5 Reminders for Parents of Children Who Were Just Diagnosed With a Health Condition

Watching your child get diagnosed with a health condition and adjusting to the new realities of life with a child with a medical condition can feel overwhelming and frightening.  If your child just received a diagnosis, you may worry about what the future holds or seek out a sense of hope that everything will be OK.  Here are five gentle reminders for anyone whose child was just diagnosed with a disability or chronic illness.

1. Your child is still the same child you’ve always loved.

When your child receives a new diagnosis, it may be easy to view them through the lens of their medical condition, especially if you’re constantly worried about their future.  Your child, though, may not know the difference between life before and after their diagnosis and might not remember this moment later with the same emotional weight you do.  Your child is the same incredible child you’ve always known and loved — you just happen to have a name for the symptoms you’ve observed in them.  Loving your child the same way you always have can help you process that a disability or chronic illness likely won’t change who your child is and may also quell some of your fears about what’s to come in your child’s medical life.

2. You can share your child’s diagnosis on your own time.

You may feel pressure to immediately open up to your loved ones about your child’s diagnosis, even if you don’t yet feel ready to share.  On the contrary, you may feel like you shouldn’t share your child’s diagnosis and might worry about how and when others will find out.  As a parent to a child with a new diagnosis, you have every right to share about your child’s medical condition on your own time.  If you need to grieve your child’s diagnosis before you share or feel like you’re just not ready, take your time.  If you’d prefer that others know about your child’s health immediately, update your loved ones as soon as you want.  How and when you choose to share about your child’s chronic condition is your decision and no one else’s — and there’s no wrong way to go about it.

3. You will figure out how to adjust to the realities of a new diagnosis.

A new diagnosis for your child can come with a myriad of extra responsibilities and commitments, and at first, you may wonder how you’ll juggle it all.  Learning new terminology at specialist appointments, taking your child in for therapies, and researching procedures that could help your child may leave you feeling completely overwhelmed and afraid that you aren’t a good enough parent to your child.  With time, though, you will likely adjust to the realities of parenting a child with a disability, feel more comfortable in medical settings, and even feel compelled to help other parents who are navigating the same emotions you’re feeling now.  The raw emotions you feel today won’t last forever, and you’ll settle into this new life as time goes on.

4. Even if your loved ones pull away, you’ll find others who will stay.

As you begin to share news of your child’s health condition with family and friends, you may find that some of your loved ones feel hesitant or distant when you need them the most.  You may wonder if you did anything “wrong” to push them away or if your relationships will ever feel as natural as they did before your child’s diagnosis.  If you notice that your family or friends don’t seem to understand your life as a parent of a child with a disability, try not to give up hope.  The people who will stay by your side on their journey will likely genuinely want to understand your child’s condition and needs, and they may even become closer friends than ever.  You may also find plenty of other parents of children with disabilities who will understand your rapidly changing life and the challenges you and your child face — and those are the bonds that can last a lifetime.

5. Your child will continue to amaze you.

After you receive your child’s diagnosis, you may feel like all of your future hopes and dreams for your child are dashed, but even if you need to adjust some of your goals for your child, your child is no less incredible.  Parenting a child with a disability may help you notice milestones other parents may not fully appreciate, and those moments might just remind you how incredible your child is.  Even if you have to put some parenting dreams on hold because of your child’s condition, your child may constantly surprise you, surpass expectations and show you just how capable they’ve always been.  Your child’s diagnosis may set them on a new life trajectory, but they will still give you new reasons to celebrate how amazing they are every day.

When You’re Hospitalized for the Medical Complications of an Eating Disorder

The last time I was hospitalized for my eating disorder, it felt like the hospital’s only aim was to get me out.

I understand why this was the goal. In the past, the hospital has exasperated my symptoms and only made things worse. However, this time things were different — and many things were missed.

I was admitted to the hospital with an extremely high heart rate. The doctors were concerned. I didn’t refuse the first nine bags of fluids they gave me overnight because I too was worried about my heart. After medication and fluid, my heart rate still remained high. I was subsequently admitted for tachycardia. Within hours of admission, my sugar dropped so low it could have resulted in serious injury to my life. I didn’t refuse the first several doses of dextrose. (Which is different for me.) Nor did I refuse to stay, which would have required me to get certified and petitioned. I tried to display I was there for help — not to “break or get away.”

After many rounds of dextrose, I questioned if anything else could be done, because one, my eating disorder started to get louder as fluids and pure sugar entered my body. (This is normal for eating disorder patients and isn’t a reason a patient isn’t doing well in the hospital.) Two, my sugar was dropping within the hour and the dextrose didn’t seem to be lasting nearly as long as it had in the past. Three, I was malnourished, and didn’t really know what was best for me at the time. Nonetheless, I continued to receive dextrose because of my “refusal or inability to eat.” I was also experiencing these symptoms at home four to five days  prior to admission, which again is why I decided to seek help from medical professionals.

On Monday, February 8, after spending the weekend still dealing with tachycardia and hypoglycemia, the social worker came and almost immediately insisted I be discharged because my behavior would only be “exacerbated” if I stayed in the hospital. The nursing staff and I disagreed with this plain at the time because my symptoms where still not under control. I had a hard time walking on my own and because of my low blood sugar and fast heart rate, I actually fell and hit my head quite hard while trying to get myself dressed to leave the hospital. A doctor did not order any kind of scan after this fall, though I clearly had a mark on my forehead from hitting the floor.

We spent hours arguing back and forth about whether it was a good idea for me get discharged, and I kept changing my mind. This is also typical of someone with an eating disorder. Sometimes when we start to receive medical help, we look for ways to talk ourselves and others out of it for fear of losing too much control or gaining weight. The flip-flopping for hours wasn’t me being “borderline,” but in fact was my eating disorder screaming for me to leave while I had the chance and continue to starve myself, all while my rational voice was screaming how much I needed medical help. How thin I had become. How I couldn’t even stand on my own two feet. How I felt like my heart was going to beat out of my chest at any second. How I was scared this time. How I really might die because I really am “that sick.” How I truly wanted to do things differently.

Over the past few months, my new therapist had started telling me things I never thought about before. Like how complex my eating disorder is. How much it gets in the way of me being able to articulate what I really want or need. I wanted to try and fight anorexia more than ever, but she was also louder than ever. I was able to give up some control and go to the hospital, stay at the hospital. So I felt let down when I was told the hospital “wasn’t the place for me” and that “I would get any better.” What was better? Being sent back to my empty apartment to die alone? After much debating, the social worker wheeled me out to my car and advised me to “pivot” myself to my car from the wheelchair because they weren’t helping me drive in my condition. This is why I refused to drive away. It made no sense to me — if I was too medically unstable to drive my car, how could I walk up my steps or even get out of bed if I made it to my bed. To me, this wasn’t “borderline behavior,” this was me trying my hardest to prove my point. I wasn’t stable enough to care for myself.

After I drove off, I lost consciousness fairly quickly and crashed my car. I knew I couldn’t drive. But I had basically been kicked out of the hospital and I wasn’t going to allow myself to stay there another second. I woke up to nurses and doctors screaming and pounding on my window. Luckily after some time, I understood what was happening and opened the door. I was immediately taken in a triage where again my heart rate was through the roof, and I of course couldn’t stand on my own, let alone drive a car safely.

I was admitted back to the sixth floor after waiting in the ER for 18 hours. No one seemed to care how this affected my mental health. And after I refused to stay any longer, I was then certified and petitioned and threatened to be restrained if I even attempted to stand up. The same hospital that had discharged me just hours before told me I wasn’t safe enough to leave. (How was this not to confuse me and/or cause my anger?) Back on the floor, my physical health was slowing getting somewhat better, but the doctor still felt my sugar levels were too dangerous for me to be sent home. One day, I apparently became combative and incoherent. I began threatening to rip out my lines and was then put into restraints and given dextrose. (Being combative or displaying abnormal behavior is very common for someone with low blood sugar.) Despite this obvious medical information, and the fact that I had no memory of the outburst I had just displayed after receiving dextrose through a shot, I was still held in four-point hard restraints with one of my arms raised up in the bed for over four hours. Only after I complained because I knew this was against the restraint policy were both of my arms able to be by my side.

I had already pulled out my pic line and feeding tube being I was put in restraints, so what more of a threat did I pose? I felt like this was their attempt to punish and control me after everything that had happened. What other conclusion could be drawn? I was immediately calm after being in restraints, but still was locked in them and was even told to “eat” while in four-point restraints for displaying inappropriate behavior during a hypoglycemic episode.

Another time, after hearing nurse “discuss” me in the hallway for hours, I decided I was going leave to hospital. The nurses said things like, “The social worker already said this was for her mental health, she shouldn’t even be here, I got a dude dying next door. This is fucking bullshit and I’m not going to deal with her if she is the one refusing to eat.”

Please, let’s remember millions of people struggling with eating disorders. This is the kind of attitude that hurts us and prevents us from getting the help we deserve. I felt so discouraged, and like I was taking the space of someone who “really” needed to be in the hospital. All the thoughts of finally getting some help — not “recovering,” but making that huge first step — left my head. I had been eating small amounts. Agreeing to receive things like potassium and magnesium. In the past, I fought these things tooth and nail. I was in fact “doing something different.” When I left, I walked down six flights of stairs before being “tackled” by security and taken back upstairs. See, I was actually getting better this time. A week ago, I couldn’t walk from a wheelchair to my car door. This time I walked down all those stairs and though my heart felt like it was going to burst wide open, I didn’t fall. I was eating little by little and getting stronger. I was trying — until I heard  those nurses talk about me for hours.

When security found me I fought to not go back. I just wanted to go home and be left alone. What was I to do if the very people who went to school to help sick people and care didn’t even want me there? I was frustrated mentally from fighting my eating disorder for days and eating food no matter how small a bite. From telling myself I needed the medicine and fluids, the feeding tube. From hearing person after person say how this “wasn’t the right place for me to be helped” and “would only made things worse.”

When they brought me back to my bed, I was in restraints for over eight hours. I cried, looked outside and realized it was dark. Memories of the sexual abuse I experienced as a child and an adult flooded my heart. My abuser had tied me down. These memories only got more vivid when I was told my only choice that whole night was to use a bedpan. I promised that I wouldn’t even walk close to the room door. That all I wanted was my hands free. This night caused just as much trauma as the night my abuser actually did what he did. What was different is I kept expecting a nurse or doctor to come in and say, “OK, you can get out.” I knew that wouldn’t happen then with my abuser. But I never thought a hospital that claimed to understand trauma would put me in restraints again for so long just for packing my things and walking down stairs, basically.

Of course it wouldn’t happen again. I now had a sitter and all the nurses and security were on high alert. Yet for hours, I laid and cried begging to just be let go so I could get up and pee. Even at one of the most recognize and respected medical facilities, I was ignored and treated with very little empathy. This is why on February 15, 2021 when I knew I would be OK to at least make it home, I signed a paper to get discharged against medical advice. Even though the doctor didn’t feel I was safe to go home, no one said I should stay and not sign the paper. The nursing staff and security seemed quite happy to see me go actually. Despite the numerous times I was told “I would do better at home,” I am not. I’m still struggling to eat food. I am not medically stable.

Imagine if I was your daughter, sister, friend, or someone you loved or cared about. As a “medical professional,” would you have wanted me to leave the hospital because I was too much of a headache? Or stay there and potentially get medically stable, then go home and continue outpatient therapy and look for treatment centers? These words have come from my heart. From a heart who maybe wishes she hadn’t left against medical advice and could let words roll off her back. Who wishes more people in the medical field understood anorexia and eating disorders and how much they just kill and destroy. Coming from a socially compromised and diverse background as well, I wonder how my treatment would have differed if I was a white women with insurance presenting with the same symptoms. If perhaps I would have been given the opportunity to be forgiven and start a new stay, instead of immediately being told I was just going to fail. I hope by reading my story, next time you’ll stop and try to be a little kinder to the next patient who has been in ER room 23-26 hours because the social worker can’t find a psych bed. We too matter and have voices just begging to be heard. Thank you for reading.

How to Create a Morning Routine to Boost Your Mental Health

Being a Navy SEAL is definitely not for me, but I’m fascinated by their discipline. I’ve watched just about every documentary I can about what SEAL candidates must endure in their “hell week” testing. During these tests, called “evolutions,” the drill sergeant’s entire job is to push candidates beyond the limit, past what they believe is physically possible, to teach them one very important, life-saving truth: When your mind says you’re done, you’re really only about 40% done.

The reason your mind is so quick to tell you you’re done is because neither your body nor mind want to do anything hard. Both have been molded through evolution to conserve resources, minimize exertion, avoid threats, and stop when it hurts. Sometimes these defense mechanisms are useful, but oftentimes they are not and can even work against you.

For example, your body wants you to eat junk food for the extra calories, it wants you to be lazy to save energy, it wants you to stay inside to avoid danger, and it wants you to depend on others for protection. There’s nothing wrong with any of these behaviors in moderation, but abusing them can condition you to have a “give up” attitude and even an addiction. Then, after enough self-hate, self-harm, self-abuse, and self-disgust, you’ve properly dug yourself into depression.

If you’re experiencing this depression, know there’s nothing wrong with you. In my experience, I just needed to start conditioning myself in the opposite direction. Instead of attempting to conquer depression as a whole, I found a far more efficient strategy was taking a few small steps at a time. To do this, it’s useful to have a good morning routine. The details of the routine can involve whichever “evolutions” work for your needs. However, if you don’t know where to start, try some tips from Navy SEAL training, so when your hell week comes, you can attack the day with flying colors.

The first thing Navy SEAL candidates do is make their bed. This seems counterintuitive because it’s not a useful skill to practice, nor does it produce value to themselves or anyone on the team. Despite this, military divisions across the world enforce it because it teaches candidates the priceless skill of being faced with a problem they might not want to do, but they do it anyway, and they do it well.

Countless times in life, we will be required to do something we think is silly, useless, or unproductive. Many of these times, we will be tired, distracted by short-term rewards, able to avoid it, procrastinate, and maybe even cheat. When these situations arise, it’s important to do the task anyway and move onto the next. The sooner I learned to treat myself with honor and integrity, the sooner I saw that if I do the easy things in life, my life will become harder, but if I do the hard things in life, my life will become easier.

A perfect example of this is hitting the snooze button. It’s such a simple action that makes us feel good, and yet, it takes away so much of our power. It’s counterintuitive, but sleeping in often makes you sluggish. If you are familiar with this phenomenon, it’s time to do the exact opposite. Set your alarm early and wake up before the rest of the world. Not hitting the snooze button is a pretty good entry-level obstacle when starting a new lifestyle. It’s predictable, you know how it works, and you have experience with it. If you succeed and get out of bed, you will have taken the first step in the right direction and feel one step ahead instead of countless steps behind.

Becoming a Navy SEAL takes a lot of steps in the right direction. The physical requirements alone are brutal. To become the best of the best, their training involves progressive overload.

Fitness, especially in the morning, is one of the greatest things a person can do for their mental health. It’s a relatively mindless activity, and it doesn’t matter if you choose running, weight training, or a combination of the two. Furthermore, it’s an easy way to find your breaking point, practice being better than before, and reach higher goals. It’s also very easy to measure your progress regarding muscle gain, weight loss, endurance, speed, or various other metrics. With these in mind, every day you can challenge yourself with progressive overload and constantly improve your peak performance level.

SEALs maintain their peak performance levels by spending much of their time in training simulations. This training often involves unexpected challenges, which are specifically designed to create a familiarity with being in the unknown. This skill is vital because when they are confronted with unexpected chaos in warfare, they need to remain calm and work the problem. They also regularly practice being in dangerous situations, so during a real mission, they instinctually move toward the target despite the threats. With both of these skills, they remain in control, and when unexpected dangers arise, they know what to do.

To exercise the same control over your fight-or-flight response, take a cold shower. Cold showers are very uncomfortable and may make your body panic for escape. If you resist your mind’s desperate urge for flight, soon you will see how easily you can calm yourself when your body is in panic mode. Furthermore, practicing your ability to do something uncomfortable every day will build your resilience toward doing things even when your mind tells you to run away, give up, or cheat. On top of that, cold showers will boost your immune system and give you extra energy.

To further boost your energy, refrain from drinking so much coffee or soda. Your body is 60% water and therefore, you should be drinking that instead. So often when we feel fatigued and want a stimulus for energy, we resort to some kind of chemical. Your body doesn’t want any more chemicals. It wants water. Chug two glasses and see if that fixes your fatigue. If it doesn’t, at least you’ve drunk two glasses of water, and you’ve again proven to yourself you can do things even when your mind tells you not to.

As you practice your own morning routine, each skill will empower the others. Building the power to reject the snooze button is the same power to reject not exercising. It’s the same power to not eat junk food. It’s the same power to not binge another show. And it’s the same power to not hurt yourself. When you are hurt, life will hit, and it will hit hard. In the middle of your hell week, your mind will do anything to convince you you’re done and it’s time to give up. Fortunately, with all your evolution training, you will know not to believe everything you think. Instead, you will be comfortable being uncomfortable, your dedication will override any lack in motivation, and you will have the self-control, confidence, and strength to keep going, keep your head up, and never give up.

Freaked Out = Home Modification

I live alone so when the electricity goes out 2 to 3 times a year I have to handle it.  My stroke took away my ability to know where vertical is unless I can see my surroundings.  So I put flashlights in every room.  My plan worked until last night when the house went completely black while I was watching TV at 10 p.m.  I reached down for the flashlight on the floor next to my couch.  I started to freak out when I could not find it.  The electricity has gone off for hours in the past and sitting on my short couch until sunrise would be awful.  I finally found the flashlight, but after the lights came back on I put the flashlight in a different location.  I moved it to the tray on my couch that holds my remote control devices.  I also moved a second flashlight to a counter directly behind the place I sit at my kitchen table.

A previous outage taught me to put a battery operated lanturn on a cart next to my bed.  I turn the lantern on by rolling on my side and pulling the cart close too me so I can feel the on switch.

Unusual problem solving after a stroke NEVER ENDS.


Patient Education: Making Sleep a Health Priority

Get the best out of your sleep

Good sleep is a necessity for the healthy functioning of the mind and body.  It is also one of the things that we can forcibly deprive ourselves.  Ideally, we spend one-third of our lives asleep.  Improving your sleep quality can be the first step toward stress resilience and  healthy decisions.

Could you imagine sleeping for 4 hours, then waking up to go to the gym to exercise, then going to work, and taking an extra cup of coffee to stay up?! If this happens to you, wouldn’t you skip the gym and maybe skip preparing a healthy meal? Without sleep, the brain has a lower threshold to develop stress, anger and impatience.  Driving a car after not sleeping well the night before is equivalent to driving under the influence of alcohol.  The system doesn’t just recalibrate the sleep deficit by sleeping in on a Saturday morning.

Sleep affects more than just the neurologic system.  Many first-time parents probably remember getting up at night because of a crying baby.  Most people recognize that sleep reduces memory and concentration and impairs judgement, but sleep also reduces the immune system, leads to weight gain and increases the risk of high blood pressure and stroke.  The endocrine, immunologic and vascular systems are regulated by sleep.

Here is a list of tips to ensure ideal sleep:

  1. Tone down technology: Silence your cellphones and other technology and put them in a different room at a set time each evening, preferably at least 2 hours before bedtime.  The screen lights can inhibit the production of melatonin, which would otherwise prepare you for sleep.
  2. Preparation: Provide yourself a 30-60 minute of winding down before lights out. Limit reading time to 20-30 minutes.
  3. Make sleep a routine: Go to bed and wake up at consistent times.  Most of the time, you will sleep for 6-8 hours naturally.  With a natural routine, you will very likely not need an alarm clock.  If you do use it, stop it and get up – don’t hit snooze 5 times.
  4. Your bed, the slumber throne. Limit activities to sex and sleep.  Watching TV, eating, working on the computer may affect your body’s ability to rest in bed.
  5. Avoid medicating to sleep: Medications to sleep should be avoided or limited to a low dose of melatonin (2-4mg nightly).  Although the medications may sometimes “work”, they come with side effects and, moreover, are not addressing the source of the problem.  The last thing you want to do is develop dependence on alcohol, benzodiazepines or ambien, etc.  and then can’t sleep without it.  As for the other side of things, avoid any intake of caffeine after noon hours.  Avoid any stimulant medications, e.g. albuterol inhalers, immediately prior to sleeping.  One interesting association of sleep apnea is the patient who drinks high levels of caffeine during the day and then takes a sleeping medication at night.
  6. Environment: Keep sleeping area dimly lit or dark.  Ambient noise should be at a minute, though white noise is acceptable.  Temperature should be on the lower side, between 60-67 degrees F.
  7. Trouble-shoot for the future: If you are having problems sleeping at night and find yourself tossing and turning, thinking too much or waiting until that magic click to start, limit time in bed to about 15-20 minutes. There is usually a reason that this has happened and it is up to you to brainstorm it.  You can sit in your chair to begin to rest, meditate and then return to your bed to sleep.  The next day, think why this happened:  It could have been that maybe you exercised too close to bedtime, took too warm of a shower before sleeping, saw a stimulating program on TV, or tried to squeeze some work on the computer too close to bedtime.

If you still have trouble sleeping after following this checklist, you should consider being evaluated for sleep apnea or other conditions (parasomnias) associated with sleeping, such as restless legs, etc.

sleep man on desk

sleep man on desk

Wuhan Coronavirus: An Emerging Global Pandemic?

A wave of influenza-like illness caused by a novel Coronavirus, named 2019-nCoV by the WHO, has swept through a populous area of China. Since December 31, 2019, there have been more than 830 people infected with at least 26 deaths (as of January 23rd, 2020).  Chinese authorities have placed Wuhan, a city of 11 million in the Hubei province, on lock down, or quarantine, canceling flights and not allowing public transportation into or out of the region.  This comes amid the busiest travel season in China, the Chinese New Year on January 25th.  During this time, it is projected that there will be 2.5 billion trips by land, 356 million by rail, 58 million by plane and another 43 million by sea.

Expect that anytime respiratory viruses (more easily transmissible) emerge in a populous city, there will be a high caseload.  Cases have already been confirmed in other parts of China, including Beijing, Shanghai, Macau and Hong Kong.  In the last week, countries outside of China, including Japan, South Korea, Thailand and Tawain, Singapore and Vietnam have confirmed cases. On January 21st, the first case of 2019-nCoV was confirmed in Everett, Washington, after a traveler to Wuhan arrived in Seattle-Tacoma airport on January 17th and presented a few days later.  As of Thursday, a second and third case were being evaluated in Los Angeles and Texas.

Wuhan virus map 11.1579841262468

Wuhan virus map 11.1579841262468

What are Coronaviruses?

Coronaviruses (CoV) are zoonotic RNA viruses which cause infections in a variety of animals including pigs, cows, chickens, cows, bats and humans.  It is the virus’s infection of bats from which likely was the source of severe acute respiratory syndrome (SARS-CoV) and Middle Eastern Respiratory Syndrome (MERS-CoV).  Viruses are typically host and tissue specific.  Though, a favorable mutation can cause a virus to be able to jump from animal to human and be transmitted from human to human.

While CoV generally causes mild respiratory infections overlapping the flu season, their usual behavior diverged with SARS-CoV.  From the outbreak of 2002-2003, there were a total of 8098 cases with 774 deaths, amounting to a mortality rate of 9% – even towards 50% in those older than 60.  Fortunately SARS wasn’t as easily transmissible as other respiratory viruses.

How did such a disease severity occur?  It likely relates to the effects of two types of damage: the damage caused directly by the virus infecting cells within the lining of the lungs and the damage caused by components of the immune system, such as cytokines. Some viruses can induce a greater inflammatory response and lead to a more severe presentation.

MERS-CoV was likely transmitted from its natural host camels, functioning as an intermediate host between bats and humans.  In one report in 2017, of the 660 cases of MERS in Saudi Arabia, 42% had contact with camels.  The mortality rate of this infection is approximately 30%, with the elderly and those with pre-existing illnesses at the highest risk.

The 2019-nCoV thusfar has had the greatest impact on the elderly (>60) and those with comorbid conditions, similar to the other emerged coronaviruses.  Fortunately, the mortality rate from this infection is approximately 3%, much lower than SARS and MERS.  Although there are no treatments or recognized vaccinations for this emerging coronavirus, Wuhan-based scientists have already determined the genetic sequence of 2019-nCoV, and Chinese health officials have released this information to the public.  Scientists are beginning to work toward determining a feasible future vaccine.

What is being done to prevent cases in the United States?

As a method of containing the outbreak, the CDC is screening passengers entering into the United States from Wuhan for signs of respiratory illness.  Also, the flights from Wuhan have been routed to five U.S. airports for screening:  Los Angeles’s and San Francisco’s International Airports, New York’s JFK airport,  Chicago’s O’Hare, and Atlanta’s Hartsfield-Jackson airport.

Presently, the CDC has defined those at highest risk for 2019-nCoV as Patients Under Investigation (PUI) to have these criteria:

Clinical Features & Epidemiologic Risk
Fever1 and symptoms of lower respiratory illness (e.g., cough, difficulty breathing) and In the last 14 days before symptom onset, a history of travel from Wuhan City, China.– or –

In the last 14 days before symptom onset, close contact2 with a person who is under investigation for 2019-nCoV while that person was ill.

Fever1 or symptoms of lower respiratory illness (e.g., cough, difficulty breathing) and In the last 14 days, close contact2 with an ill laboratory-confirmed 2019-nCoV patient.

How much should the general US population worry?

The disease has been traced to animal markets in Wuhan and has spread over the course of three weeks to include imported cases in neighboring and distant countries.  So far, there has been no local spread in the United States.  With heightened awareness and screening, it is with hope that the disease will not be as heavily transmitted to the general population.  Combined with a lower mortality rate than the other emerged coronavirus infections, I think the general population should not need to worry about this infection.  At this point, those with higher risk, including the elderly and those with health problems, are much more likely to be infected by influenza than 2019-nCov.

Do masks protect from this infection?

Respiratory droplets from sneezing or coughing are well contained by masks.  Given that coronaviruses are transmitted this way, it is likely that anyone infected with 2019-nCoV would prevent spread by wearing a mask.  I don’t think that everyone should get a mask at this point.  It is also important to mention that respiratory droplets containing virus can contaminate objects and the hands and then simply be ingested and cause infection.  As with any viral infection, good hand-washing and social distancing an are important part of prevention.

It is certainly too early to tell how many people will be affected by this virus – and what impact it will have.  Sometimes mortality rates can change during an epidemic, if subsequent mutations confer greater virulence (potency).  The WHO has yet to deem this a global emergency, but it certainly is looking like it may develop into a pandemic.  It is no coincidence that the virus emerged from a populous area where livestock and human meet – an animal market in Wuhan, a city in China of 11 million.

Wuhan Coronavirus:  Tips to Understanding the (Next) Pandemic


Ahmed, Anwar E. 2017.   The Predictors of 3- and 30-day Mortality in MERS-CoV patients. BMC Infec Dis. 2017; 17:615.

Fehr A, Perlman S. 2015.  Coronaviruses: An Overview of Their Replication and Pathogenesis.  Methods Mol Biol. 2017; 1282: 1-23



Summary: The 2019-2020 influenza season is off to an early start. Interestingly, the majority of cases have been associated with influenza B. With an increase in influenza-like illness identified in these last few weeks, it is possible that this season could be similar or worse than the 2017-2018 season.  Brace yourselves for an active season.

Welcome to the new year 2020.  As expected, at around the 46-48 week of 2019, we exceed the baseline of 2.5% of influenza-like illness (ILI).  The percentage of ILI has soared in the last few weeks compared to what it was last season.   Presently in United States, the seasonal influenza epidemic is widespread.  This season has been unique from others in the percentage of cases attributable to influenza B followed by H1N1.  The Centers of Disease Control (CDC) estimates approximately 64% of the flu cases are from influenza B.  Usually, influenza B cases pick up towards the second half of the season.





From the FLUVIEW CDC site (above), there has been a very high level of influenza-like activity.  Influenza has a high attack rate, affecting 5-10% of the adult population and 20-30% of the population of children.  High ILI activity suggests that there will be a high rate of transmission in those affected areas.  

The current activity in this flu season is already trending toward a higher caseload than 2017, with a steeper and earlier curve than in 2017-2018 (see red line in the graph below).  That season was the most severe season in recent years. By April 2018, more than 34 million people had the flu, about 1 million were hospitalized, and approximately 54,000 people died.    These deaths are usually from a secondary bacterial infection, complications of respiratory distress, or a cardiovascular complication attributable to influenza.  Although we have yet to see the peak of this season, should the percentage of ILI exceed those of 2017-2018, it is possible that this season will see a record number of influenza-attributable hospitalizations and deaths. 

ili curve.gif

ili curve.gif

As a general estimate, around 5-15% of the total US population gets the flu yearly. The hospitalization rate is 1 in 100 (1%) and the death rate is 1 in 1000 (0.1%). The highest risk of mortality is seen in the 65 and older age group, but almost 60% of reported hospitalization are ages of 18-64 years. Sure, most people will get a mild case of influenza and many people will get a classic case – with rapid onset of tiredness, body aches, chills and fever with cough, fewer will need to be hospitalized and a small percentage will die. Given the sheer magnitude of those affected, this means a lot of peopleInfluenza is NOT a mild illness.

The good news is that if you have received the vaccine, you are likely to either be protected from the disease or get a milder case.  The CDC estimates the average efficacy of influenza vaccination ranges from 40 and 60%.  Other than getting a milder infection, the vaccine reduced the risk of the influenza-associated diseases, such as heart failure, respiratory failure, and secondary pneumonia.  Predictions for the 2019-2020 influenza vaccination are forthcoming.  The components for the H1N1 vaccine and usually for influenza B are more effective than the H3N2 (H1N1 (75-80%), H3N2 (20-25%)). Last season, the estimated vaccine efficacy was 47%, approximating 61% in ages 7 months to 18 years, and lower in the over 50 age group.  

The vaccinations consist of two type of influenza viruses, influenza A and B. Type A viruses are named after cell membrane (the outer layer of a virus) components – called hemagglutinin (H) and neuraminidase (N). The 2019-2020 vaccines are quadrivalent,  consisting of 2 types of A viruses (H1N1 pandemic 2009 and H3N2) and 2 The type B viruses named after lineages B/Yamagata and B/Victoria.  The influenza B cases for 2019-2020 are from the B/Victoria lineage. 

Unfortunately, unlike the measles or other childhood viruses, there is more virus differentiation — changes known as antigenic drift, when gradual, or antigenic shift, when sudden. A new vaccine has to be decided upon each year. An extensive vetting occurs involving input from multiple centers, where the most common strains are selected. Occasionally, the vaccinations do not match the years prominent strains. This year, the majority of cases have been caused by the H1N1 pdm 09. Why not 100% effective — there are enough differences from the vaccine strains and the seasonal strains (yes – it changes/re-assorts that fast) that make an immune response from the vaccination not as effective.

Below are some general questions and answers regarding influenza:

  1. Is it too late to get the vaccine if I missed earlier?  No. It is not too late to get vaccinated. The flu season usually tapers off after April. Getting a flu vaccination now would provide some protection for the remaining 2+ months. If you don’t want to make an appointment with your doctor, you can get it at many pharmacies. I would recommend the recombinant vaccination (quadrivalent) and the high-dose if you are older than 64.
  2. How is the flu spread? What are the signs and symptoms of the flu and how do these differ from the common cold.

The influenza virus can be transmitted fairly easily in both coarse/large and fine respiratory droplets – the greater density of virus is on the smaller droplets. You can breathe these droplets in or put them in your mouth. How does this happen?  1) the droplets can land on a surface and you can touch it and then put your fingers in your mouth or touch food you then eat; 2) Person-to-person a person could cover their cough and sneeze and shake your hands 3) Fomite, a person can contaminate an inanimate object, such as a doorknob, keys and a cell phone, and you can touch it and…

Unlike the common cold (rhinovirus), the symptoms for the flu come on abruptly.  There will be fatigue and muscle aches, though cough is the most common symptom.  The reason is that influenza causes varying degrees of infection in the  lungs, known as pneumonitis. Those with advanced age may have confusion or delirium along with a non-focal fever and cough. Anyone coming in with any exacerbation of chronic disease, e.g. lung disease or heart disease or even a heart attack, should be screened for seasonal influenza, given its association as an illness trigger.

3. How can I protect myself from getting the flu?

  • The influenza vaccine – Get it sooner than later.
  • Hand-washing : think about doing this more often during this time of the year -particularly when you touch a public surface or object (e.g. pen, doorknob). It might be a good time to do the fist-bump, air handshake, bowing ? or maybe just remembering to use alcohol rub if you shake someone’s hand – and wash your hands before eating.
  • Quit smoking :  Smokers have a greater risk of more severe sequellae. It may be a good time to consider quitting or seriously reducing.
  • Limit alcohol : For multiple reasons, excessive alcohol intake can affect the immune system and increase the risk of aspiration which is likely a risk factor to secondary bacterial infections in influenza. My recommendation would to limit alcohol to no more than 1 or 2 drinks a day or less.
  • Eat a healthy diet, maintain a healthy weight : Eating a variety of vegetables rife with minerals and vitamins is a great way to bolster the body’s immune system. Various vitamins such as vitamin A, D and to a lesser extent C and E have been shown to affect the immune system in deficiency states. (complexity alert) For instance Vitamin A deficiency was found in mice to impair respiratory epithelium (layer) regeneration and antibody response to influenza A. Vitamin D has been touted to be beneficial from a meta-analysis to reduce risk of infection, but there is some conflicting evidence from other studies. Nevertheless there is some biologic plausibility that Vitamin D plays a role in both adaptive (T- and B-cell) and innate (Natural killer, macrophages,etc) immunity. A prospective controlled study of 463 students 18 to 30 years old showed a benefit in the use of mega-doses of vitamin C, with a reduction in symptoms and severity (85% reduction) if taken before or after the appearance of cold or flu symptoms. A study on vitamin E in mice showed a reduction in influenza viral titer (amount), possibly linked to enhanced T helper 1 (TH1) cytokines.
  • Get plenty of sleep:   I will explore the topic of sleep and immunity on another post. Suffice it to stay, the many effector signals are involved in keeping our immune system robust and sleep is an important piece of the puzzle of why some people get more severe infections than other.
  • Exercises and keep a stress-free lifestyle
  • Obesity has come out as a new risk factor since the 2009 H1N1 pandemic flu season. One study looking at the cases of influenza showed an increase risk of hospitalization for a respiratory illness. In a person with class I obesity (BMI 30-35) the odds ratio was 1.45 and class II (BMI 35-40) and III (BMI 40-45) obesity, the odds ratio was 2.12 — for pneumonia and influenza. This fits similarly the association of more severe presentation of influenza and chronic diseases including diabetes, lung and heart disease and advanced age (impaired immunity).

4. Do omega-3 fish oils help influenza?   NO, I was asked this question recently. From my review online, fish oils may impair immune reactivity from the influenza virus (lower IgG and IgA levels) but may not have clinical impact. In one study in 1999, fish oils had anti-inflammatory properties and led to less viral clearance and some increase symptoms in mice but did not change the outcome. The possiblity of worsening the severity of influenza was suggested in another mice study

At this point, I am going with the likelihood that fish oils do not enhance one’s recovery from influenza.

5.  Are there any treatment options available for influenzaYES!  

  1.  Oseltamivir.  Oseltamivir (Tamiflu) is given twice daily over five days and is a neuraminidase inhibitor, which blocks an important step of viral progeny (new virions) leaving an infected cell to go on to infect other cells.  It likely reduces the severity and shortens the course by a few days.  Take the therapy within a day of onset.
  2.  Baloxavir is a single-dose option recently approved for this flu season (Oct 2018) and has a novel mechanism – an endonuclease inhibitor, which blocks a step needed in viral replication (“making copies”).  The important thing about these medications is that they have to be taken within 24-48 hours of the onset of flu symptoms to experience the maximal benefits, which amount to a reduction of severity and duration by a few days.

Not everyone requires treatment other than supportive care, particularly in those with mild disease.  I would recommend that anyone with an age over 60 or BMI >30 and/or with conditions such as diabetes, cirrhosis, cardiovascular or pulmonary diseases consider taking this medication to reduce the risk of severity and duration.  Patient with lymphoma and leukemia or solid organ cancer are also at higher risk of complications.  In all of these patients, I would suggest if they present with disease within 24-72 hours or are hospitalized even after this period, that they receive the therapy.

Conclusion.  Happy New Year 2020!  I hope that you have an uneventful 2019-2020 flu season.  If you are unfortunate to get it this year, I hope it is as mild for you as the common cold. There are things you can do to ensure that it is. Remember influenza can be a significant disease.  Thank you for reading this post and please share this to your friends and contacts.  If you want to stay up-to-date with future Your Health Forum posts, register your email on the the side panel.

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Patient Information: Make a Home for Your Microbiome

Your microbiome/microbiota refers to the trillions of microbes that reside inside and outside your body.  Human cells are outnumbered by the bacterial cell population.  The highest source of bacteria in the body is within the large intestines.  The status of resident bacteria has been associated with health and illness, with greater diversity being more protective.  Bacteria perform a number of functions including 1) production of certain vitamins such as Vitamin B12, B9, B2 and Vitamin K, 2) protection from infections by competing with more harmful bacteria, and 3) maintain a healthy immune system response.

Protecting your bacteria is not difficult and will likely benefit your body as a whole.  Here are some tips to maintaining a healthy microbiome:

  1. Eat mostly a plant-based, high fiber diet with low processed carbohydrates.  Limit the amount of processed carbohydrates that you consume during the meal and with snacks.  Raw plant matter may be more beneficial over cooked.  Plain yoghurt or kefir contains a healthy dose of normal gut bacteria.


  1. Avoid a significant amount of alcohol, milk, juice or sugary drinks.  Favor the fruit itself, since it will have less sugar and more fiber.  More of these substances high in alcohol and/or sugar lead to less gut diversity and GI side effects and increased inflammation.


  1. Limit the consumption of sugar and use of sugar substitutes. Sugar, processed carbohydrates (bread, pasta, white rice) in the diet has been associated with increased inflammation.


  1. Judicious Use of Antibiotics, Steroids and Proton pump inhibitors (PPI’s). Antibiotics can cause a shift in healthy gut flora and increase the risk of diff (a bacteria that causes diarrhea and colitis), yeast, Methicillin-resistant Staphylococcus aureus (MRSA).  It takes a team effort in coordination with your doctor, because antibiotics are often prescribed unnecessarily.  Prednisone can affect the immune system and cause a shift in gut flora, including increasing the risk of yeast.  PPI’s reduce acid and increase risk of more harmful bacteria populating.
  2.  Take Care of Your Health. Good sleep hygiene, exercise and low stress have all        been associated with more diverse gut microbiota.



If you have any of the following conditions, consider making a dietary adjustment to see if there is improvement, since a shift in gut microbiome, known as dysbiosis with less diversity, has been correlated either directly with these conditions or flare-ups:

  1. Gastroenterologic conditions: Peptic ulcer disease, reflux, Irritable Bowel Syndrome, Crohn’s, Small intestine bacterial overgrowth (SIBO), celiac disease
  2. Connective tissue diseases: Rheumatoid arthritis, lupus, psoriasis
  3. Skin: Atopic eczema, Rosacea, Acne
  4. Endocrine: Diabetes mellitus, Obesity
  5. Neurologic: Parkinsonism, Multiple sclerosis, other neurologic
  6. Cardiac: Coronary Artery Disease, Atherosclerosis
  7. Other: Depression, Anxiety, other mental health


Get to Know Your Gut Bacteria.  The following are general overview of the most common bacteria in the gut.  Though, an imbalance of even these bacteria could cause host effects.

Bifidobacterium and Lactobacillus help to protect the gut from harmful bacteria Plant-based foods which contain polyphenols, found in nuts, seeds, vegetables, teas, cocoa, wine and berries, feed these beneficial bacteria.  There may be a benefit in reducing inflammation in the cardiovascular system.  Bifidobacterium is associated with butyrate production, which has a protective role in the gut and anti-inflammatory effect.

Bacteroides and Firmicutes are found in a healthy gut.  Consumption of a plant-based diet with no animal fat or protein has been associated with greater populations of these bacteria.  Plant starch can also lead to a greater population of Bacteroides, also tied to obesity prevention/treatment.

Prevotella, also may favor a setting of a high fiber, plant-based diet.

Ruminococcus is more associated with a higher amount of fruit and vegetables.  These bacteria are associated with breaking down complex plant carbohydrates and producing butyrates.

Bilophila and Faecalibacterium are found in increased populations in a high saturated fat diet and may be associated with increased inflammation.



Tomova et al. The Effects of Vegetarian and Vegan Diets on Gut Microbiota.  Front Nutr. 2019; 6: 47

Refer to The Human Microbiome: Unlocking the Key to Health at YHF blog.