Swine Flu - Questions & Answers

Will swine flu end up sweeping the globe in a flu pandemic? The Centers for Disease Control and Prevention announced that it’s taking some aggressive precautions—just in case.The federal agency reported Monday that there were 40 confirmed U.S. cases of swine flu, which were mostly mild infections seen in New York, Ohio, Kansas, Texas, and California. There are 26 confirmed cases in Mexico, but there are thought to be hundreds more not yet confirmed (including reports of 149 deaths). There have also been six cases in Canada and one in Spain.

It sounds scary. But it doesn’t mean it’s time to panic. Experts have long been searching for new flu viruses because they are known to periodically appear and sweep the globe; for example, there were at least three pandemics in the 20th century and as many “pandemic threats.” The last pandemic was the 1968 Hong Kong flu, so researchers say we’re overdue for one and are on high alert for potential candidates.

All this preparation is a good thing. Better surveillance most likely picked up the swine flu cases early. And one reason the government declared a public health emergency is to free up huge stockpiles of antiviral medication. (About 11 million courses of antiviral medication were shipped to affected states). “There’s been tremendous planning that’s been going on around the country over the past number of years,” said Richard Besser, MD, the acting director of the CDC, at a press briefing.

While it’s not time to panic, it is a good time to become more informed about swine flu and to contemplate “what if?” scenarios, including what you plan to do if your child’s school is closed or you can’t go to work, according to the CDC.

“It’s time for businesses to review their plans and think about ‘What would I do if some of my workers couldn’t come to work? How would my business function?’” said Dr. Besser. “Think about that.”

The good news is that there is a wealth of information about swine flu online, and it’s constantly being updated. For example, you can follow current cases on Google maps and get CDC updates via Twitter, as well as find information on the CDC’s and the World Health Organization’s Web sites.

Health.com talked with Brian Currie, MD, vice president and medical director for research at Montefiore Medical Center in the Bronx, N.Y., to get the facts about swine flu. Dr. Currie is an expert in disaster and bioterrorism preparedness. Here are his responses to some frequently asked questions.

Are we in the midst of a global flu pandemic?

I wouldn’t exactly call it a pandemic yet. A pandemic implies a huge spread across the world. Experts have been anticipating something like this would happen and we are somewhat prepared for it, but probably not ideally at the moment. This is a new strain that’s just been discovered, so there’s no vaccine for it—which is usually the most effective way to control dissemination. However, we do have a surveillance system and it looks like it was picked up very early, and we do have stockpiles of antiviral medications that are available if we need them.

Where did the virus come from, and why are experts concerned?

What you have is a swine flu virus that has picked up parts of human flu and mutated to incorporate them so that it can infect humans and it can cause human-to-human transmission as well. It’s made a lot of the changes it would need to become a pandemic. Unlike what’s happening in Mexico, where there’s been a lot of mortality, all of the cases that have occurred in the United States have been relatively mild disease. So it looks like as it spreads, it’s attenuating or become less virulent, so that would the saving grace here.

Isn’t avian flu supposed to be the big risk in terms of a global pandemic?

We knew it was going to be avian flu or swine flu that made the jump into humans and we’ve always been concerned about flu viruses that infect swine, birds, and humans; there are 30 or so in total. Some of the strains that can infect other species cannot typically infect humans. Human strains can infect pigs, so what happens is that pigs get infected with swine flu and human flu at the same time. They recombine the genetic material, so when they produce new viruses it’s got part of the human and part of the pig; you worry that if it gets enough of the human virus, it will be able to bind to human receptors.

Can I get swine flu from eating pork?

Absolutely not. It can’t be transmitted though the food chain. You’re not going to get it from eating pork.

Some of the swine flu cases have included symptoms like diarrhea or vomiting. What symptoms should I look for?

Typically what you are looking for is a sore throat, runny nose, high fever, and aching all over your body—a real good case of flu knocks people right on their backs.

I was sick a week ago—could I have had swine flu?

Unless you had contact with pigs or people from Mexico, it’s probably unlikely, although anything is possible.

Should I wear a mask in public? What’s the best way to avoid swine flu?

At the moment [wearing a mask in public] is a bit much. Basically you should practice good hand hygiene, and try to avoid contact with people coming from areas where there are known cases.
Read CDC recommendations regarding the use of respirators and face masks and the best ways to avoid the flu.

Should I keep my children home from school?

There’s only one school [in the New York area] where they have found cases and it’s limited to that school so far, so there is really no reason not to send your children to school at this point.

Should I cancel travel plans?

[The United States is] one of the sites people are worried about coming to now; Europe is telling people no unnecessary travel to Mexico and United States, so we’re being targeted rather than targeting other people. The caution would be, if you really don’t have to go, then put [trips] off and wait until we have more information.
Read the travel advisory issued by the CDC, which recommends delaying any non-essential travel to Mexico.

Should I get a flu shot?

No. In fact, it’s pretty unlikely that a flu shot will protect you against this strain.

I think I’m getting sick. Should I take an antiviral drug?

Currently what they are suggesting is if you are young and healthy, just go home and wait it out. That way we can keep the Tamiflu for people who have other chronic illnesses that put them at high risk, for example, those who are pregnant or the elderly. Those are people we are likely to test; then if they are positive, we’ll treat them.

Read CDC recommendations on what to do if you get sick.

I have to fly. Should I take any special precautions when traveling in a plane?

No, just stay away from people who look overtly ill. (And airports are generally screening people for symptoms.)

Should I go to the grocery store and stockpile food in the case of a quarantine?

No, just stay calm. The story is unfolding very rapidly and we’ll have more information shortly. But signs are encouraging so far, at least for what’s here in New York. If what’s happening in Mexico occurs someplace else, it could be another issue. Every U.S. case has been mild, so that’s in our favor. At the same token, there have been almost 200 [reported] deaths in Mexico.

Technorati Profile

Swine Flu

The number of confirmed cases of swine flu in the United States has doubled to 40, with all the new cases coming from a New York City high school that had previously reported eight cases of the infectious disease, U.S. health officials said Monday.

The officials also said they were tightening their travel advisory to Mexico — believed to be the source of the outbreak that continues to reach around the world — recommending that all nonessential travel to that country be avoided.

“This situation is evolving very quickly, it is changing quickly,” Dr. Richard Besser, acting director of the U.S. Centers for Disease Control and Prevention, said during an afternoon teleconference. “We are officially reporting 40 confirmed cases in the United States. The only change from yesterday is 20 confirmed cases in New York City. These are associated with the same school outbreak and really represent additional testing in that group and not an ongoing spread.”

All 40 U.S. patients — 28 in New York, seven in California, two in Texas, two in Kansas and one in Ohio — have either recovered or had mild infections, Besser said.
“Later today, we will be releasing a new travel advisory for Mexico,” he added. “This is out of an abundance of caution, and we will be recommending that nonessential travel to Mexico be avoided.”

Mexico is reporting as many as 1,900 possible swine flu infections and as many as 149 deaths.
Earlier Monday, President Barack Obama said the threat posed by the swine flu outbreak was a cause for concern but “not a cause for alarm.”

“The Department of Health and Human Services has declared a public health emergency as a precautionary tool to ensure that we have the resources we need at our disposal to respond quickly and effectively,” Obama told a gathering of scientists at the National Academy of Sciences, amid increasing worries worldwide about a possible pandemic, the Associated Press reported.

Besser said that he “expects that we will see [swine flu] cases in other parts of the country, and I would fully expect that we will see a broader range in terms of the severity of infection. Thankfully, so far we have not seen severe disease in this country as has been reported in Mexico.

Besser said the United States will step up checks of people entering the country by air, land and sea, looking for signs of infection, and the CDC will begin distributing “yellow cards at ports of entry.”

“These will provide information on swine flu, so that people coming into the United States will have information about this outbreak — what to do if they become sick, what things they can do to prevent the likelihood that they will become sick,” he said.

He also said U.S. officials were questioning border visitors about their health, looking for signs of possible infection.

The fast-unfolding events in the United States — where all 40 cases have been relatively mild and there have been no deaths — came in response to some 1,900 swine flu infections and as many as 149 deaths in neighboring Mexico.

Officials in other nations around the globe responded to the threat of a possible pandemic. China, Taiwan and Russia considered quarantines, and several Asian countries scrutinized visitors arriving at their airports, the AP reported.

The European Union on Monday advised against nonessential travel to the United States and Mexico. Early Monday, Spain confirmed that a man hospitalized in the eastern part of the country had tested positive for swine flu, in what’s believed to be Europe’s first case of the disease. Health authorities were also testing 17 other possible cases in Spain, a major travel link between Mexico and Europe, The New York Times reported.

Responding Monday to the EU’s travel advisory, the CDC’s Besser said, “Based on the situation in the United States right now, I think it is premature to put travel restrictions on people coming to the United States. As the situation changes, that needs to be evaluated by different countries.”

On Sunday, U.S. health officials declared a public health emergency in response to the swine flu outbreak.

Homeland Security Secretary Janet Napolitano said the declaration was a precautionary measure and did not mean that the threat posed by the outbreak was worsening. But, the move allows federal and state governments easier access to flu tests and medications, she said.

Napolitano said the federal government had 50 million doses of the antiviral flu medication Tamiflu, and a quarter of those doses were being released to states, if needed, “particularly prioritizing the states where we already have confirmed incidence of the flu.”

Napolitano also said Sunday that the Department of Homeland Security had started “passive surveillance protocols to screen people coming into the country.”

“All persons entering the United States from a location of human infection of swine flu will be processed by appropriate CDC protocols,” she said. “Right now, these are passive. They are looking for people and asking about: ‘Are you sick? Have you been sick?’ and the like. And if so, they can be referred over for further examination. Travelers who do present with symptoms will be isolated.”

Speaking at a Sunday press conference, Dr. Anne Schuchat, the CDC’s Interim Deputy Director for Science and Public Health Program, said that U.S. health officials had numerous tools to fight the illness’ spread and protect the health of Americans. The swine flu viruses found in the United States are resistant to two antiviral medications — amantadine and rimantadine — but are susceptible to the antivirals oseltamivir (Tamiflu) and zanamivir (Relenza), Schuchat said.

Schuchat said steps were already being taken to devise a vaccine against this strain of swine flu, although the process takes time. “We are taking the initial steps in terms of preparing the seed virus to hand off to the industry partners, to produce large quantities. But you know it takes months to produce a vaccine,” she said.

Besser said there are steps people can take to help prevent catching and spreading the flu, including frequent hand-washing. “If you are sick, it is very important that people stay at home. If your children are sick, have a fever and flu-like illness, they shouldn’t go to school. And if you are ill, you shouldn’t get on an airplane or another public transport. Those things are part of personal responsibility in trying to reduce the impact,” he said.

Meanwhile, in Mexico, authorities continued to take dramatic steps — including suspending school and public gatherings — to try to contain the outbreak that officials say has killed as many as 149 people, and sickened more than 1,900 others in that country.

Some of the U.S. cases involved people who had recently returned from trips to Mexico, Schuchat said Sunday. The two cases reported in Kansas involved a husband and wife who had recently been to that country, she said. And The New York Times reported that some of the students at St. Francis Preparatory School, in Queens, had recently come back from Mexico as well.

Also on Sunday, Canadian officials confirmed four “very mild” cases of swine flu at a school in Nova Scotia, and two other cases in British Columbia. According to the AP, a provincial health official said that the infection that sickened the students in Nova Scotia “was acquired in Mexico, brought home and spread.”

Swine flu is a respiratory disease of pigs caused by type A influenza. Swine flu does not normally infect humans. However, human infections do occur, usually after exposure to pigs. Symptoms resemble those of the regular flu, including sore throat, coughing and fever.

8 Causes of Chronic Cough

You've been coughing for weeks.
How do you know if it's just a hard-to-shake cold or something more serious?

A chronic cough, defined as lasting more than eight weeks, is not uncommon. Up to 40% of nonsmokers in the United States and Europe have reported a chronic cough at some point, and coughing is one of the five most common reasons for a doctor's visit.Only a doctor can tell for sure what's behind your endless hacking.

However, in a 2006 study of women with an average age of 48 who had a cough lasting for six months, 39% were found to have asthma, 9% had chronic upper airway cough syndrome (commonly known as postnasal drip), and 9% had gastroesophageal reflux disease (GERD).In addition, another 11% had chronic obstructive pulmonary disease (COPD), a serious, progressive disease that includes both emphysema and bronchitis.

While not all people who develop COPD are smokers, people who smoke are at higher risk. Overall, 24 million Americans—about 1 in 12 people—have COPD, although half don't know they have the disease.Read more about COPD and some common (and relatively uncommon) culprits in chronic cough.

1. Asthma and allergies

Asthma is a chronic lung disease in which the airways in the lungs are prone to inflammation and swelling. Along with chest tightness, shortness of breath, and wheezing, coughing is a characteristic symptom of asthma, one which tends to intensify at night or in the early morning.

When the symptoms of asthma flare up suddenly, it’s known as an asthma attack.Although it can begin at any age, asthma usually develops in childhood. Asthma triggers are different for everyone, and they can include exercise, colds, cigarette smoke and other airborne irritants, and certain foods.

Asthmatics usually also have allergies.Even in people without asthma, inhaling pollen, dust, pet dander, and other airborne irritants can trigger allergic rhinitis, an allergic reaction that can cause coughing, along with symptoms such as stuffy nose and sneezing.

You may be able to determine whether your cough is caused by allergies by keeping track of whether it comes and goes in certain situations.

If your coughing magically stops when you step into an air-conditioned room on a dry, pollen-heavy day, or if gets worse every time you pet Mittens, you probably have allergies.

If you’re not sure what’s triggering your allergic cough, your doctor can give you a skin test or blood test to pinpoint the allergy.

2. Chronic obstructive pulmonary disease (CPOD)
One condition that can cause a nagging cough is COPD, a lung condition that includes chronic bronchitis and emphysema.

COPD occurs when the airways and air sacs in the lungs become inflamed or damaged, most often due to smoking, and is more common after age 45. In COPD, the lungs produce excess mucus, which the body reflexively tries to clear by coughing.

COPD-related tissue damage can also make it particularly difficult to expel air from the lungs, which can make you feel short of breath.Your doctor may check you for COPD (particularly if you have risk factors, such as smoking), after ruling out other common causes of cough. To determine if you have COPD, your doctor is likely to conduct some tests, including spirometry, which involves inhaling as deeply as you can and then exhaling into a tube.

3. Gastroesophageal reflux disease
GERD is an ailment of the stomach and esophagus that occurs when stomach acid backs up into the esophagus due to a weak valve. The main symptoms? Killer heartburn. But coughing is another common symptom of GERD, along with chest pain and wheezing. In fact, GERD is a fairly common, and unrecognized, cause of a chronic cough.

4. Respiratory tract infection
Coughing is one of the most common symptoms of colds and flu and other respiratory tract infections. The other symptoms that accompany colds and flu, such as stuffy nose and a fever, are telltale signs that a viral infection is causing your cough.

However, a cough can outlast all those other symptoms, perhaps because the air passages in your lungs remain sensitive and inflamed.When this occurs, it's called chronic upper airway cough syndrome (or postnasal drip).

A more serious respiratory tract infection is pneumonia, which can be caused by bacteria or viruses. A cough, often producing a greenish or rust-colored mucus, is one of the characteristic symptoms of the illness, along with fever, chills, chest pain, weakness, fatigue, and nausea.

These symptoms may present differently depending on your age; older adults may not experience a fever, for instance, or they may have a cough but no mucus.Pneumonia is treated with antibiotics and generally clears up within two or three weeks. As with the cold and flu, however, the cough can linger for much longer.A form of pneumonia known as mycoplasma, or walking pneumonia, shares the symptoms of pneumonia (including cough) and is more common in people under the age of 40.

People who have COPD can be more susceptible to such respiratory tract infections, and may experience exacerbations—episodes of potentially life-threatening shortness of breath—when they catch a cold or breath in air pollution or other irritants.

5. Air pollution
Various pollutants and irritants in the air can cause a persistent cough. Even short-term exposure to fumes (such as diesel exhaust) can result in cough, phlegm, and lung irritation, for instance. Fumes can also exacerbate the symptoms of allergies or asthma.

Similarly, mold spores found in and around homes can cause wheezing and coughing when inhaled.

In the wake of Hurricane Katrina, New Orleans reported a sudden spike in persistent cough complaints among returning residents. This so-called Katrina cough was believed to stem from the mold caused by the flooding, as well as by dry weather and the construction dust that was then ubiquitous in the city.

6. Acute bronchitis
If you’re on the verge of recovering from a cold and suddenly develop a hacking, mucus-y cough, you probably have acute bronchitis, a condition in which the passageways in your lungs become infected and inflamed.

In addition to coughing and chest congestion, bronchitis can produce fever, chills, aches, sore throat, and other flu-like symptoms. These symptoms usually disappear within a few days, but the cough can persist for weeks.

If your cough doesn’t go away, or if you develop acute bronchitis frequently, it may be a sign of a more serious condition.

Acute bronchitis—acute means short-term—is different from chronic bronchitis. Chronic bronchitis is a condition in which the lungs produce excess mucus due to ongoing irritation, and is considered a form of COPD.

7. ACE inhibitors
ACE inhibitors are a type of medication used to treat high blood pressure and heart failure. (Check out this list of common brand-name and generic drugs that are ACE inhibitors.) About 42 million prescriptions for ACE inhibitors are written each year, and about 1 in 5 people who take the drugs develop a dry cough.

In some people, the cough can persist for weeks after they stop taking the medication; women, African Americans, and Asians may be at greater risk of developing an ACE inhibitor cough than other people.

You should never stop taking a prescribed medication without consulting with your doctor, and ACE inhibitors are important medications for lowering blood pressure (a more serious condition than a cough.) Consult your doctor if you think your cough is related to a medication.

8. Pertussis
Also known as whooping cough, pertussis is a bacterial disease with symptoms that include a slight fever, a runny nose, and, most notably, a violent cough that can make breathing difficult.

Attempting to inhale air into the lungs between coughs can produce a distinctive, high-pitched whooping sound. After the initial stage, many people do not have a fever, but the chronic cough that accompanies pertussis can last for many weeks.

Most infants receive a pertussis vaccine, but its effectiveness subsides after about 10 years. Inadequate vaccination for pertussis (which is the “P” in the DPT shot) is one reason why the bacteria are making a comeback. Once a very rare cause of chronic cough, the number of pertussis cases in the United States has risen alarmingly in recent years, especially among adolescents and adults. However, pertussis is still a relatively uncommon cause of chronic cough.

3 kind of drugs that kill sex drive

If you're having sex drive issues, check your medicine cabinet. Several varieties of prescription medication can dampen desire.

Birth control
Some hormonal birth control methods such as pills and patches can increase women's levels of sex-hormone-binding globulin (SHBG), which drops the amount of testosterone that's floating around freely in the bloodstream.

A small but alarming 2006 Boston University study, authored by Irwin Goldstein, MD, director of San Diego Sexual Medicine and editor in chief of The Journal of Sexual Medicine, found the Pill to have a long-term effect on libido in some women. The level of SHBG was twice as high in women who had taken the Pill—four months after they'd stopped taking the medication—as those who never had.

That kind of long-term effect is pretty rare, however, according to Hilda Hutcherson, MD, an ob-gyn professor at Columbia University. She finds that birth-control-related sex drive problems usually go away when her patients switch pill formulations. "It's the progestin that seems to affect libido," Dr. Hutcherson says. "Some progestins have an androgen [male hormone] effect, and those tend to have less effect on libido."

Or try another form of birth control completely. With most women Dr. Hutcherson has seen in practice, she says she's found that "if you take them off the Pill, their sex drive comes back."

Antidepressants
Selective serotonin-reuptake inhibitors (SSRIs) such as Prozac are supposed to cheer you up, but they can interfere with one potential source of happiness: sexual pleasure. Some doctors will keep the SSRI but add Wellbutrin, which increases dopamine and acts as an "antidote to the SSRIs," according to Dr. Goldstein. For others, a doctor might switch the patient to Wellbutrin and cut the SSRI.

Everyone's body reacts differently to drugs, however, and for some, depression itself is more of a sex drive dampener than the SSRIs are. For still another set of patients, notes Marjorie Green, MD, director of the Mount Auburn Female Sexual Medicine Center in Cambridge, Mass., and a clinical instructor at Harvard Medical School, "When you give them SSRIs, they get a libido and can be sexually functional when they weren't able to be before."

Diabetes drugs
Both diabetes and the medicine used to treat it can diminish desire, arousal, and orgasm. And those changes, in turn, can affect sexual interest. As Dr. Hutcherson puts it, "Who wants it if it's not fun?"

What if you need the medicine?
Sometimes simply switching to another type of medicine, or even a different formulation of the same medicine, can solve the sex drive side effect. But if it does not, and you need the medication, and your regular provider isn't coming up with any new ideas, don't despair. "Go see a sexual medicine expert who can work with the physician prescribing the medicine to figure out other strategies," advises Alan M. Altman, MD, an assistant clinical professor at Harvard Medical School and a specialist in menopausal issues and midlife sexuality.

how to detox your body

Every day we put potential toxins into our mouths, breathe them into our lungs, and track them into our homes without ever really knowing where they’ll end up—or how much damage they’ll do when they get there. In fact, if you could peek inside your body you’d find fire-retardant chemicals, heavy metals, pesticides, plastic particles, and dozens of other residues of modern life.

The time has come to fight back! Our 12 simple steps will help you detoxify everything from your food to your feet, from your bedroom to your breasts. Purifying your life won’t happen overnight, despite what those detox foot-pad makers promise on late-night television. (PS: They don’t work!) But if you begin today you’ll definitely be a little healthier by the time you get into bed. Here’s how to get started:

1. Protect against pesticides
Washing fruit and veggies is a must-do every time you bring them home. Why? An overload of pesticides in air, food, or water may set the stage for Parkinson’s disease and possibly Alzheimer’s disease decades down the road, according to research. Apparently the chemicals in pesticides—which find a home on the surface of produce—can damage the energy-producing parts of brain cells. There’s also a pesticide-and-arthritis link. Protect your brain and body by washing fruits and vegetables thoroughly, especially if you aren’t eating organic. (You don’t need to use fancy detergent; plain water should do the trick.)

Also watch out for pesticides in your own yard and garden, because anything you spray outside will likely end up in your home. Defend your greenery, instead, with insects (such as ladybugs) or a natural, safe repellent like neem oil (1 quart, $22.50).

2. It’s curtains for plastic
You know that strong odor emanating from some new plastic shower curtains and mattress covers? Blame the polyvinyl chloride (PVC) used to manufacture them—which releases toxic chemicals that can make you dizzy and drowsy with just a few deep whiffs. Retailers like Target sell curtains made with materials like cotton, polyester, or hemp, which are safer to use and easier to clean.

3. Look out for lead
Thanks to the widespread use of leaded gasoline in past decades, women 40 and up have high amounts of lead in their bones, says Ellen Silbergeld, PhD, a toxicology expert at the Johns Hopkins Bloomberg School of Public Health. Why that’s bad: As your bones greedily soak up calcium, they can easily be fooled by lead, a dangerous metalliclook-alike. Lead-laden bones may be weak and prone to breaks. And as bones start to thin after menopause, the toxic metal could be released into the bloodstream, where it can increase blood pressure and possibly lead to neurological and kidney trouble.

How to fight back? Calcium, vitamin D, and regular exercise all can slow bone loss and reduce the amount of lead that moves from the bones into the blood, Silbergeld says. To keep more lead from climbing aboard, reduce dust in your home with either frequent wet-mopping or good vacuuming with a HEPA-filtered cleaner. (HEPA vacuums trap even those tiny dust particles you can’t see.)

The lead-paint issue is a toughie. If you live in an old home or apartment with chipping paint, talk to a knowledgeable inspector about testing before you do any renovating. Call the National Lead Information Center at 800-424-5323. Keep in mind: The Environmental Protection Agency says home test kits aren’t very reliable. Ask your doctor whether you need a blood-lead test, which usually isn’t necessary unless you’ve gotten acute exposure, say, during a home renovation.

4. Be smart down there
Do tampons have dangerous levels of dioxins or asbestos? Nah, it’s a myth. But don’t ignore the small-but-real risk of toxic shock syndrome (several dozen women get it each year), a potentially fatal condition caused by poison-producing staph or strep bacteria. Lower your odds by changing your tampon every four to eight hours and avoiding highly absorbent types (often labeled “ultra”).

Protect your ovaries while you’re at it by limiting exposure to perfluorinated chemicals (PFCs)—often in the coatings of nonstick pans and many other items like clothing, furniture, and packaged-food containers—which may double the risk of infertility, according to a study in Human Reproduction.

5. Don’t party hard
There’s some concern that chemicals found in plastic bottles and food containers have estrogen-like effects and can slightly raise the risks of breast cancer. But so far there is no real proof. What do we know that really does boost breast cancer risk? Alcohol. A new, massive study from England suggests that just one drink a day is linked to 11 additional cases of breast cancer per 1,000 women, and each drink after that increases the dangers. Even then, the risks remain small—your overall lifetime risk is about 12%. But if you think of alcohol as a toxin, maybe you’ll think twice before getting a frequent buzz.

6. Soap yourself silly
It’s tempting to try those gadgets or elixirs (or even foot pads) that claim to help you shed toxins through pores or sweat glands, but they’re a waste, experts say. The one skin product every toxin-conscious person should have? Soap. Sudsing up your skin every day (with extra washes for your hands) will help clear away toxin-producing germs, including methicillin-resistant Staphylococcus aureus (MRSA), that can cause nasty skin infections. Use alcohol-based hand gels when soap and water aren’t convenient. If you’re worried about soap’s drying effects, try a natural moisturizer like Dr. Hauschka Skin Care Rose Body Moisturizer ($39.95).

7. Use pain pills sparingly
Your liver is a toxin-clearing machine, but it’s not perfect. Many medications, including common drugs such as the pain-reliever acetaminophen, can damage the organ. According to the American Liver Foundation, you shouldn’t take more than 3 grams of acetaminophen a day—the equivalent of six extra-strength pills—for more than a few days in a row. Take as small a dose as you need to feel better.

8. Don’t fool with fire retardants
Flame-retardant chemicals common in foam products and electronics, such as mattresses and televisions, have found their way into virtually every human body. No one is sure if that’s a problem for humans, but animal studies show that these chemicals, known as polybrominated diphenylethers (PBDEs), may interfere with the functioning of the thyroid gland and immune system. To be safe, seal up any rips in old foam cushions or mattresses (which may have been treated with the retardants) or get new ones, since many companies are phasing out PBDEs.

9. Stay smoke-free
You know regular smoking is a killer but think the occasional smoke can’t hurt? Not true. University of Arizona researchers found that just one cigarette impairs blood flow in the heart. And a Norwegian study showed that women who smoked one to four cigarettes a day tripled their risk of dying from heart disease and saw a fivefold jump in the risk of dying from lung cancer.

The threat of secondhand smoke is no less scary: Exposure kills nearly 50,000 adult nonsmokers every year. There are even new worries that thirdhand smoke (what’s left in your hair or your clothes after being in a smoke-filled room) is harmful, especially to babies. Sadly, you can’t stop other people from smoking. But you can help your body rebound by eating a lot of broccoli and cauliflower. These cruciferous vegetables (which also include Brussels sprouts, cabbage, and watercress) contain sulfouraphane and other compounds linked to lower disease risks. Studies suggest that people who regularly eat these vegetables enjoy protection from lung cancer. Three to five servings a week should do the trick, but don’t boil or microwave them to mush; overcooking may destroy the toxin-fighting compounds.

10. Freshen in friendlier ways
That sweet-smelling air freshener? It may be polluting your home with chemicals that can irritate your eyes and lead to headaches and nausea. Aerosol cleaners are equally guilty. Instead of covering up unpleasant smells, open the windows when weather permits. Get some fresh air in your home office, too, where ultrafine particles from laser printers can escape into the air. And green up with Areca palms, Boston ferns, and English ivy; they help purify your air. When you’re cleaning, try natural solutions like baking soda or vinegar.

11. Eat safer fish
Heavy metals can be hard on the heart. Mercury, for example, may raise your risk of atherosclerosis or a heart attack. Ironically, we get the vast majority of our mercury from fish, a supposedly heart-healthy food because of its high omega-3-fat content.

The Food and Drug Administration urges women who are pregnant or nursing to avoid mercury-rich fish including shark, swordfish, and king mackerel. It’s probably wise to go easy on slightly less-tainted types such as tuna, too. Such advice actually makes good sense for every adult, Silbergeld says. To cut down on mercury, stick with cod, flounder, and wild Alaskan or Pacific salmon, as well as shellfish like clams and shrimp. If you love sushi (with its healthy combo of resistant starch and omega-3s), limit yourself to one to two meals a month, and don’t always choose tuna.

12. Wipe your feet
Your shoes can play a vital role in detoxifying your home. Pesticides and lead-contaminated dust—not to mention annoying pollen during allergy season—tend to settle on the ground and can stick to footwear. Wiping your feet on an abrasive, high-quality door mat before walking inside can keep toxins from invading your space. Better yet, make a habit of taking off your shoes at the door.

Drug-Resistant "Super Acne" Is On the Rise

First superbug (MRSA), then super yeast infections and now health experts are warning that certain types of bacteria that cause acne are mutating and becoming more drug resistant. Great. OK, so is it a pimple, or is it super acne?

****I tell you, it's a pretty good time to be a fungus or bacteria. The latest mutant strain that's becoming more bold and brash, resisting the traditional antibiotics, is showing up in the form of acne--and dermatologists are concerned. According to the latest estimates, as many of 30 percent of people with acne may harbor some resistant bacteria.

In a nutshell, the traditional prescribed antibiotic treatments for acne are becoming less and less effective, according to some experts. The problem? Sadly, some people are dealing with acne breakouts that are much more difficult to treat. Think: perma-acne (shudder). But even worse, experts warn, the drug-resistant acne--while not life threatening--can post a health risk for other staph infections. Nope, you're not going to die from acne, but drug-resistant bacteria like this can lead to more serious infections.

What can you do to protect yourself? Talk to your doc if you have persistent acne problems--especially if the medicine you've been prescribed stops working. And, never share towels that you use to wash your face with others. One Swedish study found that drug-resistant acne could be contagious and spread from family member to family member.

Do you have acne problems? Have you ever seen a dermatologist? Ever heard of these drug-resistant acne strains?

Aspirin linked to Brain Microbleeds

A Dutch study finds an increased incidence of tiny bleeding episodes in the brains of people who regularly take aspirin.

Magnetic resonance imaging (MRI) examinations of 1,062 people found a 70 percent higher incidence of “microbleeds” among those taking aspirin or carbasalate calcium, a close chemical relative of aspirin, than among those not taking such anti-clotting drugs, according to an April 13 online report in the Archives of Neurology from physicians at Erasmus MC University Medical Center in Rotterdam. The research was expected to be published in the June print issue of the journal.

No increased incidence of microbleeds was seen in people taking clot-preventing drugs that act in different ways, such as heparin, the researchers noted.

Both aspirin and carbasalate calcium are taken to reduce the risk of cardiovascular problems such as heart attack and stroke. Both prevent formation of clots by acting against platelets, the blood cells that form clots.

The report adds information to a still unfolding medical story about the causes and effects of microbleeds, said Dr. Steven M. Greenberg, a professor of neurology at Harvard Medical School and director of the Hemorrhagic Stroke Research Program at Massachusetts General Hospital.

“They found an association between taking antiplatelet medications and having microbleeds,” Greenberg said. “That is not proof that the antiplatelet medications are causing the microbleeds. People typically are given antiplatelet medication because they have more cardiovascular risk factors, which are associated with microbleeds. They tried to adjust for those risk factors, but that doesn’t prove that taking the medications causes the microbleeds.”

And then, “it is not clear at this point what significance we can attach to seeing microbleeds,” Greenberg said. Some studies have shown an association between microbleeds and an increased risk of major bleeding events in the brain, but those studies have included only small numbers of people, he added.

There also is some data indicating that microbleeds are associated with reduced brain function, but their role is unclear, because “they tend to travel together with other kinds of small-vessel brain disease,” Greenberg said.

“It’s not clear at this point whether microbleeds are doing any substantial harm to the brain, but we do know that antiplatelet drugs help prevent heart attacks and strokes,” Greenberg said.

The most that can be said is that the study “is a little bit of a warning for us to think about antiplatelet drug therapy as a risk for hemorrhagic damage to the brain,” he said.

Therefore, there is no message to physicians yet about who should or should not be prescribed antiplatelet drugs such as aspirin, Greenberg said.

“It’s important not to overreact until we are sure of what gives people the best combination of benefit without much risk,” he said.

Beat Allergies and keep running

Running is no fun when you’re plagued by these common health complaints. Talk to your doctor about the best treatment options (and to get the all clear to exercise), then try these do-it-yourself strategies.

Allergies
Run between 5 and 9 a.m., when allergens are at their lowest, and choose the route with the fewest trees. Slowing your pace and breathing in through just your nose can help, too. Post-run, shower and wash your hair. If this move doesn’t help, hit the treadmill on high-pollen days. Check pollen counts in your area.

Asthma
Add an extended warm-up: Walk slowly for 10 minutes, then gradually increase your speed. Breathe in through your nose, not your mouth. If you’re new to running, start slowly, mixing walking with running at a moderate pace (one that allows you to hold a conversation). Also, relax your shoulders and arms as you run—you’ll open your lungs and breathe more easily.

Tummy troubles
You can thank the up-and-down motion and the fact that blood is being diverted away from digestion to your heart and muscles. The remedy: Don’t eat foods high in fat or fiber several hours before running, and give yourself two to four hours to digest a meal before you head out. Running at a different time of day may also help.

The Reason that we tired

Even if you manage to get to bed at a decent hour most nights, we’re willing to wager that you’re exhausted. Women complain about feeling tired nearly four times as often as men. But if your fatigue is so crippling that it makes it hard to care for your family, do your job, or enjoy your social life—and lasts for several weeks—don’t just blame the draining demands of modern life.

Fatigue can be a symptom of everything from the mundane to the life-threatening, says Neil Shulman, MD, associate professor in the department of medicine at Emory University Medical School and co-author of Your Body’s Red Light Warning Signals. And, while figuring out what’s wrong can be challenging, experts insist that many of the reasons for exhaustion are easy to fix. Talk to your doctor about the following possibilities.

No-need-for-alarm reasons you’re tired:You’re low on Vitamin B12 The nutrient is an energy booster that maintains healthy nerve cells and oxygen-transporting red blood cells. If you’re low, you may feel draggy. You might also suffer from constipation or diarrhea, says women’s-health expert Sandra Fryhofer, MD, past president of the American College of Physicians-American Society of Internal Medicine. If left unchecked, a deficit can lead to numbness and tingling in the hands and feet, difficulty with balance, poor memory, and confusion.

What to do: A B12 blood test (your doc can do the test in the office by taking blood from your arm) will reveal your level. B12 comes mainly from animal sources, so make sure your diet includes dairy, eggs, meat, or fish. Vegans can opt for fortified veggie burgers or soy milk. B12 does come in supplement form, but it’s not easily absorbed. Your doc might recommend an injection.

Drugs are sapping your energySide effects from prescription and over-the-counter medicines like antihistamines can secretly sap your energy. Each person reacts to allergy meds differently, and some might make you drowsy even if they’re touted as non-drowsy formulas. Many beta-blockers for hypertension are also known for causing fatigue, and certain antidepressants have the same effect.

What to do: Medicine fatigue isn’t something you always have to live with. New or different formulations may not have the same effects, so check with your doctor about switching brands, dosages, or treatments. Keep an eye on labels, too: If insomnia is listed as a side effect, don’t ignore that warning.

You have a vitamin D deficitToday’s healthy desire to avoid sun dam­age has created an epidemic of D deficiency, says Annabelle Volgman, MD, a cardiologist and medical director of the Heart Center for Women at Rush University Medical Center in Chicago. In fact, many of her female patients complaining of fatigue and chest pain are low in D, which the body makes from exposure to sunshine. The cause of the D-deficiency-and-fatigue connection isn’t clear, but low levels of this vitamin are associated with increased risks of heart disease, high blood pressure, some cancers, and neurological disorders.

What to do: A “25-hydroxy vitamin D” test of your blood (taken from a vein at the doc’s office) can check your levels; normal is about 16 to 74 nanograms per milliliter. Although you can find vitamin D in fish, eggs, and cod liver oil, Dr. Volgman says, most women who are deficient can benefit from supplements. To beat fatigue, she recommends 10 minutes of sunshine per day. A multivitamin can deliver 800 IU, twice the recommended daily amount.

Surprising disorders that can cause fatigueYour thyroid’s out of whackIf you can’t lose weight or have unexplained weight gain, drier skin than usual, a slowed heart rate, a change in your periods, or a feeling of being cold—along with fatigue—you may have hypothyroidism, says Francine Kaufman, MD, head of the Center for Endocrinology, Diabetes, and Metabolism at Childrens Hospital Los Angeles. Hypothyroidism occurs when the thyroid gland, located in your neck, doesn’t produce enough metabolism-regulating hormones. If it progresses without treatment, the disorder can cause constipation, infertility, joint pain, and heart disease. Eight out of 10 thyroid disease patients are women, and about 5% of women in their child-bearing years are thought to suffer from hypothyroidism, although some experts think the numbers are much higher.

What to do: Check into your family history, an important risk factor, to find out if anyone else has a thyroid imbalance. Your physician will order a thyroid-stimulating hormone (TSH) blood test. If it’s positive, you’ll probably need thyroid-hormone-replacement therapy for the rest of your life. Good news: It usually works great.

You’re depressed“Fatigue is one of the most common signs of major depression,” says David Mischoulon, MD, PhD, a staff psychiatrist at Massachusetts General Hospital and assistant professor at Harvard Medical School. About 12 million adults (more women than men) suffer from depression—and the lifetime risk for women is about 20%.

What to do: You may think everything’s fine, but coming clean about feeling stressed, anxious, or sad can reveal a problem. Therapy and antidepressants (despite the possible fatigue side effects) are proven solutions, and getting more exercise may help, too.

You have celiac diseaseRoughly 1 in 133 Americans suffers from this digestive condition, a destructive reaction in the small intestine to gluten, a protein in wheat, rye, and barley. When you eat regular pizza or cookies, for instance, you may experience bloating, pain, diarrhea, joint discomfort—and extreme fatigue—because the disease starves the body of basic nutrients, says Marianne Frieri, MD, PhD, Chief of Allergy Immunology at Nassau University Medical Center in New York.

What to do: If wheat-based foods seem to make you sick and tired, you’ll need a series of blood tests. Depending on the results, the doc will do an endoscopy (a small intestinal biopsy). If celiac is confirmed, you’ll need to overhaul your diet. The good news: Gluten-free eating—making creative substitutions for wheat flour—is getting easier. By some estimates the number of gluten-free foods on grocery shelves is growing annually by nearly 25%. For help, read The G-Free Diet: A Gluten-Free Survival Guide ($24.99; Center Street, 2009) by Elisabeth Hasselbeck, co-host of The View.

Scary problems you can’t ignore:You have heart diseaseWomen having heart attacks often feel fatigued. “According to a recent study, 70% of women say they had a sudden unusual sense of tiredness beforehand,” Dr. Volgman says. Doctors typically chalk up women’s heart symptoms to unrelated causes (like stress) and may miss the diagnosis of the three most common problems: heart attack, congestive heart failure, and diseased valves. Yet, in the past 25 years more women than men have died of heart disease each year.

What to do: Brush up on the lesser-known heart attack warning signs, like heartburn and loss of appetite. Your doctor may do an electrocardiogram (EKG). If that’s normal, she may do an echocardiogram, or ultrasound test of the heart’s muscle walls. Diet and exercise changes can lower your risks—and energize you.

You’re diabeticThis debilitating disease can tire you out in two ways. When blood sugar is high, glucose (i.e., energy) is literally being flushed out of the body and into the toilet, says Sue McLaughlin, RD, president of health care and education for the American Diabetes Association. The body’s cells are being starved of the energy they need to keep running. And the other problem is increased thirst, as your body (in its attempt to dilute the high sugar in the blood) prompts you to drink more. The result is many nighttime trips to the bathroom and interrupted sleep.

Nearly 12 million American women have diabetes, and another 29 million are thought to have prediabetes, or high blood sugar that isn’t quite high enough to qualify as diabetes but is plenty high enough to cause fatigue. Diabetes can quadruple heart disease risks, which explains why more than 65% of people with diabetes die of heart disease or stroke.

What to do: Your doctor will likely do a fasting-blood-glucose test. If you have diabetes, you’ll probably need to check your glucose regularly and control it with diet and exercise, oral medications, and possibly insulin. If you have prediabetes, studies show that losing weight and getting more exercise can prevent or delay the full-blown disease.

How to get express flawless skin

Just when you thought you’d escaped your teens and 20s unblemished, you find yourself battling adult acne and pimples in your 30s—and beyond. Hormones can fluctuate like mad in our 30s, 40s, and 50s, as we go on and off the pill, get pregnant, enter perimenopause and, eventually, menopause.

Pimples aren’t the only resulting problem, either. “There are quite a few conditions that mimic acne, which can make it hard for women to know what they truly have and how to treat it,” says Howard Murad, MD, associate clinical professor of medicine at the University of California, Los Angeles. But diagnosing those red bumps can be easy if you know what to look for. Consider this your clear-skin cheat sheet.

If you notice…red bumps or deep-seated, persistent lumps concentrated around the chin and jawline, or blackheads and whiteheads spread across the skin you might have adult acne

The acne you get in your early adult years erupts for the same reasons it did in high school—primarily due to genetics and hormones. But it’s not always that estrogen levels are falling and male hormones are increasing, as many people assume. “Women may have normal hormone levels, yet still suffer from acne. The body simply develops a new sensitivity to hormones, which can result in breakouts,” explains Doris Day, MD, clinical assistant professor of dermatology at New York University Medical Center. And in those who are prone, androgens—or male hormones—can overstimulate oil production and interfere with the normal shedding of skin cells, causing pores to clog and bumps, blackheads, and whiteheads to pop up.

Treat it with: Over-the-counter acne products, to start. Go for cleansers, oil-free moisturizers, and spot treatments with pore-clearing salicylic acid or sulfur, both of which are far less drying than benzoyl peroxide. Dr. Murad advises his patients to choose formulas that double as anti-agers, fighting lines with products that contain peptides and antioxidants.

Homemade solutions also exist. “You can create a pimple-fighting paste by mixing a little bit of honey, an antiseptic, a dab of 1 percent cortisone cream, and some aloe gel, which soothes the skin,” Dr. Day says. “Simply apply it to the breakout. You’ll get all of the anti-inflammatory effect of cortisone, and it’ll take some of the angriness out of the pimple.” If your skin doesn’t clear after two to three weeks of at-home treatment, see your dermatologist. She can shrink those buried cysts with a shot of cortisone or prescribe a short course of antibiotics—creams and pills—for severe cases of adult acne.

If you notice…redness on your cheeks, nose, chin, or forehead, plus visible blood vessels you might have Rosacea

The exact cause of this chronic inflammatory condition is unknown. Some experts blame it on bacteria; others attribute it to inflammation or a microorganism residing in the oil glands. Without treatment, bother­some blushing can lead to unrelenting redness, bumps, and swelling. Unlike adult acne, “rosacea bumps lack plugs—the sticky clumps that come out when you squeeze a pimple,” says Dr. Murad, who is also the creator of Murad Skincare.

Treat it with: Antioxidant-rich sunscreens, anti-inflammatory moisturizers (with caffeine or soothing botanicals, like licorice extract and feverfew), and gentle cleansers. And cover it using makeup with a green tint, which counteracts crimson. Avoiding things that cause you to blush—caffeine, alcohol, spices, the sun—is a crucial part of treatment, too. If these remedies don’t do the trick, see your dermatologist. She’ll likely prescribe oral antibiotics or recommend intense pulsed light (IPL) therapy to knock out background redness and laser treatments to target broken blood vessels. One to three treatments, at $400 to $600 a pop, are usually needed for both IPL and laser.

If you notice…small red or white pimples surrounding the hair follicles, usually on your chin you might have Folliculitis

“After age 30, women often experience an increase in facial hair and become more prone to folliculitis, an infection of the facial hair follicles,” Dr. Murad explains. Plucking unwanted chin hairs can damage the follicles, leading to inflammation and redness.

Treat it with: Remedies that slow hair growth and target inflammation that comes from forcibly removing hairs. If your ovaries are producing too much androgen—and thus contributing to excess fuzz—birth control pills can address the problem and minimize hair, Dr. Murad says. If you’re prone to facial hair, talk to your doctor about Vaniqa, an Rx cream that reduces facial hair growth over time.

The Healing Power of Tea

This old-fashioned “it” drink fights cavities, eases anxiety, and soothes irritated skin.





















Face brightener
Try this skin saver from Skinsational Skin and Body Spa in Carlsbad, California. Soak a washcloth in warm chamomile tea with three drops of lavender oil; wring dry, and press onto face. Chamomile tea contains azulene, an anti-inflammatory that calms skin.





















Cavity fighter
Want healthy teeth? Sip some antioxidant-rich white tea. “Polyphenol antioxidants in tea inhibit the growth of oral bacteria, like those that cause tooth decay,” says Milton Schiffenbauer, PhD, a microbiologist New York City’s Pace University, who has led research on the subject.

First-aid fix
Treat minor scrapes, bug bites, and sunburn with green tea, which contains tannins that act as a natural antiseptic and relieve itching and swelling. Just apply cooled tea with a cotton ball, says Leah Sherman, a naturopathic physician in Portland, Oregon.

Tension buster
In a British study, people who drank black tea four times a day for six weeks calmed down more quickly in stressful situations than those who didn’t drink tea. Black, green, and oolong teas all contain theanine, an amino acid that helps the brain and body relax.