Medicine for People!

November 2005 Extra Edition

Contents

Preparing For The Flu

We will receive eighty doses of flu vaccine about November 18th. Unlike most flu vaccine, this will be mercury-free. Since we had to order this in the spring, we estimated the demand for it. Much of it is spoken for. Call if you want to be added to the list. The cost is $30 per injection.

There is some controversy about the risks and benefits of flu shots. For a complete discussion, see our October, 2002 article on the subject:. Basic message: for people at increased risk, such as the elderly, or infants, or those with chronic disease, the vaccine is worthwhile. If you live with or provide care for anyone in those groups, vaccinating yourself will protect them.

Thoughts On Oseltamivir and Flu Epidemics

Several patients have requested prescriptions for the antiviral drug oseltamivir (Tamiflu) to have on hand in case of a flu epidemic. The Jefferson County Health Department has recommended against this, and the manufacturer has just announced it will restrict access to the drug to prevent hoarding. Here are the Health Department's thoughts on oseltamivir.

1. Although we don't know when the genetic roulette of viral transmission will result in a virus that can cause human epidemics, it is not occurring now and may not occur during the shelf life of any medication you buy today.
2. Oseltamivir is active against the current H1N1 and H3N2 types of influenza virus. Right now the strain in birds is H5N1 and it is poorly transmissible in humans, so it cannot start an epidemic. Among those humans who have contracted H5N1 influenza, oseltamivir sometimes has been helpful but is not a magic bullet. If the H5N1 now bothering the birds mutates to a form that is highly contagious in humans, we don't know which, if any, of our current antiviral drugs will work against it.
3. Current stocks of oseltamivir are needed for high-risk patients during the up-coming flu season.
4. An epidemic similar to the 1918 flu epidemic would last for three to six months, with follow-up "waves" every three months to a year. Ten capsules of oseltamivir are unlikely to provide substantial benefit in a global emergency of that scale.
5. Since you have to take the drug at the first sign of the flu, you might not time it correctly. You might experience some aching, mistakenly think you have influenza, take the drug unnecessarily, and then be without it if and when a real need arises. It's better to leave the drug supply at the pharmacy. If you do get ill in a flu epidemic, you'll be glad your pharmacy hasn't been cleaned out of oseltamivir by hoarders or scalpers.

Preparation Without Pills

The best way to prepare for an influenza epidemic is to practice good respiratory hygiene. This includes hand washing, use of masks to prevent the spread of virus, self-isolation when ill, and avoiding others who are ill. While the 1918 epidemic killed many people in the prime of life, a healthful diet and lifestyle still should reduce one's risk at any stage of life.

While we don't need to worry about hurricanes in our area, each part of the planet is exposed to its own risks, be they volcanic eruption, earthquake, flood, or disease. We need to be prepared not only to care of ourselves but also to help our neighbors. Read our summary of disaster preparedness in our May, 2003 newsletter and then take the practical measures outlined there. The Port Townsend Leader had an excellent article on disaster preparation in the November 2nd issue.

If you want a medical quality N95 face mask on hand in case of need, we have them available at our front desk for $2 each, or $6 for four. If you wait for a flu pandemic, we may not have any to spare.

More On Physical Therapy

In follow-up to last week's newsletter dedicated to phyical therapy, here are resources for preventing injury and dealing with children's bedwetting.

Injury Prevention at Work and Play

For those who want to be pro-active about injury prevention, you are invited to watch our video titled "Stretch for Health." Gentle stretching aligns muscle fibers, helps lubricate the joints, awakens nerve activity, and reduces stiffness. The video features Dwayne and Fran Russell, whose business, Optimal Health, helped Port Townsend Paper Corporation reduce work-related injury costs by 90 percent. They work with individuals, too, and are another resource to help you condition yourself so you can be active, without injury, at home, at work, and at play. To view our copy of the video you may come it and watch it at the office or borrow it for a deposit of $20, refundable within seven days.

Help for Children's Bedwetting

In last week's newsletter we discussed the success of physical therapy for adult female incontinence. After publication, Amy Irene Lynch, the physical therapist at Dirkson's Physical Therapy in Port Hadlock, brought to my attention her programs for children's bedwetting and daytime incontinence.

CJK May 24, 2006

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Medicine for People! is published by Douwe Rienstra, MD at Port Townsend, Washington. Edited by Carolyn Latteier.

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