Usually at this time of year I get lots of questions about flu shots. This year I have been getting lots and lots of questions about flu shots. Undoubtedly, this is due to the avalanche of media attention on the topic this fall. In this newsletter I add my 2�.

The office will be closed Thanksgiving until the following Monday. We will be in San Diego at a soccer tournament. At least this year we planned ahead, and so won't have Thanksgiving dinner at Coco's, like last year. I'll also be able to continue collecting data for my study on soccer referee injuries (no, not my own). Have a wonderful Thanksgiving Holiday and remember what the holiday is about. Especially in challenging times, it is important to build on the good.

Best, Michael Carlston, M.D.
www.carlstonmd.com

Evidence of positive effects of exercise on bone health continues to accumulate. Investigators tracked a group of women runners (ages 46 - 75) who ran 20 - 25 miles a week. Over a five year period these women, without any use of hormone replacement had no measurable bone loss. Of course there are side effects. The side effects of exercise include, decreased risk of heart disease and cancer, weight control, mood elevation etc etc.

I Opened the Window and Influenza Vaccination for the flu is in interesting topic because it highlights so many issues.

Influenza is a viral disease caused by members of a specific class of viruses, aptly named influenza. Each flu creates somewhat different symptoms than its brethren. Also, every person has a different response to the virus, and therefore, somewhat different symptoms. Influenzas affect the respiratory tract. That is why they can be lethal. When the flu kills it is usually because of a bacterial pneumonia overcoming the weakened immune system. Other common symptoms are fever, body aches and headache.

I am certain that many of you are familiar with the story of the influenza pandemic triggered by World War I. It was called the Spanish Flu. More people died from that illness than from WWI. In fact, some estimates are that as many as 20 - 40% of the entire world's population caught that flu. In the US alone over half a million died. It was shocking because those who die of influenza are usually old and often already sickened with chronic health problems. The Spanish flu killed previously healthy young people very rapidly, sometimes almost overnight. Thankfully we have not seen its like again.

In 1977 a flu appeared that frightened government scientists into thinking it would be similar to the Spanish flu. The Swine Flu, as it was called (because pigs are carriers of the disease), led the government to create an emergency vaccination program in hopes of preventing similar devastation to that seen 60 years before. Vaccine manufacturers did not want to incur the financial risk of any complications that would result from the vaccine, so the US government stepped in to provide coverage.

The flu turned out to be much less severe than expected. Also a large number of Americans developed a paralyzing disease (Guillain-Barré Syndrome) from the vaccine. We don't know very much about GBS, and even less about how the vaccine created it for those people. Since then research shows there is an increased risk of GBS among those who take the flu vaccine, but very, very few cases have resulted from the flu vaccine. (It appears that there is no increased rate of GBS following other vaccines).

Overall, influenza vaccine works for just over one third of the people who take it (37% effectiveness per CDC studies). In any given year it can prevent flu symptoms for 18% to 52% of those who take the vaccine. There is some evidence which suggests the vaccine is less helpful for those who need it most (elderly nursing home residents, for example). One reason that influenza vaccine is not so helpful is that the manufacturing process takes time because a panel of experts essentially has to take a guess at what each year's flu strains will be. Their track record has not been very good in recent years.

Although we have yet to face anything like a recurrence of the Spanish flu, many people in the US who are already in a sickened condition succumb to pneumonia as a consequence of influenza.

The influenza vaccine is contraindicated for people with a sensitivity to eggs or chickens, a history of GBS, history of a bad reaction to a previous influenza vaccine, current illness with fever or pregnancy. The vaccine carries Thiomersol (mercury) as a preservative.

The most common adverse effects of the influenza vaccine mirror the symptoms of the flu - headache, body aches, fever and fatigue. It does not begin to provide protection for at least 2 weeks.

The government has expanded their recommended populations this year to include children and adults down to age 50. I think this is excessive. Over the years I1ve seen patients who developed chronic health problems following influenza vaccines. The mysterious risk of neurologic disease like GBS is ever present. Finally, the evidence is that the vaccine is just not that effective. I do recommend flu vaccine to certain patients, including those with chronic disabling respiratory conditions or immune suppression.

Several antiviral medications were introduced in recent years, hoping to gain acceptance as medical treatments for the flu. Unfortunately these medications don't work very well and have significant adverse effects. Ironically, some of them are contraindicated for patients most at risk for problems from the flu (asthma patients). The most common alternative treatment choices are high doses of vitamins (C and mixed carotenoids), zinc, herbs such as echinacea and andrographis and homeopathic remedies. For example, one homeopathic remedy (Oscillococcinum, aka Flu Solution) has been the subject of a series of clinical trials over the past 15 years, with mostly positive findings.