Posted in Health, news

EpiPens Secretly Contain More Than One Dose Used in Emergency Wilderness Settings

The EpiPen® auto-injector contains epinephrine, used during an emergency to treat severe allergic reactions, or anaphylaxis.

If one is allergic to an insect or food, a severe allergic reaction may ensue upon exposure, in which the immune system releases a flood of chemicals that can cause throat tightness, hives, lip and facial swelling, difficulty breathing, nausea, vomiting, low blood pressure, rapid heart rate, cardiac arrest and possibly death.

Epinephrine stimulates the heart to increase cardiac muscle contractility, cardiac output, subsequently raising the blood pressure. Additionally it relaxes the muscles surrounding the airways, allowing one to breathe easier and take in more oxygen. Moreover it helps to stop the release of additional immune chemicals.

The EpiPen® is manufactured by Mylan.  Its cost made headlines when the EpiPen two-pack recently stickered for close to $600. Now generic forms are available costing anywhere from $109-$300 for a dual pack.

The disposable auto-injector, for an adult, delivers 0.3 mg of epinephrine, while the EpiPen Jr., used in pediatric populations, delivers 0.15mg of the medication.  It can be self-administered, through clothing if necessary, into the thigh muscle in one smooth movement once the safety release is removed.

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After 0.3 ml is administered during the single adult dose, the EpiPen® unit is discarded.

However many are not aware that 1.7 ml of solution remains within the cartridge.  This could, in theory, be used for an additional 5 doses if in a remote, “wilderness” setting.

Dr. Arthur (Tony) Islas, Fellow of the Academy of Wilderness Medicine, and professor at the University of Nevada, Reno School of Medicine’s Department of Family Medicine, demonstrated how to extract the remaining doses from the autoinjector at the January Nevada Academy of Family Physicians meeting in Lake Tahoe.

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Although its recommended that all users follow the manufacturer’s labels, those trained in emergency and wilderness medicine may take the used cartridge, cut off the top plastic, and extract the syringe with the remaining fluid.

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Dr. Islas states the initial 0.3 mg dose of epinephrine lasts for 20 minutes.  For most people this allows plenty of time for emergency responders to come to the site of the victim.  However, in a “wilderness” or remote setting, another dose may need to be administered during a very severe case of anaphylaxis.

Please note manipulation, destruction, and off-label use of an EpiPen cartridge could be dangerous and should only be performed by a trained professional.

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

 

 

 

Posted in Health, news

Meningitis from Marijuana?

A 48 year old California woman reportedly acquired life-threatening meningitis from marijuana contaminated with fungus.

Dr. Bryan Shapiro explains in a case study published in the British Medical Journal that she contracted Cryptococcus neoformans from her 3-6 joint-a-day smoking habit.

Crytococcus infections can commonly affect those who are immunosuppressed, but this patient was believed to be relatively healthy.

Her symptoms included feeling fatigued and dizzy but began getting combative, reportedly assaulting a coworker.  She eventually was seen at Cedars of Sinai Medical Center in Los Angeles, where they tested the cerebral spinal fluid surrounding the brain, revealing the life threatening fungus.

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After she was successfully treated, Dr. Shapiro investigated the dispensary in Bakersfield from where she purchased her marijuana.  Nine samples tested positive for the fungus.

Its been established that marijuana leaves are contaminated with pesticides, chemicals and mold.

This is one of the first cases reported of one acquiring meningitis from marijuana use.

This is a developing story.

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

 

Posted in Entertainment, Health, news

Glee’s “Puck” Mark Salling Reportedly Commits Suicide, age 35

Glee actor, Mark Salling, was found dead in a riverbed near Big Tujunga Creek in Los Angeles.  The exact cause of death is still being investigated.

The 35-year-old had been battling depression and the family had reported him missing Tuesday evening and feared he would hurt himself.

Mark Salling was a registered sex offender and was facing 4-7 years of prison after pleading guilty to possession of child pornography.  His sentencing was slated for March 7th.

It’s been reported that he attempted suicide last summer by slitting his wrists.

This is a developing story.

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

Posted in Health, news

Vaping Found to Raise Cancer and Heart Disease Risk

 

A study from New York University found the nicotine in electronic cigarettes to cause DNA damage similar to cigarette smoking.

Dr. Moon-shong Tang and his colleagues exposed mice to e-cig smoke during a three-month period, 5 days a week for three hours a day.  They found these mice, compared to those breathing filtered air, to have DNA damage to cells in their bladders, lungs and hearts. The amount of nicotine inhaled was approximately 10mg/ml.   That dose would be commonly consumed by many humans who vape.

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They then looked at human bladder and lung cells and found tumor cells were able to grow more easily once exposed to nicotine and vaping chemicals.

Last May, researchers from Vanderbilt-Ingram Cancer Center in Nashville found e-cig smoke to increase one’s risk of bladder cancer.

In 2015, the University of Minnesota identified chemicals commonly found in e-cig vapor to include:

  • Formaldehyde (human carcinogen)
  • Acetaldehyde (carcinogen related to alcohol drinking)
  • Acrolein (highly irritating and toxic)
  • Toluene (toxic) NNN, NNK (tobacco carcinogens related to nicotine)
  • Metals (possible carcinogens and toxins)

Although electronic cigarette “juice” may appear safe, it could produce harmful chemicals once heated to become a vapor.

A lethal dose of nicotine for an adult ranges from 30-60 mg and varied for children (0.5-1.0 mg/kg can be a lethal dosage for adults, and 0.1 mg/kg for children).  E-cigs, depending on their strengths (0 – 5.4%) could contain up to 54 mg of nicotine per cartridge (a 1.8% e -cig would contain 18mg/ml).

The topic of nicotine increasing one’s vulnerability to cancer is nothing new as decades ago researchers found nicotine to affect the cilia (brush border) along the respiratory tree, preventing mucous production and a sweeping out of carcinogens trying to make their way down to the lungs.

More research needs to be performed but this recent report reminds us that exposing our delicate lung tissue and immune system to vaping chemicals may not be as safe as we think.

 

For more on the study read here.

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

 

Posted in flu, Health, news

Flu Increases Risk of Heart Attack

A study published in The New England Journal of Medicine reports the flu increases one’s risk for a heart attack by six within the first week.

Study author Dr. Jeff Kwong, a family physician and epidemiologist from the Institute for Clinical Evaluative Sciences and Public Health Ontario, and his colleagues looked at 20,000 adults who were diagnosed (and lab confirmed) with the flu in Ontario from 2009 – 2014.  Of these adults, 332 had a heart attack, either the year before, after or during the flu.   Heart attack risk was 6 times higher the week of the flu and was elevated in those older than 65.

Many of the individuals had cardiac risk factors (diabetes, high blood pressure, high cholesterol) illustrating if one is at risk for a heart attack, a cardiac event may be more likely to occur if they get the flu.

This isn’t the first time a link between heart attack and flu has been suggested.    In 2007, Meade et al found a bout with the flu to double the risk of a heart attack and stroke.

Their theory was the flu dislodged fatty deposits sitting along the arteries, allowing them to travel to the coronary arteries or those in the brain resulting in a heart attack and stroke respectively.

Another theory is the cardiac risk factors may worsen during the flu. Blood sugars are difficult to control, hence fats in the blood will follow, and blood pressure may be affected when one is battling an infection.

Inflammation has been linked to heart attack, thus inflammation resulting from the flu may also be a culprit.

The study authors wrote, “Cardiovascular events triggered by influenza are potentially preventable by vaccination.”  The flu shot this year has been projected to only be 30% effective against this season’s active strains but is still being recommended this season as hospitalizations and deaths from the flu are reaching record numbers.

 

What causes a heart attack?

A heart attack occurs when part of the heart muscle fails to receive the blood and oxygen it needs. This can occur by arteries supplying the heart muscle to become blocked.  Coronary artery disease can be caused by plaque build up from fats, sugars, calcium, fibrin that settle on the blood vessel wall. These plaques can build up and occlude the lumen, obstructing blood flow.

Additionally a heart attack can occur when an unstable plaque rips off, tearing the blood vessel lining causing the body to form an immediate clot. This clot can also be deadly as it obstructs the lumen as well.

Heart disease, however, can be prevented……..

Firstly, we must know our risk factors. These include:

Family history of heart disease

Personal history of heart disease

High Blood Pressure

High Cholesterol

Diabetes

Smoking

Obesity

Inactivity

Males over 40

Females who are post menopausal

High stress

and even short stature has been cited as a potential risk factor.

As you can see, many of us can be at risk for heart disease.  Therefore secondly, we should be evaluated with an EKG, echocardiogram and any other exams our medical provider and/or cardiologist deem necessary.

Thirdly, reduce your risk by the following:

Maintain a normal blood pressure

Maintain normal blood sugar

Maintain normal cholesterol and lipid levels

Reduce stress

Maintain a balanced diet, rich in potassium-rich foods such as fruits and vegetables

Quit smoking

Stay active

Maintain a healthy weight.

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network and Board Certified Family Physician

Posted in flu, Health, news

Flu Deaths: Are We Missing a Severe Pneumonia Season?

This year’s flu season has claimed the lives of at least 30 children and many more adults.  It’s widespread in all states except Hawaii, and we are told its one of most severe flu seasons yet.

However, the number one cause of death when it comes to the flu is pneumonia.  And the respiratory depression that appears to come on with these otherwise healthy individuals, appears to affect them within hours (as we learned with the tragic death of 36-year-old Tandy Harmon). Which brings the question?  Should we be entertaining the possibility that a severe pneumonia strain is affecting us this “flu season”?

Most children are vaccinated against pneumonia

The vaccine schedule for children in the US includes the pneumococcal vaccine (PCV13) given at 2 months, 4 months, 6 months, 12 – 15 months of age.  Over 2 years of a child, one can get the PPSV23 if they did not receive the PCV13.

Not all young adults get the pneumonia vaccine, however if one if over 65, the CDC recommends the pneumococcal vaccines receiving a dose of PCV13 first, followed by a dose of PPSV23, at least 1 year later.

Now a variety of pathogens can be responsible for pneumonia, including viruses’, fungi, and bacteria other than pneumococcus, but streptococcal pneumonia is the most common cause.  If those affected by pneumonia this year were vaccinated, we need to know the strain, meaning specifically what pathogen was responsible for their pneumonia.

Not all pneumonia presents with a cough

Although pneumonia presents with symptoms such as fever, body aches, cough, shortness of breath and sputum production, some individuals may not present with these symptoms when they have pneumonia. Some of the tragic “flu death” cases this year were in adults who initially had a “mild cough”. Since flu symptoms are similar, some may never know if they have pneumonia.

As a result we are telling patients who have the flu to return immediately to the doctor’s office/urgent care/emergency room if they have any of the below symptoms:

  • Recurring fever
  • Fever that won’t subside after 2 days
  • Shortness of breath
  • Difficulty breathing
  • Confusion
  • Weakness
  • Productive cough
  • Fast breathing
  • Fast heart rate
  • Chest pain

and speak with your medical provider regarding other symptoms he/she may want you to watch out for.

How to tell when your flu is turning deadly

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

 

 

 

Posted in food, Health, news

California to Soon Rule if Coffee Causes Cancer

Last September we learned of a legal battle ensuing in California regarding the lack of warnings on coffee products when it comes to a cancer causing chemical that’s produced during the bean roasting process.

This week we learn that in the coming weeks a California state judge will weigh in and most likely be the deciding voice, as opposed to a medical organization, on whether coffee, and its acrylamide byproduct, cause cancer.

 

The Council for Education and Research on Toxics (CERT) wants coffee manufacturers, distributors and retailers to post warnings regarding the acrylamide content.

Proposition 65, The Safe Drinking Water and Toxic Enforcement Act, passed in 1986, requires businesses that expose individuals to toxic chemicals in the course of doing business to first give warnings to such individuals.

If they do not, they can be open to liability.

What is acrylamide?

Acrylamide is a chemical used in many industrial products that produce plastics, adhesives, food packaging and the treatment of drinking water.  It can also be produced when foods are heated, fried, baked, or roasted to above 120 degrees Celsius (248 degrees Fahrenheit).  In 2002 reports came out regarding acrylamide in french fries, and in 2013 the FDA issued guidance to the food industry on how to minimize producing the chemical.

Roasting coffee requires the beans to be heated to close to 450 degrees Fahrenheit.  This heat produces a chemical reaction between the amino acid asparagine and sugars resulting in the formation of acrylamide.

The amounts however are miniscule.  Much smaller than other modes of acrylamide exposure such as cigarette smoking and exposure at work when working in industries that use acrylamide such as plastics, food processing, mining, paper, agriculture and construction.

What can acrylamide do?

In rodents, acrylamide was found to increase several types of cancer. But the doses were 1,000-10,000 times greater than what the average human is exposed to.

According to the American Cancer Society, most of the studies done so far have not found an increased risk of cancer in humans. For some types of cancer, such as kidney, ovarian and endometrial cancer, the results have been mixed, but there are currently no cancer types for which there is clearly an increased risk related to acrylamide intake.

How do I decrease exposure?

As noted earlier, acrylamide can be in a variety of products we use throughout the day.  Large quantities, however, can be consumed through cigarette smoke, hence avoiding smoking is key.  Moreover, avoiding frying foods, especially starches, greater than 120 degrees Celsius/248 degrees Fahrenheit if possible.  Frying and or toasting to a light gold, rather than crispy dark brown color, may limit your exposure as well.

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But keep in mind, numerous studies have found coffee drinkers to lower their risk of cancer, especially liver, uterine, prostate and mouth cancer.  However 4-6 cups had to be consumed in order for researchers to notice a benefit.

More research still needs to be done.  So while we wait for the verdict lets kick back with a cup of …..hot chocolate?

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

Posted in Health, news, Sports

Are Many Athletes at Risk for Depression?

Post-athletic activity depression (PAAD) may affect multiple athletes when their season ends due to the high hormone levels induced by their prior rigorous exercise regimen suddenly dropping.

 

Olympic gold medalist Michael Phelps admitted at the The Kennedy Forum in Chicago last week that he had battled depression for years and contemplated suicide.  With his multiple decade athletic career, the most decorated in history, how could an Olympian find life so unlivable?

Other decorated athletes have suffered from depression as well:   Terry Bradshaw, Daryl Strawberry, Larry Sanders, Dwayne “The Rock” Johnson, and Oscar de la Hoya to name a few.

Post-athletic activity depression (PADD) may ensue when the high levels of exercise aren’t maintained and the mind isn’t prepared for losing or being surpassed by another athlete.  As you will see biology as well as psychology play huge factors in the mental health of an athlete.

Exercise wards off depression

Michael Phelps admitted to going into a depression after each Olympics.  His workouts leading up to each of the 2004, 2008, 2012 and 2016 Olympics were illustrated by Arizona State coach Bob Bowman at the American Swimming Coaches Association, and demonstrated thousands of hours and yards swum each week.

Multiple studies have proven that exercise wards off depression. This is in part due to multiple mood enhancing hormones being released during athletic activity such as:

  • endorphins
  • norepinephrine
  • dopamine
  • serotonin

So if after a meet, marathon, playoff or Olympic race ends, does the average athlete keep their rigorous training schedule? Probably not.  Hence these hormones that the body has become accustomed to seeing aren’t there at their previous levels, inducing a depression.  If someone is at risk for depression, the drop in these hormone levels could, in theory, depress one to the point that they contemplate suicide.

Being the best puts you psychologically at risk

They say winning is addictive and from a psychological standpoint, that’s correct.  Once you win you reform a new identity.  Those psychologically mature and stable will not find their win their only identifying factor and additionally will understand that you “win some, lose some”.  However those who struggled for years to win, especially if the prize is an Olympic medal, may not deal with “lose some” so easily.

Once you own that Superbowl ring, first place blue ribbon or gold medal others look at you as “one of the best”.  How much higher can you go?  Usually an athlete only has two choices. Maintain their “top” status, difficult to do with aging and younger up and comers vying for their spot, or start losing. Most athletes aren’t preparing for how to lose.  They can’t. They use all their waking hours preparing on how to win.  So when the loss does come, they’re unprepared.

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Could some CTE symptoms be related to post-athletic activity depression?

I believe so. Chronic Traumatic Encephalopathy (CTE) is a progressive degeneration of brain tissue and function from multiple hits to the head.  Many who suffer from CTE have mood changes, anxiety, anger and impulsivity.  CTE tau protein build up in the brain contributes to this but hormones can play a role as well.

What needs to be studied are the mood changes incurred by athletes after each season or race to see if a “funk” sets in because their exercise regimen is not being maintained.

Moreover all athletes should have access to counseling to thwart depression and suicidality because losing is inevitable for everyone.

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

Posted in Entertainment, Health, news

Opioids Contributed to Tom Petty’s Death

The Los Angeles County Medical Examiner released this week the cause of death of music legend Tom Petty.

According to the report, he died accidentally of “multisystem organ failure due to resuscitated cardiopulmonary arrest due to mixed drug toxicity” of the following medications:

  • Opioids:  fentanyl  and oxycodone (pain killers)
  • Benzodiazepines;  temazepam (br. Restoril) and alprazolam (br. Xanax) (sedatives)
  • and an SSRI antidepressant citalopram (brand name Celexa)

Adding benzodiazepine to a narcotic could accelerate the respiratory depression leading to overdose and death.

There’s been suggestions that SSRI’s and opioids could increase the risk of serotonin syndrome, a toxicity reaction causing dangerous drops in blood pressure, hallucinations, muscle rigidity and low oxygen. This can also induce cardiopulmonary arrest.

Fentanyl was implicated in the overdose death of Prince in April 2016.  Its a powerful narcotic  found to be 50-100 times stronger than morphine and 30-50 times more powerful than heroin.

Petty’s medical issues included a recently fractured hip, emphysema and possible underlying cardiovascular disease.

Emphysema is a lung condition most commonly caused by smoking.  With mild respiratory depression induced by a narcotic, a person with emphysema can easily go into severe respiratory distress.  Those with lung disease are discouraged to regularly use opioids.

 

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His family issued the following statement on his facebook page:

Our family sat together this morning with the Medical Examiner – Coroner’s office and we were informed of their final analysis that Tom Petty passed away due to an accidental drug overdose as a result of taking a variety of medications.

Unfortunately Tom’s body suffered from many serious ailments including emphysema, knee problems and most significantly a fractured hip.

Despite this painful injury he insisted on keeping his commitment to his fans and he toured for 53 dates with a fractured hip and, as he did, it worsened to a more serious injury.

On the day he died he was informed his hip had graduated to a full on break and it is our feeling that the pain was simply unbearable and was the cause for his over use of medication.

We knew before the report was shared with us that he was prescribed various pain medications for a multitude of issues including Fentanyl patches and we feel confident that this was, as the coroner found, an unfortunate accident.

As a family we recognize this report may spark a further discussion on the opioid crisis and we feel that it is a healthy and necessary discussion and we hope in some way this report can save lives. Many people who overdose begin with a legitimate injury or simply do not understand the potency and deadly nature of these medications.

On a positive note we now know for certain he went painlessly and beautifully exhausted after doing what he loved the most, for one last time, performing live with his unmatchable rock band for his loyal fans on the biggest tour of his 40 plus year career. He was extremely proud of that achievement in the days before he passed.

We continue to mourn with you and marvel at Tom Petty and the Heartbreakers’ incredible positive impact on music and the world. And we thank you all for your love and support over the last months.

Thank you also for respecting the memory of a man who was truly great during his time on this planet both publicly and privately.

We would be grateful if you could respect the privacy of the entire Heartbreaker family during this difficult time.

Dana Petty and Adria Petty

This is a developing story.

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, iHeart Radio and Board Certified Family Physician

 

Posted in flu, Health, news

How to Tell When Your “Flu” is Turning Deadly

IMAGE ABOVE FROM ABC NEWS

This week the CDC reports a 5th pediatric flu death as we face a season, many have predicted, to be “severe.”

And in previous years, once healthy children and young adults fell victim to severe circulating flu strains  prompting parents this year to fear the worse when it comes to theirs or their child’s flu symptoms.

Who can blame them. Flu symptoms can last up to 2 weeks, and most patients are told to go home and rest as antibiotics do not help fight the flu and symptoms will usually “resolve on their own.” This is true, but then why are some people..healthy people…dying?

What are the symptoms of the flu?

To understand why people are often misdiagnosed for flu-related illness when something even more serious is occurring, let’s first list the common symptoms of the flu.

  • Fever
  • Body Aches
  • Cough
  • Sneezing
  • Sore Throat
  • Shortness of Breath
  • Rapid Breathing
  • Rapid Heart Rate
  • Fatigue
  • Headache
  • Nausea
  • Vomiting

As opposed to a cold, in which symptoms are less severe and come on more slowly, the flu seems to hit you within hours.   The fatigue may be the first symptom, followed by body aches, scratchy throat, cough, runny nose and then fever. The fever could range anywhere from 100 – 106 F.  The fever usually lasts 2 days and the majority of those affected by the flu will average symptoms from 3-5 days.

How can you die from the flu?

There are multiple ways to die from the flu.  The most common cause is pneumonia.  A secondary viral or bacterial infection can affect the already weakened lungs.  Pneumonia can be deadly, especially if untreated.  Symptoms of pneumonia are very similar to the flu:  shortness of breath, cough, fever, fatigue, body aches, etc.

Respiratory failure from inflammation can be fatal as well. The flu virus affects the respiratory tree causing acute inflammation and distress of the tissues whose job is to bring oxygen to the blood.  Additionally, other organs including the heart may become inflamed, impeding their duties.

Flu can increase one’s risk of heart attack and stroke.  A study in 2007 found coming down with the flu doubled one’s risk of heart attack and stroke.

Moreover, having the flu could worsen any disease states already being battled. Hence a diabetic, if suffering from the flu, may struggle to control his blood sugar numbers.

Rarely, some may go into multi-organ failure as a result of septic shock initiated by the flu.  This is what killed 21-year-old body builder Kyler Baughman.

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21-YEAR-OLD ATHLETIC TRAINER KYLER BAUGHMAN DIED DAYS AFTER FEELING FLU-LIKE SYMPTOMS

 

But one risk that doesn’t get discussed as much as it should is coming down with an illness during flu season and being mis-diagnosed, a “guilty by association” picture.

Four days before her death, 12-year-old Alyssa Alcaraz was sent home by an urgent care with a flu diagnosis when in fact she had a strep infection in her blood that put her into septic shock.

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12-YEAR-OLD ALYSSA ALCARAZ WAS DIAGNOSED WITH THE FLU WHEN SHE IN FACT HAD A STREPTOCOCCAL INFECTION.

 

How will I know when the flu is turning deadly?

Since symptoms of the flu start to resolve in a couple of days, any symptoms beyond those few days should spark suspicions.   These can include:

  • A fever that does not subside
  • A fever that returns, recurring fever
  • New symptoms forming such as weakness
  • Confusion
  • Delirium
  • Dizziness
  • Unable to keep fluids down
  • Dehydration
  • Chest pain – could signify pneumonia or heart involvement
  • Bluish lips or skin
  • Difficulty breathing
  • Worsening cough

Understanding what the flu virus can affect and not underestimating its severity is paramount in preventing flu fatalities.  If symptoms start improving after 2 days it’s a great sign!!  However, any symptoms that either do not resolve, lag on for days, evolve into something worse, or recur are red flags that something more than the flu could be going on.

Most importantly, if one has not been vaccinated yet against the flu, they should still consider getting the flu vaccine.

 

spanish book

Learning Medical Spanish is Easy!!!

 

Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on GCN Network, KDWN, and iHeart Radio.