Archive for the ‘Health Tips’ Category

The H1N1 flu: Will there be a second surge?

By Tyrone M. Reyes, M.D.

Many countries are bracing for a second wave of swine-flu infections that could sicken millions of people and hospitalize thousands, including many children and young adults. While flu viruses are notoriously capricious, making firm predictions impossible, a second wave could hit some countries and lead to major disruptions in schools, workplaces, and hospitals, according to international health officials. “The virus is still around and ready to explode,” said William Schaffner, a Vanderbilt University School of Medicine influenza expert.

It was in April 2009 when the news broke that a new flu had shown up in Mexico, California, and Texas. By June, the outbreak had become a pandemic, meaning it was spreading rapidly throughout the world. Though initially referred to as swine flu, the never-before-seen virus — officially called H1N1 influenza — actually contains genes from viruses that circulate in pigs, birds, and humans.

As the first flu pandemic in 41 years spread around the world, scientists found that the pandemic overall hadn’t been worse than an average seasonal flu — just more widespread. No signs have emerged that the microbe had mutated into a more dangerous form, and most infected people seem to experience relatively mild illness.

Many experts suspect the second wave, however, could be more severe than an average flu season. Because the virus is new, most people have no immunity against it. “This epidemic will transmit faster than usual, because the population is more susceptible,” said Mark Lipsitch, a Harvard School of Public Health professor of epidemiology who has been helping the US Centers for Disease Control and Prevention (CDC). “We have to be worried about our ability to handle a surge of severe cases,” he added.

Perhaps more important, the virus continues to affect children and young adults much more commonly than typical flu viruses. Most of those who developed serious illness and died had other health problems. But those include many common conditions, such as diabetes, asthma, and obesity. Pregnant women appear to be especially at risk. And the virus can cause severe illness and death in otherwise healthy people in perhaps one-third of cases.

To protect yourself against this and other potential pandemics, it’s important to arm yourself with the facts about H1N1 influenza.

What Is H1N1?

Lab testing of the virus revealed a unique combination of gene segments. The new virus looked very different from the flu viruses that normally circulate in pigs. H1N1 is what epidemiologists call a “triple-reassortment” virus because it combines genes from different flu viruses — viral strains that normally affect pigs, along with birds and human flu strains.

People, particularly those under age 65, have little or no natural immunity against a novel flu strain such as H1N1. As a result, the virus can affect large numbers of people. In addition, the virus could mutate and lead to more severe cases.

• How it spreads. H1N1 influenza spreads the same way as does a typical seasonal flu —from person to person, mainly through coughing or sneezing. The virus can also be transmitted if you touch something contaminated with it, such as a desk or phone, and then touch your mouth or nose. You can’t get H1N1 flu from eating or preparing pork or from tap water or swimming pools.

One thing different about this flu is that it has affected younger people more commonly. Last year, the majority of people who were infected were age 18 or younger. The CDC estimates that about one-third of people over age 60 may have cross-antibodies that could protect them from the illness.

• Signs and symptoms. Signs and symptoms of H1N1 influenza are similar to those of regular flu. These include fever, cough, sore throat, headache, body aches, fatigue, and runny nose. Diarrhea and vomiting occurred in about 25 percent of cases. Most people infected with the virus experience a mild to moderate illness and recover quickly without medical treatment. But the flu can also be severe and cause complications or even death.

Deaths from influenza often result from complications, such as viral or bacterial pneumonia or the worsening of a chronic condition, such as asthma or diabetes. About half the people who were hospitalized with H1N1 influenza had underlying health conditions or weak immune system. Pregnant women and very obese people seem to face a higher risk of serious illness.

How can you prevent it?

Each year, a vaccine against the expected strains of seasonal flu becomes available. The vaccine for this year’s seasonal flu won’t work against H1N1 flu. At present, however, a limited supply of H1N1 flu vaccine is already available in the Philippines. Ask your doctor about the need to have it for you or your family.

But even if you aren’t vaccinated against H1N1, you can take simple steps to prevent infection:

• Clean your hands often. Wash thoroughly with soap and warm water for at least 15 to 20 seconds, and dry your hands completely. If you don’t have access to soap and water, use an alcohol-based hand sanitizer.

• Avoid touching your nose and mouth. Also cover your nose and mouth with a tissue when you cough or sneeze, and throw the tissue away.

• Avoid close contact with people who might be sick. If flu is widespread in your community, stay away from crowded settings when possible.

It is not necessary to wear a facemask in public to avoid H1N1 flu. If you’re caring for someone with flu, you can wear a mask when in close contact. Throw the mask away as soon as you’re done, and wash your hands thoroughly.

What if you get the flu?

If you develop symptoms of influenza, follow these precautions:

• Stay home. Don’t venture out until your fever is gone for 24 hours.

• Cover your mouth and nose when coughing or sneezing. Wash your hands afterwards.

• Rest and drink plenty of fluids. Most people recover from H1N1 flu with supportive care at home, including rest, fluids, and pain relievers for aches.

• Keep your home clean with household disinfectant.

• Don’t give aspirin to children or teens. Use acetaminophen instead.

• When to seek medical care? You probably won’t be able to tell the difference between regular seasonal flu and H1N1 since symptoms are similar. Still you don’t have to contact your physician unless you develop more severe symptoms or are at high risk of flu complications. You may be at higher risk of complications if you’re pregnant, 65 years old or older, or have a weakened immune system or a chronic condition such as asthma, heart disease, obesity or diabetes.

In adults, the following warning signs require urgent medical attention: difficulty breathing or shortness of breath, pain or pressure in your chest or abdomen, sudden dizziness, fever that lasts more than three days, confusion, severe or persistent vomiting, flu symptoms that improve and then return with fever and a worse cough.

If you have a severe bout of influenza or at risk of complications, your doctor may recommend that you take an anti-viral drug such as oseltamivir (Tamiflu), to help prevent or treat the illness. This prescription drug keeps flu viruses from reproducing in your body.

Be Informed, Be Prepared

As the first pandemic of the 21st century, H1N1 influenza will likely continue to pose a threat for some time. By being well-informed, you can stay on top of this flu.

“There’s only so much that can be done to get ready,” said Eric Toner of the University of Pittsburgh’s Center for Biosecurity. “Flu, like a hurricane, is a force of nature. You can’t stop it. You can’t make it less severe than it would be otherwise. All you can do is try to be prepared to deal with the consequences.”

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For more up-to date information, please log on to www.pandemicflu.gov.

Source:Philstar.com

Can aspirin really prevent a heart attack?

By Tyrone M. Reyes, M.D.

Aspirin has long been known to relieve fever, aches, and pains. Today, it has also gained a reputation as a drug that can lower the risk of heart attack and clot-related stroke. Thousands of adult Filipinos now take a daily dose of aspirin. Yet this type of therapy isn’t right for everyone; and others who need aspirin aren’t taking it.

So, if you’re currently taking a daily aspirin, or wondering if you should, here are the latest recommendations from the experts.

How Aspirin Prevents A Heart Attack Or Stroke

Aspirin reduces the clumping action of your blood’s clotting cells (platelets), which helps keep blood flowing to your heart and brain. Platelets normally clump together, or clot, at the site of a cut or a wound. This action seals openings in the blood vessels and stops bleeding. But clots can also form within blood vessels that supply your heart and brain with blood. If these blood vessels are already narrowed from an accumulation of fatty deposits (atherosclerosis), a blood clot can quickly block an artery and cause a heart attack or ischemic stroke.

Aspirin Works Differently In Men And Women

Although early studies on aspirin therapy involved men, more recent studies have focused on women. These studies have found that there do appear some differences between the sexes when it comes to the role aspirin plays in the prevention of a first (primary) heart attack or stroke.

In the past, studies showed that among men, aspirin provided primary heart attack prevention but had mixed results when it came to reducing the risk of a first stroke. By 2005, it seemed that the same couldn’t be said for women. That year, the Women’s Health Initiative (WHI) released results from a 10-year study of 40,000 women which found that aspirin didn’t prevent first heart attacks, but it did reduce the risk of stroke.

Since then, additional information has been published on aspirin therapy. Those studies reached the same overall conclusions, as did the WHI study. It found that in women, aspirin provided prevention of a primary stroke but didn’t reduce the risk of a first heart attack. In men, aspirin provided primary heart attack prevention but didn’t reduce the risk of a primary stroke.

Should You Take A Daily Aspirin?

People should take steps to reduce their risk of heart disease and stroke. After all, these two conditions are among the top causes of death and disability in most parts of the world, including the Philippines. However, that doesn’t mean that everyone is a good candidate for daily aspirin therapy.

Much of the decision-making process depends on your risk of heart attack and stroke. Therefore, it’s important to be aware of the risks and to discuss your risk level with your doctor. Factors that increase your risk include older age, a family history of heart attack and stroke, smoking, uncontrolled high blood pressure, high cholesterol, and diabetes.

If you have a condition that increases your risk of heart attack or stroke, have multiple or uncontrolled risk factors or have had prior cardiovascular events, current guidelines recommend that you should be on daily aspirin therapy. However, it’s important not to start this therapy without consulting your doctor. The reason: Aspirin’s possible side effects.

Aspirin can cause side effects such as nausea, vomiting, heartburn, and a rash. Rarely, more serious side effects may occur, including swelling of the eyes, lips, tongue or throat, wheezing and hoarseness, a rapid heart rate and breathing, and ringing in the ears (tinnitus) or loss of hearing. Contact your doctor immediately if you experience any of these effects, or any unusual reaction to aspirin use. Other side effects, related to certain medical conditions and drug interactions, also bear watching.

Who Should Avoid It?

The occasional aspirin, or daily low-dose aspirin therapy under medical supervision, is safe for most adults, but the drug can have serious side effects in certain individuals. Aspirin is a blood thinner, so a bleeding tendency, such as hemophilia (a condition where the blood is slow to clot) is the main contraindication for its use. This also means that if you take another blood-thinning drug, such as warfarin (Coumadin), you shouldn’t take aspirin.

Aspirin may also increase the risk of stomach ulcers, so it should be avoided if you suffer from these or from gastritis (inflammation in the stomach). An allergy to aspirin is also a contraindication, though it may not be clear you have one until you take the drug. Those with asthma, chronic nasal congestion or a constantly running nose, or nasal polyps, are more likely to have an allergy, and tinnitus often is a prime indication of aspirin allergy if it begins when you start daily aspirin therapy.

What Is The Best Dose?

Lower doses of aspirin have been shown to work as well as full-strength doses in preventing heart attack and stroke. Low doses also may reduce the risk of bleeding complications. A low-dose is usually considered to be 81 milligrams (mg) or one “baby” aspirin. A full-strength dose is 325 mg, or what one regular aspirin provides. Your doctor may recommend a dose anywhere between these two amounts, depending on your needs.

Taking aspirin with a protective coat (enteric-coated) that helps it get through the stomach without being broken apart sounds like a great idea for preventing stomach irritation. But it doesn’t work. Aspirin in the bloodstream irritates the stomach just as much, and there’s some evidence that not all of the aspirin in a coated pill gets into the circulation.

If you’ve already had a heart attack or stroke or are resistant to the beneficial effects of aspirin, your doctor may suggest supplementary aspirin therapy with another clot-preventing drug, such as clopidogrel (Plavix). Clopidogrel may even be suggested as an alternative drug therapy, particularly if you’re allergic to aspirin or can’t tolerate its side effects.

If you’re currently on aspirin therapy, be aware that ibuprofen can counteract aspirin’s benefits. It’s best to take aspirin in the morning, then wait at least 30 minutes before taking ibuprofen. If that’s impossible, try to delay taking aspirin for at least eight hours after taking ibuprofen.

Important Precautions

If you’re scheduled to have surgery, tell your doctor if you take a daily aspirin — you may need to stop taking it prior to surgery to reduce your risk of bleeding. Since aspirin can exacerbate stomach ulcers, tell your doctor if you ever had one of these and also if you are prone to heartburn. He/she also needs to know if you have hemophilia, or kidney or liver disease. Avoid excessive alcohol intake (stick to one drink a day, maximum) while on daily aspirin therapy since alcohol can act as a blood thinner.

Acetaminophen (Tylenol) and ibuprofen (Advil, Alaxan, Brufen, etc.) are the main alternatives to aspirin for the purpose of reducing pain and fever. Acetaminophen is less likely to irritate the stomach but isn’t as efficient at soothing inflammation. Ibuprofen works in a similar way to aspirin, but neither it nor acetaminophen carries the same heart benefit as aspirin.

Aspirin During A Heart Attack

If you’re experiencing a heart attack, aspirin can save your life. This is true even if you’re currently taking daily aspirin therapy. Experts say it’s best to take two to four low-dose, or “baby” aspirin, or one regular- strength aspirin during a heart attack. Chewing up the aspirin is recommended because it speeds up the absorption process.

Beyond Aspirin

Aspirin lowers the chances of having a first heart attack or stroke by 25 percent, which is great, but it also means that you can’t rely on aspirin alone to protect you. If you’re really serious, there’s a lot more you can do. The combination of not smoking, maintaining a healthy diet, exercising daily, and drinking alcohol in moderation lowers the risk of having a heart attack or stroke between 50 percent and 80 percent.

As one wag said, if you plan to take aspirin every day to prevent a heart attack or stroke, take it for a long walk before you swallow it!

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References:

• Aspirin to reduce stroke risk in women. Circulation: Cardiovascular Quality and Outcomes, March 2009

• Aspirin for primary prevention. Annals of Internal Medicine, March 17, 2009

Source:Philstar.com

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