SWINE FLU ALL THE FACTS YOU NEED TO KNOW

The outbreak of a new form of swine flu has prompted the United States and the World Health Organization to declare a public health emergency. President Obama has called the emergency a "precautionary tool," since so far the outbreak has had only limited impact in the United States. But public health officials are scrambling to determine the extent of the outbreak.

This outbreak could peter out, like a 1976 swine flu outbreak did. Or the virus could spread easily from one person to the next, sparking a pandemic in which millions of people are infected. Richard Besser, the acting CDC director, says it's too early to say if we'll see more severe disease here in the United States. "Viruses are unpredictable and variable over time," he said yesterday. "What we say and what we learn will change."

Here's the rundown on what we know so far, as well as the options for avoiding swine flu and for treating it if you get it.

How is swine flu different than seasonal influenza and bird flu?
This is a new flu bug that includes genetic segments from human, swine, and avian flu viruses. It is an influenza A H1N1 strain, named for two proteins in the bug's protein coat. H1N1 viruses often circulate without causing major outbreaks. But since this flu virus is new, people might not have immunity to it. That's why the global public health system is on alert. No one knows where this outbreak might lead.

What symptoms would tell me I have swine flu?
Swine flu symptoms are similar to the symptoms of regular seasonal flu, according to the CDC. Those include:

-Fever
-Lethargy
-Lack of appetite
-Coughing

Some people with swine flu have also reported runny nose, sore throat, nausea, vomiting, and diarrhea.

How can I tell if someone sitting next to me has swine flu?
You can't. If someone is showing the symptoms described above, it couldn't hurt to keep your distance. Jeff Duchin, chief of the communicable disease section at Public Health Seattle, says it's best to say 6 feet away from someone who has the flu because the virus spreads in droplets when people talk, cough, or sneeze. Of course, your neighbor might just have a stuffy nose caused by a mild cold or seasonal allergies.

Should I be wearing a face mask, like they're wearing in Mexico?
Not unless you're taking care of a person who's sick with swine flu or are sick yourself. Wearing masks is a popular reaction to respiratory outbreaks in parts of the world, but it's not a step that the U.S. government has recommended for the current outbreak. The CDC has an online guide to using masks and respirators to prevent flu transmission.

Is there a vaccine available for this new swine flu?
No. Developing and producing a vaccine matched to this flu virus will take several months. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, said yesterday that a swine flu vaccine could be added to the seasonal flu vaccine now being produced for next fall, either as a replacement for one of the three strains in that vaccine or as an addition that makes it a four-strain vaccine.

What's the best way to avoid getting exposed to the swine flu virus?
For now, avoid people who are coughing or sick. The CDC also recommends hand washing to reduce the risk of flu. Though frequent hand washing hasn't specifically been proved to protect against swine flu, it does reduce the risk of respiratory infections generally.

What other things can I do to get my family prepared?
It never hurts to think about what you would do if swine flu hits your community hard, the CDC's Besser says. That may mean that schools would be closed, as has been done in Mexico. The federal government's pandemic flu website has suggestions on getting ready at home and at work. One example: Do you have enough food in the house to feed your family if you had to stay home for a week? You can also check with your employer to make sure the company has a plan in case of a flu pandemic. And you can prepare yourself for the possibility you'd have to work from home for a while.

Is it dangerous to eat pork?
No. This flu virus is spread from person to person by touching surfaces infected with the virus or by inhaling viruses from someone coughing. You can't get swine flu from eating pork.

What should I do if I or someone in my family is sick?
"Calling the doctor is never the wrong thing to do," says Mark Metursky, a professor of medicine at the University of Connecticut School of Medicine and immediate past chair of the chest infection network for the American College of Chest Physicians. You'll know you have the flu and not just a cold if you've got a fever of 102 or more, a headache, and muscle aches.

"If you have a respiratory infection with fever, don't go to work or school," says Duchin. To minimize the risk of infecting others, avoid traveling by air and taking public transportation if you have the flu.

People aren't at risk of swine flu for now, Metursky says, unless they have traveled to Mexico of are exposed to someone who has.

What medications work against swine flu?
Laboratory tests suggest this swine flu is susceptible to the antiviral drugs Tamiflu (oseltamivir) and Relenza (zanamivir). To be effective, these drugs need to be taken as soon as possible after a person has flu symptoms. "The sooner you talk to your doctor the better," Metursky says. The CDC has new recommendations for using antivirals to treat swine flu; people who are sick and have recently been to Mexico or who have been exposed to people with swine flu should speak with a doctor about whether to take an antiviral medication.

Should I stockpile Tamiflu?
The federal government doesn't recommend that people stockpile Tamiflu at home, saying it should be saved for people who are sick with influenza now. But many public health scientists have set aside some Tamiflu for themselves in the past few years because of concern about the possibility of a pandemic caused by bird flu. It's your call.

I'm not sick. Should I avoid traveling?
This might not be the wisest time to vacation in Cancun, but travel hasn't been banned by the CDC and WHO, so it's up to you. Airlines will let passengers to certain destinations re-book their trips at no cost. Check the CDC or WHO website before traveling, because the advisories could change at any time.

Why has the swine flu been deadly in Mexico but not in the U.S.?
No one knows for sure. It could be that Americans who've gotten infected had better, faster access to health care. Or it could be that the U.S. is just at an earlier stage in the outbreak, Duchin says. If that's the case, U.S. deaths could occur as the outbreak matures.

Where do I look for more news on swine flu?
The CDC's new swine flu website is a good place to start, for information both on the state of the outbreak and on how to keep your family healthy. Other good options:

-The World Health Organization is tracking swine flu cases worldwide.

-The Center for Infectious Disease Research and Policy is following swine flu, bird flu, and the possibility of a flu pandemic.

-The Infectious Diseases Society of America gears its swine flu news to doctors, but that information on treatment and avoidance is useful for individuals, too.

-The federal government's pandemic flu website provides a broad range of information on preparing for a pandemic.

WHAT CAUSES DIABETES IN CHILDREN ALL THE FACTS

The exact cause of type 2 diabetes is not known.

But experts believe the disease develops in children the same way it does in adults: the body does not produce enough of the hormone insulin, or it cannot correctly use the insulin available (insulin resistance). Either or both of these conditions lead to excess sugar (glucose) in the blood.

Insulin resistance

Insulin resistance occurs when the body's cells do not correctly use insulin, which helps control the amount of glucose in the blood. The body then needs more insulin to control blood sugar levels. The pancreas produces more insulin to try to keep blood sugar levels normal. If it cannot produce enough insulin, blood sugar rises, and diabetes may develop.

Factors that affect the body's resistance to insulin in childhood include:

Developmental stage. Insulin resistance normally increases about 30% during puberty, probably because of the effects of growth hormone.

Being female. Girls seem to develop more resistance to insulin than boys.

Race. The body's resistance to insulin is about 30% higher in African-American teens than in white teens.

Body composition. Insulin resistance increases as the amount of fat around the waist increases.

Activity. Exercise may improve how the body's cells use insulin and get the sugar they need.

Too little insulin

Normally, the pancreas produces more insulin than usual during puberty to support the rapid growth of the child. If the body cannot produce enough insulin to meet its needs, diabetes develops. Over time, the pancreas may produce less and less insulin, making the diabetes worse.

INJECTIONS FOR BACK PAIN WHAT YOU NEED TO KNOW

Trigger point injections Sometimes, putting pressure on a certain spot in the back can cause pain at that spot or extending to another area of the body, such as the hip or leg. To relieve pain, a local anesthetic, either alone or combined with a corticosteroid, may be injected into the area of the back that triggers pain (trigger point injection).

Facet joint injections A local anesthetic or corticosteroid is injected into a facet joint, which is one of the points where one vertebra connects to another.

Epidural injections A corticosteroid is injected into the spinal canal where it bathes the sheath that surrounds the spinal cord and nerve roots.

These injections can be done by an orthopedist, an anesthesiologist, a neurologist, a physiatrist, a pain management specialist, or a rheumatologist.

How It Works
Local anesthesia is believed to break the cycle of pain that can cause you to become less physically active. Muscles that are not being exercised are more easily injured, so the irritated and injured muscles can cause more pain and spasm and can disrupt sleep. This pain, spasm, and fatigue, in turn, can lead to less and less activity.

Steroids reduce inflammation, so a corticosteroid injected into the spinal canal can help relieve pressure on nerves and nerve roots.

Why It Is Used
Injections may be appropriate if you have symptoms of nerve root compression or facet inflammation and you do not respond to nonsurgical therapy after 6 weeks.

How Well It Works
Trigger point injections
Research has not demonstrated that local injections are effective in controlling chronic low back pain.

Facet joint injections
When used to treat chronic low back pain, facet joint injection of a corticosteroid is no more effective than a placebo injection and may even be harmful.1

Epidural steroid injections
Evidence supporting epidural steroid injection is mixed. Research does not demonstrate a clear benefit.But some people seem to get short-term relief, especially from pain that spreads down the leg.

Side Effects
Trigger point injections
Possible side effects include nerve or other tissue damage, infection, or excessive bleeding.

Facet joint injections
Possible side effects include pain at the injection site, infection, excessive bleeding, nerve damage, or spinal cord inflammation.

Epidural steroid injections
Rare possible side effects include headache, fever, spinal cord inflammation, or infection.


What To Think About
These injections can be painful.

Most orthopedists and rheumatologists advise against repeated injections of corticosteroids directly into joints, including joints of the spine, because degeneration or damage to joint cartilage may occur.

CAN BROCCOLI CURE CANCER? SOME THINK SO

Eating 2.5 ounces a day of broccoli sprouts appeared to reduce the risk of stomach ulcers and probably stomach cancer including cancer of the esophagus, bladder, skin and lung, among others. The evidence is all pointing toward broccoli or broccoli sprouts being able to prevent cancer in humans. Broccoli contains sulforaphane,A study in Japan included 48 people infected with H. pylori Half ate 70 grams a day of broccoli sprouts, and the others ate alfalfa sprouts, which do not contain sulforaphane. After eight weeks, tests showed significantly lower levels of H. pylori infection in those who ate broccoli sprouts, with no reduction among the alfalfa sprout eaters.