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Influenza is transmitted by direct and indirect contact via respiratory droplets from coughing, sneezing or from just shaking hands.  The incubation period is several days and contagiousness can last as long as a week after the symptoms begin.  The best way to limit its spread is by frequent hand washing with soap and water for 15 to 20 seconds and by limiting close face to face contact with others when symptoms are present.  It is very important to know the difference between the common winter cold and influenza.  As opposed to a common cold, influenza has these distinguishing characteristics:

  • Very sudden onset
  • Fever
  • Aches
  • Sore throat

At the onset of influenza symptoms people often say they feel as if they had been “run over by a truck.”

The treatment for influenza is mostly symptomatic care:  plenty of rest, Tylenol or Advil (ibuprofen) for fever and aches, and maintaining adequate liquid intake.  There are drugs such as Tamiflu, available from a doctor which if taken within the first 48 hours of influenza symptoms may shorten the course of the illness by several days.  These are recommended for the elderly or chronically ill patients with influenza symptoms.

Being immunized by a flu shot significantly lessens one’s chance of getting the flu.  But as with any treatment there is no guarantee of 100% success.  One can still get a bad viral upper respiratory infection during the winter months even after the flu vaccine. Most people who receive the flu shot have no bad reaction to it.  Some people may experience redness and swelling at the injection site lasting a few days.  One cannot get the flu from a flu shot because it is made from a deactivated dead virus.  The benefit of the flu shot far outweighs the minimal risks.  Although the ideal time for a flu shot is from mid-October through November, the flu season can extend through May.


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Atrial fibrillation is an irregular often rapid heart rate, causing the heart’s two upper chambers to quiver instead of beating regularly. Fortunately, the lower two chambers still work normally and are able to pump the blood out of the heart, although not as efficiently. It is this inefficient pumping that can cause the frequent symptoms of palpitations, shortness of breath, weakness, and lightheadedness.

Atrial fibrillation is the most common heart arrhythmia. It is found in over 6 million Americans and accounts for some 90,000 deaths annually. It occurs in about 1% of individuals in their 60s increasing to up to 12%of adults in their 80s. Some 30% of people with atrial fibrillation are unaware of their condition.

Atrial fibrillation can be brought on by increasing age, prior coexisting heart disease, high blood pressure, thyroid disease, and drinking alcohol.  It can come and go or it can be chronic and permanent. It is usually not life threatening but it is a serious condition and needs to be treated.

There are two main goals in the treatment of atrial fibrillation. First is to attempt to control the rhythm, that is, get the rhythm back to the normal beating pattern. If a normal rhythm cannot be obtained then the second goal is to control the heart rate. Ideally one would want to have the rate 80 beats per minute or below.  Both of these goals can be accomplished with medication.

If one is very symptomatic or has relatively new onset atrial fibrillation, the heart can be electrically treated with a small electrical shock while under  brief anesthesia. This however is rarely a permanent solution.

One of the  main problems with atrial fibrillation is the chance of having a stroke. Blood clots can form in the quivering upper chambers. If a clot breaks loose it can go to the brain causing a stoke.  This can be prevented by taking a blood thinning medication. Another complication is heart failure due to a weakening of the heart muscle.

There is a new advanced procedure called ablation. In this case a catheter is inserted in a large blood vessel in the groin and threaded up into the heart. Through highly technical computerized imaging, the trigger area for the fibrillation in the upper chamber is identified and lightly treated with high frequency radio waves. This destroys the area where the abnormal impulses of atrial fibrillation are generated. The success rate for this procedure is around 70% initially and up to 90% if a second procedure is necessary.

Many people with atrial fibrillation are living relatively normal lives today when properly managed. It is a condition not to be feared but to be monitored closely and treated appropriately by your doctor.

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Seasonal allergies are commonly referred to as allergic rhinitis a.k.a. “hay fever” if the nose is mostly affected and allergic conjunctivitis if the eyes are involved.

Allergic rhinitis affects up to 40 percent of children and 10 to 30 percent of adults in the United States. It is referred to as “seasonal” if symptoms occur at particular times of the year or “perennial” if it occurs year round.

Common symptoms of seasonal allergies include sneezing, itchy eyes, nasal congestion, headache, and fatigue.  These symptoms can have a tremendous negative impact on the quality of life and on productivity. American workers lose an estimated 6 million work days yearly to this disorder, as well as incurring costs of several billion dollars in medical care.

Seasonal allergies usually occur from spring to early fall, and are due to pollens from trees, grass and weeds.    Interestingly, in this neck of the woods people associate the now beautiful yellow blooming acacia trees as the main source of allergies at this time. However, the fact is that the acacia pollen is quite heavy and usually just falls to the ground. Coincidentally at this same time, Birch, oak and a number of grasses are the real allergy producing culprits.

Perennial allergies, occurring throughout most of the year, are caused by indoor factors such as dust mites, animal dander, and mold.

Nasal stuffiness from allergic rhinitis can cause swelling and obstruction of the sinuses which can lead to a sinus infection.

There is a strong association between allergic rhinitis and asthma.  Up to 50 percent of patients with asthma have allergic rhinitis. Sleep disorders in adults and a high proportion of ear infections in children are also associated with allergic rhinitis.

Treatment for people who think they have allergic rhinitis can begin with an over the counter antihistamine such as Benadryl or Chlortrimeton,  however, they are often associated with the bothersome side effect  of drowsiness.  They should be avoided in children below 2 years of age and in the elderly.    Newer  oral antihistamines such as Claritin, Allegra and Zyrtec, are now available without a prescription and cause significantly less side effects and are more conveniently dosed at once or twice a day.  Steroid nasal sprays such as Nasacort and Flonase are very effective and are now sold over the counter.

Seasonal allergies can also affect the eyes causing redness, tearing, itching, and swelling of the lids. This can be treated with cold compresses and with one of the newer oral antihistamines mentioned above. It would also be worth trying over the counter allergy eye drops such as Zaditor,  Alaway  or Naphcon A.  If these treatments aren’t working sufficiently, see your doctor who can help you decide what treatment is best for your symptoms.


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Poison Oak


Having treated thousands of cases of poison oak in my career, I’d like to share with you what I’ve learned about this miserable affliction.

The poison oak plant which is so prevalent in our locale, contains an oil in its sap called urushiol. This oil is found in all parts of the plant; leaves, stems, and roots. Even in extremely minute quantities, like a billionth of a gram, it can cause a very severe allergic reaction to our skin. This usually occurs within 24-36 hours after exposure.

Eighty five percent of our population is susceptible to this rash and a lucky fifteen percent have a natural resistance to it.

You can be exposed to the oil by direct contact with any part of the plant, or by indirect contact with an object such as your own hands, clothing, tools, or anything that may have the urushiol oil on it. There have also been reported cases of smoke from burning poison oak, causing either a skin rash or a reaction in the lungs, although I have never seen this in any patient I’ve treated.

Once you have contact with the oil you have only a matter of minutes to wash it off before it will bind to the skin and begin the allergic rash. The best way to remove the oil from the skin is to rinse with lots of water and then wash with soap and water. Most any kind of soap will do. Also, wash any object which may have come in contact with the oil with soap and water, including the clothes you were wearing. And don’t forget to do the same to your shoes, tools and pets. Urushiol oil can remain active on inanimate objects for over a year.

There are a number of over the counter products including Technu and Zanfel, which are to be used on the skin after exposure to poison oak, to remove the oil. I have heard mixed reviews on their effectiveness. For now, I’ll stick with water and soap.

Poison oak rash never becomes systemic. It is medically called a “contact dermatitis,” and the only place where a rash can develop is where the urushiol oil has contacted the skin. Poison oak rash can affect almost any part of the body. The rash does not spread by touching it even if it is oozing a liquid, although it may seem to when it breaks out on new areas over a number of days. This may happen because the oil absorbs more slowly on thicker skin, such as the forearms, legs or trunk and faster on thinner kin such as the face and genitals.

Can poison oak rash be prevented before contact with the oil? Some allergy pills or shots have been used with limited success, but in general, they are no longer used, because of potentially serious side effects

A poison oak rash will always eventually clear up on its own if one is willing to wait it out. There are an abundance of home remedies to cure poison oak, none of which have been proven to be effective. However there is effective, proven, and safe medical treatment for those who wish not to suffer for several weeks. Your doctor may prescribe some form of a steroid cream which is stronger and much more effective than over-the-counter cortisone cream. If the rash is more serious and especially involving the face, systemic treatment may be necessary. This involves the use of cortisone pills called prednisone, which is my preferred treatment, or as a steroid shot. Either of these treatments is safe and very effective for most patients. Your doctor will help to determine the best treatment for your particular condition.

The bottom line is that you should avoid contact with poison oak, wash your skin and clothing as soon as possible if you do come in contact, and see your doctor for effective medical treatment if symptoms persist or worsen.

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I’d like to talk about several common activities involving our children and how to ensure safety and to avoid unnecessary injury.

Playground injuries, mostly from falls, account for over 200,000 emergency room visits per year. The highest risk group is 5-9 years of age. Young children need close adult supervision. Make sure that underneath the equipment there is an adequate shock absorbing material such as chipped wood or any type of rubber product. Also, the equipment needs to be inspected to ensure that it appears to be in good repair.

Bicycling (300,000 emergency visits a year) and skateboarding (30,000 visits) are the leading cause of head injury accidents in children. Proper safety for these activities includes adult supervision of the younger children, routine bicycle maintenance, and mandatory use of head protective helmets. These helmets must be proper to the activity and they must fit appropriately. But most importantly they must be worn!

Swimming accidents leading to drowning, are the second leading cause of injury death among children 14 years and younger. All pools must be adequately fenced in and have properly functioning gates. Injury can be avoided by not running around the pool, not jumping onto floating objects and proper use of a diving board. Again, adult supervision is paramount in preventing swim related activities.

In 1971, trampoline injuries lead to the NCAA eliminating the trampoline from sports competition. I’m sure it’s also why we don’t see this event in the Olympics. Trampoline injuries cause 80,000 emergency visits per year for children age five and younger. If you own a trampoline, do not allow a smaller child to be on a trampoline with a larger child, as the smaller one is much more likely to be injured.  In fact one should follow the manufacturer’s recommendations and not allow more than one person on a trampoline at a time. Safety netting around the trampoline is essential to protect a child but is not fool proof to prevent injuries.  As with all the above activities, adult supervision is mandatory.

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I’d like to share some of my thoughts on making for a very safe summer for everyone.

  • Sunscreen – Almost everyone who spends time out in the sun must wear sunscreen to block the harmful, damaging effects of the sun’s ultraviolet rays on our sensitive skin.  Use a sunscreen that offers protection against both UVA and UVB rays and has an SPF rating of at least 30. Apply it liberally and often (at least every two hours) especially when sweating or swimming.  Parents, protect your kid’s precious skin.
  • Insects – Beware of the many summer bugs lurking out there.  For mosquito protection use a repellant that contains DEET which when used as directed is safe for adults and children over 2 months of age. Regarding the stinging insects such as yellow jackets, wasps and honeybees, avoid them if they are in your vicinity. If you do get stung by a honey bee (which is the only one of the stinging insects that leaves a stinger behind in your skin), remove it as quickly as possible by any means possible.  It is now OK to just pull it out with your fingers and not waste time finding something with which to scrape it off.  Immediately apply ice to the sting. When out in a woody or grassy area always check your entire body for ticks when you get home. If you find one, remove it as soon as possible by getting a pair of tweezers, grabbing the tick  close to the skin and pulling it straight out.
  • Poison oak – The best protection is to recognize it and avoid it. If you come into contact with poison oak with your skin, clothing (including shoes and shoe laces), or garden tools, wash off immediately with soap and water.  Poison oak oil must be washed off of your skin with in a few minutes in order to avoid the dreaded rash. Remember, all parts of the poison oak plant contain the nasty oil, including the leaves, branches and roots.
  • Heat – Heat exhaustion is manifested by extreme sweating, fatigue and cramps. Heat stroke (a life threatening condition) is manifested by lack of sweating, red hot skin,  and a very high body temperature.  Both conditions can usually be prevented by drinking plenty of liquids and avoiding direct sun as much as possible especially between the hours of 11:00 AM and 4:00 PM.
  • Water safety – 4,000 Americans drown every year, mostly men by a factor of 4 times more than women.  Alcohol is frequently involved.  Make sure the kids are supervised in the water every single minute. Watch out for rapid currents, rip tides, rocks, and always be aware of your surroundings.  Boat injuries claim another 700 American lives a year.  Drive your boat sensibly, have enough life preservers on board and do not drink alcohol and drive.
  • Bicycling – WEAR A HELMET!  No matter how obvious this bit of advice is, I still see people riding without a helmet and I really cringe when I see children without this life saving protection. Head injuries are often very serious, if not deadly, and are inexcusable for lack of a helmet. Be aware of your surroundings and be in control of your bike at all times.  Don’t take foolish chances.
  • Eating – Summer picnics can be a common source of food poisoning manifested by vomiting and/or diarrhea..  Food left out too long is the usual culprit. Handling uncooked chicken or eating undercooked chicken is also a common source of this illness.
  • Driving – We all drive more during the summer.  The cheapest form of life insurance while you are in a car is the good old seal belt.  WEAR IT!  Make sure your children are in proper age appropriate car seats.  Hand held cell phone use while driving your car can be deadly and is now illegal. Don’t break the law.

Have a very enjoyable safe summer.

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Heart Health


You don’t have to spend a lot of money or take medication to maintain a healthy heart, just follow these guidelines:

  1. Quit smoking.  Smoking causes high blood pressure, decreases exercise tolerance, increases blood clotting, and double the odds of a heart attack.
  2. If you drink alcohol, do so in moderation. Alcohol can increase the blood pressure and in higher doses can significantly weaken heart muscle.
  3. Exercise the heart as much as you would do for any other muscle to help strengthen it and keep it healthy. 30 minutes a day of moderate intensity exercise, such as brisk walking five days a week, or 20 minutes of vigorous activity, such as jogging three days a week.  Try to make your exercise enjoyable (bring a friend or listen to music) and be persistent.
  4. Eat plenty of fiber such as fruits, nuts, whole grains and vegetables. Avoid saturated fats such as those found in most meats, chicken skin and many dairy products.  Instead, eat good fats such as olive oil, nuts, avocados and olives.
  5. Maintain a normal blood pressure. High blood pressure increases the work load on the heart and eventually will cause it to become thicker, stiffer and weaker.  This can lead to heart attacks and heart failure.
  6. Maintain as normal a weight as possible. As with hypertension, excess weight also increases the workload of the heart leading to the same end result of heart damage. Recent research shows that people who carry most of their weight around their middle (apple shaped as opposed to pear shaped), are at an even greater risk of heart disease.
  7. Controlling diabetes is important because up to three quarters of people with diabetes will die of some form of heart disease.
  8. Keep calm. Stress triggers the release of certain hormones that have an adverse effect on the heart muscle.  Studies have shown that clam and happy people have fewer heart attacks than those who are angry and discontent.  “Don’t worry – be happy”.
  9. Avoid salt as much as possible especially if you have high blood pressure. The recommended daily limit of salt is 2,300 mg. (one teaspoon). Try to avoid processed food and read food labels to steer clear of the worst offenders.
  10. Maintain levels of vitamin D. Research shows that people with low levels of vitamin D were twice as likely to have a heart attack as those who have adequate levels. The new 2010 recommended daily allowance (RDA) is 600 IU for those 1-70 years of age, and pregnant or breastfeeding women, and 800 IU for those over 71 years of age.

The above guidelines are tried and true methods of significantly improving your odds of decreasing heart disease and thereby promoting a healthier, happier, and longer life.

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