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November 19th, 2009
12:33 PM ET

Nasal vaccine for 14-month-old?

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From Elaine in New Jersey:

I attended a clinic this weekend for the H1N1 shots, and they administered the nasal spray to my 14-month-old! According to the CDC website it should NOT be administered to children under 2 years of age! I contacted the pharmacy where the clinic was held, and they took my contact info and said we will get back to me. Can you tell me is my child at risk?? I also have a call into my pediatrician. I also contact the CDC and was told they are not medical professionals.

Answer:

Elaine, it is easy to sense dismay and concern from your e-mail, and as a father I can certainly relate.

The reality is – yes – the nasal spray version of the H1N1 vaccine, which contains a weakened live flu virus, should be given only to people ages 2 to 49. We also know that children with conditions such as asthma may not be eligible for the live flu vaccine.

In order to ease your mind a bit, unless he or she has asthma, chances are very good that your 14-month-old will be fine.

The primary reason children younger than 2 do not get the nasal spray H1N1 vaccine is that it has not been tested in, and therefore is not licensed for, that age group. It is that simple. You need solid data to submit to the Food and Drug Administration before a medication can be approved for use in a particular population – that data do not exist for children younger than 24 months.

To ease your mind a bit more, rare complaints among adults and children taking the nasal spray form of the H1N1 vaccine are runny nose, sore throat, and sometimes fever. These symptoms usually go away within a couple of days. If they do crop up for your 14-month-old, you should not be too concerned, but if the symptoms get worse or your instinct tells you to, do see your pediatrician.

On the bright side of your predicament, your son or daughter is now vaccinated against H1N1. There are many parents who are still waiting to have their children vaccinated, so count yourself among the fortunate. Your child should soon have a second H1N1 vaccine dose – this time with the injectable form of the vaccine. And if you have not yet been vaccinated, you should do so – as the caregiver for your baby, you are eligible for these early doses of vaccine.


November 12th, 2009
01:41 PM ET

H1N1 vaccine safe with egg allergy?

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From Kali in Florida:

My 4-year-old daughter has egg and peanut allergies. Can she still take the H1N1 vaccine? If not what are her choices. I've been getting conflicting answers.

Answer:

Kali thanks for writing in. We’ve received several questions like yours since the H1N1 vaccine became available. Let me start by saying that if your daughter has a true egg allergy, and not just a sensitivity, then she can not have the H1N1 or the seasonal flu vaccine. The two types of H1N1 vaccine, the shot and the nasal spray, are made with eggs so it is not recommended for people with severe egg allergies.

However, allergists we spoke with said people with mild reactions to eggs can get vaccinated. Keep in mind that the amount of egg protein in a vaccine is often less than you would find in most baked goods. So if your daughter has been able to eat bread or cake, she may have a more mild allergy.

Consider going to an allergist and ask about getting a skin-prick test. The allergist will have a diluted and non-diluted version of the vaccine. Their first step will be to do the skin-prick test with the undiluted version. If your daughter does not break out in hives or have a strong reaction, then she can have a stronger test with a small, diluted injection. If your child doesn’t have a strong reaction to that test, then her allergy may not be severe and your allergist may give her a flu shot.

If your child does have a strong reaction and your doctor believes she shouldn’t get the flu shot, then talk with your health care provider about strategies for keeping her healthy. These steps are basic hygiene, such as washing hands for the count of singing the “Happy Birthday” song twice and staying away from sick friends plus, avoid wiping your eyes and touching your face if possible.

I hope this helps and your daughter has a flu-free season


Filed under: Allergies • Expert Q&A • H1N1 Flu • H1N1 Flu Vaccine

November 5th, 2009
10:52 AM ET

Should I be charged for the H1N1 vaccine?

As a feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From Robert in Kansas:

“I heard this week that the H1N1 virus has now turned up in pigs. Does this mean it can get into our food supply and I’ll get sick if I eat it?”

Answer:

Great question. The U.S. Department of Agriculture did recently announce that a commercial herd of pigs tested positive for swine flu. The USDA continues to stress that you will not infected with the HIN1 virus from eating pork. In fact, the infected pigs in Indiana weren’t destroyed. Once they recover from the flu, they will go to slaughter according to the USDA. Officials experimentally infected pigs earlier this year to see whether their blood and meat also became contaminated. They concluded that the H1N1 virus stayed contained in the respiratory tract of infected pigs and the virus did not infect the meat. The World Health Organization and World Organization for Animal Health have also concluded that humans can not be infected with the H1N1 virus from consuming pork. For more information about H1N1 and food safety, click here.

From Cheryl:

“While at my doctor's office, I asked about the H1N1 vaccine. I was told it will be very expensive, like $300. Since I do not have health insurance, the expense of the H1N1 vaccine will factor into whether I get it.”

Answer:

$300 is an excessive amount to pay for a free vaccine! That’s right – it’s free. The federal government has purchased the H1N1 vaccine and is shipping it out to states free of charge. They’re even picking up the tab for the syringes, needles, sharps containers, and alcohol swabs. Centers for Disease Control and Prevention has also stated private clinics may not charge patients a co-pay or other out-of-pocket charges for the vaccine. The only thing you should be paying is perhaps an administrative fee for your office visit but in many cases that fee is being waived as well. I would double check with your doctor again on the price. If the office still attempts to charge you $300, I would decline and instead contact your state’s health department to locate public clinic administering the vaccines near you. You can also track the vaccine’s shipments in your state through the CDC’s Web site. Check it out by clicking here.


Filed under: Expert Q&A • H1N1 Flu • H1N1 Flu Vaccine

November 2nd, 2009
12:30 PM ET

Deciding whether or not to get the H1N1 vaccine

By Rebecca Leibowitz
CNN Medical Intern

I had H1N1. It started with a cough, which quickly progressed to a headache, body aches and a 102-degree fever. A rapid flu test came back positive, confirming my diagnosis. Although this nasal swab test for H1N1 is not very reliable, so much so that it is no longer being used, I had all of the symptoms of the flu. H1N1 was pretty much the only strain circulating in late August, so chances are very high that I did indeed have it. I spent the next three days isolated in my apartment, pumping my body with vitamin C and chicken soup. Then I was fine. I felt great and I was no longer contagious; I could go to class, to the grocery store and to the gym without fear of infecting others. To my friends, I was finally “swine-free.”

My decision whether to be vaccinated against H1N1 has been made for me. Since I most likely already had H1N1, and therefore have built up immunity to the virus, I will not be getting a vaccination. However, millions of Americans are facing the decision of whether to vaccinate themselves and their children against the novel influenza A virus.

The Centers for Disease Control recommends the following high-priority groups get vaccinated: pregnant women; people who live with or provide care for infants younger than six months; health workers; people aged six months to 24 years old; and people 25-64 years old with certain pre-existing conditions.

So, when my mom told me that her doctor recommended she not get the H1N1 vaccine, I was confused. As a chronic Lyme disease sufferer (who is well under 64) and a social worker who works with very young children, my mom fits into one of the high-risk groups. Why, then, did her doctor advise her against getting it?

As I later discovered, there are several reasons why people are apprehensive about getting the H1N1 vaccination. My mom’s doctor told her that he did not see the evidence that the H1N1 inoculation protects one from getting the virus, a concern he also raised regarding the seasonal flu vaccine. This contradicts what the CDC has been saying for weeks. CDC Director Dr. Thomas Frieden recently told reporters that the vaccine should work very well because “it is an excellent match with the strains of the virus that are circulating.”

There is also widespread concern about the safety of the vaccine. During the 1976 swine flu epidemic in the United States, those who received the vaccine for that strand of swine flu were proven to have an elevated risk of contracting Guillain-Barré syndrome. Guillain-Barré syndrome is a disorder in which the body’s immune system attacks part of its nervous system. The most common complications from Guillain-Barré syndrome are breathing-related, and patients are often placed on respirators. The majority of people who contract the disorder recover, but it can be fatal.

The CDC says that it expects the H1N1 inoculation to follow a similar safety profile as the seasonal influenza vaccine, which has not been associated with increased risk of Guillain-Barré. Officials also say that this new pandemic vaccine is much “purer” than the 1976 inoculation. The expected side effects from the 2009 H1N1 vaccine are similar to those from the regular flu shot, including soreness or swelling at the point of injection, low-grade fever and body aches. The CDC and the Food and Drug Administration will be closely monitoring the safety of the immunization. The Vaccine Adverse Event Reporting System exists so that health care providers can report vaccine concerns directly.

And then there are those who think natural immunity is better and safer than any vaccine and are suggesting “swine flu parties” are the way to go – get yourself infected with H1N1 and your body will build up immunity. Most doctors and the CDC strongly advise against this method of protection.

What factors have influenced your decision whether or not to get the H1N1 vaccine? What advice has your doctor given you? Have you come to a decision whether to vaccinate you or your children?


October 29th, 2009
02:51 PM ET

Will breastfeeding protect my baby from H1N1?

As a  feature of CNNhealth.com, our team of expert doctors will answer readers' questions. Here's a question for Dr. Gupta.

From Shannon:

"I have a 4-month-old infant and I recently had myself and my 6-year-old son vaccinated for H1N1. My question is, will my infant also gain my immunity to H1N1 through my breast milk? I hope so." 

Answer:

This is a great question and a huge concern for many parents whose children are less than 6 months old and therefore too young to get the H1N1 vaccine. Unfortunately, there is no clear answer to your question, Shannon, so the best we can do is spell out what we do know.

We know that any time you breastfeed your 4-month-old, you pass on potent antibodies (proteins that your immune system produces to fend off disease in the body) that protect him or her against a whole range of infections.

We also know a bit about other vaccines and breast milk, for example, the pneumococcal vaccine that protects against things like pneumonia and meningitis. According to the National Institute of Allergy and Infectious Diseases, mothers who received that vaccine produced antibodies that were detectable in their breast milk, and passed them on to their babies. What is not as clear is whether those antibodies actually conferred immunity to their newborns.

The Centers for Disease Control and Prevention guidance about breast milk and the flu vaccine is a tinge more hopeful, albeit far from conclusive: "By breastfeeding, mothers can pass on to the infant the antibodies that their bodies make in response to the flu shots, which can reduce the infant's chances of getting sick with the flu."

While experts wrestle with this question, you have already taken a positive step – and significantly reduced your baby’s chances of getting the H1N1 virus – by getting yourself vaccinated. The next step is to create a "cocoon of protection" around your baby by making sure that other caregivers in the family also get vaccinated.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


Filed under: Caregiving • Children's Health • Cold and flu • Expert Q&A • H1N1 Flu • H1N1 Flu Vaccine • Parenting • Vaccinations

October 22nd, 2009
01:13 PM ET

Do the flu vaccines contain thimerosal?

By Ann J. Curley
CNN Medical Assignment Manager

Many of our readers are still asking questions about H1N1 and seasonal influenza. Today we’ve got a question from Patty:

I am a 63-year-old health care worker in relatively good health, and I’m caring for a 2-month-old infant (my granddaughter). I have had a reaction to thimerosal in the past. It was used as a preservative in contact lens solution.

Is thimerosal used as a preservative in either seasonal flu vaccine or H1N1 vaccine? Are there available alternatives to these vaccines? How would I access them?

Thanks,
Patty Holly

Patty,

Thank you for your question. It’s important that you make your health care provider aware of your sensitivity to thimerosal, which is a preservative used in many products, including some vaccines, nasal products, and eye solutions.

According to the Centers for Disease Control and Prevention, the 2009 H1N1 influenza vaccines approved by the FDA are being manufactured with and without thimerosal.

Multi-dose vials of flu vaccine need to contain a preservative to prevent bacterial contamination, which can occur when multiple syringes are inserted into the same bottle.  However, some manufacturers also produce single-dose flu shots, which do not require any preservatives.

The nasal flu vaccine – both for seasonal flu and H1N1 – is always thimerosal-free. However, it is recommended only for people ages 2 to 49 who have no underlying health problems. The nasal spray vaccine is made from a weakened live virus and is not recommended for people with autoimmune disorders, pregnant women, and patients with certain chronic health problems, including diabetes, heart disease, asthma, and lung disease. Unfortunately, you can’t take the nasal flu vaccine because you are 63. You can find more information about the live vaccine here.

Ask your doctor for a thimerosal-free flu shot. If he or she doesn’t have one, you can visit the CDC’s H1N1 Web site and check out its “flu shot locator” .  It has links to the Web site of each state’s health department, with specific information about where vaccine can be found.

The Centers for Disease Control and Prevention has a lot of useful information about both seasonal flu and H1N1 flu on its Web site. Also be sure to check out CNN.com’s flu page.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


September 24th, 2009
10:40 AM ET

Do I need the H1N1 vaccine if I think I already had the virus?

As a regular feature of CNNhealth.com, our team of expert doctors answers readers’ questions. Here’s a question for Dr. Gupta.

From Birgitta in Newcastle, Washington:

I think I already had the swine flu but do not know for sure if it was swine flu, do I take the vaccination anyway? Is it safe to take if I suspect that the flu I had was swine flu?

Answer:

Tens of thousands of people right now, like Birgitta, are suffering from or getting over the H1N1 virus. Those numbers will continue to swell as the flu season wears on, and these questions will inevitably come up over and over again.

Incidentally, I can relate. I contracted the H1N1 virus recently while reporting on the war in Afghanistan, and I was miserable for days. I got my immunity to H1N1 the hard way, so I can take a pass on the vaccine this year. But what about people who are not as sure, like Birgitta?

The bottom line is, unless you got a laboratory test confirming it, you cannot be sure that you actually got the H1N1 virus. There are several strains of influenza floating around out there this season, two of which are H1N1 and seasonal influenza. There are a handful of other strains you could have contracted.

The old adage, "Better to be safe than sorry," may apply here. Unless you're sure you had H1N1, the Centers for Disease Control and Prevention recommends that you get vaccinated. Even if you did, in theory, get H1N1 the CDC reports no evidence that subsequently getting the H1N1 vaccine would cause problems for you.

You can think about your vaccination like an insurance policy. If you did have H1N1 during your recent illness, then you're protected. If you did not, you're also protected.

If you're wondering when the vaccine will be available, the largest shipment of H1N1 vaccine is scheduled for mid-October. By then, the first 45 million doses of the vaccine will be ready, with another 20 million doses shipped out each week until December.

And don't forget, the CDC recommends that you get the seasonal flu vaccine as well.


September 11th, 2009
01:15 PM ET

Stop calling it swine flu!

By Miriam Falco
CNN Medical News Managing Editor

The U.S. Department of Agriculture symbolically slapped the news media on the hand Thursday for perpetuating the term "swine" flu in reports about the new H1N1 strain of influenza that's spreading across the world.

In a written statement and during two telebriefings, the USDA reminded reporters that since last Spring they have “consistently asked that the media stop calling this ‘novel’ pandemic virus ‘swine flu.’”

So what's the big deal? Health officials say the H1N1 virus more closely resembles the pandemic Spanish flu of 1918 than a swine flu. The USDA says struggling pork farmers are being hurt in a big way when the virus is called “swine flu.” USDA officials stress that “ you cannot get infected with 2009 pandemic virus from eating pork or pork products."

"Each time the media uses the phrase ‘swine flu’ a hog farmer, their workers and their families suffer,” says USDA Secretary Tom Vilsack in a statement posted on the USDA Web site. “It is simply not fair or correct to associate the 2009 pandemic H1N1 influenza with hogs, an animal that does not play a role in the ongoing transmission of the pandemic strain."

USDA officials point out that China is not importing U.S. pork because of the erroneous belief that eating pork is tied to the spread of this new type of flu.

I am a member of the news media and I have used both H1N1 and “swine flu” in my stories because some people know the virus only as “swine flu,” which is what it was originally labeled.

So how did the confusion start?

Back in the spring, when we first heard about "swine" flu, it was given that name because initial tests showed it resembled some known viruses that have circulated in pigs. However, the CDC explains on its Web site, "…further study has shown that this new virus is very different from what normally circulates in North American pigs." The agency explains that this new H1N1 virus has genetic material from viruses found in European and Asian pigs, as well as genes from birds and humans. Plus, USDA officials point out that this is a human virus because it was first detected in humans. They say there are no reports of H1N1 circulating in any swine herds here in the United States. They acknowledge that Canada, Australia and Argentina have found H1N1 in a few pigs. And Deputy Agriculture Secretary Dr. Kathleen Merrigan says she wouldn’t be surprised if the H1N1 virus does eventually surface in U.S. pig herds. But she stresses that pigs infected with the virus would not be sent to market.

Health officials keep reminding us that the best way to avoid getting sick with this new H1N1 flu virus is to take the following precautions:
– Wash your hands frequently.
– Cough into a tissue or your sleeve, not into your hand.
– Get a regular seasonal flu shot now, and the H1N1 flu vaccine when it becomes available, allowing the highest risk groups to get their shots first.

And please don't call it swine flu.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


August 20th, 2009
11:56 AM ET

Back to School Flus

By Jennifer Adaeze Anyaegbunam
CNN Medical News Intern

This year my back-to-school to do list looks a bit different than it has in previous years. Select senior year courses, check. Purchase school supplies, check. Don’t get swine flu. Um—I’ll try?

Colleges represent a diverse and mobile population. Individuals don’t sleep enough, eat right, practice the best hygiene, or make the healthiest choices. Say you’re at a party, and there is only one used cup left, do you drink from it? In college, too frequently the answer is yes! And if you don’t drink from the dirty red cup, your best friend might. Let’s face it, on campus there are only a few degrees of separation so I’m wondering how I will separate myself from the latest H1N1 viral outbreak.

Swine flu is spread via the same mechanism as regular seasonal influenza. When people with these viruses cough or sneeze the virus is released into the air via tiny in respiratory droplets. You can contract swine flu by coming in contact with these droplets or touching a surface contaminated with these droplets containing the H1N1 virus up to 8 hours after it was deposited.

There were a few cases of swine flu on my campus at the end of last semester. According to the Centers for Disease Control and Prevention (CDC), avoiding contact with the sick and frequent hand sanitizing can help reduce the risk of spreading the flu. I interviewed some of the members of Harvard’s class of 2009 to find out exactly how swine flu had affected their commencement ceremony, and apparently the seniors I spoke with saw these CDC tips in action. According to graduate Devin Smith, the Dean of the college, “… announced that swine-flu had, in fact, worked its way into Harvard graduation and instructed graduates, family, and friends to refrain from hugging and shaking hands.” Matthew Clair, another recent graduate, noted that everyone at graduation seemed to be coughing and sneezing but, “besides the hand sanitizer they squirted into our hands before we received our diplomas and the general paranoia, graduation proceeded as usual.”

So when I return to campus, will my life proceed as usual too?

Clinical trials for a swine flu vaccine are in progress, and public health officials are hopeful that the swine flu vaccine will be ready for public distribution by mid-October. Due to the number of swine flu cases in my demographic, the CDC’s Advisory Committee on Immunization Practices has suggested that college-aged students are among the first to get the H1N1 vaccine this fall. The CDC will be updating their recommendations for swine flu prevention and preparedness for institutions of higher learning later today, but so far the organization does not recommend that colleges dismiss lectures or other large gatherings—so unfortunately, summer vacation will not last until mid-October when the vaccine becomes available.

If you do happen to get sick, public health officials recommend that you self-isolate and stay home until at least 24 hours after your fever breaks. Many college students live in dorms so isolation may be difficult. But before you burn all of Sally’s belongings or douse John with holy water you should consult these CDC tips for those living with someone with swine flu.

Exposing yourself to swine flu may seem like the easiest way to build a natural immunity to the H1N1 virus and/or get excused from your midterms. I know the thought has crossed your mind, but don't do it. Swine flu has been mild for many people, but deadly for others– so you should probably devise an alternate, less fatal scheme (or maybe just study).

Until the vaccine becomes available, I hope that for my sake and others’, those living in communal environments practice healthier habits and take active steps to prevent the spread of swine flu. So, always cough or sneeze into your sleeve or a tissue, and if you must drink from the red cup, wash your hands after!

College students, will you be getting vaccinated? Do you think this vaccine should be required for all those living in communal environments?

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


August 5th, 2009
12:05 PM ET

Swine flu vaccine for pregnant women

By Miriam Falco
CNN Medical News managing editor

Last October, I blogged about why health officials say pregnant women need to get a flu shot. (Full Story) Reporting on the need to get vaccinated against the influenza virus is something medical reporters do every year. Why in October? Because that's when the vaccine is usually available and when flu season is right around the corner. Why pregnant women? Well, as I learned last year, if a pregnant woman gets the flu, it could lead to serious complications including pneumonia, dehydration and hospitalization. Because pregnancy changes a woman's immune system, she can get a lot sicker than women who aren't pregnant. She can even die from it.

What was even more alarming was learning that the flu can also lead to preterm labor and fetal demise, according to one of the top flu experts at the Centers for Disease Control and Prevention, Dr. Carolyn Bridges. The CDC also found that less than 14 percent of pregnant women between the ages of 18 and 44 actually got a flu shot during the 2006-2007 flu season. I was pregnant last October. After speaking to health officials and several moms who had experienced the flu and told me they’d never been so sick before, I decided that for me, avoiding the risks to me and my unborn child was worth getting a flu shot. Apparently it worked because I didn't get sick.

But now it's August, not October. So why are we thinking about the flu already? Because of the new strain, H1N1. Health officials are now saying that pregnant women not only need to get a seasonal flu shot, but they also should be vaccinated against this new, 2009 H1N1 pandemic flu, better known as the "swine flu" (even though pigs have nothing to do with it) - once the vaccine has been tested and deemed safe.

Last week, the CDC's point person for this new strain of flu virus, Dr. Anne Schuchat, told reporters that pregnant women are “disproportionately” affected by this virus and that they have a fourfold increase of being hospitalized compared with the general population.

The H1N1 virus is causing worse complications and severe infections in pregnant women, Schuchat said.

A study published in the medical journal The Lancet found that pregnant women are more likely to die from this virus and that vaccinating them is one important step to prevent such serious complications.

Health officials told reporters this week that once the H1N1 vaccine is proven safe and becomes available, those in the high priority groups will have to get two H1N1 flu shots – three weeks apart, in order to get full immunity. Those high priority groups include not only pregnant women, but also household contacts of children under 6 months of age (because those children can't get the vaccine); children and young adults age 6 months to 24 years; health care workers and emergency medical personnel; and non-elderly adults with pre-existing medical conditions. It will take two weeks after the second flu shot to build up to full immunity, which means the whole process to protect yourself from H1N1 takes a total of five weeks. Since this new flu vaccine isn't expected to roll out until mid-October, health officials don't expect the population to be protected until the end of December.

Given the experience earlier this spring, where swine flu rapidly spread in some schools and colleges and other places with lots of people in close quarters, health officials are bracing for a big uptick in people getting sick as the regular flu and the new H1N1 flu viruses spread during the cold weather months.

So this year, I once again am pondering what to do. This time it's a lot more difficult because come October, my little son will be just old enough to fall into the priority "six months to 24 years-old" category. Should he get two brand new flu shots plus a seasonal flu shot? It's not an easy decision. Fortunately, I still have a little time to think this over.

How about you? Are you pregnant? Will you get seasonal and H1N1 flu shots when available? Are you a parent of a newborn or infant and are you planning vaccinations for yourself or your child?

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


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