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Archive for May, 2009

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Terry Hollenbeck, M.D., is an urgent-care physician in Santa Cruz County. A doctor with 34 years’ experience, health-related questions are welcome at valleydoctor@sbcglobal.net.

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Swine influenza (aka swine flu) is most commonly a respiratory infection caused by a virus that up to now has been confined to pigs. There have previously been few reported cases of transmission of this disease to human beings.

The swine flu virus is similar, but not exactly the same, as the more commonly known influenza virus that affects humans during the flu season. Both of these viruses attack the respiratory tract — the nose, throat and lungs.

Symptoms are characterized by sudden onset of fever, sore throat, cough, runny nose and generalized body aches. However, unlike the regular influenza, the swine flu is also sometimes associated with symptoms of vomiting and diarrhea.

So far, reported cases of swine flu in the United States have been mostly mild, as has not been the case in Mexico. Most people can expect to recover within one to two weeks without requiring medical treatment. As with regular influenza outbreaks, the very young, the very old and those with chronic illnesses could be at more serious risk of severe complications.

Influenza such as swine flu is easily passed between people through the air in tiny droplets from an infected person when they sneeze or cough. The virus found in these droplets gains entry into a susceptible person through the nose and mouth. People may also become infected by touching something with flu virus on it and then touching their mouth or nose.

It then takes one to four days of incubation before a person develops symptoms. A person with swine flu is contagious from at least one day prior to the onset of symptoms until the symptoms have cleared up.

Laboratory testing to confirm swine flu can be done, but at this time only those with influenza symptoms who have traveled to an area with known swine flu cases in the past few weeks, or who have been very close to someone who has been in those areas, should be tested. If the swine flu is confirmed in our county, then as a precaution everyone with flu symptoms will be assumed to have it and treatment will be determined by severity of those symptoms.

The question of how and when to treat swine flu can be difficult. Although there is no vaccine yet to prevent the infection, there are antiviral medications to treat it. This is an hour by hour developing situation, and there will be advisories regarding the need and availability of medications. At this moment, the only people who would benefit from treatment are those with flu symptoms and have been to areas with confirmed swine flu.

It is imperative that we all do as much as possible to prevent the spread of swine flu. I recommend the following measures:

  • If you have flu-like symptoms and have not been in an area of documented swine flu, stay home and treat your symptoms.
  • Cover your nose or mouth with tissue and discard the tissue after use.
  • Wash hands often with soap and water, especially after sneezing or coughing. Alcohol-based hand cleansers are also effective.
  • avoid touching your nose, mouth and eyes.
  • Avoid shaking hands or any close contact with anyone who is sneezing, coughing or who appears ill.

If you develop symptoms of fever, cough aches and sore throat:

  • Stay at home and rest.
  • Take Tylenol (acetaminophen) or Advil (ibuprofen) in recommended doses. This will treat fever, aches and a sore throat.
  • Drink lots of liquids and try to maintain a normal, healthy diet.

See your doctor if you have the following symptoms:

  • A fever at or above 104 degrees Fahrenheit.
  • Difficulty breathing or shortness of breath.
  • Chest or abdominal pain.
  • Lethargy or confusion.
  • Severe or persistent vomiting or diarrhea.

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Pinkeye, medically known as conjunctivitis, is an inflammation or infection of the conjunctiva, the transparent thin tissue covering the surface of the eyeball and inner eyelids. This condition causes the affected eye or eyes to appear pink or even red because the tiny blood vessels on the surface of the eye become swollen, thus causing the pink color.

There are several causes of pinkeye. The most common form is caused by a virus infection that is often associated with a head cold. Virus pinkeye is highly contagious and passed on to others by direct contact with the patient and his or her secretions or with contaminated objects or surfaces. Patients usually report awakening in the morning with a crusty mucous in their eyes and perhaps a small amount of mucous during the daytime. One may have the sensation of grittiness, burning or just irritation. Usually both eyes are involved. Virus pinkeye will cure itself, so no treatment is necessary. Over-the-counter eye drops such as Naphcon-A may provide some relief from the symptoms. It has to run its course and is usually gone within one week but may take up to two weeks.

Another form of infectious pinkeye is caused by a bacterial infection. This is usually not associated with the common cold and is more common in children than in adults. It is also very contagious and is spread as mentioned above in virus pinkeye. Patients with this infection often have just one eye involved and it is usually “stuck shut” upon awakening. The affected eye or eyes usually produce a pus-like discharge throughout the entire day, which helps to differentiate it from virus pinkeye and only has mucous upon awakening. Bacterial pinkeye is treatable with prescription antibiotic eye drops, which will usually clear up the infection within a few days.

Another form of pinkeye is due to allergies. This is usually caused by airborne particles such as pollen or cat dander to which a person is allergic. A patient with this form of pinkeye usually has both eyes affected, has an itchy feeling and also can produce some crusting upon awakening. Prescription allergy eye drops from your doctor are available for more severe symptoms.

Contagiousness seems to be the greatest concern about pinkeye. As mentioned, the infectious varieties caused by either virus or bacteria are highly contagious from contact with the discharge from the eye. Children who are too young to understand the concepts of hygiene are the most contagious. That’s why it is so prevalent in preschool and kindergarten.

It is generally believed that a child who has been placed on antibiotic eye medicine can return to school after 24 hours of treatment. Although there is no scientific proof to support this concept, it does seem to work. My personal bias is that a person with infectious pinkeye is contagious as long as there is discharge from the eyes.

Practicing good hygiene is the best way of limiting the spread of pinkeye. Once you have symptoms of an infection, I suggest the following:

  • Don’t touch your eyes with your hands.
  • Wash your hands with soap and water thoroughly and frequently.
  • Don’t share towels or face cloths with anyone.
  • Change to new eye cosmetics, especially mascara.
  • Follow your eye doctor’s recommendation if you wear contact lenses.

If you have any of the following symptoms, see your doctor immediately:

  • Decreased vision
  • Sensitivity to bright light
  • Sensation of something painful in the eye.

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