, we have good medicines that really slow the progression of disease.
Bottom Line: Memory loss with Alzheimer's Disease can be distinguished from memory changes with normal aging; if you are concerned, go see your doctor!

Farewell, Farrah- From Charlie's Angel to our REAL HPV Angel

We all were desperate to have Farrah's hairdo, complete with gorgeous waves and "feathers". Farrah's character- JILL- (yes, I loved that!) was our icon of beauty back then. Which of us would have predicted this stunning actress's final performance would be the real story of her painful struggle and death from a not-s0 glamorous disease- anal cancer.

Ninety percent of anal cancers are thought to be caused by HPV, the human papilloma virus. Smoking is also a significant risk factor, and the highest rate of anal cancers occurs in white females and black males. HPV is transmitted via direct, skin-to-skin contact, often through intercourse. There does not need to be anal penetration to develop HPV infections (warts or cancers) in or around the anus.

The good news is that we now have a vaccine that protects against two strains of HPV that cause 70% of cervical cancers. A bonus to the vaccine is that it will help protect against other cancers also linked to HPV such as anal and penile cancers. Would Farrah still be alive and thriving if Gardasil had been available 30 years ago? Possibly. BUT, not if she chose not to get the vaccine.

BOTTOM LINE: I hope Farrah's death and her willingness to share her story despite the awkward nature of the topic and the intense personal strain will motivate her fans to vaccinate their children against HPV. In that way, Farrah Fawcett will become a REAL angel for another generation.

Disney Delerium

Wow, our summer is full speed ahead! Our girls' dance troupe was thrilled to perform at Disney World's Downtown Disney stage last week, which meant four days of park hopping craziness with half the sleep and twice the heat. I believe Disney must be not only the "happiest place on earth", but one of the most challenging family destinations.

How many families have kids who all have identical likes and dislikes when it comes to an amusement park? Usually one likes shows, another likes the characters, another ONLY wants to do the "thrill rides" that give mom vertigo, and one develops a fear of darkness and loud noises. Unless you've been lucky enough to have a parent for every child (ie., able to divide and conquer), this creates a wonderful opportunity to work on compromise. Except that everyone is tired, hot, hungry, and cranky by mid-afternoon.

My completely unsolicited advice? Be at the gates when the park opens, with fully fed (if not fully awake) kids. Cheerfully rush in with the other Disney Commandos, and you will likely be able to hit a dozen of your favorite rides in the first two hours. Do the "kid swap" where a kid that does not want to do the ride only has to stand in line with the gang, but then is allowed to wait with an adult rather than be dragged kicking and screaming (as we saw, believe it or not, on Small World) on a ride that terrifies them. Then, as the lines swell, slow down and grab food and drinks, and do the shows. If possible, take an afternoon break and go back to the hotel for a swim.

It's easy to get caught up in the desire to stay at the park because of how much you paid, but is it worth it if the kids are whiny and miserable? Enjoy it in chunks, and relax.

Bottom Line: Remember you are at amusement parks for FUN and family memories. Stay flexible, and don't force the "FUN" on a terrified kid!