Monday, August 03, 2015

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What is influenza (also called flu)?

The flu is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death. The best way to prevent the flu is by getting a flu vaccine each year.

Symptoms of flu

People who have the flu often feel some or all of these symptoms:

  • fever* or feeling feverish/chills
  • cough
  • sore throat
  • runny or stuffy nose
  • muscle or body aches
  • headaches
  • fatigue (very tired)
  • Some people may have vomiting and diarrhea, though this is more common in children than adults.

*It’s important to note that not everyone with flu will have a fever.

How flu spreads

Most experts believe that flu viruses spread mainly by droplets made when people with flu cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby. Less often, a person might also get flu by touching a surface or object that has flu virus on it and then touching their own mouth, eyes or nose.

Period of contagiousness

You may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick. Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5-7 days after becoming sick. Some people, especially children and people with weakened immune systems, might be able to infect others for an even longer time.

How serious is the flu?

Flu is unpredictable and how severe it is can vary widely from one season to the next depending on many things, including:

  • what flu viruses are spreading,
  • how much flu vaccine is available
  • when vaccine is available
  • how many people get vaccinated, and
  • how well the flu vaccine is matched to flu viruses that are causing illness.

Certain people are at greater risk for serious complications if they get the flu. This includes older people, young children, pregnant women and people with certain health conditions (such as asthma, diabetes, or heart disease).

Flu seasons are unpredictable and can be severe. Over a period of 30 years, between 1976 and 2006, estimates of flu-associated deaths range from a low of about 3,000 to a high of about 49,000 people.

During 2009-2010, a new and very different flu virus (called 2009 H1N1) spread worldwide causing the first flu pandemic in more than 40 years. It is estimated that the 2009 H1N1 pandemic resulted in more than 12,000 flu-related deaths in the U.S. In contrast to seasonal flu, nearly 90 percent of the deaths occurred among people younger than 65 years of age.

Complications of flu

Complications of flu can include bacterial pneumonia, ear infections, sinus infections, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes.

Preventing seasonal flu: Get vaccinated

The single best way to prevent the flu is to get a flu vaccine each season. There are two types of flu vaccines:

  • The "flu shot"–an inactivated vaccine (containing killed virus) that is given with a needle. The seasonal flu shot is approved for use in people 6 months of age and older, including healthy people, people with chronic medical conditions and pregnant women.
  • The nasal–spray flu vaccine –a vaccine made with live, weakened flu viruses that do not cause the flu (sometimes called LAIV for "Live Attenuated Influenza Vaccine"). LAIV is approved for use in healthy* people 2-49 years of age who are not pregnant.

About two weeks after vaccination, antibodies develop that protect against influenza virus infection. Flu vaccines will not protect against flu-like illnesses caused by non-influenza viruses.

The seasonal flu vaccine protects against the three influenza viruses that research suggests will be most common. The 2010-2011 flu vaccine will protect against 2009 H1N1, and two other influenza viruses (an H3N2 virus and an influenza B virus).

When to get vaccinated against seasonal flu

Yearly flu vaccination should begin in September, or as soon as vaccine is available, and continue throughout the flu season which can last as late as May. This is because the timing and duration of flu seasons vary. While flu season can begin early as October, most of the time seasonal flu activity peaks in January or later.

Who should get vaccinated?

On February 24, 2010 vaccine experts voted that everyone 6 months and older should get a flu vaccine each year starting with the 2010-2011 influenza season. CDC's Advisory Committee on Immunization Practices (ACIP) voted for "universal" flu vaccination in the U.S. to expand protection against the flu to more people. While everyone should get a flu vaccine each flu season, it’s especially important that certain people get vaccinated either because they are at high risk of having serious flu-related complications or because they live with or care for people at high risk for developing flu-related complications.

Who is at high risk for developing flu-related complications?

  • Children younger than 5, but especially children younger than 2 years old
  • Adults 65 years of age and older
  • Pregnant women
  • Also, last flu season, American Indians and Alaskan Natives seemed to be at higher risk of flu complications
  • People who have medical conditions including:
    • Asthma (even if it’s controlled or mild)
    • Neurological and neurodevelopmental conditions [including disorders of the brain, spinal cord, peripheral nerve, and muscle such as cerebral palsy, epilepsy (seizure disorders), stroke, intellectual disability (mental retardation), moderate to severe developmental delay, muscular dystrophy, or spinal cord injury]
    • Chronic lung disease (such as chronic obstructive pulmonary disease [COPD] and cystic fibrosis)
    • Heart disease (such as congenital heart disease, congestive heart failure and coronary artery disease)
    • Blood disorders (such as sickle cell disease)
    • Endocrine disorders (such as diabetes mellitus)
    • Kidney disorders
    • Liver disorders
    • Metabolic disorders (such as inherited metabolic disorders and mitochondrial disorders)
    • Weakened immune system due to disease or medication (such as people with HIV or AIDS, or cancer, or those on chronic steroids)
    • People younger than 19 years of age who are receiving long-term aspirin therapy
    • People who are morbidly obese (Body Mass Index [BMI] of 40 or greater)

Who else should get vaccinated?

Other people for whom vaccination is especially important are:

  • People who live in nursing homes and other long-term care facilities
  • People who live with or care for those at high risk for complications from flu, including:
    • Health care workers
    • Household contacts of persons at high risk for complications from the flu
    • Household contacts and caregivers of children younger than 5 years of age with particular emphasis on vaccinating contacts of children younger than 6 months of age (children younger than 6 months are at highest risk of flu-related complications but are too young to get vaccinated)

Use of the nasal spray seasonal flu vaccine

Vaccination with the nasal-spray flu vaccine is an option for healthy* people 2-49 years of age who are not pregnant. Even people who live with or care for those in a high risk group (including health care workers) can get the nasal-spray flu vaccine as long as they are healthy themselves and are not pregnant. The one exception is health care workers who care for people with severely weakened immune systems who require a protected hospital environment; these people should get the inactivated flu vaccine (flu shot).

Who should not be vaccinated against seasonal flu?

Some people should not be vaccinated without first consulting a physician. They include:

  • People who have a severe allergy to chicken eggs.
  • People who have had a severe reaction to an influenza vaccination in the past.
  • People who developed Guillian-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine previously.
  • Children younger than 6 months of age (influenza vaccine is not approved for use in this age group).
  • People who have a moderate or severe illness with a fever should wait to get vaccinated until their symptoms lessen.

If you have questions about whether you should get a flu vaccine, consult your health care provider.

For more about preventing the flu, see the following:

* "Healthy" indicates persons who do not have an underlying medical condition that predisposes them to influenza complications.

Content source: Centers for Disease Control and Prevention


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The primary NIH organization for research on Flu is the National Institute of Allergy and Infectious Diseases -

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Library on Oct 29, 2010

Picture this.  It's a grey fall morning in Northeast Ohio, the kind of morning when the nip in the air prompts people to get out the mittens and the knitted hats. There's a peek of sun now and then; a few moments of lucent optimism.  Each time the light glows, the leaves flash iridescent orange and red.  But it doesn't last long.  The clouds quickly reassemble and cover the sun.  Unlike the leaves that still cling to the branches, the leaves that litter the ground are brown, wet, and dead.  Winter is just a moment away.  

From the corner seat in our local coffee shop, I'm blogging and watching life go by. The first guy who comes in from the street has a prominent belly that's hanging way over his belt.  He orders a coffee, a doughnut and a blueberry muffin.  He pours sugar liberally into his cup of joe. 

The pastry case looks tempting.  There are five different types of muffins, multiple slices of pound cake, rice crispy treats, cookies and scones.  If you ask for coffee, the smiling staff has been trained to ask, "Anything else for you today?".  They appear to be slightly offended--mildly shocked--- if you don't get something sweet.

I flash back to a story from Don's medical school days.  He was assigned to take an eating history from a very overweight patient.  She reported that she usually ate cake for breakfast.  He came home and told me this and we were so shocked that the story was repeated for years.  That was 1980.  Now I sit and watch as the majority of people in our town leave this coffee shop with a bag full of cake for breakfast.  Actually, they've probably already had breakfast, because it's now 10 am.  

 A vertical rack offers a selection of newspapers with their front pages tilted forward attractively.  Bold headline, above the crease on USA Today:   DIABETES CASES MAY DOUBLE BY 2050.

 The pace of our sugary dissolution is apocalyptic, frightening.  Why are we all becoming diabetic and why doesn't anyone care?  Smoke in our house, flames licking at our feet.  Sometimes I feel like I'm a lone voice shouting FIRE.  It's like a bad dream.  The one in which you try to call someone with an urgent message, but your feet stick in the sand, your fingers turn to rubber when you try to dial the phone, the line is dead.  Over and over. 

 Last night we held our second Refuse to Regain Group.  Eleven maintainers showed up, all so anxious to learn from each other.  Many in our group have lost over 100 pounds and one person has lost over 250 pounds, but the tasks of maintenance remain the same.  In order to maintain, in order to beat off the world of illness, fat and diabetes, we must find a way to live outside the sugar and starchy American norm.  How we do this was the subject of heated debate.  Can we eat whatever we want, but just have three bites?  The National Enquirer reports that Kim Kardashian eats a bite of dessert and pours champagne over the rest to ruin it, perhaps the ultimate demonstration of our wasteful, profligate society and our search for ways to have our cake and avoid it too.  

 At the meeting, there was a clear division between those who had maintained weight for years and those who were just getting started.  The newbies were still wrestling with the Kardashian solution.  Surely there was a way to continue to "play" with pasta, potatoes, grains, bread, cereal and sweets.  Maybe on the weekends?  Maybe with steely self control?  Maybe by keeping a food diary?  Please, please let there be a way!

 The more experienced maintainers had long since made their peace with the elimination of sugars and starches.  They ate by consistent rules and had discovered certain non-triggering treats (NTTs) that worked for them. Their diets relied on large amounts of fruits and vegetables, lean proteins like poultry, fish and low fat dairy and some nuts.   When their weight went up a bit, they eliminated their NTTs temporarily. 

 What is causing our obesity and diabetes?  The honest answer is that no one knows.  Perhaps we've simply exceeded the amount of stress our insulin systems can tolerate.  Perhaps epigenetic changes that occurred in utero, in wombs that were exposed to much higher levels of sugar than earlier generations, have left us vulnerable to these foods.  Or, there may be new obesogens in our environment, chemicals that disrupt the normal ability of our insulin to choose whether sugars should be burned or stored.  We store everything and become fat and increasingly sugar intolerant.  (And please remember that all starches are sugar too, including whole grains). 

 It doesn't much matter, because the short term answer is clear.   Eat a diet that is consistent with your ancient genes and one that avoids as much starch and sugar as possible.  This removes the stress from an insulin system that is busted...either by overexposure or by some unknown obesogenic cause. 

 The tsunami is gathering.  The fire is already raging.  We are facing an untold epidemic of overweight, diabetic, atherosclerotic Americans.   You are in the line of fire.  I'm telling you the answer.  I'm shouting that the roof's about to cave in.  But so far, there aren't many people running for the exits.  They are still staring, glassy eyed, at the pastry case and pondering the Kardashian compromise.

Dr. Barbara Berkeley on Oct 27, 2010

Published in the News-Herald, October 14, 2010
By Janet Podolak

Michael Allen Blair/ Holly Kimborowicz, Health Science Librarian for Lake Health’s TriPoint Medical Center, researches eye information for a resident on Monday at TriPoint Medical Center in Concord Township.

The online resources and medical library at Lake Health have changed the way dermatologist Dr. Jaye Benjamin delivers care to his patients.

"Take Leishmaniasis, for instance," he said. "It's a transmissible organism that causes inflamed crusty areas of the skin, and it's been seen among people who have served in the Middle East," he said.

"As physicians, there are some things we see every day, but when people travel there are a lot of things we may never see. Often it takes lab tests and biopsies to come up with a diagnosis, but research in our library at least gives us a clue."

A full 90 percent of the doctors who used the library last year also said that it has changed the way they practice medicine, said Holly Kimborowicz, Medical Librarian, after reviewing a survey taken by Lake Health doctors.

"It's a valuable resource that the community can tap into to help them make informed health care choices that they are comfortable with," said Benjamin, chairman of the library for Lake Health. "Even as a medical specialist, I find the volumes of available information overwhelming.

"The Web is like a giant flea market," he said. "There's lots of stuff out there, but very few treasures. Our librarians can be very helpful in directing us to the most trusted websites."

The hospital system has long had a fine medical library, Kimborowicz said.

"I've been here 23 years, and Librarian Cathy Murch has been with Lake Health for 25 years."

The librarians are able to hone in on needed information and save doctors time, Benjamin said.

The Carol DeJoy Lake Health Community Resource Center at TriPoint Medical Center in Concord Township also is open to members of the community wanting access to authoritative, current medical and health information. It's on the first floor of the Physician Pavilion, which is attached to the TriPoint Medical Center.

"When patients receive a diagnosis they are often overwhelmed with information and automatically search the Internet for answers," Kimborowicz said. "They now can come to the resource center where we can assist them in researching good, quality information versus incorrect information to encourage being a true partner in health care."

Michael Allen Blair/ Heather Francis holds her newborn daughter Paige while watching the local artists channel, part of the new patient education system at TriPoint Medical Center in Concord Township.

Another aspect of the library's services are relaxation videos that patients can view in their rooms on a digital arts channel.

"When Lake Health began designing its state-of-the-art digital hospital five years ago, we envisioned a technologically advanced facility offering holistic, integrated patient and family centered care," said Murch, project manager for the TVRC implementation.

TVR Communications is the largest provider of interactive patient services and entertainment products in the United States.

"Based on evidence that relaxation reduces pain and stress, we designed the whole facility — from the colors to the private patient rooms — around relaxation," Murch said.

The digital arts channel also highlights works from local artists and includes patient education and entertainment videos, including movies and games. Usage data showed that since it began being offered, relaxation content resulted in a rate of more than 14 viewings per day in the 119-bed TriPoint Medical Center.

The Carol DeJoy Lake Health Community Resource Center not only provides library services including Internet and research databases, but it also answers reference questions, loans books and journals, and provides personalized training on research techniques and copies of articles from other libraries. It has a small audiovisual room with a TV and DVD player and Internet access and soon expects to be able to loan laptops to patients for use in their rooms. Support groups, community organizations and family members also are encouraged to use this room for meetings.

"It's a comfort to patients to be able to keep up with their e-mails or schoolwork and for family members to keep their friends and other family members apprised of a patient's condition," Kimborowicz said.

"If you just Google a health topic, the results you get can be very frustrating," observed Kimborowicz. "But the truth is, more than 80 percent of all Internet users are researching health information."

She offers these tips:

A key starting place is, she said.

"That's the national library of medicine for the National Institutes of Health," she said. "They don't write the information, but instead have subject experts search the Internet for the best."

Another good resource is the website for American Family Physicians:

"Usually websites ending in .org are not for profit. If it ends in .edu, it could be an academic center or .gov — it's a government agency," she said.

"It's important to find out the date of the information and who wrote it," she continued. "Often that's pretty challenging, but if you work at it you can find it. One clue that it's not up-to-date is if you click on links and they don't work."

The modern Internet makes her work much easier than it was in 1981 when she worked for Case Western Reserve University.

"I went around to four hospitals to get articles and had a portable computer with a rubber suction cup that I stuck on the phone to transmit information," she recalled.

Community members wishing to use the resource center are encouraged to make an appointment if they have specific questions or need additional help with resources.

Reach the center by e-mail at or call 440-639-4387.

Library on Oct 18, 2010

Breast cancer affects one in eight women during their lives. Breast cancer kills more women in the United States than any cancer except lung cancer. No one knows why some women get breast cancer, but there are a number of risk factors. Risks that you cannot change include:

  • Age - the chance of getting breast cancer rises as a woman gets older
  • Genes - there are two genes, BRCA1 and BRCA2, which greatly increase the risk. Women who have family members with breast or ovarian cancer may wish to be tested.
  • Personal factors - beginning periods before age 12 or going through menopause after age 55

Other risks include being overweight, using hormone replacement therapy, taking birth control pills, drinking alcohol, not having children or having your first child after age 35 or having dense breasts.

Symptoms of breast cancer may include:

  • A lump in the breast
  • A change in size, shape, or feel of the breast
  • Fluid (called “discharge”) from a nipple

You have a better chance of surviving breast cancer if it’s found early. Talk to a doctor about your risk for breast cancer, especially if breast or ovarian cancer runs in your family. Your doctor can help you decide when and how often to get a mammogram.
Lake Health Resource Center

The Patient and Community Resource Center, located in the Carol DeJoy Lake Health Resource Center, is available for all Lake Health patients, family members and our community residents.  It is located on the 1st floor, Suite 113 in the Physician Pavilion adjacent to TriPoint Medical Center. 


 To visit the Carol DeJoy Lake Health Resource Center please call to check on staff availability.  Email and voicemail are available 24/7.

Carol DeJoy Lake Health Resource Center
Phone:  440-639-4387 or ext.42019

After cancer treatment : heal faster, better, stronger / Julie K. Silver.

Silver, J. K. (Julie K.), 1965-

Baltimore : Johns Hopkins University Press, 2006.


The American Cancer Society's healthy eating cookbook : a celebration of food, friends, and healthy living.

3rd ed.

Atlanta, Ga. : American Cancer Society, c2005.


Cancer caregiving A to Z : an at-home guide for patients and families.

Atlanta, GA : American Cancer Society/Health Promotions, c2008.


Choices in breast cancer treatment : medical specialists and cancer survivors tell you what you need to know / edited by Kenneth D. Miller.

Baltimore : Johns Hopkins University Press, c2008.


The complete guide to relieving cancer pain and suffering / Richard B. Patt and Susan S. Lang.

Patt, Richard B.

Rev. and expanded edition.

Oxford ; New York : Oxford University Press, 2004.





Coping with chemotherapy and radiation / Daniel Cukier ... [et al.].

New York : McGraw-Hill, c2005.


Dr. Susan Love's breast book / Susan M. Love, with Karen Lindsey ; illustrations by Marcia Williams.

Love, Susan M.

4th ed., fully rev., 1st DeCapo Press ed.

Cambridge, MA : DeCapo Lifelong, 2005.


Lymphedema : understanding and managing lymphedema after cancer treatment / from the experts at the American Cancer Society ; foreword Atlanta, Ga. : American Cancer Society, c2006.


Understanding cancer : a patient's guide to diagnosis, prognosis, and treatment / C. Norman Coleman.

Coleman, C. Norman.

2nd ed.

Baltimore : Johns Hopkins University Press, 2006.


What to eat during cancer treatment : 100 great-tasting, family-friendly recipes to help you cope / Jeanne Besser ... [et al.].

Atlanta, GA : American Cancer Society, c2009.


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Library on Oct 13, 2010

One of the first questions I get asked about acupuncture is "do the needles hurt?"  This is usually followed by the words, "I hate needles!"  Well, surprise, I hate needles too!  However, there is a big difference between the size and thickness of acupuncture needles and the hypodermic (injection) needles you have experienced at a doctor’s office or hospital.
If you are the typical person, you have either donated blood, had your blood drawn for a yearly physical, or have been given an injection of some sort. So when you hear the word "needle," you probably revert back to the time you were giving blood, lying on a table while the nurse placed a tourniquet on your arm, slapped your elbow crease tofind the perfect vein, as you turned your head to prepare for the sharp pierce of the seemingly large, scary needle.  Sound familiar?

Acupuncture needles have no resemblance to the hypodermicneedles.  Hypodermic needles are hollow and have a large diameter because they are used to inject substances into the body or extract liquids, like blood, from the body.  Acupuncture needles are solid and thin.  They can be thinner than the size of a human hair. Many people do not even feel the acupuncture needles being inserted, while others may feel a very mild tingling, which usually last for a few seconds.  If there is any discomfort, it is typically very short and very mild.  The most commonly used length of an acupuncture needle is one inch.

Acupuncture needles are FDA approved and are always made from stainless steel.  The acupuncture needles are always pre-sterilized, and are disposed of after a single use.   
So, do not think of acupuncture needles like the needles you have experienced in the past.  There is no need to be afraid of acupuncture needles; they are safe, sterilized and almost painless!

Susan M. Kim DC, CCN, CSCS on Oct 11, 2010