Flu, Flu and Flu
Sat/Oct/09 07:26 PM
Well,the H1N1 is upon us
in East TN. I thought I would put down some information
that might give my take on the ever changing CDC
recommendations. First, this is a "novel" H1N1
Influenza A virus. It's genetic makeup resembles
viruses from the 1950's and after that they presumably
jumped in the hog population living there for 50 years
before re-emerging in this past year. Generally flu
viruses change over time and occassionally they will
have a major genetic shift. Whenever that happens any
potential immunity developed from previous years is
non-existant and larger numbers of people are prone to
getting infected. When a very different strain emerges
this is especially true. This virus and variations of
it have not been seen by folks less than 50 years old
and therefore more young people will be getting ill.
We have known that influenza is especially spread by school children and efforts to immunize them in this country have been increased in the past several years. Generally seasonal influenza is riskier for people who are infirmed, elderly or immun-compromised with healthy kids not being particularly at risk for severe disease and death. The pandemic H1N1 seems to be affecting children group more seriously. Children under 3 years (especially unter 18 months), pregnant women (who's immune system is downregulated to prevent damage to the "parasite" in the womb) and the usual high risk groups are the most likely to get severe disease and even death.
Remember that death from influenza generally is a result of overwhelming pneumonias that developed during or shortly after people contract the flu. Aggressive use of antibiotics may help but people need to understand that the fever and cough of flu are not the fever and deeper cough of pneumonia. Sometimes this is hard to distiguish. See or call your doctor for help.
Early on we thought we would be using a lot of Tamiflu as we faced this deadly strain. However, with experience the CDC has urged more prudent use of the drug. As most people in low risk catagories are not getting very ill they have suggested using the drug for those who are hospitalized, caregivers of high risk persons or housemates of high risk persons. The drug will decrease the illness by about 1/2 day and contagiousness by about 1 day. It is not a wonderdrug.
Finally what to do with immunization. First, the vaccine is safe. It is produced just like seasonal flu. If you are over 50 without high risk designation it is not recommeneded although will be used if someone insists. If you are in a high risk group it is recommended with some younger children needing a booster dose after the initial dose. In east TN where seasonal flu comes in late December through March I have suggested to my patients to try to get the H1N1 first and then get their seasonal flu shot. There is some theoretical benefit to getting the shots in that order and not the other way around. The nasal spray is live virus and you cannot take 2 nasal sprays at the same time. I would space nasal sprays by 1 month for maximum effect. The shots can theoretically be given without spacing but as I said above I would urge people to consider spacing the shots if they can. As usually call us for questions. AND WASH YOUR HANDS!
We have known that influenza is especially spread by school children and efforts to immunize them in this country have been increased in the past several years. Generally seasonal influenza is riskier for people who are infirmed, elderly or immun-compromised with healthy kids not being particularly at risk for severe disease and death. The pandemic H1N1 seems to be affecting children group more seriously. Children under 3 years (especially unter 18 months), pregnant women (who's immune system is downregulated to prevent damage to the "parasite" in the womb) and the usual high risk groups are the most likely to get severe disease and even death.
Remember that death from influenza generally is a result of overwhelming pneumonias that developed during or shortly after people contract the flu. Aggressive use of antibiotics may help but people need to understand that the fever and cough of flu are not the fever and deeper cough of pneumonia. Sometimes this is hard to distiguish. See or call your doctor for help.
Early on we thought we would be using a lot of Tamiflu as we faced this deadly strain. However, with experience the CDC has urged more prudent use of the drug. As most people in low risk catagories are not getting very ill they have suggested using the drug for those who are hospitalized, caregivers of high risk persons or housemates of high risk persons. The drug will decrease the illness by about 1/2 day and contagiousness by about 1 day. It is not a wonderdrug.
Finally what to do with immunization. First, the vaccine is safe. It is produced just like seasonal flu. If you are over 50 without high risk designation it is not recommeneded although will be used if someone insists. If you are in a high risk group it is recommended with some younger children needing a booster dose after the initial dose. In east TN where seasonal flu comes in late December through March I have suggested to my patients to try to get the H1N1 first and then get their seasonal flu shot. There is some theoretical benefit to getting the shots in that order and not the other way around. The nasal spray is live virus and you cannot take 2 nasal sprays at the same time. I would space nasal sprays by 1 month for maximum effect. The shots can theoretically be given without spacing but as I said above I would urge people to consider spacing the shots if they can. As usually call us for questions. AND WASH YOUR HANDS!
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Faith and courage
Thu/Apr/09 11:27 PM
I have not had the time
or creative energy to do much writing of any sort
lately. Winter does that for a doctor. There is lots of
illness and work to be done but the days are short and
by the time the day is over you have darkness. It's
natural to start to feel down or deflated. My ability
to be self-centered is boundless but at times God pulls
me back to reality by showing me a glimpse of what he
intends for us to experience as we walk in relationship
with Him.
Last fall one of my brother's daughters was found to have a rare cancer in her abdomen. After a time of rapid evaluation and second opinions half way across the country, she was started on chemotherapy prior to what was possibly going to be a horrific surgery to try to save her life. The chemo and complications of it meant that her senior year in high school was to be very different that what she had thought it would be. A great athlete, she would have her basketball season cut short and her soccer season ended before one game.
Through it all she had a peace and faith that God was in charge and would use this event, awful as it seemed, to bring about great things. An outsider might say this was just innocence of youth or delusions of an old religion. That outsider would be wrong. Through her fight and her testimony she has touched literally thousands of people in her state and the love poured back on her and her family has been nothing short of astounding.
The day came last week for surgery and we all knew that this story was no longer one of cancer but of courage and great faith. When the surgeon opened her abdomen no new sites were found and those that had been there had been killed by the chemo. Now just a week after surgery she is eating some, walking and has been told she is cancer-free. Now this is all good stuff and worthy of great praise to God for His kindness and healing but my view was seeing a young woman, her family and her faith community coming together with love and support. As a result all who came into contact with them were blessed. To me that was the purpose and that was the miracle.
As a doctor I see the ravages of cancer but I also have seen how disease, especially cancer, can transform patients, families and communities. I have been blessed to witness such a transformation through my niece. Thank you Katie. Praise to our Great Father.
Last fall one of my brother's daughters was found to have a rare cancer in her abdomen. After a time of rapid evaluation and second opinions half way across the country, she was started on chemotherapy prior to what was possibly going to be a horrific surgery to try to save her life. The chemo and complications of it meant that her senior year in high school was to be very different that what she had thought it would be. A great athlete, she would have her basketball season cut short and her soccer season ended before one game.
Through it all she had a peace and faith that God was in charge and would use this event, awful as it seemed, to bring about great things. An outsider might say this was just innocence of youth or delusions of an old religion. That outsider would be wrong. Through her fight and her testimony she has touched literally thousands of people in her state and the love poured back on her and her family has been nothing short of astounding.
The day came last week for surgery and we all knew that this story was no longer one of cancer but of courage and great faith. When the surgeon opened her abdomen no new sites were found and those that had been there had been killed by the chemo. Now just a week after surgery she is eating some, walking and has been told she is cancer-free. Now this is all good stuff and worthy of great praise to God for His kindness and healing but my view was seeing a young woman, her family and her faith community coming together with love and support. As a result all who came into contact with them were blessed. To me that was the purpose and that was the miracle.
As a doctor I see the ravages of cancer but I also have seen how disease, especially cancer, can transform patients, families and communities. I have been blessed to witness such a transformation through my niece. Thank you Katie. Praise to our Great Father.
No, Not Everyone
Fri/Nov/08 08:18 PM
Our church had a recent
revival and I am still processing what was changed in
me. Revival assumes something was previously alive and
then has been re-energized. This primarily then, is a
term for Christians as opposed to a crusade for
evangelism.
The first night's speaker gave me two kernels for thought and hopefully songs that I will attempt to flesh out here. First was the idea that we have the DNA, the finger prints so to speak, of our Father IF we indeed are Christians. He used the text where Christ says that not all who call Him "Lord" when standing at the brink of heaven or hell will be welcomed by Him into paradise. This is a disturbing passage. Those who rely on their own works (the texts says casting out demons, prophecy, healing and the like) are not the criteria upon which God's decision will rest. Rather it will be the act of Christ's death only that will be used to credit righteousness for us.
Those who are His will be unmistakable to Him. We have the DNA of the Holy Spirit residing within us. Our way of talking, acting, living all should be identifiable as from His family. Just as earthly children come to act like and resemble others in their families, we too should have a family resemblance. It is too true that I often must appear to the world as not from the family by the choices I make and the way I act.
The second thought was "No, not everyone". Meaning that not all who think they are Christians will actually be saved. This is the scary part as one starts to question "what about me?" The passage paints a picture of humans pleading their case somewhat indignantly when told "I do not know you". How then are we to be comforted? By the Comforter who dwells within us. The Holy Spirit will confirm to those in whom He resides that their salvation is sure and real. He was sent to teach, to comfort and to make manifest in us the new DNA we possess when we are saved.
That's a lot to chew on for one sermon!
The first night's speaker gave me two kernels for thought and hopefully songs that I will attempt to flesh out here. First was the idea that we have the DNA, the finger prints so to speak, of our Father IF we indeed are Christians. He used the text where Christ says that not all who call Him "Lord" when standing at the brink of heaven or hell will be welcomed by Him into paradise. This is a disturbing passage. Those who rely on their own works (the texts says casting out demons, prophecy, healing and the like) are not the criteria upon which God's decision will rest. Rather it will be the act of Christ's death only that will be used to credit righteousness for us.
Those who are His will be unmistakable to Him. We have the DNA of the Holy Spirit residing within us. Our way of talking, acting, living all should be identifiable as from His family. Just as earthly children come to act like and resemble others in their families, we too should have a family resemblance. It is too true that I often must appear to the world as not from the family by the choices I make and the way I act.
The second thought was "No, not everyone". Meaning that not all who think they are Christians will actually be saved. This is the scary part as one starts to question "what about me?" The passage paints a picture of humans pleading their case somewhat indignantly when told "I do not know you". How then are we to be comforted? By the Comforter who dwells within us. The Holy Spirit will confirm to those in whom He resides that their salvation is sure and real. He was sent to teach, to comfort and to make manifest in us the new DNA we possess when we are saved.
That's a lot to chew on for one sermon!
Grace
Sun/Sep/08 10:02 PM
Today in Sunday School we
were discussing the concept of grace. Unmerited favor
is the way I have always thought of grace. In the
Christian world view this would mean that nothing
within me should have caused the God of the universe to
carry out a plan to remove the blood-guilt that my sin
demands. God’s act of grace starts and ends in the will
and action of God alone. I am the unworthy recipient.
Ah, but I must both see my need, confess my inability to save myself and then accept the grace that is given me by the act of Christ dying in my place. There’s the rub.
Accepting grace and then understanding that it was all sufficient and freeing is not easy. Grace frees us from the slavery to sin under which we lived and places us in a righteous (here I would say blameless or sinless) position free to live fully the way God intended. The problem is the way we think about it as humans.
I tend to look back or regret my sin....to wallow in my guilt. This is almost like a slave once freed who has no idea how to live free. I have patients who have a complaint and after an exhaustive work-up are told, “good news, there is nothing dangerously wrong with your body”, who seem unhappy with the news! Moreover many go from doctor to doctor trying to find something wrong rather than embracing their health and living. Too often I see myself in that pattern. Bound up by guilt of past sin or of future sin afraid to seize the joy that grace has given to me.
In the Screwtape Letters, C.S. Lewis outlines how Satan desires to keep humans focused on the past (regrets) or the future (fear) rather than living fully free in the present. He says that the present is the closest thing to the “eternal now” of heaven and if humans fully embraced the present as God intends our eternal nature would recognize its joy and Satan would lose his grip on our lives. Embracing grace would seem to be the first step. If you are a Christian saved by the death and resurrection of Christ then you indeed have received a clean bill of health.
Ah, but I must both see my need, confess my inability to save myself and then accept the grace that is given me by the act of Christ dying in my place. There’s the rub.
Accepting grace and then understanding that it was all sufficient and freeing is not easy. Grace frees us from the slavery to sin under which we lived and places us in a righteous (here I would say blameless or sinless) position free to live fully the way God intended. The problem is the way we think about it as humans.
I tend to look back or regret my sin....to wallow in my guilt. This is almost like a slave once freed who has no idea how to live free. I have patients who have a complaint and after an exhaustive work-up are told, “good news, there is nothing dangerously wrong with your body”, who seem unhappy with the news! Moreover many go from doctor to doctor trying to find something wrong rather than embracing their health and living. Too often I see myself in that pattern. Bound up by guilt of past sin or of future sin afraid to seize the joy that grace has given to me.
In the Screwtape Letters, C.S. Lewis outlines how Satan desires to keep humans focused on the past (regrets) or the future (fear) rather than living fully free in the present. He says that the present is the closest thing to the “eternal now” of heaven and if humans fully embraced the present as God intends our eternal nature would recognize its joy and Satan would lose his grip on our lives. Embracing grace would seem to be the first step. If you are a Christian saved by the death and resurrection of Christ then you indeed have received a clean bill of health.
Vitamin D
Sun/Sep/08 09:51 PM
I know that I have
written about Vitamin D before but I have got to do so
again, albeit briefly. When the research on Vitamin D
deficiency’s link with depression was published a
couple of years ago I became curious about what I had
read. Then consistent research linked low levels of
vitamin D with not only depression but increased cancer
risk and, certainly, poor bone deposition. I started to
test patients, especially those who were elderly or at
risk of osteoporosis fractures or the ones that were
depressed. Gradually I began to test more patients in
my practice. The results have been astounding. Like
most silent epidemics, vitamin D deficiency is easy to
find when you are first testing in a population. The
prevalence is high and the yield of testing is also
high. I was not prepared for 8 of 10 tests to return
under the levels thought to be needed for good bone
health. That’s correct...80%. Both men and women are
testing low and largely middle aged to elderly. Those
who get little sunlight and little supplemented dairy
products are the largest group.
With supplementation I have seen levels rise to acceptable and those patients will be able to use OTC supplementation thereafter....we hope. The question will be “Is there a clinically relevant benefit to raising these levels? Given the associations with cancer and depression and osteoporosis one would hope so. Time will tell. More later.
With supplementation I have seen levels rise to acceptable and those patients will be able to use OTC supplementation thereafter....we hope. The question will be “Is there a clinically relevant benefit to raising these levels? Given the associations with cancer and depression and osteoporosis one would hope so. Time will tell. More later.
Olympics
Sun/Aug/08 11:55 PM
Of course I have been
watching the Olympics this past week....who could not.
The drama of sport at high levels is reality TV cubed.
I enjoy the races of all types. It seems a great way to
test your competitor. I’ll race you to the tree. Just
the type of race we all had when we were little. I like
but get frustrated with the judged competitions as it
seems there is way too much subjectivity. I do like the
stories and pictures of sportsman/womanship. The Games
seem to always bring some type of special stories out.
But I still don’t get Greko-Roman Wrestling. I will be
back from the summer hiatus soon and hope to have some
changes to put on the site.
Kids and Statins
Mon/Jul/08 09:31 PM
OK, so those of you who
know me already know where this is going. Today the
American Academy of Pediatrics released and expert
panel statement recommending more aggressive screening
of cholesterol in kids AND selective use of statin
drugs in kids as young as 8 years old AND a move away
from whole milk in children after the age of 12 months
especially if they are overweight. The first is in an
effort to identify those with risk of heart disease who
may benefit from intervention. The second is based on
some small studies that did not show harm if children
used the meds for a short term (long term followup does
not exist yet). The last is a major deviation from long
held belief that for younger kids a certain amount of
fat in the diet is crucial for brain development.
My take is mixed: Obesity in children is rampant in America. The causes are not that complex. We eat too many calories, too many calories as rapidly absorbed sugars and too little good protein and fiber. Parents eat poorly so their children follow suit. We have used sweet sports drinks to satiate our kids growing sweet teeth and as a society we “do exercise” rather that “live active”. Our schools and social institutions feed our kids poorly and cheaply and exercise them rarely. Our kids sleep too little (which in the < 8 year old crowd has been linked with obesity.
As health professionals we have also failed. We reach for pills because we don’t want/cannot spend time with patients trying to educate and change lifestyles. We have not been out front in advocating for healthy local school food and against corporate takeover of the lunchroom. We have reached for pills to correct ignorance or sloth from parents who seem not to understand that they are killing their kids and we have gone away from common sense approaches.
Medicine has not lead the way in nutrution even for the youngest amoung us (unless they have an illness). Did you know that nearly 1/3 of our baby boys in some surveys are drinking SOY forumla. At the same time we promote soy as a phytoestrogen to help with the sympotms of menopause. THINK ABOUT THOSE TWO STATEMENTS. Although obesity < 2 years of age has not been as strongly linked to adult obesity as in kids 3-8 we now seem poised to recommend against fats that nearly all science says may be cruicial for brain development in a toddler. (Oh, well, there’s always Ritalin for the consequences).
If you think that the pharmaceutical industry is not licking its lips anticipating a new group of “patients” who will take meds FOR LIFE you are kidding yourselves. Doctors will not want to be “behind the times” and will start screening (not a bad thing) and given meds. My experience over the years especially when I was teaching was that given a choice between educating and prescribing a medication, the Rx always won. Just look how quickly marginally effective drugs spread through our society. So do not be decieved, these recommendations will largely increase testing costs, prescriptions to younger kids and side effects from those meds.
My suggestions? Work on the parents with new kids. Obese parents who eat poorly and do not exercise may wish their children were fit and active but, in my experience, the children quickly adopt the parent’s livestyle. We must as a nation make obesity as high a priority as smoking. Sugars must become public enemy number one with high fructose corn syrup becoming our number one bad guy. We need to have health care integrate nutrition and exercise eduation for children. We need to insist on good independent sources of research on nutrition rather than relying of data compiled by manufactuers of medications. We need to see that consuming is not healthy when it comes to medications and that the hard road of personal discipline and long term view is far better for society than the short term gratification of our taste buds. We need to put patients back on the hot seat as active in their own health. We need to do it now.
My take is mixed: Obesity in children is rampant in America. The causes are not that complex. We eat too many calories, too many calories as rapidly absorbed sugars and too little good protein and fiber. Parents eat poorly so their children follow suit. We have used sweet sports drinks to satiate our kids growing sweet teeth and as a society we “do exercise” rather that “live active”. Our schools and social institutions feed our kids poorly and cheaply and exercise them rarely. Our kids sleep too little (which in the < 8 year old crowd has been linked with obesity.
As health professionals we have also failed. We reach for pills because we don’t want/cannot spend time with patients trying to educate and change lifestyles. We have not been out front in advocating for healthy local school food and against corporate takeover of the lunchroom. We have reached for pills to correct ignorance or sloth from parents who seem not to understand that they are killing their kids and we have gone away from common sense approaches.
Medicine has not lead the way in nutrution even for the youngest amoung us (unless they have an illness). Did you know that nearly 1/3 of our baby boys in some surveys are drinking SOY forumla. At the same time we promote soy as a phytoestrogen to help with the sympotms of menopause. THINK ABOUT THOSE TWO STATEMENTS. Although obesity < 2 years of age has not been as strongly linked to adult obesity as in kids 3-8 we now seem poised to recommend against fats that nearly all science says may be cruicial for brain development in a toddler. (Oh, well, there’s always Ritalin for the consequences).
If you think that the pharmaceutical industry is not licking its lips anticipating a new group of “patients” who will take meds FOR LIFE you are kidding yourselves. Doctors will not want to be “behind the times” and will start screening (not a bad thing) and given meds. My experience over the years especially when I was teaching was that given a choice between educating and prescribing a medication, the Rx always won. Just look how quickly marginally effective drugs spread through our society. So do not be decieved, these recommendations will largely increase testing costs, prescriptions to younger kids and side effects from those meds.
My suggestions? Work on the parents with new kids. Obese parents who eat poorly and do not exercise may wish their children were fit and active but, in my experience, the children quickly adopt the parent’s livestyle. We must as a nation make obesity as high a priority as smoking. Sugars must become public enemy number one with high fructose corn syrup becoming our number one bad guy. We need to have health care integrate nutrition and exercise eduation for children. We need to insist on good independent sources of research on nutrition rather than relying of data compiled by manufactuers of medications. We need to see that consuming is not healthy when it comes to medications and that the hard road of personal discipline and long term view is far better for society than the short term gratification of our taste buds. We need to put patients back on the hot seat as active in their own health. We need to do it now.
BFF
Mon/Jun/08 10:04 PM
The other great thing
about cyberspace is the fact that folks can find you
drifing out there. Recently I had a dear friend from
years ago contact me because they found my website.
This was amazing in and of itself as we have had <
5000 visits in the past year! Anyway I was found and
then contacted. I am so greatful that they took the
effort to connect. The other thing I have learned is
that certain things are eternal. I am sure that the
eternal part of each of us recognizes the eternal part
in our close friends. How else can it be that after
decades you can pick up almost without a pause? It
seems that certain types of human interaction just
trancend (or may suspend) time. Thanks for reachiing
out when you did. I have not had much to blog about
with a busy summer schedule and I try to avoid politics
other than bashing the
pharmaceutical/medical/industrial complex. There have
been some studies out recently that I am digesting and
trying to put into words to get out here. I am also
going to look at a podcast (because those of you who
know me know I can talk and talk and talk). Catch the
poem in the verses page look at some friendship
lines.
Forum on Hold
Mon/Jun/08 10:02 PM
OK so maybe it was not
such a good idea. I certainly don’t LIVE to sit at the
computer typing and trying to intice “friends” to
cyberchat. The forum will go into hybernation for now.
I still would like have ideas on how to develop a more
interactive site. I really would like to “ask the doc”
for both patients and others visiting the site but the
forum was not working and I don’t want to look at the
site with in on any more. The king is dead. Long live
the king.
Flippin Out
Mon/Jun/08 09:54 PM
If you check out
the last page on the site
you will find a video
of a trip I recently took with some friends and
family. The amazing thing is the camera on which the
video was shot. The Flip Mino is a new small video
camera that is about the size of my very small cell
phon. It looks a lot like a blak iPod with a lens on
one side. The back has a large red button around
which are four directional toggles and above which
are 2 selection buttons. The form is much like and
MP3 player and is very intuitive. There is a built
in microphone and electronic zoom and a 1.5 inch LED
screen in the back to watch what is being shot and
to review the video clips. Much like a digital
camera, you can trash the clip if you don’t like
them. It can record up to 1 hour of video/audio. Now
here it the kicker, it has a built in USB male port
that pops out at the push of a button alowing you to
link and download to a Mac or PC without much fuss.
If you want to use Quicktime or other players it is
pretty straight forward. And you can dump into movie
software. Thus the first effort you see posted. This
will be great for web video work. I’m just learning
the ropes and will let the kids take it on a trip to
North Dakota in July to shoot more footage. I love
the fact that you can be creative with minimal
investment.