Davis Square Family Practice Newsletter
In This Issue
The H1N1 and Seasonal Flu
What you Need to Know
Article Headline
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Featured Article
Swine flu
Deborah Bershel, MD 
Marie Botte, NP
Paula Mahoney, Office Mgr
Qianna Price, Med. Assist.
Kristen O'Callaghan, M. A.
Monica Perreira, Sec.
Jason Joyce, Sec.
Dorothy Anderson, Phlebot.
Important Info
Office Phone 
Appts.-  Same day appts. should always be available  for emergencies
Call Backs- Should be completed by your clinician by the end of day.
Refills- Allow 24 hrs. for handwritten refills
After hours- Call office for name and phone number of covering physician. If you prefer to confer with Dr. Bershel her cell is (617) 230-7988
(sometimes phone is shut off so Dr. Bershel can sleep)
Issue: # 2 October  5, 2009
Sneezing boy
It is the hope of this practice to provide timely and reliable information on topics of interest to our patients. As this is a new addition to Davis Square Family Practice, please send us your thoughts and comments.
The H1N1 and the Seasonal Flu
What You Need to Know
What is the flu?-  It is a respiratory illness, not unlike a 'common cold' but there is usually also a fever and a significant cough. There can be a sore throat and often there are muscle aches.
What is the difference between the H1N1 (Swine) flu and the Seasonal flu? - Not much as far as symptoms go except that the H1N1 has been associated with nausea  and vomiting and diarrhea about 25% of the time (but nausea and vomiting without a cough/fever/sore throat is probably not the flu). The current flu that is going around is the H1N1 and not the seasonal flu.  The seasonal flu usually strikes in Massachusetts in Dec thru March.
Is the H1N1 flu more dangerous than the seasonal flu? Not really but it is a strain of flu that hasn't really been around since the mid1970's and so younger people seem to be more susceptable to getting it. It will probably be more widespread than the seasonal flu because there is so little immunity in a large portion of the population. But most people will have a relatively mild 5-7 day illness.
Who is at greatest risk for complications such as hospitalization? It is important to realize that the H1N1 virus is not showing any sign that it is more dangerous than any other flu from years past.
Pregnant women and chronically ill patients with heart, kidney, lung disease, seizure disorder or cancer and immune-suppressed patients (including HIV) are more susceptable to complications. Children under 5 are also more at risk. Because of all the media attention given to this illness there is an inordinate fear amongst some about this flu. In the average year more people die in automobile accidents than from the flu and most of those folks who succumb to the flu are old and chronically ill. There is no reason to expect that this year will be much different than other years except there may be a tilt toward younger chronically ill people.
Warning signs? 
a. Confusion and/or shortness of breath
b. Unconsolable irritability in a child
c. Worsening symtoms perhaps days after person seemed to be improving. (This could be a sign of secondary bacterial pneumonia).
Flu Prevention and Treatment and Logistical Issues
 Sneezing boy
Vaccination - While it will be your choice, vaccination will be the best way to prevent getting the flu. Unfortunately the H1N1 vaccine is not available yet in Massachusetts and the small amount (36,000 doses) that will be in the first shipment will be administered to healthcare workers. We hope that a significant supply will arrive by November. Children under 10 will need 2 doses of the H1N1 at least 21 days apart to be considered immunized.  Side effects from the flu vaccine are usually mild.
2. Avoid sharing food and utensils with others as people will be highly infectious just prior to coming down with symptoms. This will be especially important for parents with little children. I'd avoid kissing my child near the mouth or nose and suggest to friends and relatives that they not kiss little ones at all.
3. Use good hygeine - The virus stays alive on some surfaces for up 2-6 hours and so washing your hands before eating or touching your face is very important. (Unfortunately the virus can be transmitted through the air too. Interestingly, if you have someone in your home with the H1N1 flu you have about a 15-20% chance of getting infected and that is no different than with the typical seasonal flu.) 
1.Stay at home -  The CDC is now recommending that you stay at home for at least 24 hours after your fever is gone (without the use of fever reducers). They no longer recommend that you stay home for at least 5 days. Don't sneeze into your hands. Wash your hands with soap and water after you blow your nose or touch your mouth.
2. Medication-
a.Drink plenty of fluids and use ibuprofen or tylenol for fever. Do not use aspirin with the flu as it is associated with Reyes syndome (a liver complication). 
b. If you call the office within 24-48 hours of coming down with flu symptoms we can call in antiviral medication for you. Tamiflu and Relenza (when given early) shorten the course of the illness by 1 day and may lower the risk of complications. If you suffer from a chronic illness I would recommend treatment.
Logistics :
1. Vaccines- Currently I do not have the seasonal flu vaccine and may get some in by the middle of October. (I had pre-ordered vaccines 1 year ago but unfortunately Walgreens has more clout than I). You can get both flu vaccines (H1N1 and seasonal flu) at the same time as long as both vaccines are not live vaccines.  If you are anxious about getting the seasonal flu vaccine ASAP you can try the local pharmacies and check for availability.
2. Contacting Patients with new information - We will attempt to call high risk patients when we have an update on when the vaccines will arrive and when we will be having  vaccine clinics. I plan on having an update email newsletter with this information too.

Much of the information that I have given to you was culled from the CDC website www.cdc.gov/h1n1flu/ and from the excellent Massachusetts Dept of Health H1N1 blog www.mass.gov/flu. I'm happy to entertain any questions and concerns you may have about the flu or about the newsletter at dbershel@gmail.com
I plan on putting together a newsletter on a regular basis so your comments will help make this an even better source of information in the future.


Deborah Bershel, MD