Michael Carlston, M.D. - Family Practice & Complementary Medicine

Carlston, M.D.
Family Practice and Complementary Medicine

www.carlstonmd.com

October 2, 2009
Swine Flu H1N1

Understandably, most of you, or maybe all of you, have questions about swine flu, especially how much you should be concerned and what actions you should consider taking. Here are my comments as of this moment.

Best,
Michael Carlston, MD
www.carlstonmd.com

State of the Pandemic

When this outbreak was first identified, the potential for a worldwide health care disaster quickly grabbed everyone’s attention. With the passage of time we have learned a great deal, but unfortunately that knowledge seems not to have tempered communal anxiety as much as it should. This flu looks it might be a bit worse than the typical seasonal flu, but nothing at all like the demon many feared. In an average year we estimate that 40,000 Americans die as a consequence of influenza, usually elderly and/or already weakened individuals, so influenza always deserves some consideration.

As flu spreads mostly during the winter, South Americans became international guinea pigs for this pandemic. I spent some time there during their winter. Despite the anxiety, it turned out not to be such a big deal.

Right now swine flu is all over the USA, with nearly 40,000 confirmed cases, especially affecting college students. The CDC currently estimates that over 1 million Americans have already been infected with the virus. Just less than 600 Americans have died from H1N1 (swine) flu. Anyone you know who has had flu symptoms (body aches, cough, fatigue, fever, head ache, sore throat, runny nose, diarrhea, vomiting) in the past couple of months almost certainly had swine flu. Unexpectedly, there is some question as to whether the infection rate might already be dropping in some areas of the country. While there is always a possibility of a viral mutation making any flu virus nastier, the CDC is reporting that this one shows no sign of doing so thus far.

Personally, I have yet to see a patient who was seriously ill with swine flu. The disease has been thankfully mild in almost everyone who has been sick so far. I do not feel that we should just forget about it, though. Following some simple preventive measures, that are good health practices anyway, would be wise.

Conventional Medicine – Vaccination and Antiviral

Vaccination theoretically can prevent spread of various diseases, including influenza. However, the difficulties of real world application and problems with the vaccinations make this approach less than perfect.

Vaccine Effectiveness

One of the reasons I am less than enthusiastic about the annual influenza vaccine as those who choose which virus from which to make the vaccine have been doing a poor job of guessing. A couple of years ago they made a good choice for the worlds population however, the virus they choose, called the Santa Clara virus, was so named as it made its first appearance here in the SF Bay Area the year before. As you guessed, it did not work around here that next year.

There is very good evidence that the H1N1 Swine flu vaccine is properly directed against the current virus. So that is a plus.

Even if the vaccine will work, it will take 2-3 weeks for an adult and up to 6 weeks for a child to develop immunity from the vaccine. In addition, public health estimates are that 70% of the populations must be vaccinated to effectively prevent spread of the virus. Despite the lack of evidence that influenza vaccine actually works to prevent the most serious cases, propelled by a public health and drug company promotional campaign, it has been growing in popularity in recent years. In 2007-2008, vaccination rates ranged from 15-45% across various risk and age populations in the US.

To sum this up so far, for the H1N1 vaccine to be effective experts think that two to four times the usual number of people need to be vaccinated and should have been vaccinated several weeks ago.

The government last funded an influenza vaccine program in the 1970’s, when there was also fear of a re-emergence of the 1918 swine flu.   That epidemic never developed; however, nearly 700 Americans died from a neurologic disease (Guillain-Barré Syndrome - GBS see http://www.ninds.nih.gov/disorders/gbs/gbs.htm    and http://www.cdc.gov/FLU/about/qa/gbs.htm) as a consequence of   the vaccine. Much more often, people with GBS do not die, but are left with persistent paralytic weakness. Since that time our ignorance about why some developed GBS and then what to do to prevent   GBS persists.

Those who are allergic to eggs should not take the flu vaccine. The first vaccine available will be made with living H1N1 virus and sprayed into people’s noses. This intranasal vaccine should not be used by those who have had any asthma symptoms within a year, pregnant women, children, those taking aspirin or anyone who is immune suppressed or living with someone who is immune suppressed (like someone on chemotherapy, for example).

As the most likely serious complication of influenza is bacterial pneumonia, those who are already quite ill with chronic disease should consider the pneumonia vaccine.

Antiviral Medication

Antiviral medication can be helpful. The neuraminidase inhibitor drugs (like oseltamivir – TAMIFLU) are moderately effective so far in this H1N1 but only if taken in the first 48 hours. The adverse effects can be quite bad including hallucinations, self-injury and “unusual behavior”.

Fundamental Prevention

Someone with swine flu typically passes it along to another person within 3 days. Although swine flu is highly contagious, if someone in your household has it, you have about a 25% chance of catching it from them. What can you do?

WASH YOUR HANDS

Some of you know that an interview clip of me appears in an infomercial for a book on a broad range of health topics sold by Bottom Line. When I sat down in my waiting room to film that piece two years ago I was shocked to learn that I was supposed to talk for 30-60 seconds without disclosing what I was talking about. I supposed to interest the viewer without revealing what my article was about.   That was a very strange and somewhat stressful experience (possibly why I looked so pained in the infomercial).

I will reveal to you (drum roll here) that the subject of my contribution was hand washing and the evidence that plain soap and water were as effective and safer than antibacterial soaps and other fancy hand washes. Another new study has confirmed this simple fact.

In the new study, researchers contaminated the hands of 20 health care workers with flu virus and instructed them to wash their hands in different ways. Using water alone and air-drying their hands, 14 of 20 still had virus-contaminated hands. The three alcohol-based hand rubs worked better than plain water but, on the top of the heap, the combination of soap and water was triumphant.

COVER YOUR MOUTH

If you aren’t sick but in a big gathering and you are very worried, wear a facemask. If you are sick, when you cough, cover up. Use your arm not just your hand.

STAY HOME

If you are sick, stay home and don’t share it with others. Just as importantly, resting will help you recover more quickly.

The Best Approach

I plan to continue to “do the right thing” as far as maintaining my health (keep hydrated, good diet, exercise, sleep, stress management, keeping my vitamin D up), and use other immune support as the circumstances warrant.   All of these elements have general and specific effects to improve your immunity. Don’t get caught up in the allure of drugs and supplements and forget about taking care of the basics!

Vitamin D

Vitamin D levels drop markedly during the very months that influenza tends to spread. There is evidence to suggest that this is not a coincidence, and more evidence that vitamin D supplementation reduces both the likelihood of getting sick and the severity of the illness if you do get it. Early reports from across the US confirm that these findings may be even more true with this flu.

Keep your blood above that target of 50. As it is so difficult to make yourself sick on vitamin D, even without a blood level you can simply take a lot of it. As the sun is leaving us, unless you have an unusual health condition (sarcoid or parathyroid disease) you can safely take even 10,000 iu daily for months without a worry.

Other Supplements

The root of echincaea purpurea and echincaea angustafolia can be very helpful but remember that if it does not make your mouth tingle when you bite on it, it is not good. Andrographis and astragulus are other herbs, which can be effective in prevention. Bee pollen, mushroom extracts, zinc and vitamin C are also safe and effective.

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