Thursday, July 30, 2009

FLU - H1N5, H1N7 & H1N1 Swine Flu (from BBC)

When to Seek Emergency Medical Care

Get medical care right away if the sick person at home:
FLU!
* has difficulty breathing or chest pain
* has purple or blue discoloration of the lips
* is vomiting and unable to keep liquids down
* has signs of dehydration such as dizziness when standing, absence of urination, or in infants, a lack of tears when they cry
* has seizures (for example, uncontrolled convulsions)
* is less responsive than normal or becomes confused

COUGHS COLDS AND FLU!

Swine flu has spread across the world since emerging in Mexico and is now officially the first flu pandemic for 40 years. Experts fear millions of people will be infected.

What is swine flu and what are the symptoms?

SWINE FLU SYMPTOMS
Human body with internal organs
Typical symptoms: sudden fever (38C or above) and sudden cough
1. Other symptoms include: Tiredness and chills
2. Headache, sore throat, runny nose and sneezing
3. Stomach upset, loss of appetite, diarrhoea
4. Aching muscles, limb or joint pain
Source: NHS

Swine flu is a respiratory disease, caused by a strain of the influenza type A virus known as H1N1.

H1N1 is the same strain which causes seasonal outbreaks of flu in humans on a regular basis.

But this latest version of H1N1 is different: it contains genetic material that is typically found in strains of the virus that affect humans, birds and swine.

Although the strain may have originated in pigs, it is now a wholly human disease.

It can be spread from person to person by coughing and sneezing.

Symptoms of swine flu in humans appear to be similar to those produced by standard, seasonal flu.

A fever - which is a temperature of 38ºC (100.4ºF) - is the key symptom, combined with other complaints which may include a cough, sore throat, body aches, chills and aching limbs. Some people with the virus have also reported nausea and diarrhoea.

As with normal flu, the severity of symptoms will depend on treatment and the individual. Many people have only suffered mildly and have begun to recover within a week.

People are most infectious soon after they develop symptoms, but they cease to be a risk once those symptoms have disappeared. The incubation period may be as little as two days.

Apparently healthy people are dying from the virus. Does that means it is getting worse?

Experts say this does not change anything, and that if anything it is surprising that it has taken this long in the UK for someone without underlying health problems to die.

THE AT RISK GROUPS
People with lung disease
People with heart disease
People with kidney disease
People with diabetes
Those with immunosuppression problems either because of treatment or disease
Patients who have had drug treatment for asthma
Pregnant women
Children under five

Apparently healthy people can die of any flu-related virus if it causes complications such as pneumonia so these latest deaths do not give any extra cause for concern.

Indeed, so far, many people who have developed symptoms of infection have not needed drugs to make a full recovery, according to the WHO.

Flu expert Professor Peter Openshaw, of Imperial College London, says about one in every three people who become infected will not realise they have had swine flu because they will have had no or only very few symptoms.

"About 98% of people who get infected will recover fully without any hospital treatment so I think the public needs to be reassured."

The real fear is that the strain will mutate and become more virulent which would pose a greater threat. This has been the feature of previous flu pandemics.

But this has not yet happened - and in any event it is worth remembering that seasonal flu often poses a serious threat to public health - each year it kills 250,000 - 500,000 around the world.

Avian Flu


Why are younger people more affected by H1N1 / Swine Flu?

In the UK the infection has been found to affect younger people more due to it spreading quickly in schools where there is a lot of mixing and where infections can quickly spread. This is not unusual and children are known to be important in the spread of flu. It is thought that older age groups may have some immunity as they have been exposed to previous H1N1 viruses.

Why has the UK been more affected than other countries?

The UK has a comprehensive flu surveillance system, hence more cases may be identified in the UK than in other countries with less comprehensive monitoring services.

Also, the spread of the infection in the early stages was linked to flights out of Mexico. With Mexico being a popular tourist destination for British tourists, Britain was one of the first countries alongside America and Canada to start seeing cases.

As the UK was affected earlier than some other countries the infection has spread to a higher number of people.

What should I do if I think I have it?

Anyone with flu-like symptoms who suspects they might have the swine flu virus are being advised to stay at home and contact the National Flu Service on 0800 1 513 100 or via the internet at www.direct.gov.uk/pandemicflu

The service allows sufferers to get access to anti-flu drugs without the need to consult a GP.

However, those with underlying health conditions, the under ones and pregnant women are still being advised to contact a doctor.

The GP route is also open to anyone who does not want to use the service.

In the initial phase of the outbreak, lab testing was done to diagnose the flu but this is no longer happening routinely.

How is it treated?

Two drugs commonly used to treat flu, Tamiflu and Relenza, are effective at treating infection, reducing the length of the illness and cutting the chances that people will have serious complications.

Use of these drugs may also make it less likely that infected people will pass the virus on to others.

However, the drugs must be administered at an early stage to be effective.

The UK government already has a stockpile of Tamiflu, ordered as a precaution against a pandemic.

However, there is concern that if too many people start taking anti-virals as a precaution, it could raise the risk of the virus developing resistance, reducing the drugs' effectiveness. There is however no evidence at present that this is happening.

In any event there is little point taking these drugs as a precaution as each tablet only provides a day's worth of cover. Given that the virus may be with us for many months - or indeed years - taking a regular pill is ill-advised as the long-term side effects are not known.

The drugs can have side-effects, most commonly nausea and vomiting.

What measures then can I take to prevent infection?

As yet there is no vaccine, but manufacturers are trying to develop one. Good progress is being made and the first doses may be available in the UK by August. However the NHS says it may be next year before everyone can be immunised.

FLU PANDEMICS

1918: The Spanish flu pandemic remains the most devastating outbreak of modern times. Caused by a form of the H1N1 strain of flu, it is estimated that up to 40% of the world's population were infected, and more than 50 million people died, with young adults particularly badly affected

1957: Asian flu killed two million people. Caused by a human form of the virus, H2N2, combining with a mutated strain found in wild ducks. The impact of the pandemic was minimised by rapid action by health authorities, who identified the virus, and made vaccine available speedily. The elderly were particularly vulnerable

1968: An outbreak first detected in Hong Kong, and caused by a strain known as H3N2, killed up to one million people globally, with those over 65 most likely to die

Older people and those under 16 - as well as health workers and those with existing clinical conditions - will be given priority.

It is hoped that even if the virus mutates in coming months, the vaccine would still confer a high degree of protection against related strains.

In the meantime, avoid close contact with people who appear unwell and who have fever and cough.

General infection control practices and good hygiene can help to reduce transmission of all viruses, including the human swine influenza.

This includes covering your nose and mouth when coughing or sneezing, using a tissue when possible and disposing of it promptly.

It is also important to wash your hands frequently with soap and water to reduce the spread of the virus from your hands to face or to other people, and cleaning hard surfaces like door handles frequently using a normal cleaning product.

In Mexico masks have been handed out to the general public, but experts are sceptical about how useful this is.

Some suggest it may even be counterproductive.

What is the advice for pregnant women?

The Department of Health has clarified its advice on how expectant mothers should protect themselves following a series of apparently mixed messages.

Concerns were heightened after a woman with swine flu died last week shortly after giving birth prematurely.

Pregnant women are among the groups at increased risk from swine flu. It is important that they follow the advice about hand hygiene.

They may also want to avoid very crowded places and unnecessary travel, but experts stressed people should use their own judgement and should carry on with their daily lives.

Where can I get further advice?

Further information and advice on swine flu can be found at websites of leading health and research organisations around the world. The World Health Organisation gives background information on the virus.

The UK's government services website is carrying regularly updated health and travel information. The Health Protection Agency advises the public about what to do if returning from an affected area. NHS Choices outlines how swine flu is different from other flu.

The European Centre for Disease Prevention and Control is another good source of information.

The US government's Centers for Disease Control and Prevention is counting the number of cases in the US.

You can also track spread of swine flu reports using unofficial sources. Google is mapping search term data as an indicator of flu activity both across the US down to state level and in Mexico. Healthmaps maps viruses using news reports. Social media guide Mashable lists a range of ways to track the virus .

Information and links to useful websites are being shared on Twitter, the micro-blogging service, while social networking website Facebook is tracking swine flu discussion amongst users.

Further questions from our readers have been answered by a UK-based expert.

And the BBC's medical correspondent, Fergus Walsh, is filing regular entries on his blog on H1N1.

HOW SWINE FLU OUTBREAK EMERGED

Flu viruses in different species
Flu viruses mutate over time causing small changes to proteins on their surface called antigens. If the immune system has met a particular strain of the virus before, it is likely to have some immunity; but if the antigens are new to the immune system, it will be weakened.
Radio 4 BBC Swine Flu Broadcasted: April 30, 2009

HRT revisited



With all the new talk and research about hormone replacement therapy and menopause we offer this COMMERCIAL post, as well as a link to the last posting. Using every resource and the expert advice of your MD offers every woman opportunities for empowerment and control. Talk with professionals, review the options and then decide what feels appropriate and healthy for you. As always, be critical and seek medical information and evaluation from professionals.


Thursday, July 9, 2009

RELAX ~ don't say it .......


Do It several times a day
  • Sit upright with your hands clasped behind your head.

Gently pull your elbows back as far as you can hold them in position

ANGER AND STRESS (& sex) USE THE SAME AUTONOMIC NERVOUS SYSTEM PATHWAYS. Pay attention to your body! So that you can always be in control.

  • Eat little and often – learn to watch and pay attention to what your body is saying. Even fill in a ‘body clock’ to chart mood and physicality.
  • Smoking is supposed to calm the nerves, but researchers have found evidence that it might have the opposite effect.
  • The body will have a transition at roughly 4:00am and 4:00pm – learn to nurture at those times.
  • Remember that most people have panic/anxiety attacks when they are NOT stressed and when the crisis is over.
  • Each day stop and breathe several times. In breathe to the count of five (tensing your whole body gradually - finishing with tensing your shoulders) and then as you exhale to the count of five let your body relax down and outwards towards the tips of the fingers and toes.
  • If you think you have a task that is worrisome -- work out the steps beforehand. Then you are “chunking" it into manageable proportions that are not as stressful.
  • If you feel like you are going to stress out.... stop, shut everything down, breath and stretch, put your hands behind your head.... then think about what you want to do and go back to it.
  • Remember; work at a task in manageable 'bites' of around twenty minutes. Then stop, do something else or look up and away from the task, before returning. This means that you are rolling WITH your attention and learning curve instead of getting stuck on the plateau.
  • When your mind wanders to something that provokes anxiety – write it down and then defer dealing with it until a specific time later in the day. Write a short phrase – not a journal! Normally come back to your short list at a time when you are distracted, for example watching television, and can look at the issues without stressing out. Do not try for solutions - let your mind percolate naturally and with a night's rest you will find things easier the next day.
  • Don't stress about sleep - rest can be enough. Let your body do the 'talking'.
  • Describe your physical sensations both to yourself and to someone who is trying to help. Feeling anxious or panicked is about the body not the mind. So validate the sensations and that means that the feelings of helplessness and hopelessness are lessened by treating this as something that will eventually be managed.
  • Eat something carbohydrate at 4:00pm with some liquid - even when you are off work
  • put hands behind head in a basket to disable chest wall muscles and calm down anxiety - several times a day. Simple chair stretching helps.
  • Change task every twenty or thirty minutes - this can mean just stop and look up and straighten your back but preferably do the hands as a basket exercise.
  • Try not to drink cold milk after 6:00pm. Warm milk releases tryptophan which is a natural ‘de-compressant’.
  • think of " anxiety " as physiological stress not paranoia/ in your head
  • at night take a shower and then stretch in the shower
  • Clench your body and breathe in to the count of five, then hold for one and breathe out for the count of five relaxing the muscles out towards your finger tips and toes. Do this several times a day.
  • SING in the car to music
  • Each night have ten minutes quiet time and DOODLE - teach the kids to do this too.... - take a half hour to unwind some time in the evening.
  • MINDFULNESS:

Anxiety normally starts to peak about half an hour after you get up. Anticipate it by doing some simple breathing exercises.

Mindfulness is about being in the 'now': being present in this body, at this time, doing this thing. It has a quiet, unassuming and unobtrusive nature. It is also non-judgmental and not characterized by emotional reactions. It is often linked with compassion1.

The simplest form of mindfulness, which can be practiced very easily without anyone noticing, is to focus on the breath for three inhalations and exhalations. Some people do this hourly. It involves taking in a deliberate breath and noticing the quality of the air as it enters the body through the nostrils and making its way to the lungs. Then, when exhaling, you focus on the air as it leaves your body.

It's worth taking a look at the way you breathe. Most people breathe quite shallowly, using only the top part of their lungs. For the purposes of mindfulness breathing, you should use the whole of your capacity. This means inflating the bottom part first, which can be done by allowing your belly to swell (a bit like a balloon). Next, fill the mid-section by expanding your ribs sideways. Finally fill the top part of your lungs.

If you are sitting down, you can augment this by noticing the feel of the chair underneath your buttocks and the ground on your feet.

This practice will bring you back to the present moment and is very grounding.

How to Win an argument – even if it is only in yourself!

Stop - Think - Act - Reflect!!!

Creating Your Rebuttal Voice

After making a commitment, the next hardest task facing you is to develop effective rebuttals to your self‑statements. It will help greatly to imagine a person as your rebuttal voice‑someone else who can stand up to your pathological critic when you're down. This person becomes the champion of your cause, your advisor, your teacher or coach. Here are some suggestions.

Healthy Coach. If you are athletically inclined, you might like the idea of a healthy coach. This is the person of experience who is committed to helping you win. He or she gives you pointers and pep talks, sets up a regimen of healthy things to do each day, and keeps you fit and motivated.

Accepting Friend. This is a friend who has known you for years and accepts all your quirks and failings. There's nothing you can't say to this friend and nothing your friend says can hurt you. This friend is totally on your side, ready with understanding, and able to remind you of your good points when you forget them yourself.

Assertive Agent. Picture a Hollywood or Broadway agent who is totally dedicated to you. He or she is out there shouting your praises from dawn to dark. Your agent thinks that you're the greatest, you can do anything, you're going right to the top, you can't fail. Your agent is a shoulder to cry on, a reservoir of confidence.

Rational Teacher. This is the stern but kindly, rational but warm teacher who lives only so that you may learn. He or she points out opportunities to learn and grow. Your teacher's comments are always factual and insightful, enlightening you and showing you how the world works and how you work in it.

Compassionate Mentor. This is an older, wiser person who has chosen to guide you in your development as a whole and healthy human being, This mentor has seen everything, lived through everything, and is an invaluable source of good advice. The chief characteristic of your mentor is a deep and abiding compassion for you and all living things. You are totally safe with your mentor.

You can choose one of these personae for your rebuttal voice or make up a voice based on somebody you know, read about, or saw in a movie. It could be a priest or rabbi, an admired movie actor, or even an alien from another galaxy‑whoever you feel safe with, whoever will help. You can even imagine an entourage of these people who go everywhere with you, speaking up to give advice and support as needed.

When you rebut your pathological critic, hear your imaginary support person speaking to you in the second person, addressing you by name: "No, John, you're not weird. You have a vivid imagination”

Rules for Rebuttal

But what should these rebuttal voices say? How do you refute distortions like mind reading or emotional reasoning that seem so right, so unassailable?

In composing an effective rebuttal to a distorted self‑statement, there are four rules to take into consideration.

1. Rebuttals must be strong. Imagine your rebuttals spoken in a loud, forceful voice. If you invent a coach or trainer or mentor to be your rebuttal voice, make that person strong and forceful. Your pathological critic is powerful, with years of experience in delivering devastating messages to you. You need to counter with equal or greater force. Try beginning your rebuttals with a loud mental exclamation that will shock your critic into silence: "NO!" or "SHUT UP!" or "LIAR!". You might even do something physical to interrupt your negative train of thought‑snap your fingers or pinch yourself.

2. Rebuttals must be nonjudgmental This means that if you have been indulging in global labeling, all those pejorative adjectives and adverbs‑"awful, disgusting, horrible"‑have got to go. Get rid of notions of right and wrong. Concentrate on what is, not what should be, You are not "stupid," you merely got a C in sociology. You are not "selfish," you just wanted some time for yourself.

Being very exact in your statements, rather than exaggerating or minimizing, will help remove the judgmental quality from your self statements. You are not fat, you weight 198 pounds. Your blood pressure is not astronomical, it is 180 over 90. You are not a boob at parties, you just don't like to talk to strangers unless they speak first.

3. Rebuttals must be specific. Think in terms of specific behavior or a specific problem. If your self‑statement is "Everything I do turns out wrong," make it specific: "Only three out of the eight people I invited came to my party." Instead of saying, "Nobody will ever love me again," say, "At this moment, I am not in a relationship." You are not without friends, you have three people you can call up if you want to. Your date wasn't cold and rejecting, he just said that he was tired and wanted to make it an early night.

Constantly ask yourself, "What are the facts? What would stand up in court? What do I know for sure?" This is the only way to find mind reading and emotional reasoning. If you feel that your boss disapproves of you, examine the facts: all you really know is that he didn't say anything about the memo you sent him and that he blinks a lot when he looks a,t you. Beyond that, it's all fantasy.

4 Rebuttals must be balanced. Include the positive as well as the negative. "Five people didn't come to my party, but three people did come and had a good time." "I'm not in a relationship right now, but I have been in the past and will be in the future. " " I weigh 198 pounds, but I have a kind heart." "I'm not the best‑looking guy in my class, but I know I'll achieve something in life."

When you use these rules to compose your own rebuttals, write them out on paper using the three‑column technique‑ You will probably have a long paragraph of analysis, refutations, and positive statements to rebut each negative self‑statement. When you are finished, underline or star the parts of your rebuttal that seem the strongest. These stronger statements are the ones you should memorize and use the next time your pathological critic starts attacking you,

Tuesday, April 28, 2009

CDC GUIDELINES FOR influenza A (H1N1)





This document provides guidance ~ You cannot get Influenza H1N1 from eating pork, pork products, meat or poultry.

Influenza A (H1N1) virus infection (swine flu) can cause a wide range of symptoms, including fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. People with swine flu also can have vomiting and diarrhea. Like seasonal flu, swine flu in humans can vary in severity from mild to severe.Severe disease with pneumonia, respiratory failure and even death is possible with swine flu infection. Certain groups might be more likely to develop a severe illness from swine flu infection, such as persons with chronic medical conditions. Sometimes bacterial infections may occur at the same time as or after infection with influenza viruses and lead to pneumonias, ear infections, or sinus infections.

The following information can help you provide safer care at home for sick persons during a flu pandemic.
How Flu Spreads

The main way that influenza viruses are thought to spread is from person to person in respiratory droplets of coughs and sneezes. This can happen when droplets from a cough or sneeze of an infected person are propelled through the air and deposited on the mouth or nose of people nearby. Influenza viruses may also be spread when a person touches respiratory droplets on another person or an object and then touches their own mouth or nose (or someone else’s mouth or nose) before washing their hands.


People with influenza A (H1N1) who are cared for at home should:

* check with their health care provider about any special care they might need if they are pregnant or have a health condition such as diabetes, heart disease, asthma, or emphysema
* check with their health care provider about whether they should take antiviral medications
* stay home for 7 days after the start of illness and fever is gone
* get plenty of rest
* drink clear fluids (such as water, broth, sports drinks, electrolyte beverages for infants) to keep from being dehydrated
* cover coughs and sneezes. Clean hands with soap and water or an alcohol-based hand rub often and especially after using tissues and after coughing or sneezing into hands.
* avoid close contact with others – do not go to work or school while ill
* be watchful for emergency warning signs (see below) that might indicate you need to seek medical attention

Medications to Help Lessen Symptoms of the Flu
Check with your healthcare provider or pharmacist for correct, safe use of medications

Antiviral medications can sometimes help lessen influenza symptoms, but require a prescription. Most people do not need these antiviral drugs to fully recover from the flu. However, persons at higher risk for severe flu complications, or those with severe flu illness who require hospitalization, might benefit from antiviral medications. Antiviral medications are available for persons 1 year of age and older. Ask your healthcare provider whether you need antiviral medication.

Influenza infections can lead to or occur with bacterial infections. Therefore, some people will also need to take antibiotics. More severe or prolonged illness or illness that seems to get better, but then gets worse again may be an indication that a person has a bacterial infection. Check with your healthcare provider if you have concerns.

Warning! Do not give aspirin (acetylsalicylic acid) to children or teenagers who have the flu; this can cause a rare but serious illness called Reye’s syndrome. For more information about Reye’s syndrome, visit the National Institute of Health website at

* Check ingredient labels on over-the-counter cold and flu medications to see if they contain aspirin.
* Teenagers with the flu can take medicines without aspirin, such as acetaminophen (Tylenol®) and ibuprofen (Advil®, Motrin®, Nuprin®), to relieve symptoms.
* Children younger than 2 years of age should not be given over-the-counter cold medications without first speaking with a healthcare provider.
* The safest care for flu symptoms in children younger than 2 years of age is using a cool-mist humidifier and a suction bulb to help clear away mucus.
* Fevers and aches can be treated with acetaminophen (Tylenol®) or ibuprofen (Advil®, Motrin®, Nuprin®) or nonsteroidal anti-inflammatory drugs (NSAIDS). Examples of these kinds of medications include:

Generic Name Brand Name(s)

Acetaminophen: Tylenol®

Ibuprofen: Advil®, Motrin®, Nuprin®

Naproxen: Aleve

* Over-the-counter cold and flu medications used according to the package instructions may help lessen some symptoms such as cough and congestion. Importantly, these medications will not lessen how infectious a person is.
* Check the ingredients on the package label to see if the medication already contains acetaminophen or ibuprofen before taking additional doses of these medications—don’t double dose! Patients with kidney disease or stomach problems should check with their health care provider before taking any NSAIDS.

Check with your health care provider or pharmacist if you are taking other over-the-counter or prescription medications not related to the flu.For more information on products for treating flu symptoms, see the FDA website: http://www.fda.gov/fdac/features/2005/105_buy.html


When to Seek Emergency Medical Care

Get medical care right away if the sick person at home:

* has difficulty breathing or chest pain
* has purple or blue discoloration of the lips
* is vomiting and unable to keep liquids down
* has signs of dehydration such as dizziness when standing, absence of urination, or in infants, a lack of tears when they cry
* has seizures (for example, uncontrolled convulsions)
* is less responsive than normal or becomes confused


Monday, February 23, 2009

Dialectical Behavior Therapy revisited

With all the recessional woes and stress some of our least calm people have experienced problems with containing emotion. It might be a timely reminder that help can be available - at least in the Seattle area.

http://dbtseattle.com/ http://depts.washington.edu/brtc/ http://depts.washington.edu/brtc/sharing/publications/assessment-instruments
Harborview Mental Health Center: DBT Counseling Center
Provides Adult DBT
Phone: (206) 744-9600

William Levy MD
2519 31st Ave S
WA 98144
Levy is VERY good with stressed people and is superb at teasing out the biology from the psychology.
Phone: (206) 721-0421
or
David Lisschner MD
126 NW Canal St

Seattle, WA 98107
(206) 633-4544
solo practice, takes some insurance, slight reduced fee for students.
Relationships, mood and anxiety. Also works with the DBT Center of Seattle (www.dbtseattle.com).


http://phenomenologyexistent.blogspot.com/2007/10/reality-bites.html
http://phenomenologyexistent.blogspot.com/2008/04/alternatives-to-serious-self-harm.html

http://depts.washington.edu/brtc/clinical-services/affiliated-clinics

OTHER LOW COST resources:

UW Medical Center Outpatient Psychiatric Center, 206-598-7792
University of Washington, on Roosevelt
Provide 60-90 minute consultation and evaluation session, can provide ongoing if recommended.
Take most major insurance, no sliding scale - Need referral from therapist or health care provider.


Samaritan Center of Puget Sound, 206-527-2266
564 NE Ravenna Blvd. (main office, have several satellite offices in Seattle, over 30 therapists)
www.pcscounseling.org
Accepts insurance, sliding scale available ($35-$95), low-fee services for under $30,000 annual income. Low-Fee Clinic is separate from their sliding scale provided by approximately 10 graduate student interns and Master