Eyedrops After Cataract Surgery

People who do not have someone to put drops in their eyes four times a day need help.  Task modification helped me succeed after my recent cataract surgery.  It is easy to drop and difficult to squeeze the stiff sides of a tiny 5 ml bottle.  I am glad I found the Autosqueeze Eye Drop Bottle.  The big wings are easy to hold and require only a gentle squeeze.

Before I lie down on my bed I gather two bottles of eye drops and a Kleenex tissue.  I put a pillow on my chest (not stomach) and put my sound elbow on the pillow.  This support makes my hand remain steady instead of bobbing around as I hold the bottle in the air.  To stop myself from blinking I distract myself by looking through the opening formed by my thumb and index finger instead of the bottle.  I try to get the drop in the inner corner of my eye.

When I put the cap back on I need to stop my hand from bobbing up and down and accidentally touching the tip of the bottle.  I keep my hand still by pressing my elbow firmly against the pillow.  homeafterstroke.blogspot.com

Smartphone Use During Quarantine: Ways in which to keep it in Check

As you read this article, potentially on your smartphone, you may wonder if you may be overusing your smartphone during the radical shift in schedule that is this quarantine.  Keep in mind that, in the US, 41 states, 3 counties, 8 cities, the District of Columbia and Puerto Rico have enacted abrupt and extreme social distancing measures.  This amounts to approximately 310 million people being asked to stay and work at home, except for emergency needs.  Know that while the USA is waiting this out in their homes, so too are countries worldwide restricting the movement of people.  This may mean a lot of people with more free time, or at least some time to kill, now that the commute times have been reduced to getting up from the bed and walking to your home office.

What is likely to happen while we are sheltering in place?  While many of us have the best intentions to use this time to bond with our families at home, we still need to keep in touch with our work groups and our extended families who may live in other states or countries.  Additionally, more options are available for online learning, reading and video content options, including those with socializing elements, and they are getting more trendy as we hunker down.  While a smartphone can be a tremendous tool to allow us to venture virtually out of our houses and connect with distant family, it can also be emotionally isolating, physically harmful for us, and a disconnect to the family in house.

What most people don’t realize is the negative impact of excessive use of smartphones. When one has difficulty regulating the amount of time they spend on the phone or have negative consequences from use such as relationship strain, financial issues, accidents and loss of productivity, smart phone use becomes problematic or addictive.  One study suggested that the prevalence of problematic smartphone use is common (about 38%). During this shelter-in-place period, you might be tempted to spend the better part of the day on your smartphone, or quickly realize that what started as a “quick check” just ate up more time than you planned.

One common behavior seen with any dependence, including substances and devices, is that it becomes the first and last thing done each day.  When a smoker wakes up, there is a stimulus to use, as serotonin and dopamine deficiencies increase cravings and the brain triggers an action or a person goes through withdrawal.  Prior to going to bed, a smoker may take a cigarette to reduce withdrawal at night.  These behaviors are usually reflexive and outside of the realm of  conscious awareness.  Though they describe a pattern that is seen in dependence.

Does this apply to you?  Do you find yourself looking at your phone the moment you get up and just prior to calling it the night?  You are not alone.  One survey of 536 online respondents in 2017 found that nearly half of those surveyed checked their phones just after waking up and half checked their phones just before going to bed.

 

The World on Smartphones, the Brain’s Wiring and Where did all the time go?

Over the last twenty years, there has been an expansion of internet use around the world.  Some of this has been fueled by smartphones and increased availability of Wi-Fi and satellite coverage.  It is estimated that approximately half of the world’s population has access to a smartphone.  With increased access comes increased use.  With increased use comes increased dependence.

global internet usage

In his thought-provoking book, “The Shallows: What the internet is doing to our brains,”  Nicholas Carr outlines the neuroscience of technologies like the internet and smartphones and how they affect the neurotransmitters and neural maps in our brains.  Essentially, our brains incorporate smartphones as if they were an appendage of our bodies.  That harkens back to that sudden visceral feeling we get when we think we lost our phones.  Interesting research discussed in the book is how our attention spans and memory are altered with smartphone use.  Essentially, the internet, and smartphone use, is dumbing us down.

The problem with smartphone use is that it is insidious and can be hard to know when it has become too much – and even harder to limit.  According to research conducted by a senior living community provider Provision Living,  the average person spends approximately 5.4 hours on their smartphones each day, with millennials spending 5.7 hours a day.  Facebook and Instagram each took up about one hour daily.  While this is a substantial amount, people tend to underestimate their use.  When you put that time together, it makes up about 81 days a year, or about one and a half days a week on the phones.  Sure, some of the time may be work-related, but probably a lot less than you think.

 

Side Effects of Smart Phone Overuse

Here is a list of some of the known side effects of smart phone overuse:

Neck pain or “Text Neck”

Excessive use of smartphone can result in neck strain.  This occurs when the neck is flexed forward and there is rounding of the shoulders.  With normal posture, the neck supports the 10-12 pound weight of the head well.  Looking down at your smartphone flexes the neck and exerts a force on it that may be up to 60 pounds.  Since our smartphone use can be almost subconscious, we often don’t realize that we are forward flexed until we start noticing the neck tension and headaches.  The ongoing strain can eventually lead to degenerative disk disease and cause you increased pain issues and severe disability.

Other than generally spending less time on the phone, taking care to look at the phone for shorter durations, doing neck stretches, and keeping the phone at a higher viewing angle may reduce the strain.

pexels-photo-2364447
Photo by Oladimeji Ajegbile on Pexels.com

Eye strain or “Computer vision syndrome”

Also referred to as “digital eye strain“, eye strain is associated with the excessive use of mobile phones and tablets. It generally causes the following problems:

• Blurred vision and eye fatigue
• Pain and discomfort due to looking at a digital screen for more than two hours
• Eye burning and itching from dry eye
• Frontal headaches

Eye strain and dry eye are worsened by a greater duration of smartphone use and a brighter intensity of light.

Distraction

Driving a car requires one’s full attention, and greater velocities require shorter reaction times for emergency stops.  The use of a phone while driving increases the chance of an accident 6 times more than driving while drunk.  Given the average person checks their phones once every 12 minutes, it isn’t unreasonable to predict that the brain would want to look at it anytime — even while driving.  But it’s a completely unreasonable behavior and anyone would agree.

Yet, it happens and it can be lethal.  The National Safety council reports that phone use, whether talking, texting or checking, leads to 1.6 million crashes each year.  That’s nearly one in every four car crashes, and one in ten that are fatal.  An estimated 3,500 people (and probably more) die from distracted driving in the United States each year.

And it isn’t just deaths from cars.  There is a growing list of sometimes bizarre, all of the times tragic, deaths caused by distraction from smartphone use.  Whether it is a person who falls to their death while taking a selfie or dies trying to rescue their phone, it begs the question:  was it worth it?

 

Sleep issues

Interrupted or Self-induced sleep deprivation.  Smartphone use can impact sleep in a number of ways.  The use of smartphone can reduce the duration of sleep and increase pre-sleep arousal, either from spending time binge-watching movies or checking social media in bed.  If the phone is not turned off or to silent mode, it can interrupt sleep with a chime, ring or buzz alert.    Even after you check the message and see that it wasn’t important – just an email about a coming discount at a store you only went to once – getting back to sleep is not always successful.  In one study, the majority (76.5%) of sleep disruptions that were caused by smartphones were outgoing message, while calls (21.7%) and Facebook checks (1.8%) occurred less commonly.  The interruptions were seen in 41% of subjects in the study period of month, amounting to at least one weekday in a four week period.  Those with frequent interruptions were also found to have less sleep duration and a higher  body mass index.

Insomnia.  Computer screens, TV screens and phone screens emit a greater degree of blue light.  Our brains take in environmental cues to sleep, including a decrease in ambient light.  These signals trigger the release of melatonin from our pineal gland, which prepares the body for the sleep state.  When we see the blue lights of a screen, the body is receiving the light which causes mixed signals and impairs the ability to sleep.  Just a simple behavioral change of turning the phones off thirty minutes before bedtime made a significant improvement of sleep quality and duration.

 

Mood alterations with increased risk of depression and loneliness

Multiple studies have shown a correlation between smartphone dependence and depressive symptoms and reports of loneliness.  This is particularly prevalent in cell phone dependence in adolescents.  It is likely that the overuse of smartphones leads to destabilization and development of poor coping skills and reduced resilience that provokes depression, anxiety, loneliness. As with other dependent states, an imbalance of neurotransmitters, gamma aminobutyric acid (GABA) and glutamate, is likely involved.

 

Exposure to radiofrequency (RF) radiation

The CDC does not report any definite evidence of cancer from smartphone.  However, smartphones give off radiofrequency radiation.  The International Agency for Research on Cancer (IARC) does classify RF radiation as a “possible human carcinogen!” (cancer-causing agent).  It is possible to mitigate the risk of this possible carcinogen by using a hand-free headset, airpods, or headphones, using the speaker of the phone, and turning the phone in airplane mode or placing the phone in another room while charging.

 

 

Strategies to Protect Yourself From Problematic Smartphone Use During the Quarantine

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Photo by Skitterphoto on Pexels.com

Anyone in their forties like me recalls the day that they bought their first smartphone.  I was in my early twenties and in my medical training.  Beside handy books for the white coat, many of us residents, interns and students used personal desktop assistants (PDA), which were aptly termed “peripheral brains.”  With the PDA, cellphone and a pager, we carried the devices to keep us informed and stay within-reach.  There was an immediate appeal to have an all-in-one device with a resource available at hand to review literature and link our curiosity to answers.

Now children are getting phones at an increasingly younger age.  In one European study in 2015, 46% of children between the ages of 9 and 16 had a smartphone.  As parents we are unwittingly enrolling our children in a research study on how the smartphones affect the developing brain.  It is becoming increasingly harder to unplug, in part because of increased convenience, but more so because of dependence.

The only time we can experience smartphone-free time (aside from powering down our devices!) is in locations where Wi-Fi service is unavailable, such as hiking or traveling – though I am amazed at many people I see toying with their phones even in remote areas.  In the year 2020, a child operating a device without Wi-Fi loses interest rapidly.   We are fast approaching a day when satellite internet access will be available in all reaches of the world – and people are working on this now.

During the current situation, there are even less options to distract yourself from using your smartphone.  Other than breaking it, locking it away, or going off the grid, here are some of the ways everyone can still enjoy the benefits of smartphone technology while limiting excessive, problematic use:

 

1. Set a daily time limit on the phone.

Time use can add up throughout the day.  A check every 12 minutes could be a set-up for checking sites, responding to other’s texts.  Most smartphones have a program that does a daily assessment of your use and calculates an average usage during a week.

Another way around counting your time is simply to change a behavior that you normally do.  For example, if you check your phone immediately when you wake up, use the bathroom, or fall asleep you could avoid that behavior.  This will likely cut down on the total time.  While it is hard to say an exact time of healthy smartphone use, it likely a “less is more” thing.

 

2.  Set aside the smartphone and other electronics for one days each week and set that as an example for all family members.

One important point is that children’s screen-time used is influenced by their parent’s use.  Techniques such as selecting one day a week without electronic devices, including smart phones, may be a welcome strategy for keeping overuse in check.  I have encouraged our family to do this once a week – I am calling it, somewhat ironically, “Sunday Funday.”  It is interesting to see how often topics of electronics and smartphones come up during the day.

 

3. Set up some daily time-out routines with phone use.

During this quarantine for COVID-19, there is much more time to fall into the use of a smartphone.  Setting up a routine, such as all the phones are switched off or to airplane mode by 8:00pm may prevent the time creep of evening use and sleep issues.

 

4. Practice Mindfulness. Know when you might need to limit.

One thing about human behavior is that it occurs below the level of conscious detection.  Yes your brain makes you do things that you don’t realize that you are doing. Although smartphone doesn’t seem to overlap with mindfulness, the use of this practice may help you by slowing down reflex decision-making to use or staying aware of the passing of time.

 

5.  Get outside and power down.

Aside from the (peculiar) behavior of using an outdoor smartphone app (e.g. Pokémon go), getting outside may provide a chance to power off your phone and connect to the present moment.  Smell the flowers, hear the birds chirp, and hear the wind.  Nature doesn’t know that there is a pandemic.

 

5. Refer to a number of applications that are designed to curb phone addiction.

There are a number of Apps available on Android and IPhone that can help regulate time and curb smartphone overuse.  Some of these include AppDetox  (free/android), Flipd (free/android/ios), Offtime (ios/android), ClearLock (paid/android), and QualityTime (free/android).

It’s always a slippery slope when using an app on your smartphone to modify your smartphone overuse.  It is always possible to turn off the alarm and just continue to use it.  Nevertheless, they may be beneficial in creating mindfulness of the behavior.

6.  Consider getting help if the above efforts don’t work.

Cognitive behavioral therapy (CBT) has a role in the treatment of forms of dependence, including smartphone addiction.  The idea of CBT is to increase one’s awareness of how emotions and thoughts shape an action that leads to the dependence and how to break that arc.  There are several online conferencing CBT sites available as well.

 

Summary

At least for the next three or four weeks, the United States and other countries will continue these strict social distancing measures, which result in a change in the usual schedule.  If it hadn’t been a problem already, it is likely that this adjustment might come with it increased smartphone use.  Besides increasing the risk of physical problems, problematic smartphone use can lead to disrupted sleep, increases in anxiety and depression and relationship problems, and increase distraction.  An awareness and attention to this problem can ensure that this time is one of growth and productivity.

 

Resources:

Proposed Diagnostic Criteria for Smartphone Addiction

Take the Nomophobia Test   Nomophobia  “No mobile phone phobia”

Screen Time and Children:  Advice regarding setting limits on screen time for children

Bank my cell website:  Informational Website regarding tools to manage overuse of smartphones

Nurturing the Resilient Spirit: Ways to Support Mental Wellness during the COVID-19 Quarantine

My Stroke Strategies for the Corona Virus

These strategies are related to my daily routine.  They are examples of what stroke survivors can do to protect themselves.  Your risk of catching the corona virus is probably different from mine but I think we can agree that a stroke creates enough drama for a lifetime.

Washing hands with the backwards rule:   With the soap dispenser facing away from me, I push down on the nozzle with my palm and catch soap with my fingers.  After I scrub my hands, I run my soapy thumb over the top of the handle before I rinse.  I started washing my hands this way years ago when I handled raw chicken.  I did not want to leave chicken fluids on the bar of soap and soap dish.

Paying:  Many infected people do not cough so the rapid spread of the corona virus cannot be explained by lots of people spraying germs in the air.  We do not know how long the corona virus lives on environmental surfaces.  For now I pay with a credit card instead of handling coins that hundreds of people have touched.  It is cold enough to wear a coat so I put this credit card in my coat pocket rather than dig through my purse to find it.

Shopping cart:  It is easier to push and steer a shopping cart with both hands.  However, physical exertion makes my hemiplegic thumb bend fully so I don a piece of foam to stop my thumb nail from cutting into my skin.  I use a Kleenex tissue to take the foam off when I get in the car and then I isolate it in a special location.

Handles and keys:  Some people wipe the handle of a cart before they start shopping.  This does not protect them when they touch cans and boxes touched by employees who stock the shelves.
We do not know how long the corona virus lives on environmental surfaces.  I currently have 2 cuts on my sound fingers so before I get out of the car I don a thin vinyl glove used by beauticians.  It is one size too large so it is easier to don.  I remove the glove after I get the cart to my car.  My sound hand is clean when I open the car door, pull my car key out of my purse (green wrist band), and put my hand on the gear shift handle and steering wheel.  I throw the glove in a bag in my car.  My sound hand is clean when I pull out my house key (purple band) and open my front door.  I wash both hands when I get inside.

Touch screens:  Before the corona virus I refused to use a filthy touch screen to order a meal and then pick up food with my sound hand.  Ordering in person is slower but safer as long as I use a napkin to handle the menu which is never washed.  If a transaction forces me to use a touch screen, I use the back of a knuckle which I never stick in my ear, nose, or mouth.

Touching my face:  On the news a reporter touched her face 13 times in one hour while using a computer even though she was trying not to.  Transferring germs from our hand to our eyes, nose, or mouth is a common way to get sick.  The news story concluded that it is really hard to stop this unconscious behavior.  Any suggestions would be welcome.            homeafterstroke.blogspot.com

Pandemic COVID-19: Applying Early Lessons Learned

The novelty of the novel COVID-19 outbreak has passed. Sure our imagination that drums up images of viral apocalypse and global chaotic destabilization are simmering. Although the fears are transforming into measured preparedness, there still remains an allure of uncertainty with how this outbreak will affect the rest of the world.    In the wake of this recent outbreak, the global public health community and the world in general is left with many important questions.  In real-time, the community has had to develop a blueprint to testing, containment and risk mitigation.  While the United States and countries in Europe are reporting higher case loads, some important lessons can be gleaned from the early part of the epidemic:

Emerging Lessons:

  1.  Containing the Transmission of a Respiratory Virus is like trying to hold water in your hands.

When the nCoV-19 (COVID-19) outbreak was declared in Wuhan, China in late December 2019, about three weeks of potential transmission for the index cases had occurred.  The first wave of cases were close contacts and healthcare workers.  The virus was transmitted to others through coughing, sneezing, talking, kissing, or from contaminated surfaces or objects.

Just one cough sends out thousands of respiratory droplets, varying from 10 to 100 microns in size, at a speed of 50 miles an hour to a distance of a meter or more.  If you sneeze when you have the cold, you are sending out 40,000 droplets of 0.5 to 12 microns at a speed of 100 m/s.  Imagine that if viruses, such as COVID-19, are 100 nanometers (0.1 micron), hundreds can surf on these droplets and easily become sprayed onto objects or surfaces at a closer distance, while droplet nuclei (<5 microns) may spread distances of a few meters or may even follow air currents still further.

These infectious secretions can easily then enter the mouth, nose of eyes of a passersby or get ingested after touching the face from surface or fomite transfer.  Studies support the concept of a “personal cloud” of infectious particles supplied by coughing and sneezing and air currents around an infected person.  With so many viral particles, transmission of an infection to multiple people becomes easy.

droplet modelThe Wells evaporation-falling curve of droplets  From Annex C. Respiratory droplets.

 

2.  Case Fatality Rates (CFR) are always overestimated in the beginning of outbreaks

An outbreak requires constant reassessment.  Imagine trying to isolate and contain an outbreak, while at the same time trying to identify the pathogen, confirm cases, protect those at risk, and consider treatment and vaccination options – all in real time.

Epidemiologists can draft a case definition early on, but if the outbreak is from a novel pathogen, cases are defined by syndromic presentation first until more specific tests become available.  The public health system and the general public have sensitive ears for case fatality rate, the amount of those dying from a specific infection over the amount of those infected.

Case fatality rates (CFR) depend on knowledge of all affected cases, which for respiratory virus is usually not possible.  The problem is that most patients that have mild infection may not get tested.  On the other hand, some serious cases may not go attributed to the infection.  As we are learning, even later into the outbreak, e.g. in the US, outbreak investigation and containment largely depends on the availability of tests kits.

In China, the Wuhan COVID-19 outbreak had an attributable CFR of 4%. These original rates are higher than what has mostly been seen in secondary outbreak countries, such as South Korea.  One-third of the caseload was determined by syndromic definition rather than specific testing.  Many more may have not been tested.  The more people that are tested including those mildly symptomatic or asymptomatic, the closer we get to understanding the true CFR.

Enter South Korea.  When COVID-19 was reported in South Korea, great strides were made to identify cases.  On Tuesday March 3rd, Moon Jae-in declared “war” on COVID-19.  This comes after an outbreak of MERS in South Korea where tests kits were not readily available, and 38 people died.  By March 4th, South Korea has already tested more than 140,000 people for COVID-19, even providing a “drive-through” testing option.  South Korea has detected 6,593 cases with 43 total deaths.

If you take into account a sensitivity of 95%, there may be 5% false negatives, this would equate to a CFR of  43 deaths/6,593 x 100% = 0.65%.   This represents the unadjusted CFR based on the positive tests.  However, there is a false negative rate of 5%, so taking into account all of those tested (158,456 – 6,593),  the adjustment could be as low as 0.2%.  Although there is a possibility that the numerator may not be correct, it is less likely to shift, as there isn’t another definition for “death” but it could not capture the attributable deaths from COVID-19.

The WHO declared that the case fatality rate of COVID worldwide has been 3.4%, which appears to be an gross overestimate.  However and importantly, even with the calculated CFR from  South Korea, the rate is likely to be twofold higher (or greater) than what is encountered with seasonal influenza yearly.  When determining risk, the Wuhan data closely correlated advanced age and those with chronic diseases with increased CFR.  So the adjusted case fatality rate is likely to be higher in these at-risk groups and lower in the general population.

covid-mortality-rates*This is coming from the China outbreak – Expect a similar mortality distribution though needs adjusted from other underlying risk factors

 

Think of a virus as a chain reaction.  Anytime a virus can spread easily and only cause some deaths, sometimes considered a “sweet spot” in disease transmission, it is likely to have a significant impact.  When a virus kills off its hosts too quickly or is transmitted by a different route (e.g. Ebola with infected blood and secretions), it is impactful in its severity, but it can’t get around to infecting too many people.  The CDC estimates that influenza causes about 10,000 to 60,000 deaths annually (CFR 0.1%) – in the Unites States alone.  Even if the CFR for COVID-19 similar to influenza, widespread disease could be impactful on our elderly and other at-risk groups and strains health care delivery.

 

3.  Outbreak Containment and Risk Mitigation Strategies Benefit Greatly from Accurate Case Definition 

Efforts to contain COVID-19 improve as the case definition becomes more specific.  The original CDC case definition was more rigid, since the outbreak was related to the specific outbreak city, Wuhan.  As is always the case, coming up with an accurate definition up front can be difficult in real-time.  The Chinese government imposed strict lockdown measures, which crippled the cities and was meant to interrupt further transmission.  It became apparent, that low grade transmission and milder cases continued both inside China and to other countries.

Chinese scientist defined the genome of the novel Coronavirus shortly after declaring the outbreak, allowing for the development of testing.  Once testing became available, it was as if an invisible menace could be seen.  In the South Korea outbreak, people were readily tested, so active recommendations for quarantine could be given.  Truly it is important to recognize the efforts of the South Korean government and medical community to contain and test the population.  This testing may have contributed to the lower case fatality rates, by identifying at-risk people and keeping them free of disease.

With the further spread of COVID-19, a country will be able to gain a greater control on the outbreak through greater testing.  This provides knowledge of active cases, so that voluntary quarantine can be put into affect.

4.  Protecting Healthcare workers, Care givers and High Risk Populations is a key strategy 

With the SARS outbreak in 2002, we were reminded that the ability to provide healthcare relies on its personnel.  During that epidemic, one-fifth of all cases were healthcare workers.  As the outbreak of COVID-19 continues, some people will require medical attention and report to the hospital – maybe not even knowing that they have the disease.

As the caseload increases in the United States, the at-risk definition will increase.  It may be necessary to wear personal protective equipment with anyone who exhibits a viral infection.  Healthcare workers will be a greater risk of acquiring the illness.  When healthcare workers are unable to attend to patients because they are sick, healthcare delivery is consequently impacted.

It is clear that there is a higher case fatality rate with the elderly and those with health condition.  When an infected person, whether it is a healthcare worker, patient or visitor comes into a population of those at risk, you see a perfect storm for severe disease and fatality.  Recently, the Life Care center in Kirkland, Washington had a spate of 13 deaths from COVID-19.  it is incumbent on long-term care facilities to develop strategies to prevent any further outbreaks of COVID-19 in such high-risk settings.

5.  With any viral spillover, there are always two outbreaks: Infectious Disease and the Infectious Fear. 

An outbreak is an unpredictable process.  It can sometimes burn out, even as we are still learning of the risk factors of its spread.  As for a respiratory virus outbreak, it is easily transmitted, often leading to relatively silent spread.  Containment strategies are often too late.  As information emerges from the virus, speculation can create narratives that lead to fear, panic and rapid decision-making.

Reports from the news are often related to deaths and how the viral infection is changing regular life and can be sensationalistic.  Online authors and presenters are shaping the news and narratives.  The images of the strict containment measures in China tempt us to think about self-preservation from an unknown invader.  These fears shape behaviors:  cancelling flights, stocking up on masks, cancelling conferences.  While it is not wrong that containment measures can help, defining cases can lead to more targeted containment without crippling the flow of a functioning society.

In the unknown of the COVID-19 outbreak, the stock market has seen great losses and is showing volatility.  Imposing mass quarantine and containment efforts can have real effects on the economy and productivity.  Canceling major conferences can lead to losses that can affect multiple sectors.  Even if you decide not to cancel your European trip, strict measures could be applied in the setting of an outbreak, that can limit or spoil your vacation plans.

Stories of vampires, werewolves and zombies go back hundreds, if not thousands of years.  The concept of some unknown force overpowering humans and causing them to morph into someone or something else hits the nerve of our self-preservation instinct.  In many ways, viruses are the true vampires.  They are lifeless forces other than the primitive instincts of self-preservation and self-generation.  A virus’s consciousness is generativity – producing copies to transmit to others.  It’s  result is a destructive untangling of the fiber of society. A virus is transmitted through social interactions and an interruptions in these behaviors although may be useful,  often results in a significant fallout.

A Viral Outbreak Creates a Fissure in Human Collaboration Efforts, leaving a wake of economic and sociopolitical fallout.

 

Future direction:

  1.  The use of already existing apps for description of symptoms to determine places for targeted testing.
  2.  The coordination of an international outbreak system either through already-arranged WHO or influenza surveillance sites.
  3.  Selecting specialized labs to launch testing as early as possible.
  4.  More rapid protocols for vaccine development in emergency situations that do not require the rigid testing phases as those that are currently imposed by the FDA and other entities.

 

Summary

Managing the COVID-19 outbreak will require a group effort to stay aware of our individual symptoms and use standard precautions, to identify cases through rapid testing, to mitigate risk through targeted containment and to transform fears into preparation.

 

 

 

 

 

A viral outbreak in many ways is like a natural force.  The transmission

 

 

At present, with multiple people testing positive, COVID-19 has hit several areas in the United States.  Do we need to be concerned about this.

High Cholesterol is a Bad Thing, and Now Low Cholesterol Is Not Much Better

Since I was a little girl and able to understand scary stuff, my mother said that her body “manufactured” too much cholesterol. Never mind the fatty foods she ate like red meat and extra buttery toast and cheesecake, her favorite dessert. She stood by her story to the end. I was scared I would inherit the same “manufactured” condition. But I was spared even though I had a hemorrhagic stroke that was from Protein S deficiency. (Don’t get me started on a lousy gene pool).

My mother probably familial hypercholesterolemia, this news  brought you by US National Library of Medicine, a disorder that is passed down through families. It causes LDL (bad or think of loathsome) cholesterol level to be very high. The condition begins at birth and can cause heart attacks at an early age. My mother didn’t have a heart attack, but she could have had one.

Familial hypercholesterolemia is a genetic disorder. It is caused by a defect on chromosome 19. The defect makes the body unable to remove low density lipoprotein (LDL, or bad) cholesterol from the blood. This results in a high level of LDL in the blood.

This condition makes you more likely to have narrowing of the arteries from atherosclerosis at an early age. The condition is typically passed down through families in an autosomal dominant manner (that is, inheriting a disease, condition, or trait depending on which type of chromosome was affected).

And that’s probably what she meant by manufacturing high cholesterol. So I thought to myself, I’m lucky that I escaped the high-cholesterol syndrome, and now that I am a pescatarian or, as I like to say, a vegan with fish. That got me thinking: Can your cholesterol be too low? The answer scared me more.

In April of 2019, a study by the American Academy of Neurology said that low cholesterol was linked to a higher risk of “bleeding [hemorrhagic] stroke” in women.

A study found out that women who have levels of LDL cholesterol 70 mg/dL or lower may be more than twice as likely to have a hemorrhagic stroke than women with LDL cholesterol levels from 100 to 130 mg/dL.

The study also discovered that women with the lowest triglyceride levels, that is, fat found in the blood, had an increased risk of hemorrhagic stroke compared to those with the highest triglyceride levels.

“Strategies to lower cholesterol and triglyceride levels, like modifying diet or taking statins, are widely used to prevent cardiovascular disease,” said Pamela Rist, ScD, study author of Brigham and Women’s Hospital in Boston and a member of the American Academy of Neurology.

“But our large study shows that in women, very low levels may also carry some risks. [I’ll say]. Women already have a higher risk of stroke than men, in part because they live longer, so clearly defining ways to reduce their risk is important. Women with very low LDL cholesterol or low triglycerides should be monitored by their doctors for other stroke risk factors that can be modified, like high blood pressure and smoking, in order to reduce their risk of hemorrhagic stroke.

“Also, additional research is needed to determine how to lower the risk of hemorrhagic stroke in women with very low LDL and low triglycerides,” Rist said.

My head was spinning. Low cholesterol and low triglyceride are considered bad now? I wanted to find out more.

The study of 27,937 women age 45 and older participated  in the Women’s Health Study (supported by the National Institutes of Health) who had total cholesterol, LDL cholesterol, high density lipoprotein (HDL or good cholesterol), and triglycerides measured at the beginning of the study. Researchers reviewed tons of medical records to determine how many women had a hemorrhagic stroke.

With an average follow up at 19 years, researchers identified 137 women who had a bleeding stroke. Nine out of 1,069 women with cholesterol 70 mg/dL or lower, or 0.8 percent, had a bleeding stroke, compared to 40 out of 10,067 women with cholesterol 100 mg/dL up to 130 mg/dL, or 0.4 percent.

Some other factors were weighed in that could affect risk of stroke, such as age, smoking status, high blood pressure and treatment with cholesterol-lowering medications, and researchers discovered that those with extremely low LDL cholesterol were 2.2 times more likely to have a bleeding stroke.

Researchers divided the women into four groups for triglyceride levels. Women in the group with the lowest levels had fasting levels 74 mg/dL or lower, or non-fasting levels of 85 mg/dL or lower. Women in the group with the highest levels had fasting levels that were higher than 156 mg/dL, or non-fasting levels that were higher than 188  mg/dl. Researchers found that 34 women of the 5,714 women with the lowest levels of triglycerides, or 0.6 percent, had a bleeding stroke, compared to 29 women of the 7,989 with the highest triglycerides, or 0.4 percent.

The study’s key limitation was that cholesterol and triglyceride levels were only measured once at the beginning of the study. In addition, menopause was evident in a large number of the women, which prevented researchers from examining whether menopause status may be the missing link between cholesterol and triglyceride levels and bleeding stroke. More study is needed.

WELCOME TO CHECK. CHANGE. CONTROL. CALCULATOR, compliments of the American Heart association (AHA).

Through blood tests, CBC and Lipid Panel, and vitals like blood pressure, you can fill in the blanks on the form to see if you’re susceptible to a heart attack or stroke. Shouldn’t you know rather than guess?

Statins are effective at lowering cholesterol and protecting against a heart attack and stroke, although they may lead to side effects for some people.

The Mayo Clinic says that doctors “often prescribe statins for people with high cholesterol to lower their total cholesterol and reduce their risk of a heart attack or stroke.” But they have been associated with the onslaught of muscle pain, digestive problems, and mental confusion in some people who take them and may cause liver damage, albeit rare.

Statins include:
  • atorvastatin (Lipitor)
  • fluvastatin (Lescol XL)
  • lovastatin (Altoprev)
  • pitavastatin (Livalo)
  • pravastatin (Pravachol)
  • rosuvastatin (Crestor, Ezallor)
  • simvastatin (Zocor, FloLipid)

 

The reason that doctors prescribe statins is that that block a substance your liver needs to make cholesterol, and causes your liver to remove cholesterol from your blood.
If you’re already on statins, talk to your doctor before stopping them. My doctor told me to stop reading articles on the Internet. Hoo, boy. Like that’s gonna happen.
If you have muscle pain, the statin you’re on may be producing  rhabdomyolysis which can cause severe pain, liver damage, kidney failure, and death. The risk is very low, and numbers are equal to a few cases per million people taking statins. Rhabdomyolysis can happen when you take statins in combination with certain drugs so ask your pharmacist.

Or statin use could cause an increase in liver inflammation. But if the increase is severe, you may need to try a different statin because all statins are not alike. Again, talk to your doctor, if you also have unusual and increased fatigue or weakness, loss of appetite, pain in your upper abdomen, dark-colored urine, or yellowing of your skin or eyes.

It also possible your blood sugar level may increase when you take a statin, which may lead to developing type 2 diabetes.
The risk is barely significant but important enough that the Food and Drug Administration (FDA) has issued a change on warning labels regarding blood glucose levels and diabetes with statin use prevalent.

Also, the FDA issues a warning on statin labels that some people have memory loss or confusion while using statins.

Everyone who takes a statin may not experience side effects.

Risk factors include:

  • Being female
  • Being age 80 or older
  • Having kidney or liver disease
  • Drinking too much alcohol
  • Having certain conditions such as hypothyroidism or neuromuscular disorders including amyotrophic lateral sclerosis (ALS)
  • Having a small body frame
  • Taking multiple medications to lower your cholesterol

If your doctor says it’s fine, take a small break from statin and see whether the muscle aches or other problems you’re having are statin side effects. It may be just part of the aging process.

Or switch to another statin drug if that’s ok with your doctor.
Or change your dose with the doctor’s permission. Another option is to take the medication every other day, especially if you take a statin that stays in the blood for several days. Again, talk to your doctor.
More than usual exercise may increase the risk of muscle injury. And it’s difficult to know if your muscle pain comes exercise or a statin.
One more thing. Is your diet healthy enough not to produce high cholesterol and, by the way, high triglycerides? My mother, again, probably had Familial hypercholesterolemia, the inherited gene that you could help by eating healthy, exercising, and not smoking, all of which my mother did not do.

I Am the Queen of Velcro

I buy lots of self-sticking Velcro because is makes me independent and safe.  The 1st time I used Velcro was to stop a tote bag from banging against my cane when I walked.  The white line shows where the
two pieces of Vecro connect.

I put Velcro on my wallet and inside my purse.  The Velcro adhesive is NOT strong enough to stay fastened to the wallet when I pull my wallet away from the inside of my purse.
So I stapled the Velcro to the wallet.

Velcro stopped my wallet from falling out of my tiny 1st purse.  It had a latch (see black line) that was hard to snap together with one hand.  Now Velcro makes it hard for a stranger to grab my wallet out of my 2nd purse which has a zipper that is hard to close with one hand.

I put Velcro on foam tubing designed to make the handle of a fork or spoon bigger.  Velcro sticks the foam to the shelf that holds my computer keyboard.  This keeps my hemiplegic fist uncurled.  Velcro also allows the shelf to support of my arm so my weak shoulder is not sore after I use my computer.

A computer technician used white tape to stop my USB hub from sliding when I push a thumb drive into a port.  However, the tape covers 2 ports so I cannot use them.  When I move to Michigan
I will have my brother put 2 strips of Velcro on my compter desk and 2 strips on the bottom of the USB hub.

homeafterstroke.blogspot.com

Freaked Out = Home Modification

I live alone so when the electricity goes out 2 to 3 times a year I have to handle it.  My stroke took away my ability to know where vertical is unless I can see my surroundings.  So I put flashlights in every room.  My plan worked until last night when the house went completely black while I was watching TV at 10 p.m.  I reached down for the flashlight on the floor next to my couch.  I started to freak out when I could not find it.  The electricity has gone off for hours in the past and sitting on my short couch until sunrise would be awful.  I finally found the flashlight, but after the lights came back on I put the flashlight in a different location.  I moved it to the tray on my couch that holds my remote control devices.  I also moved a second flashlight to a counter directly behind the place I sit at my kitchen table.

A previous outage taught me to put a battery operated lanturn on a cart next to my bed.  I turn the lantern on by rolling on my side and pulling the cart close too me so I can feel the on switch.

Unusual problem solving after a stroke NEVER ENDS.

homeafterstroke.blogspot.com

Patient Education: Making Sleep a Health Priority

Get the best out of your sleep

Good sleep is a necessity for the healthy functioning of the mind and body.  It is also one of the things that we can forcibly deprive ourselves.  Ideally, we spend one-third of our lives asleep.  Improving your sleep quality can be the first step toward stress resilience and  healthy decisions.

Could you imagine sleeping for 4 hours, then waking up to go to the gym to exercise, then going to work, and taking an extra cup of coffee to stay up?! If this happens to you, wouldn’t you skip the gym and maybe skip preparing a healthy meal? Without sleep, the brain has a lower threshold to develop stress, anger and impatience.  Driving a car after not sleeping well the night before is equivalent to driving under the influence of alcohol.  The system doesn’t just recalibrate the sleep deficit by sleeping in on a Saturday morning.

Sleep affects more than just the neurologic system.  Many first-time parents probably remember getting up at night because of a crying baby.  Most people recognize that sleep reduces memory and concentration and impairs judgement, but sleep also reduces the immune system, leads to weight gain and increases the risk of high blood pressure and stroke.  The endocrine, immunologic and vascular systems are regulated by sleep.

Here is a list of tips to ensure ideal sleep:

  1. Tone down technology: Silence your cellphones and other technology and put them in a different room at a set time each evening, preferably at least 2 hours before bedtime.  The screen lights can inhibit the production of melatonin, which would otherwise prepare you for sleep.
  2. Preparation: Provide yourself a 30-60 minute of winding down before lights out. Limit reading time to 20-30 minutes.
  3. Make sleep a routine: Go to bed and wake up at consistent times.  Most of the time, you will sleep for 6-8 hours naturally.  With a natural routine, you will very likely not need an alarm clock.  If you do use it, stop it and get up – don’t hit snooze 5 times.
  4. Your bed, the slumber throne. Limit activities to sex and sleep.  Watching TV, eating, working on the computer may affect your body’s ability to rest in bed.
  5. Avoid medicating to sleep: Medications to sleep should be avoided or limited to a low dose of melatonin (2-4mg nightly).  Although the medications may sometimes “work”, they come with side effects and, moreover, are not addressing the source of the problem.  The last thing you want to do is develop dependence on alcohol, benzodiazepines or ambien, etc.  and then can’t sleep without it.  As for the other side of things, avoid any intake of caffeine after noon hours.  Avoid any stimulant medications, e.g. albuterol inhalers, immediately prior to sleeping.  One interesting association of sleep apnea is the patient who drinks high levels of caffeine during the day and then takes a sleeping medication at night.
  6. Environment: Keep sleeping area dimly lit or dark.  Ambient noise should be at a minute, though white noise is acceptable.  Temperature should be on the lower side, between 60-67 degrees F.
  7. Trouble-shoot for the future: If you are having problems sleeping at night and find yourself tossing and turning, thinking too much or waiting until that magic click to start, limit time in bed to about 15-20 minutes. There is usually a reason that this has happened and it is up to you to brainstorm it.  You can sit in your chair to begin to rest, meditate and then return to your bed to sleep.  The next day, think why this happened:  It could have been that maybe you exercised too close to bedtime, took too warm of a shower before sleeping, saw a stimulating program on TV, or tried to squeeze some work on the computer too close to bedtime.

If you still have trouble sleeping after following this checklist, you should consider being evaluated for sleep apnea or other conditions (parasomnias) associated with sleeping, such as restless legs, etc.

sleep man on desk

sleep man on desk

Wuhan Coronavirus: An Emerging Global Pandemic?

A wave of influenza-like illness caused by a novel Coronavirus, named 2019-nCoV by the WHO, has swept through a populous area of China. Since December 31, 2019, there have been more than 830 people infected with at least 26 deaths (as of January 23rd, 2020).  Chinese authorities have placed Wuhan, a city of 11 million in the Hubei province, on lock down, or quarantine, canceling flights and not allowing public transportation into or out of the region.  This comes amid the busiest travel season in China, the Chinese New Year on January 25th.  During this time, it is projected that there will be 2.5 billion trips by land, 356 million by rail, 58 million by plane and another 43 million by sea.

Expect that anytime respiratory viruses (more easily transmissible) emerge in a populous city, there will be a high caseload.  Cases have already been confirmed in other parts of China, including Beijing, Shanghai, Macau and Hong Kong.  In the last week, countries outside of China, including Japan, South Korea, Thailand and Tawain, Singapore and Vietnam have confirmed cases. On January 21st, the first case of 2019-nCoV was confirmed in Everett, Washington, after a traveler to Wuhan arrived in Seattle-Tacoma airport on January 17th and presented a few days later.  As of Thursday, a second and third case were being evaluated in Los Angeles and Texas.

Wuhan virus map 11.1579841262468

Wuhan virus map 11.1579841262468

What are Coronaviruses?

Coronaviruses (CoV) are zoonotic RNA viruses which cause infections in a variety of animals including pigs, cows, chickens, cows, bats and humans.  It is the virus’s infection of bats from which likely was the source of severe acute respiratory syndrome (SARS-CoV) and Middle Eastern Respiratory Syndrome (MERS-CoV).  Viruses are typically host and tissue specific.  Though, a favorable mutation can cause a virus to be able to jump from animal to human and be transmitted from human to human.

While CoV generally causes mild respiratory infections overlapping the flu season, their usual behavior diverged with SARS-CoV.  From the outbreak of 2002-2003, there were a total of 8098 cases with 774 deaths, amounting to a mortality rate of 9% – even towards 50% in those older than 60.  Fortunately SARS wasn’t as easily transmissible as other respiratory viruses.

How did such a disease severity occur?  It likely relates to the effects of two types of damage: the damage caused directly by the virus infecting cells within the lining of the lungs and the damage caused by components of the immune system, such as cytokines. Some viruses can induce a greater inflammatory response and lead to a more severe presentation.

MERS-CoV was likely transmitted from its natural host camels, functioning as an intermediate host between bats and humans.  In one report in 2017, of the 660 cases of MERS in Saudi Arabia, 42% had contact with camels.  The mortality rate of this infection is approximately 30%, with the elderly and those with pre-existing illnesses at the highest risk.

The 2019-nCoV thusfar has had the greatest impact on the elderly (>60) and those with comorbid conditions, similar to the other emerged coronaviruses.  Fortunately, the mortality rate from this infection is approximately 3%, much lower than SARS and MERS.  Although there are no treatments or recognized vaccinations for this emerging coronavirus, Wuhan-based scientists have already determined the genetic sequence of 2019-nCoV, and Chinese health officials have released this information to the public.  Scientists are beginning to work toward determining a feasible future vaccine.

What is being done to prevent cases in the United States?

As a method of containing the outbreak, the CDC is screening passengers entering into the United States from Wuhan for signs of respiratory illness.  Also, the flights from Wuhan have been routed to five U.S. airports for screening:  Los Angeles’s and San Francisco’s International Airports, New York’s JFK airport,  Chicago’s O’Hare, and Atlanta’s Hartsfield-Jackson airport.

Presently, the CDC has defined those at highest risk for 2019-nCoV as Patients Under Investigation (PUI) to have these criteria:

Clinical Features & Epidemiologic Risk
Fever1 and symptoms of lower respiratory illness (e.g., cough, difficulty breathing) and In the last 14 days before symptom onset, a history of travel from Wuhan City, China.– or –

In the last 14 days before symptom onset, close contact2 with a person who is under investigation for 2019-nCoV while that person was ill.

Fever1 or symptoms of lower respiratory illness (e.g., cough, difficulty breathing) and In the last 14 days, close contact2 with an ill laboratory-confirmed 2019-nCoV patient.

How much should the general US population worry?

The disease has been traced to animal markets in Wuhan and has spread over the course of three weeks to include imported cases in neighboring and distant countries.  So far, there has been no local spread in the United States.  With heightened awareness and screening, it is with hope that the disease will not be as heavily transmitted to the general population.  Combined with a lower mortality rate than the other emerged coronavirus infections, I think the general population should not need to worry about this infection.  At this point, those with higher risk, including the elderly and those with health problems, are much more likely to be infected by influenza than 2019-nCov.

Do masks protect from this infection?

Respiratory droplets from sneezing or coughing are well contained by masks.  Given that coronaviruses are transmitted this way, it is likely that anyone infected with 2019-nCoV would prevent spread by wearing a mask.  I don’t think that everyone should get a mask at this point.  It is also important to mention that respiratory droplets containing virus can contaminate objects and the hands and then simply be ingested and cause infection.  As with any viral infection, good hand-washing and social distancing an are important part of prevention.

It is certainly too early to tell how many people will be affected by this virus – and what impact it will have.  Sometimes mortality rates can change during an epidemic, if subsequent mutations confer greater virulence (potency).  The WHO has yet to deem this a global emergency, but it certainly is looking like it may develop into a pandemic.  It is no coincidence that the virus emerged from a populous area where livestock and human meet – an animal market in Wuhan, a city in China of 11 million.

Wuhan Coronavirus:  Tips to Understanding the (Next) Pandemic

References

Ahmed, Anwar E. 2017.   The Predictors of 3- and 30-day Mortality in MERS-CoV patients. BMC Infec Dis. 2017; 17:615.

Fehr A, Perlman S. 2015.  Coronaviruses: An Overview of Their Replication and Pathogenesis.  Methods Mol Biol. 2017; 1282: 1-23

https://www.telegraph.co.uk/travel/news/chinese-new-year-chunyun-in-numbers/

FLU SEASON 2019-2020: BRACE YOURSELVES FOR AN ACTIVE SEASON

Summary: The 2019-2020 influenza season is off to an early start. Interestingly, the majority of cases have been associated with influenza B. With an increase in influenza-like illness identified in these last few weeks, it is possible that this season could be similar or worse than the 2017-2018 season.  Brace yourselves for an active season.

Welcome to the new year 2020.  As expected, at around the 46-48 week of 2019, we exceed the baseline of 2.5% of influenza-like illness (ILI).  The percentage of ILI has soared in the last few weeks compared to what it was last season.   Presently in United States, the seasonal influenza epidemic is widespread.  This season has been unique from others in the percentage of cases attributable to influenza B followed by H1N1.  The Centers of Disease Control (CDC) estimates approximately 64% of the flu cases are from influenza B.  Usually, influenza B cases pick up towards the second half of the season.

FluWeeklyReport

FluWeeklyReport

ILI_WeeklyMap

ILI_WeeklyMap

From the FLUVIEW CDC site (above), there has been a very high level of influenza-like activity.  Influenza has a high attack rate, affecting 5-10% of the adult population and 20-30% of the population of children.  High ILI activity suggests that there will be a high rate of transmission in those affected areas.  

The current activity in this flu season is already trending toward a higher caseload than 2017, with a steeper and earlier curve than in 2017-2018 (see red line in the graph below).  That season was the most severe season in recent years. By April 2018, more than 34 million people had the flu, about 1 million were hospitalized, and approximately 54,000 people died.    These deaths are usually from a secondary bacterial infection, complications of respiratory distress, or a cardiovascular complication attributable to influenza.  Although we have yet to see the peak of this season, should the percentage of ILI exceed those of 2017-2018, it is possible that this season will see a record number of influenza-attributable hospitalizations and deaths. 

ili curve.gif

ili curve.gif

As a general estimate, around 5-15% of the total US population gets the flu yearly. The hospitalization rate is 1 in 100 (1%) and the death rate is 1 in 1000 (0.1%). The highest risk of mortality is seen in the 65 and older age group, but almost 60% of reported hospitalization are ages of 18-64 years. Sure, most people will get a mild case of influenza and many people will get a classic case – with rapid onset of tiredness, body aches, chills and fever with cough, fewer will need to be hospitalized and a small percentage will die. Given the sheer magnitude of those affected, this means a lot of peopleInfluenza is NOT a mild illness.

The good news is that if you have received the vaccine, you are likely to either be protected from the disease or get a milder case.  The CDC estimates the average efficacy of influenza vaccination ranges from 40 and 60%.  Other than getting a milder infection, the vaccine reduced the risk of the influenza-associated diseases, such as heart failure, respiratory failure, and secondary pneumonia.  Predictions for the 2019-2020 influenza vaccination are forthcoming.  The components for the H1N1 vaccine and usually for influenza B are more effective than the H3N2 (H1N1 (75-80%), H3N2 (20-25%)). Last season, the estimated vaccine efficacy was 47%, approximating 61% in ages 7 months to 18 years, and lower in the over 50 age group.  

The vaccinations consist of two type of influenza viruses, influenza A and B. Type A viruses are named after cell membrane (the outer layer of a virus) components – called hemagglutinin (H) and neuraminidase (N). The 2019-2020 vaccines are quadrivalent,  consisting of 2 types of A viruses (H1N1 pandemic 2009 and H3N2) and 2 The type B viruses named after lineages B/Yamagata and B/Victoria.  The influenza B cases for 2019-2020 are from the B/Victoria lineage. 

Unfortunately, unlike the measles or other childhood viruses, there is more virus differentiation — changes known as antigenic drift, when gradual, or antigenic shift, when sudden. A new vaccine has to be decided upon each year. An extensive vetting occurs involving input from multiple centers, where the most common strains are selected. Occasionally, the vaccinations do not match the years prominent strains. This year, the majority of cases have been caused by the H1N1 pdm 09. Why not 100% effective — there are enough differences from the vaccine strains and the seasonal strains (yes – it changes/re-assorts that fast) that make an immune response from the vaccination not as effective.

Below are some general questions and answers regarding influenza:

  1. Is it too late to get the vaccine if I missed earlier?  No. It is not too late to get vaccinated. The flu season usually tapers off after April. Getting a flu vaccination now would provide some protection for the remaining 2+ months. If you don’t want to make an appointment with your doctor, you can get it at many pharmacies. I would recommend the recombinant vaccination (quadrivalent) and the high-dose if you are older than 64.
  2. How is the flu spread? What are the signs and symptoms of the flu and how do these differ from the common cold.

The influenza virus can be transmitted fairly easily in both coarse/large and fine respiratory droplets – the greater density of virus is on the smaller droplets. You can breathe these droplets in or put them in your mouth. How does this happen?  1) the droplets can land on a surface and you can touch it and then put your fingers in your mouth or touch food you then eat; 2) Person-to-person a person could cover their cough and sneeze and shake your hands 3) Fomite, a person can contaminate an inanimate object, such as a doorknob, keys and a cell phone, and you can touch it and…

Unlike the common cold (rhinovirus), the symptoms for the flu come on abruptly.  There will be fatigue and muscle aches, though cough is the most common symptom.  The reason is that influenza causes varying degrees of infection in the  lungs, known as pneumonitis. Those with advanced age may have confusion or delirium along with a non-focal fever and cough. Anyone coming in with any exacerbation of chronic disease, e.g. lung disease or heart disease or even a heart attack, should be screened for seasonal influenza, given its association as an illness trigger.

3. How can I protect myself from getting the flu?

  • The influenza vaccine – Get it sooner than later.
  • Hand-washing : think about doing this more often during this time of the year -particularly when you touch a public surface or object (e.g. pen, doorknob). It might be a good time to do the fist-bump, air handshake, bowing ? or maybe just remembering to use alcohol rub if you shake someone’s hand – and wash your hands before eating.
  • Quit smoking :  Smokers have a greater risk of more severe sequellae. It may be a good time to consider quitting or seriously reducing.
  • Limit alcohol : For multiple reasons, excessive alcohol intake can affect the immune system and increase the risk of aspiration which is likely a risk factor to secondary bacterial infections in influenza. My recommendation would to limit alcohol to no more than 1 or 2 drinks a day or less.
  • Eat a healthy diet, maintain a healthy weight : Eating a variety of vegetables rife with minerals and vitamins is a great way to bolster the body’s immune system. Various vitamins such as vitamin A, D and to a lesser extent C and E have been shown to affect the immune system in deficiency states. (complexity alert) For instance Vitamin A deficiency was found in mice to impair respiratory epithelium (layer) regeneration and antibody response to influenza A. Vitamin D has been touted to be beneficial from a meta-analysis to reduce risk of infection, but there is some conflicting evidence from other studies. Nevertheless there is some biologic plausibility that Vitamin D plays a role in both adaptive (T- and B-cell) and innate (Natural killer, macrophages,etc) immunity. A prospective controlled study of 463 students 18 to 30 years old showed a benefit in the use of mega-doses of vitamin C, with a reduction in symptoms and severity (85% reduction) if taken before or after the appearance of cold or flu symptoms. A study on vitamin E in mice showed a reduction in influenza viral titer (amount), possibly linked to enhanced T helper 1 (TH1) cytokines.
  • Get plenty of sleep:   I will explore the topic of sleep and immunity on another post. Suffice it to stay, the many effector signals are involved in keeping our immune system robust and sleep is an important piece of the puzzle of why some people get more severe infections than other.
  • Exercises and keep a stress-free lifestyle
  • Obesity has come out as a new risk factor since the 2009 H1N1 pandemic flu season. One study looking at the cases of influenza showed an increase risk of hospitalization for a respiratory illness. In a person with class I obesity (BMI 30-35) the odds ratio was 1.45 and class II (BMI 35-40) and III (BMI 40-45) obesity, the odds ratio was 2.12 — for pneumonia and influenza. This fits similarly the association of more severe presentation of influenza and chronic diseases including diabetes, lung and heart disease and advanced age (impaired immunity).

4. Do omega-3 fish oils help influenza?   NO, I was asked this question recently. From my review online, fish oils may impair immune reactivity from the influenza virus (lower IgG and IgA levels) but may not have clinical impact. In one study in 1999, fish oils had anti-inflammatory properties and led to less viral clearance and some increase symptoms in mice but did not change the outcome. The possiblity of worsening the severity of influenza was suggested in another mice study

At this point, I am going with the likelihood that fish oils do not enhance one’s recovery from influenza.

5.  Are there any treatment options available for influenzaYES!  

  1.  Oseltamivir.  Oseltamivir (Tamiflu) is given twice daily over five days and is a neuraminidase inhibitor, which blocks an important step of viral progeny (new virions) leaving an infected cell to go on to infect other cells.  It likely reduces the severity and shortens the course by a few days.  Take the therapy within a day of onset.
  2.  Baloxavir is a single-dose option recently approved for this flu season (Oct 2018) and has a novel mechanism – an endonuclease inhibitor, which blocks a step needed in viral replication (“making copies”).  The important thing about these medications is that they have to be taken within 24-48 hours of the onset of flu symptoms to experience the maximal benefits, which amount to a reduction of severity and duration by a few days.

Not everyone requires treatment other than supportive care, particularly in those with mild disease.  I would recommend that anyone with an age over 60 or BMI >30 and/or with conditions such as diabetes, cirrhosis, cardiovascular or pulmonary diseases consider taking this medication to reduce the risk of severity and duration.  Patient with lymphoma and leukemia or solid organ cancer are also at higher risk of complications.  In all of these patients, I would suggest if they present with disease within 24-72 hours or are hospitalized even after this period, that they receive the therapy.

Conclusion.  Happy New Year 2020!  I hope that you have an uneventful 2019-2020 flu season.  If you are unfortunate to get it this year, I hope it is as mild for you as the common cold. There are things you can do to ensure that it is. Remember influenza can be a significant disease.  Thank you for reading this post and please share this to your friends and contacts.  If you want to stay up-to-date with future Your Health Forum posts, register your email on the the side panel.

        Share the Post but don’t share this (Cover your cough with an arm)