In the past few months the number of H1N1 infections has decreased substantially. According to the CDC the current influenza activity is relatively low throughout the country. Furthermore, most children in our area have been vaccinated for H1N1 influenza. El Camino Hospital has decided to remove the temporary visiting restrictions effective February 26, 2010.

We at WPMG still want to stress the importance of hand-washing precautions, especially around newborns or anyone who may be immune suppressed. We still strongly recommend that any potential hospital visitor, including children of patients, should be in good health and free of cold or flu symptoms (e.g. sore throat, cough, fever, runny nose.) We still encourage H1N1 vaccinations, especially for anyone in high risk groups or in close contact to anyone in a high risk group.

Admission is free. You can preregister at 800-216-5556 or www.elcaminohospital.org/dayofdance. With your preregistration you will automatically be entered in a raffle.

The experience thus far with this vaccine has shown that it is as safe as the regular seasonal flu vaccine. It has also been shown to be effective in preventing what can be a serious flu epidemic in previously healthy people, at times resulting in hospitalizations and death. We hope that this epidemic has peaked and the outbreaks will be decreasing, but once an epidemic peaks, 50% of the hospitalizations and 50% of the deaths are still yet to occur.

Unless you have a contraindication, we at WPMG recommend that everyone have this vaccination. Even if you are at low risk of complications, you could unknowingly pass it on to someone else who is at high risk of complications since people can transmit the virus to others 2 days before the symptoms occur.

If you would like to have this vaccination at our office for a $25 injection fee, please call first at 650-988-7550 to confirm a time to come in.

Due to recent controversy over mammography screening, the El Camino Hospital Breast Cancer Task Force is hosting a panel discussion on what you need to know to make an informed decision about when and how often to have a mammogram. The panel of physicians will discuss the new information and answer any questions on the subject.

The panel includes:

Imtiaz Qureshi, MD, Chief of Radiology
Shyamali Mallick Singhal, MD, PhD, Medical Director of the Cancer Center
Jessie Jacob, MD, Director of Breast Imaging and Intervention
Rakesh Patel, MD, Breast Cancer Specialist

To register and for more information about any of these events,
call 800-216-5556!

The following groups are high risk:
-Pregnant women;
-People who live with or care for infants younger than 6 months of age;
-Healthcare workers (HCWs) and emergency medical personnel;
-Persons 6 months to 24 years of age;
-Persons 25-64 years of age who have chronic diseases (including immunodeficiency states) that pose risk for influenza.

Contraindications to the inactivated vaccine include:
-Previous Guillain-Barré syndrome;
-Life-threatening reaction to previous influenza vaccination; and
-Severe illness (a “moderately or severely ill” patient is advised to wait, but a mild upper respiratory infection or other illness is not a contraindication).

Note that pregnancy and breastfeeding are not contraindications to receiving the inactivated vaccine. The most common side effect with the killed virus vaccine is soreness at the injection site. The cost is $25.

The USPSTF recommendations were based on recent studies published November 17, 2009 in the Annals of Internal Medicine. These showed that both women in their 40’s and women in their 50’s have an equal decreased risk of dying from breast cancer if they get routine screening mammograms. However, women in their 40’s may have denser breasts and so are more likely to require additional imaging studies and perhaps breast biopsies to rule out breast cancer. This could result in harm from radiation exposure, false-positive and false-negative results, overdiagnosis, pain during procedures, and anxiety. The USPSTF decided that for women in their 40’s the risk of harm was greater than for women above 50 but the likelihood of benefit was less since only about half as many women in their 40’s actually have breast cancer identified on routine screening.

The American College of Obstetricians and Gynecologists (ACOG) has also reviewed recent data on risks and benefits of mammograms. At the present time, they recommend:
• Screening mammography every 1-2 years for women aged 40-49 years
• Screening mammography every year for women age 50 or older
• BSE; BSE has the potential to detect palpable breast cancer and can be recommended.
The American Cancer Society (ACS) also continues to recommend routine screening for women 40 and above. The Department of Health and Human Services (HHS) is not changing their current funding guidelines for women 40 and above.

Your doctors here at WPMG support ACOG guidelines until there is compelling evidence to the contrary. We will also individualize recommendations for high risk women.

Where to Get the H1N1 Flu Vaccine

The following clinics are for people at higher risk for getting or having complications from the H1N1 flu. Over the next weeks and months, as regular shipments of vaccine continue to arrive, there should be enough vaccine for anyone who wants it.

Public vaccination clinics for the following groups will be held on November 15, and November 21 from 9:30 a.m. to 3:30 p.m.

Pregnant women;
Children and young adults between the ages of 6 months and 24 years;
People who live with or provide care for infants under six months;
Adults between the ages of 25 and 64 years who have medical conditions that put them at higher risk for flu-related complications; and,
Healthcare and emergency medical services workers.
Because the vaccine supply is so limited at this time, it is important that persons not belonging to one of the groups above wait to be vaccinated so that those at highest risk of severe illness can get the vaccine.

Once the demand for vaccine for people at highest risk has been met, the Public Health Department and local providers will begin providing the vaccine to all others who want it. It is important to remember – this is the beginning of a long vaccination effort. We thank you for your patience and understanding.

Clinic locations, days, and hours may change based on the vaccine’s availability and public demand. Please check www.sccphd.org/h1n1flu for weekly updates to clinic schedules.

November 15th to November 21st

Times
Sunday, November 15
Saturday, November 21 9:30 a.m.
3:30 p.m.
Location
Santa Clara County Fairgrounds
EXPO HALL
334 Tully Road
San José, CA 95111

For more information about the H1N1 flu and vaccination clinics offered by the Santa Clara County Public Health Department, visit www.sccphd.org.

“The only portals of H1N1 entry are the nostrils and mouth/throat.. In a global epidemic of this nature, it’s almost impossible to avoid coming into contact with H1N1 in spite of all precautions. Contact with H1N1 is not so much of a problem as proliferation is.

While you are still healthy and not showing any symptoms of H1N1 infection, in order to prevent proliferation, aggravation of symptoms and development of secondary infections, some very simple steps, not fully highlighted in most official communications, can be practiced (instead of focusing on how to stock N95 or Tamiflu):

1. Frequent hand-washing (well highlighted in all official communications).

2. “Hands-off-the-face” approach. Resist all temptations to touch any part of face (unless you want to eat, bathe or slap).

3. *Gargle twice a day with warm salt water (use Listerine if you don’t trust salt). *H1N1 takes 2-3 days after initial infection in the throat/ nasal cavity to proliferate and show characteristic symptoms. Simple gargling prevents proliferation. In a way, gargling with salt water has the same effect on a healthy individual that Tamiflu has on an infected one. Don’t underestimate this simple, inexpensive and powerful preventative method.

4. Similar to 3 above, *clean your nostrils at least once every day with warm salt water. *Not everybody may be good at Jala Neti or Sutra Neti (very good Yoga asanas to clean nasal cavities), but *blowing the nose hard once a day and swabbing both nostrils with cotton buds dipped in warm salt water is very effective in bringing down viral population.*

5. *Boost your natural immunity with foods that are rich in Vitamin C (Amla and other citrus fruits). *If you have to supplement with Vitamin C tablets, make sure that it also has Zinc to boost absorption.

6. *Drink as much of warm liquids (tea, coffee, etc) as you can. *Drinking warm liquids has the same effect as gargling, but in the reverse direction. They wash off proliferating viruses from the throat into the stomach where they cannot survive, proliferate or do any harm.”

To view a video clip on how to do saline irrigation, you can go to the following site: http://www.mayoclinic.com/health/nasal-lavage/MM00552

The risk of having a blood clot or stroke is 1 in 10,000 in the general population. In a study published by the British Medical Journal this year, the risk increases to 3.6-7.3 in 10,000 with BCP use. Pills containing levonorgestrel such as Seasonale/Seasonique and Alesse have a risk of 3.6 per 10,000; those containing desogestrel such as Desogen, Mircette and Orthocept have a risk of 7.3 per 10,000; and drospirenone birth control pills such as Yaz or Yasmin have a risk of 6.3 per 10,000. The risk of getting a clot while taking BCPs is 3.6 to 7.3 times higher than if a person is taking no BCPs, but it is important to remember that the the risk of developing a clot during a normal pregnancy is even higher than when using BCPs. Women who have a normal pregnancy have a rate of blood clots of 8-10 per 10,000.

When looking at the risk, also take into account the benefits of being on BCPs. In addition to preventing pregnancy, BCP cause lighter periods, less cramping, less acne and hair growth, fewer ovarian cysts, decreased PMS, and lower risk of ovarian and endometrial cancer.

Not all pills are tolerated well by all patients. Although clotting risk needs to be considered when prescribing a pill, the overall response to the pill is important. If you have tried other pills and are happy with your current pill, stick with it. You can decrease your risk of getting a clot by not smoking and maintaining a healthy weight.

Some women fear that BCPs will cause other problems like cancer or infertility. Actually, BCPs help to prevent ovarian and endometrial cancers and they do not increase the risk of breast cancer. They do not cause infertility and can actually help preserve fertility by decreasing the risk of endometriosis and ovarian cysts.

If you have concerns about whether or not you are a good candidate for using the pill, make an appointment with your doctor who will review your family history, your health habits, your current symptoms, and your fertility goals and timing to help you decide if BCPs are right for you.