July 31, 2009 | 12:21 pm

H1N1 Flu:  Potential Pregnancy Problem

Posted by Albert Fuchs, M.D.

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H1N1, the flu previously known as swine, is still in the news, but this week for a good reason.

Most of us still have little to worry about.  The CDC estimates that over a million Americans have been sick with H1N1 flu as of July 24.  The vast majority of illnesses were mild and resolved without incident, many without any treatment.  As of that same date there have been 5,011 hospitalizations and 302 deaths.  That means that getting sick with H1N1 flu caries half a percent chance of hospitalization and a probability of death that is 3 percent of 1 percent.

But there is a special population that may be at increased risk:  pregnant women.  This week Lancet published a paper studying the statistics from the U.S. on pregnant women with H1N1 flu.  The numbers were much more worrisome than those for the general population.  Of 34 confirmed or probable H1N1 flu cases in pregnant women, 11 (32%) were hospitalized and six (about 18%) died.  All the pregnant women who died were healthy prior to developing the flu.

Pregnant women should therefore seek medical attention immediately if they develop flu symptoms. They should receive treatment with antiviral medicines (Tamiflu or Relenza) as early as possible.

Pregnant women will also be a high-priority target group for the H1N1 vaccine, but vaccine availability is at least 3 months away.  I’ll have more to say about the H1N1 vaccine before then.

Learn more:

Lancet article:  H1N1 2009 influenza virus infection during pregnancy in the USA

Wall Street Journal article:  CDC: Pregnant Women With Flu Symptoms Should Receive Anti-Viral Drugs

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor despite the fact that you read or comment on my posts.  Leaving a comment on a post is a wonderful way to enter into a discussion with other readers, but I will not respond to comments (just because of time constraints).

July 24, 2009 | 7:09 pm

It’s West Nile Virus Season

Posted by Albert Fuchs, M.D.

The news is still flooded with stories about Swine Flu, which will continue to demand the attention of public health officials, but probably doesn’t need much more attention from the public.

Meanwhile summertime brings mosquitoes which bring West Nile Virus.  West Nile Virus is transmitted to people by mosquito bites.  Most infected people have a very mild illness, but some develop encephalitis (brain inflammation) or meningitis (inflammation of the lining of the brain and spinal cord).  There is no vaccine or specific treatment.  Last year in California 445 people became ill with West Nile Virus and 15 died.  This year West Nile Virus has been identified in animals in California, but no people have yet been infected this season.

So instead of worrying about Swine Flu, which there’s not much you can do to avoid, why not take a few steps to prevent getting infected with West Nile Virus?  The CDC recommends that you

• Use mosquito repellant whenever going outside,
• Eliminate standing water where mosquitoes can lay eggs, and
• Install or repair window and door screens to keep mosquitoes out.

That’s all.  You may return now to wall-to-wall coverage of the Swine Flu.

Tangential miscellany:

In an article in the LA Times this week (link below) Dr. Rahul Parikh extols the virtues of communicating with his patients by email and using electronic medical records!  Check it out and forward it to any doctors who still communicate by carrier pigeon or keep records on papyrus.

Learn more:

The Centers for Disease Control webpage on West Nile Virus

LA Times article:  The doctor is in and logged on

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor despite the fact that you read or comment on my posts.  Leaving a comment on a post is a wonderful way to enter into a discussion with other readers, but I will not respond to comments (just because of time constraints).

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July 21, 2009 | 12:55 am

The Shortsighted AMA

Posted by Albert Fuchs, M.D.

The AMA just endorsed the house version of the healthcare reform bill.  The Wall Street Journal excoriates them in this editorial:  What’s Up, Docs?  If you had any notion that the AMA was concerned with patient welfare, I urge you to read it.  Perhaps non-membership in the AMA will soon be a bragging point.  I think I’ll post a sign in the reception area: “Not a member of the AMA for over 10 years.”

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July 17, 2009 | 5:26 pm

Travelers Troubled by Thrombosis

Posted by Albert Fuchs, M.D.

Prolonged immobility has long been known to increase the risk of blood clots forming in veins in the legs (the medical term for which is deep venous thrombosis).  Blood clots in the legs can be quite painful and debilitating but they can also travel to the lungs which can be life threatening.  So doctors use medicines or inflatable leg squeezing devices to prevent blood clots in hospitalized patients who are bed-bound.  But there is a much more common time when we all are fairly immobilized – travel.  On long trips we frequently sit still for hours at a time, a perfect setting for blood in our leg veins to pool and clot.

An article in the current issue of Annals of Internal Medicine formally reviewed the existing studies on travel-associated deep venous thrombosis and concluded that travel increases the risk of a blood clot almost threefold, and that each 2 hour increase in the duration of travel increases the risk by 18%.

The likelihood of a blood clot in any single episode of travel wasn’t estimated, but is presumably very low, given the huge number of people who travel.  So this should not make you cancel your trip to see Aunt Martha.  Instead, follow these common sense suggestions from the Centers for Disease Control anytime you have to sit for longer than four hours:

• Get up and walk around every 2 to 3 hours.
• Exercise your legs while you’re sitting by:
  • Raising and lowering your heels while keeping your toes on the floor
  • Raising and lowering your toes while keeping your heels on the floor
  • Tightening and releasing your leg muscles
• Wear loose-fitting clothes.

Tangential miscellany:

That reminds me.  If you happen to fly on US Airways this month, pick up their in-flight magazine.  They printed my post on cyberchondria.

Learn more:

Centers for Disease Control and Prevention Tips for Healthy Living:  Deep Vein Thrombosis

Annals of Internal Medicine article:  Travel and Risk for Venous Thromboembolism

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor despite the fact that you read or comment on my posts.  Leaving a comment on a post is a wonderful way to enter into a discussion with other readers, but I will not respond to comments (just because of time constraints).

0 Comments — Leave your comment