Thoughts on Swine Flu

Since the explosion of swine flu in Mexico and confirmed cases in California, Texas, New York, Ohio and Kansas, we need to take notice and calmly evaluate what we might want to do over the next few weeks as the situation evolves.

Description

Swine flu affects pigs and usually does not infect humans. This particular strain is a new one and contains genetic material from the avian flu virus as well as human inflenza. This newness presents a problem since the more unique a virus is, the less humans have been exposed to it in the past and the longer it takes to mount an effective immune response. For example, a significant outbreak of Hong Kong type A flu (designated by protein type H3N2) occurred in 1968, and I will never forget how ill it made me; however, that past infection will give me protection from future H3N2 flu appearances.

Bird or avian flu is H5N1, and this new swine flu is H1N1. The H and N are designations for specific proteins that are on the surface of the virus:




Symptoms

Many people call usual upper respiratory infections ("colds") the flu, although that is incorrect. Influenza is very different from the sniffles, mainly in how systemic symptoms predominate (fever, headache and muscle aches). It is said that this strain appears to have more gastrointestinal symptoms (vomiting and diarrhea) than the usual flu. Swine flu has a short incubation period (2-4 days) and an affected individual's contagious state will continue for several days even after the peak symptoms are over.

In Mexico, the most severely affected were people between 25 and 45 years of age, and this likely signifies that this age cohort has not been exposed to viruses that carry portions of the protein antigens that this particular virus contains. However, all of us are vulnerable.

It is also interesting to note that the 20 or so individuals affected in this country so far have manifested milder symptoms than the Mexican cases, but this is a small sample so far and things could change rapidly.

Finally, the flu shot you got this year is likely of no help at all with this strain.

What To Do

First: obtain prescriptions for either Relenza or Tamiflu so that you will have it and avoid the rush in case things get worse. Relenza is administered by inhalation (not recommended for asthmatics or those with other types of chronic lung disease) and Tamiflu is a pill. Both are administered twice a day for five days as therapy.

In areas where cases have been reported, wearing a painter's or surgeon's mask should be considered if attending an event with crowds. Wash hands after contact with people, and don't kiss hello or goodbye. If you're ill with possible flu, stay home (another good reason for filling the scrips now).


© Copyright 2009 Doctor's Weekly Commentary
May not be reproduced whole or in part without citation and/or link to this site

Those "Health" emails: What to Do if You Have a Heart Attack

Last week, my dear Cousin Cookie sent me a new “health” email, this one offering lifesaving information: how to give yourself CPR if you’re alone and having a heart attack.

A few weeks back I examined the claims made in an email about bananas, and now after reading this new one on cardiac emergencies, I realize why these "health advice" emails annoy me so much (aside from sometimes giving out dangerous advice): It’s their tone. The writers of these pseudo-informed pieces seem to say “The answers to these health-related issues are so simple; unfortunately, professionals like physicians, nurses, public health officials, drug companies, etc., aren’t going to give you this great information, so I have to.” There’s an all-knowing smugness that infiltrates these emails that compels me to look into their claims.

Here's the one Cookie sent (I had actually seen it before, but was happy she sent it now), with my comments in blue within. I have tried to maintain the colors and composition of the original email (which actually was a Power Point slide show complete with pictures, but I left them out):




Heart Attack Slide Show—Worth 45 Seconds of Your LIFE [email subject heading]



Let's say it's 6.15pm and you're driving home (alone of course) after an unusually hard day on the job.

You're really tired, and frustrated……

YOU ARE REALLY STRESSED AND UPSET ….

Okay...let's stop right here. The immediate implication is that being "stressed and upset" contributes to having a heart attack. This is the Hollywood effect--we have been taught over the years by TV and movies that psychological stress can give you a heart attack. But, we know that most people who have very severe psychological distress never get a heart attack, and while stress may contribute to some heart attacks, there is much evidence to suggest that it plays no part in the majority of their occurrences.

Most heart attacks occur in the morning, as do other cardiovascular events as seen in the slide below which came from Medscape:

However, it is thought that the higher incidence in the morning is due to the physical stresses of increased blood pressure and heart rate that occur at this time of day, rather than any emotional or psychological stress.

It is also interesting to note that there is a syndrome known as Takotsubo cardiomyopathy found mainly among depressed postmenopausal women that is associated with chest pains and symptoms of a heart attack, but is ultimately a benign condition. Okay...back to the email:

Suddenly you start experiencing severe pain in your chest that starts to radiate out into your arm and up into your jaw.


This is pretty good, but could have been better. The pain is often described as "crushing" but can also be felt as just chest "discomfort." It can radiate into your jaw, and certainly down your left arm, but need not, since chest pain alone is enough to raise a red flag.



You are only five miles from the hospital nearest your home.

Unfortunately you don't know if you'll be able to make it that far

WHAT TO DO ???

YOU HAVE BEEN TRAINED IN CPR, BUT THE GUY THAT CONDUCTED THE COURSE DID NOT TELL YOU HOW TO PERFORM IT ON YOURSELF !!!


Really? The writer knows that you were trained in CPR (when only a tiny minority of people ever receive that training). But, that dumb instructor didn't tell you how to do it to yourself! And why is that? Because it's IMPOSSIBLE, that's why.

When someone is in need of CPR (cardiopulmonary resuscitation) their heart has ceased pumping blood and their lungs have stopped inflating and deflating (i.e., they've stopped breathing). Your chest must be compressed over your heart with enough force to pump the blood out and you must inflate the lungs with a mask and bag or via mouth-to-mouth (they will deflate on their own) in order for the oxygen/carbon dioxide exchange to take place. You simply cannot do this on your own since by this time you're practically dead.


HOW TO SURVIVE A HEART ATTACK WHEN ALONE?

SINCE MANY PEOPLE ARE ALONE WHEN THEY SUFFER A HEART ATTACK, WITHOUT HELP, THE PERSON WHOSE HEART IS BEATING IMPROPERLY AND WHO BEGINS TO FEEL FAINT, HAS ONLY ABOUT 10 SECONDS LEFT BEFORE LOSING CONSCIOUS

WHAT TO DO ??
ANSWER:

DO NOT PANIC, BUT START COUGHING REPEATEDLY AND VERY VIGOROUSLY.

Do not panic is good advice, but if you think you're having a heart attack, the first thing to do is call 911! The SECOND thing you do is take a regular aspirin (NOT Tylenol or Advil, but aspirin). See here for the steps taken when a heart attack is suspected.

A DEEP BREATH SHOULD BE TAKEN BEFORE EACH COUGH, THE COUGH MUST BE DEEP AND PROLONGED, AS WHEN PRODUCING SPUTUM FROM DEEP INSIDE THE CHEST.

A BREATH AND A COUGH MUST BE REPEATED ABOUT EVERY TWO SECONDS WITHOUT LET-UP UNTIL HELP ARRIVES, OR UNTIL THE HEART IS FELT TO BE BEATING NORMALLY AGAIN.

DEEP BREATHS GET OXYGEN INTO THE LUNGS AND COUGHING MOVEMENTS SQUEEZE THE HEART AND KEEP THE BLOOD CIRCULATING. THE SQUEEZING PRESSURE ON THE HEART ALSO HELPS IT REGAIN NORMAL RHYTHM. IN THIS WAY, HEART ATTACK VICTIMS CAN GET TO A HOSPITAL

There are three basic outcomes for your heart's functioning when you have a heart attack (doctors call this myocardial infarction, but the spectrum of heart-attack like syndromes is referred to as acute coronary syndrome and differ mainly in how much of the heart muscle is damaged). First, your heart may have stopped beating completely, and back in my hospital days as a medical student we were taught to give the patient a sharp rap on the chest with the fist. We were told that this sometimes would get things going again. Therefore, there is no harm in doing this to yourself.

The second thing that your heart may be doing is called ventricular fibrillation and this is an electrical disturbance secondary to the heart attack that causes the ventricles of the heart to fire in an uncoordinated manner (the heart looks like a "bag of worms") and is incapable of pumping blood. This is the condition in which the chest is shocked with a defibrillator to restore normal rhythm.

The third thing that may happen is that the muscle is so damaged by the heart attack that although the heart pumps, the pumping is ineffective since the damaged area is large and does not contract. Again, the most important things to do are 1) call 911 and 2) pop an aspirin.

ARTICLE PUBLISHED ON N.º 240 OF JOURNAL OF GENERAL HOSPITAL ROCHESTER

This is just a lie. There was never any article about anything remotely tied to this topic by any journal from the Rochester Hospitals (see here for another discussion of this email and the false reference).

TELL AS MANY OTHER PEOPLE AS POSSIBLE ABOUT THIS.

IT COULD SAVE THEIR LIVES !!! DON'T EVER THINK THAT YOU ARE NOT PRONE TO HEART ATTACK AS YOUR AGE IS LESS THAN 25 OR 30. NOWADAYS DUE TO THE CHANGE IN THE LIFE STYLE, HEART ATTACK IS FOUND AMONG PEOPLE OF ALL AGE GROUPS.

Utter nonsense. The incidence of heart attacks has fallen dramatically over the past 50 years or so. When anyone under the age of 50 gets a heart attack, they essentially always have some particular genetic issue that separates them from others and greatly increases their risk.



BE A FRIEND AND PLEASE SEND THIS ARTICLE TO AS MANY FRIENDS AS POSSIBLE

What you might do is send this deconstruction to anyone you might have sent the original email. And, the best way to avoid heart attacks? Keep your BMI at 25 or below, stick with the gay caveman diet and work out at least 20 minutes for three times per week. If you're at special risk, speak to your doc about your possible need for a daily baby aspirin, lipid-lowering agents, etc.

© Copyright 2009 Doctor's Weekly Commentary

May not be reproduced whole or in part without citation and/or link to this site