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    1. 1. THE FLU AND YOU Nick Karapasas, D.C. Staff Physician (Chiropractic and Functional Medicine) The Raya Clinic
    2. 2. Introduction What is “the flu” What are the risks? What can I do?
    3. 3. What is influenza?
    4. 4. What is influenza? The term “influenza”
    5. 5. What is influenza? The term “influenza” (taken from the Italian word for “occult or astral influence”)
    6. 6. What is influenza? The term “influenza” (taken from the Italian word for “occult or astral influence”) Influenza is a virus (over 10,000 strains)
    7. 7. What is influenza? The term “influenza” (taken from the Italian word for “occult or astral influence”) Influenza is a virus (over 10,000 strains) The flu is different than “upper respiratory tract infections” or “flu like illness”
    8. 8. What is influenza?
    9. 9. What is influenza? Estimated mortality
    10. 10. What is influenza? Estimated mortality 36,000 people per year in the USA
    11. 11. What is influenza? Estimated mortality 36,000 people per year in the USA 500,000 worldwide
    12. 12. Differential Diagnosis
    13. 13. Differential Diagnosis Signs and Symptoms:
    14. 14. Differential Diagnosis Signs and Symptoms: Runny nose, fever, malaise, etc...
    15. 15. Differential Diagnosis Signs and Symptoms: Runny nose, fever, malaise, etc... Same as URTI and FLI
    16. 16. Differential Diagnosis
    17. 17. Differential Diagnosis More than 200 known viruses and other pathogens can cause the suite of symptoms known as “influenza-like illness”
    18. 18. Differential Diagnosis More than 200 known viruses and other pathogens can cause the suite of symptoms known as “influenza-like illness” respiratory syncytial virus, bocavirus, coronavirus, and rhinovirus
    19. 19. Differential Diagnosis More than 200 known viruses and other pathogens can cause the suite of symptoms known as “influenza-like illness” respiratory syncytial virus, bocavirus, coronavirus, and rhinovirus Depending on the season, in up to two-thirds of the cases of flu-like illness, no cause at all can be found.
    20. 20. Differential Diagnosis
    21. 21. Differential Diagnosis Severity of illness is not indicative of flu
    22. 22. Differential Diagnosis Severity of illness is not indicative of flu Diagnosis can only be confirmed with testing
    23. 23. Differential Diagnosis
    24. 24. Differential Diagnosis Testing Blood Test Throat swab
    25. 25. Differential Diagnosis Testing Blood Test Throat swab Last year only 1%-3% of samples tested came back positive for influenza
    26. 26. Differential Diagnosis Testing Blood Test Throat swab Last year only 1%-3% of samples tested came back positive for influenza Most people will have antibodies to influenza by the end of the year regardless of presence or severity of symptoms
    27. 27. Epidemics
    28. 28. Epidemics Worst
    29. 29. Epidemics Worst “Spanish Flu” 1918-1919
    30. 30. Epidemics Worst “Spanish Flu” 1918-1919 30% of the world was infected
    31. 31. Epidemics Worst “Spanish Flu” 1918-1919 30% of the world was infected 40 - 100 million dead
    32. 32. Epidemics Worst “Spanish Flu” 1918-1919 30% of the world was infected 40 - 100 million dead Others?
    33. 33. Epidemics Worst “Spanish Flu” 1918-1919 30% of the world was infected 40 - 100 million dead Others? 1957 & 1968 (not particularly lethal)
    34. 34. Predictions?
    35. 35. Predictions? H1N1
    36. 36. Predictions? H1N1 Predicted to infect up to 50% of the US population
    37. 37. Predictions? H1N1 Predicted to infect up to 50% of the US population “could kill up to 90,000”
    38. 38. Predictions? H1N1 Predicted to infect up to 50% of the US population “could kill up to 90,000” Reports from South America
    39. 39. Predictions? H1N1 Predicted to infect up to 50% of the US population “could kill up to 90,000” Reports from South America Highly infectious, not particularly lethal
    40. 40. Predictions?
    41. 41. Predictions? Australia
    42. 42. Predictions? Australia ...will finish winter with under 1000 deaths
    43. 43. Predictions? Australia ...will finish winter with under 1000 deaths fewer than the usual 1500 - 3000 from “seasonal flu”
    44. 44. Predictions? Australia ...will finish winter with under 1000 deaths fewer than the usual 1500 - 3000 from “seasonal flu” US
    45. 45. Predictions? Australia ...will finish winter with under 1000 deaths fewer than the usual 1500 - 3000 from “seasonal flu” US 70% of deaths from “flu” were from those already suffering from other conditions
    46. 46. Predictions? Australia ...will finish winter with under 1000 deaths fewer than the usual 1500 - 3000 from “seasonal flu” US 70% of deaths from “flu” were from those already suffering from other conditions cerebral palsy / cancer / asthma / AIDS
    47. 47. Vaccination Public health officials consider vaccine the most formidable defense. Success polio / smallpox / measles / mumps
    48. 48. Well... what about flu? impact is harder to determine flu comes and goes with seasons often does not kill people directly makes body more susceptible to secondary infections
    49. 49. Well... what about flu?
    50. 50. Well... what about flu? So... researchers study the impact by looking at deaths from all causes during flu season
    51. 51. Well... what about flu? So... researchers study the impact by looking at deaths from all causes during flu season then... compare the vacciated and unvaccinated populations
    52. 52. Well... what about flu?
    53. 53. Well... what about flu? Dramatic difference between the two populations
    54. 54. Well... what about flu? Dramatic difference between the two populations people who get a flu shot in the fall are about 50% less likely to die that winter
    55. 55. Well... what about flu? Dramatic difference between the two populations people who get a flu shot in the fall are about 50% less likely to die that winter ... from ANY cause.
    56. 56. Yay!! Sign me up!!
    57. 57. Hold on a second...
    58. 58. Hold on a second... Influenza causes only a small minority of all deaths in the USA, even among senior citizens, and even after adding in the deaths to which flu might have contributed indirectly.
    59. 59. Hold on a second... When researchers from the National Institute of Allergy and Infectious Diseases included all deaths from illnesses that flu aggravates, like lung disease or chronic heart failure, they found that flu accounts for, at most, 10 percent of winter deaths among the elderly.
    60. 60. Wait... then how do you reduce deaths by half ? “For a vaccine to reduce mortality by 50 percent and up to 90 percent in some studies means it has to prevent deaths not just from influenza, but also from falls, fires, heart disease, strokes, and car accidents. That’s not a vaccine, that’s a miracle.” -Tom Jefferson, M.D. (Head of the Vaccines Field at the Cochrane Collaboration)
    61. 61. Wait... then how do you reduce deaths by half ?
    62. 62. Wait... then how do you reduce deaths by half ? “cohort studies” compare death rates in large groups
    63. 63. Wait... then how do you reduce deaths by half ? “cohort studies” compare death rates in large groups Education, lifestyle, income, and many other “confounding” factors can come into play
    64. 64. Wait... then how do you reduce deaths by half ? “cohort studies” compare death rates in large groups Education, lifestyle, income, and many other “confounding” factors can come into play ...and as a result, cohort studies are notoriously prone to bias.
    65. 65. 2001 season
    66. 66. 2001 season if we are to take the combined figure of influenza and pneumonia deaths,we are left believing that 62,034 people died from influenza.
    67. 67. 2001 season if we are to take the combined figure of influenza and pneumonia deaths,we are left believing that 62,034 people died from influenza. The actual figures are 61,777 died from pneumonia
    68. 68. 2001 season if we are to take the combined figure of influenza and pneumonia deaths,we are left believing that 62,034 people died from influenza. The actual figures are 61,777 died from pneumonia ...and only 257 from influenza
    69. 69. 2001 season if we are to take the combined figure of influenza and pneumonia deaths,we are left believing that 62,034 people died from influenza. The actual figures are 61,777 died from pneumonia ...and only 257 from influenza ...only 18 were lab confirmed as positive for the influenza virus!
    70. 70. What about today?
    71. 71. What about today? October 11, 2009 the World Health Organization reported that, worldwide, there have been more than 399,232 laboratory confirmed cases of pandemic influenza H1N1, and over 4,735 deaths.
    72. 72. What about today? October 11, 2009 the World Health Organization reported that, worldwide, there have been more than 399,232 laboratory confirmed cases of pandemic influenza H1N1, and over 4,735 deaths. Folks, that is 4,735 deaths in the ENTIRE world, not just the US!
    73. 73. What about today? October 11, 2009 the World Health Organization reported that, worldwide, there have been more than 399,232 laboratory confirmed cases of pandemic influenza H1N1, and over 4,735 deaths. Folks, that is 4,735 deaths in the ENTIRE world, not just the US! Most of these deaths were immunocompromised individuals.
    74. 74. What about today? October 11, 2009 the World Health Organization reported that, worldwide, there have been more than 399,232 laboratory confirmed cases of pandemic influenza H1N1, and over 4,735 deaths. Folks, that is 4,735 deaths in the ENTIRE world, not just the US! Most of these deaths were immunocompromised individuals.
    75. 75. What about today?
    76. 76. What about today? Perspective Malaria kills ONE MILLION people EVERY YEAR, worldwide. Death is a direct result of the malaria infection.
    77. 77. What about today?
    78. 78. What about today? Every day
    79. 79. What about today? Every day 2740 deaths from malaria
    80. 80. What about today? Every day 2740 deaths from malaria 13 deaths from H1N1
    81. 81. What about today? Every day 2740 deaths from malaria 13 deaths from H1N1 ...if you disregard that most of those died from secondary infections and complications.
    82. 82. Other studies
    83. 83. Other studies “healthy user” phenomenon
    84. 84. Other studies “healthy user” phenomenon people who get vaccines are more likely to have health care
    85. 85. Other studies “healthy user” phenomenon people who get vaccines are more likely to have health care people who don’t get vaccinated are generally older, sicker, bedridden, more serious issues
    86. 86. Jackson, et al
    87. 87. Jackson, et al eight years of data (72,000+ people 65 and older) who got flu shots and who didn’t which group’s members were more likely to die of any cause when it was not flu season.
    88. 88. Jackson, et al
    89. 89. Jackson, et al outside of flu season, the baseline risk of death among people who did not get vaccinated was approximately 60 percent higher than among those who did
    90. 90. Jackson, et al outside of flu season, the baseline risk of death among people who did not get vaccinated was approximately 60 percent higher than among those who did ...supports the hypothesis that on average, healthy people chose to get the vaccine, while the “frail elderly” didn’t or couldn’t.
    91. 91. Jackson, et al outside of flu season, the baseline risk of death among people who did not get vaccinated was approximately 60 percent higher than among those who did ...supports the hypothesis that on average, healthy people chose to get the vaccine, while the “frail elderly” didn’t or couldn’t. explained the entire benefit that other researchers were attributing to flu vaccine, suggesting that the vaccine itself might not reduce mortality at all
    92. 92. What else?
    93. 93. What else? 2004 vaccine production fell behind, causing a 40% drop in immunization rates NO increase in mortality
    94. 94. What else?
    95. 95. What else? 1968 & 1997 Vaccine “mismatches” (in effect, no one was vaccinated) ...death rates from all causes, including flu and the various illnesses it can exacerbate, did not change
    96. 96. Majumdar, M.D. researcher and physician @ U of Albert Rising rates of vaccination of the elderly over the past two decades have not coincided with a lower overall mortality rate.
    97. 97. Majumdar, M.D. 1989 15% of patients over 65 were vaccinated (USA and Canada) Today 65% of the same population are immunized Death rates have INCREASED, not decreased
    98. 98. Immune response Immunization antibodies higher response in young, healthy immune systems lower response in older, immune compromised systems
    99. 99. so far... as of August 8 36 deaths among children in the US from H1N1 most with multiple, severe health disorders
    100. 100. Immunization doctrine Double blind studies and ethics Tamiflu / Relenza resistance
    101. 101. Weird conspiracy moment...
    102. 102. Weird conspiracy moment... USA began stockpiling Tamiflu and Relenza in 2005
    103. 103. Weird conspiracy moment... USA began stockpiling Tamiflu and Relenza in 2005 11/1/05: GWB pronounced pandemic flu a “danger to our homeland”
    104. 104. Weird conspiracy moment... USA began stockpiling Tamiflu and Relenza in 2005 11/1/05: GWB pronounced pandemic flu a “danger to our homeland” $2.8 billion approved for military stockpile
    105. 105. Weird conspiracy moment... USA began stockpiling Tamiflu and Relenza in 2005 11/1/05: GWB pronounced pandemic flu a “danger to our homeland” $2.8 billion approved for military stockpile The patent for Tamiflu is held by Gilead Sciences
    106. 106. Weird conspiracy moment... USA began stockpiling Tamiflu and Relenza in 2005 11/1/05: GWB pronounced pandemic flu a “danger to our homeland” $2.8 billion approved for military stockpile The patent for Tamiflu is held by Gilead Sciences before joining the Bush cabinet, SecDef Donald Rumsfeld was chairman of Gilead Sciences
    107. 107. Tamiflu
    108. 108. Tamiflu cuts the duration of flu symptoms by 24 hours in otherwise healthy individuals
    109. 109. Tamiflu cuts the duration of flu symptoms by 24 hours in otherwise healthy individuals 1 in 5 will experience nausea and vomiting
    110. 110. Tamiflu cuts the duration of flu symptoms by 24 hours in otherwise healthy individuals 1 in 5 will experience nausea and vomiting 1 in 5 children will experience neuropsychiatric side effects (possibly including anxiety and suicidal behavior)
    111. 111. Tamiflu cuts the duration of flu symptoms by 24 hours in otherwise healthy individuals 1 in 5 will experience nausea and vomiting 1 in 5 children will experience neuropsychiatric side effects (possibly including anxiety and suicidal behavior) Japan: possibly 50 deaths due to cardiopulmonary arrest
    112. 112. Tamiflu
    113. 113. Tamiflu Tamiflu Website “Tamiflu has not been proven to have a positive impact on the potential consequences (such as hospitalizations, mortality, or economic impact) of seasonal, avian, or pandemic influenza.”
    114. 114. Health care workers? Letter to Neurologists from Gov’t Health Service in Great Britain Watch for increase in GBS after immunization with Swine flu vaccine similar to outbreak in 1976 The Daily Mail, 8/15/2009
    115. 115. Double Blind Studies??
    116. 116. Double Blind Studies?? This is the first year mock vaccines have been used to gain FDA approval. The vaccines that have been tested are not the same vaccines your children will be given.
    117. 117. Double Blind Studies?? This is the first year mock vaccines have been used to gain FDA approval. The vaccines that have been tested are not the same vaccines your children will be given. Ethics and double blind studies (when it is the “standard of care”
    118. 118. more...
    119. 119. more... First of all, nearly all of the swine flu vaccines that will be made available in October will be a nasal spray type that contains live virus’, which is not recommended for pregnant women, people over 50, or those with asthma, heart disease or several other health problems, according to the Centers for Disease Control and Prevention (CDC).
    120. 120. more...
    121. 121. more... The nasal spray causes a much greater immune reaction, and since it contains live virus’ they may multiply too quickly if your immune system is already compromised.
    122. 122. more... The nasal spray causes a much greater immune reaction, and since it contains live virus’ they may multiply too quickly if your immune system is already compromised. The injectable vaccine will supposedly contain only killed and fragmented virus components, but in order to “make it more effective” it also contains adjuvants; ingredients designed to cause a greater immune reaction by lowering your immune function.
    123. 123. more...
    124. 124. more... Some of these adjuvants, such as squalene, have already been shown to carry considerable health risks. Thimerosal, a preservative, is also being added to the non attenuated vaccines. 
    125. 125. more... Some of these adjuvants, such as squalene, have already been shown to carry considerable health risks. Thimerosal, a preservative, is also being added to the non attenuated vaccines.  none of the coming vaccines have undergone any form of safety testing?
    126. 126. more... Some of these adjuvants, such as squalene, have already been shown to carry considerable health risks. Thimerosal, a preservative, is also being added to the non attenuated vaccines.  none of the coming vaccines have undergone any form of safety testing? Some media reports have stated vaccines will be approved following a five-day safety review.
    127. 127. more...
    128. 128. more... Interestingly, despite the fact that health authorities around the world were “shocked” at the emergence of this never-before-seen hybrid flu strain, Baxter had patented a flu vaccine covering these now infamous strains
    129. 129. more... Interestingly, despite the fact that health authorities around the world were “shocked” at the emergence of this never-before-seen hybrid flu strain, Baxter had patented a flu vaccine covering these now infamous strains ...on August 28, 2008.
    130. 130. wait... what? Baxter’s patent # US20090060950A1 includes “more than one antigen such as influenza A and influenza B in particular selected from of one or more of the human H1N1, H2N2, H3N2, H5N1, H7N7, H1N2, H9N2, H7N2, H7N3, H10N7 subtypes, of the pig flu H1N1, H1N2, H3N1 and H3N2 subtypes, of the dog or horse flu H7N7, H3N8 subtypes, or of the avian H5N1, H7N2, H1N7, H7N3, H13N6, H5N9, H11N6, H3N8, H9N2, H5N2, H4N8, H10N7, H2N2, H8N4, H14N5, H6N5, H12N5 subtypes.”
    131. 131. What else can I do?
    132. 132. Vitamin D Vitamin D deficiency Therapeutic level [50-65 ng/ml] if you are coming down with symptoms if NOT supplementing with vitamin D 50,000 IU / day for 3 days
    133. 133. what else?
    134. 134. what else? Sleep / Rest
    135. 135. what else? Sleep / Rest Avoid sugar and processed foods
    136. 136. what else? Sleep / Rest Avoid sugar and processed foods reduce stress
    137. 137. what else? Sleep / Rest Avoid sugar and processed foods reduce stress Exercise
    138. 138. what else? Sleep / Rest Avoid sugar and processed foods reduce stress Exercise Omega 3
    139. 139. what else? Sleep / Rest Avoid sugar and processed foods reduce stress Exercise Omega 3 Garlic
    140. 140. what else? Sleep / Rest Avoid sugar and processed foods reduce stress Exercise Omega 3 Garlic Vitamin C
    141. 141. Q&A
    142. 142. Q&A Q: How can I tell if my symptoms are from the flu or a cold?
    143. 143. Q&A Q: How can I tell if my symptoms are from the flu or a cold? A: In short, you can’t. At least not with any degree of certainty. And neither can doctors. According to a review by Dr. Tom Jefferson*when doctors determine that a patient’s symptoms are consistent with flu, they are wrong on average over 90% of the time.
    144. 144. Q&A Q: How can I tell if my symptoms are from the flu or a cold? A: In short, you can’t. At least not with any degree of certainty. And neither can doctors. According to a review by Dr. Tom Jefferson*when doctors determine that a patient’s symptoms are consistent with flu, they are wrong on average over 90% of the time. Other studies fix the number at half of the time. That’s because the common cold and other viruses cause symptoms that are often indistinguishable from the flu despite the common wisdom that flu patients are more likely to experience generalized muscle aches and pains, headaches, and fever along with a cough and runny nose.
    145. 145. Q&A
    146. 146. Q&A Q: If symptoms aren’t reliable indicators, how can my doctor tell if I have swine flu?
    147. 147. Q&A Q: If symptoms aren’t reliable indicators, how can my doctor tell if I have swine flu? A: The only way to make a definite diagnosis of the 2009 H1N1 flu (previously known as swine flu) is to do a nasal swab or blood tests. The rapid tests are highly inaccurate; for example the rapid influenza detection test (RIDT) is completed in 30 minutes but only picks up 10-70% of influenza A viruses and can’t distinguish between swine flu and other types of influenza A viruses. Viral cultures or RNA amplification tests are more accurate but take from 2 to 10 days to get results, making them irrelevant for decision-making regarding antiviral drugs, for example, which are supposed to be started within 36 hours of the onset of symptoms. The Centers for Disease Control and Prevention currently recommends testing only in limited circumstances.
    148. 148. Q&A Q: If symptoms aren’t reliable indicators, how can my doctor tell if I have swine flu? A: The only way to make a definite diagnosis of the 2009 H1N1 flu (previously known as swine flu) is to do a nasal swab or blood tests. The rapid tests are highly inaccurate; for example the rapid influenza detection test (RIDT) is completed in 30 minutes but only picks up 10-70% of influenza A viruses and can’t distinguish between swine flu and other types of influenza A viruses. Viral cultures or RNA amplification tests are more accurate but take from 2 to 10 days to get results, making them irrelevant for decision-making regarding antiviral drugs, for example, which are supposed to be started within 36 hours of the onset of symptoms. The Centers for Disease Control and Prevention currently recommends testing only in limited circumstances.
    149. 149. Q&A
    150. 150. Q&A Q: What’s known about the risks of flu shots?
    151. 151. Q&A Q: What’s known about the risks of flu shots? A: Risks are considered by most experts to be very low and limited largely to local pain and swelling at the site of injection with rare instances (1 in 1 million) of a paralyzing condition known as Guillian-Barre Syndrome (that rate was higher during the previous swine flu outbreak in 1976 when the incidence was estimated at 1 in 100,000). According to the CDC, none of the shots approved for use in the U.S. will contain adjuvants (substances that enhance immune reactions) such as squalene. Vaccines containing adjuvants have been approved in Europe. However, injected flu vaccines may contain thimerosal, a mercury-containing preservative, which many doctors believe is safe but others believe may be responsible for effects on the brain and nervous system. For people who want to take the vaccine but avoid the mercury, they can ask for single-dose vaccines.
    152. 152. Q&A Q: What’s known about the risks of flu shots? A: Risks are considered by most experts to be very low and limited largely to local pain and swelling at the site of injection with rare instances (1 in 1 million) of a paralyzing condition known as Guillian-Barre Syndrome (that rate was higher during the previous swine flu outbreak in 1976 when the incidence was estimated at 1 in 100,000). According to the CDC, none of the shots approved for use in the U.S. will contain adjuvants (substances that enhance immune reactions) such as squalene. Vaccines containing adjuvants have been approved in Europe. However, injected flu vaccines may contain thimerosal, a mercury-containing preservative, which many doctors believe is safe but others believe may be responsible for effects on the brain and nervous system. For people who want to take the vaccine but avoid the mercury, they can ask for single-dose vaccines.
    153. 153. Q&A
    154. 154. Q&A Q: How dangerous is swine flu?
    155. 155. Q&A Q: How dangerous is swine flu? A: At this point, it is proving to be relatively mild and less fatal than the average flu, according to data from some countries in the Southern Hemisphere that already experienced their winter flu season. Unless the virus mutates, it appears that the most serious threat is largely to people with underlying health problems.
    156. 156. Q&A
    157. 157. Q&A Q: I see studies that say the flu vaccine is highly effective. Why is there any question?
    158. 158. Q&A Q: I see studies that say the flu vaccine is highly effective. Why is there any question? A: Effectiveness is often measured by showing that people who get the vaccine develop antibodies in response to the vaccine. Those antibodies can be helpful in fighting off future bouts of that year’s flu. The problem is that young, healthy people are very good at developing antibodies but they are not the people who tend to develop pneumonia or die, while older people and people with immune disorders, who are most likely to die, don’t develop protective antibodies as well. This has led to the question, “Is it necessary for those whom it helps, and will it help those for whom it’s necessary?”
    159. 159. last bit of trivia...
    160. 160. last bit of trivia... 1918 flu epidemic
    161. 161. last bit of trivia... 1918 flu epidemic Davenport, Iowa
    162. 162. last bit of trivia... 1918 flu epidemic Davenport, Iowa 50 MDs cared for 4,953 cases with 274 deaths.
    163. 163. last bit of trivia... 1918 flu epidemic Davenport, Iowa 50 MDs cared for 4,953 cases with 274 deaths. 150 DCs saw 1,635 cases with only one death.
    164. 164. last bit of trivia... In the state of Iowa MDs treated 93,590 patients, with 6,116 deaths, a loss of one patient out of every 15. In the same state, excluding Davenport, 4,735 patients were seen by chiropractors with a loss of only six patients – a loss of one patient out of every 789.
    165. 165. last bit of trivia... National figures show that 1,142 chiropractors cared for 46,394 for influenza during 1918, with a loss of 54 patients – one out of every 859. In New York City, 950 out of 10,000 cases died with medical methods while 25 out of 10,000 died using drugless methods.
    166. 166. last bit of trivia... Oklahoma 233 cases in which were pronounced “lost” or “beyond hope” DCs took care of all 233 with only 25 deaths.
    167. 167. QUESTIONS?

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