I’ve been getting many e-mails over the past couple of days concerning swine flu.  So I’ve decided to answer a few of them here.

Dear Dr. Manny,
If I had the swine flu in 1976 after I received the swine flu vaccine as a college student, do I have any anti-bodies that may help ward off this version of the virus?
                  —Amy Gorman
                  Lutherville, MD

Probably not. This current swine flu’s genetic makeup is different from the swine flu from the ‘70s, and therefore the vaccination won’t be protective for you. But the silver lining is that this current swine flu is less lethal, and there may components in it that more Americans have been exposed to. So you may have a greater chance of being protected already which can minimize the symptoms.    

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Dear Dr. Manny,
We have friends who have returned from a trip to Mexico City two weeks ago. How long would it take for swine flu symptoms to show up if they were infected?
Thank you for your time,
—Alan

The typical incubation time for a virus is 48-72 hours.  So if your friends have been back for two weeks, and don’t have any symptoms, you can feel confident that they are safe. 

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Dr. Manny,
My wife and I are very concerned of the complications swine flu/treatment would pose to her pregnancy. Are the approved drugs for treatment approved for use during pregnancy?
Thanks,
Ben Demaline
Jacksonville, FL

Yes, all of the current flu treatments can be given to pregnant women. As a matter of fact, we tend to be more aggressive in treating the flu in expectant mothers because pregnancy can make flu symptoms worse and put the patient at higher risk. That’s why it’s recommended that all pregnant women get flu shots annually.

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Dr. Manny,
I will be flying to Las Vegas next week with a two-hour layover in Atlanta. I had a liver transplant five years ago and have done really well. Do you think that I should wear a mask at the airport and on the plane? I am very concerned about the large crowds and would like your opinion.
Thank you for any answer!
G. Savage

As a liver transplant recipient you are probably taking immunosuppressant therapy drugs and therefore you do have to take precautions to avoid exposure to the swine flu ― or any kind of flu. Even though I’m not a big advocate of wearing masks, I do feel that you should wear one. But remember: Not all facial masks are created equal, so get one that has been proven to protect against viruses. There are many supply stores that carry this specific mask for viruses. Also, try to wipe down all the surfaces on your airplane seat with antibacterial wipes. Be sure to wash your hands before, during and after the trip. And avoid any contact with anyone who you suspect might be sick. I know that this is a big stretch, but until we know exactly the extent of the spread, in your particular case, I would be extra cautious. I hope that this doesn’t ruin your vacation! 

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Dr. Manny,
I have no choice but to commute using public transportation everyday.  How should I take precautions against the swine flu?
                  Thanks,
                  —Paul

If you can avoid public transportation, especially crowded subway cars, then do it.  But if you can’t here’s what you can do:

• If you are a healthy individual you can just use antibacterial products, including wipes and gels, chronically throughout your trip.
• Avoid contact with people who are coughing or appear sick.  If they are in your car, move to another one. 
• As soon as you get home or to the office wash your hands, wipe down your cell phone, iPod or any device that you used during your trip. 

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Dear Dr. Manny,
I’m a chronic nail biter and I’m really concerned about the swine flu.  What should I do?
Best,
                  —Mel

First and foremost — wash your hands. Your hands are the most common tool for picking up germs and viruses in general. So if you are a nail biter, this would be the perfect incentive for you to quit. Also, biting your nails can make you ingest things other than viruses that you don’t want to have in your body.

There’s no doubt that this H1N1 flu, also known as swine flu, has been a real doozy. With more than 1 million people infected in the U.S. alone and approximately 263 deaths, attention must be paid to a potentially worsening condition.

I typically don’t like to scare people into paying attention to health care issues, but I do think that as soon as a vaccine becomes available here in the U.S. for the H1N1 virus, you should get it.

I recently learned of two alarming cases where pregnant women became affected with the H1N1 virus. Any type of flu can be quite devastating for a pregnant patient. The reason for the significant effect in pregnancy is that pregnant women typically have suppressed immune systems and their pulmonary compliance is significantly altered due to the pressure from the pregnant uterus. So when they get the flu, it could very quickly turn into a deadly pneumonia with very high degrees of complication for both the mother and the unborn child.

That was just the case with these two recent reports — one from Australia where a mother fell ill from the swine flu and ultimately the baby died in utero, and in the other case, a woman in Florida had to deliver at 27 weeks of gestation due to the flu, and the infant ultimately died from complications associated with his prematurity.

So the message is loud and clear: This new virus is very contagious. We don’t have natural immunity, and if you have any risk factors — especially if you’re pregnant — get the vaccine as soon as it is available.

Click here to read the full story.

Q: What are the drugs that have been mentioned in connection with Jackson’s death and how do they work?
A: Propofol (Diprovan): A powerful intravenous sedative — not a DEA controlled substance — was found on the premises. It is used by anesthesiologists to put a patient to sleep before general anesthesia and surgery, or alone in a surgical suite for an elective procedure such as a colonoscopy or biopsy. Only small doses are necessary to be effective, and it can easily be misused by an untrained health professional leading to a respiratory arrest.

Narcotics: Demoral, Percocet, Vicodan — there are varied reports of prescriptions for these being found. All can lead a patient to stop breathing or sustain a cardiac arrhythmia and cardiac arrest if overdosed — especially if used in combination. These are controlled substances and prescriptions are subject to DEA review. Misuse can lead to loss of license or criminal prosecution.

Sedatives: A prescription for Xanax was reportedly found. This can also lead to supressed breathing.

Q: What are the questions about substandard care that surrounded Jackson’s death?
A: Excess prescriptions of narcotics and sedatives. When he stopped breathing, no opiate antagonist (narcan) was given to reverse the effects of narcotics. The doctor in residence did not coordinate the 911 call. CPR was done on the bed without a backboard, rather than on the floor where more force could be administered to the heart. No defibrillator was available, and no mouth-to-mouth breathing was reportedly given.

Q: Why is there a delay in getting the autopsy results?
A: The initial autopsy apparently showed no structural damage to the heart to explain his death. There is speculation that prescription drugs contributed to or caused Jackson’s sudden death, and initial toxicology reports may soon be ready. More extensive reports take longer because they look at blood and hair to quantify the exact amounts and combinations that could have led to his death. This will include a microscopic examination of the brain itself, which could show the effects of drugs and help determine the exact cause of death.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.” Read more at www.doctorsiegel.com

There has been a firestorm of medical coverage, my own included, on Michael Jackson’s untimely death last week. There is much we still don’t know, including the final toxicology report which may help us to determine the combination of chemicals that appear to have led to his demise.

Here is what we do know:

1 – The initial autopsy appears to have shown no structural heart disease, in other words, no heart attack or heart failure. This increases the likelihood that prescription drugs were involved as a cause, leading to either a respiratory arrest (most likely), or an irregular heart rhythm which led to the heart stopping.

2 – The behavior of the medical team, especially Jackson’s personal physician, is very questionable, at least by my standards. I am a practicing internist, and I worked in the Bellevue Hospital Emergency Room for 8 years, and here are some of the points I and others have raised. Why wasn’t narcan, which rapidly reverses the effects of narcotics, administered? Why wasn’t he brought to the hospital if he wasn’t feeling well? Why did his personal physician allow or facilitate this concoction of pills that Jackson was supposedly taking. It isn’t simply a matter of writing or not writing a prescription; as a primary care doc I feel responsible for knowing and overseeing ALL medications my patients are taking. Why was CPR done on the bed instead of the floor, when the amount of force necessary to provide 30% cardiac output (the goal in CPR) requires full force that can be wasted on a bouncy mattress. Was Mouth to Mouth resuscitation used? Why didn’t the doctor direct the 911 call – why did he leave it to a security guard?

3 – The latest news involves a drug known as propofol or Diprivan. There are reports that Jackson may have been demanding, and possibly receiving this intravenous drug, which could certainly have led him to stop breathing. This is a drug that anesthesiologists ONLY use to induce anesthesia either as a stand alone treatment in elective procedures such as colonoscopies, endoscopies, small plastic surgeries, etc., or as a pre-anesthetic to put patients to sleep followed by general anesthesia and intubation. As a stand alone for colonoscopy, it is generally accompanied by a mask, though it is given intravenously. The dose must be very carefully regulated by an anesthesiologist, and in the doses used, generally only lasts for a half hour or hour. It is never used outside of a hospital or surgical suite.

4 – We have an epidemic of pill popping in our society. Narcotics are vastly overused, in combination with sedatives. These are dangerous combinations, especially when you consider that people become tolerant, requiring more and more to achieve the effect they want, and can easily slip into a toxic, life-threatening range.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.” Read more at www.doctorsiegel.com

Michael Jackson’s sudden death by cardiac arrest is less shocking than the slow, but steady demise of his soul, which turned him into a music machine fueled by addictions to drugs, money, possessions, fame and plastic surgery.  As my friend and fellow journalist Josh Resnek has remarked, Jackson’s body died at 50; the rest of him died much younger.

Jackson’s life story is a cautionary tale about what happens when a child is deprived of his core self.  That deprivation likely stemmed from what Jackson himself described as the physical and psychological brutality of his father Joe, who reportedly whipped him and verbally abused him and monetized his talents from age 10 through endless rehearsals and performances of The Jackson 5.  Now Joe is planning a big, public funeral for his twice-dead son, keeping him on the stage even after he is gone from this earth.

Jackson’s first, long, tortuous death was a gradual stopping of his metaphorical heart—the heart of a boy harnessed to a father’s tyrannical plans to enslave him.  It left him uncertain whether anything at all was authentic about him, whether there was anything whatsoever he could embrace as the truth. 

He was forever ambivalent about his race, bleaching or otherwise altering his skin tone to appear Caucasian. 

He was forever ambivalent about his facial structure, undergoing plastic surgeries until his nose seemed in danger of falling off his face, his chin became a caricature of the kind with a cleft he must have admired on other people’s faces, and his jaw line became a haunting skeletal representation of just how dead he really was inside.

He seemed forever ambivalent about his gender, because he could not claim even that as his own, morphing from tough guy to girl in appearance and garb. 

He seemed ambivalent about his age, living in an amusement park he built, with zoo animals on display.  Could he have actually missed the fact that he was a caged animal himself, thrilling crowds with his exotic movements and appearance? 

He may have been ambivalent or twisted about what pleased him sexually, given his habit of inviting young boys into his bed and his history of having paid out $20 million to settle a child sexual molestation suit.

He staged sham marriages and “fathered” children who appeared wearing carnival masks in public—all part of the show.  He dangled his baby boy over a railing for his fans, in what may have been the starkest representation of how he felt his own life had ended shortly after birth. 

The distance between a man’s mind and his core self — his soul — is the breeding place for anxiety and depression.  And Jackson apparently tried to contain those unwieldy emotions in the predictable ways — drugging himself by acquiring possessions and trying to shut up the long-dying person inside him with opiates and tranquilizers.  Then the truth asserted itself in the final way it sometimes does.  It stopped his heart suddenly, when, for all intents and purposes, it had not been beating (not for real) for decades.

According to William and Janis Mohat, their son Eric, a 17-year-old, was bullied to death at Mentor High School in Mentor, Ohio.  On March 29, 2007 Mohat shot himself after relentless harassment and intimidation that included being pushed, shoved and hit ― not to mention being humiliated by being called a fag, a queer and a homo.  Eric had never shown any interest in homosexuality at all.

Click here to read the full story on FOXNews.com
 
The Mohats are suing their school district, alleging that one of Eric’s teachers — Thomas M. Horvath — saw the bullying and did nothing to stop it.  Two other students committed suicide the same year Eric did.  His parents say bullying was a factor in their deaths, too.  And another parent, named Dan Hughes, reportedly withdrew his son Brandon from the school after he was picked on, non-stop.
 
The Mohats aren’t after cash.  They want to force the school system to put a comprehensive and effective anti-bullying program in place.  I think they should be after both.  I also think they should urge local authorities to press criminal harassment (and possibly wrongful death) charges against Eric’s bullies.
 
Bullying is an old problem that repeated and dogged litigation may be the only way to solve.  The litigation may have to be as relentless as the bullying itself. 
 
Schools have, for decades, either utterly ignored or done far too little to fix the bullying that takes place in their schoolyards and classrooms, cafeterias, restrooms and hallways.  Too little is done to prevent bullying, and bullies aren’t sufficiently disciplined.  Eric Mohat’s assailants, for instance, should have been identified, punished and, if they persisted, suspended from school.  Period.  The same goes for bullies in any other school district, in any other community.
 
As a psychiatrist who has treated bullies and their victims, I believe that early detection of aggressive kids and vulnerable kids, with preventive strategies targeted toward each can be effective.  But reaching deep into the souls of bullies to find out what shattered their empathy and turned them into child predators (yes, predators) can take a fair amount of time.  So when bullies are identified, the first order of business has to be to stop their emotional and physical abusiveness—through discipline, containment, suspension or expulsion.  The healing work of identifying and addressing the roots of their violence can then begin.
 
Eric Mohat allegedly lost his life to bullying.  Indeed, researchers have identified a connection between bullying and suicide.   What’s more, the U.S. Centers for Disease Control estimates that every day in this country160,000 children stay home from school because they fear bullies.
 
In my psychiatry practice, I have met adolescents, young adults and adults who bear the scars.  Bullying can cause lasting low self-esteem, persistent anxiety and major depression.  It can warp personality structure, either spawning a tendency toward irritability and violence in victims, or a tendency toward isolation and passivity. 
 
The word needs to go out loud and clear, not only from William and Janis Mohat, but from school administrators and the law enforcement community, that bullying will be seen as any other form of assault.  That means that child bullies get sent home from school and started in therapy, adolescent bullies get suspended from school or expelled (and started in therapy) and teenage bullies get their therapy, along with being suspended, expelled and/or referred to the juvenile justice system.  
 
It’s really that simple.  I hope that that any school system, school administrator or teacher who ignores bullying is sued and has to dig very deep into their pockets to pay a very significant judgment.  No amount will ever compensate victims and their families — certainly not those who lose sons or daughters to suicide.  But using litigation (or the threat of it) to shape social policy may be the fastest route to keeping our kids safe at school.

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His newest book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement. Check out Dr. Ablow’s website at livingthetruth.com or e-mail him at info@keithablow.com.

British reality TV star Jade Goody, who appeared on the show ‘Big Brother’ in 2002, is turning her death into reality television.  Goody suffers from terminal cervical cancer and is making a show about her impending demise.  Recently, she wed an ex-con named Jack Tweed, in a televised ceremony, which included bridesmaids who had shaved their heads (to mimic Goody’s hair loss from chemotherapy).  Tweed was allowed by officials to stay out past his house arrest curfew, imposed after his 18-month jail sentence for attacking a teenager with a golf club.

Television can do very good things, and it can do very bad things.  This is a very bad thing, and Goody is doing no service to herself, her two sons (ages 4 and 5) or the public.  Her decision to televise her demise turns what should be private moments between Goody, her children and her “husband” and her Maker (if she believes in God) into entertainment. 

It dehumanizes her, deprives her children of the certain knowledge that life and death and family and love are greater than fame, and injures every person who struggles to make sense of our mortality, rather than distorting it with the lens of a camera and rendering it absurd.

If you want to know why some young people have no reluctance to tape beatings and air them on YouTube, take a look at Jade Goody (and the reprehensible producers of her series).

If you want to know why we have an epidemic of character pathology—including extreme narcissism—gripping this nation, take a look at Jade Goody.

If you want to know why real empathy is in short supply, too often replaced by a thin, synthetic veneer of concern for others, no deeper than applause, take a look at Jade Goody.

Turning death into a make-believe circus of photo ops, paydays (Goody reportedly received $2.2 million for the media rights to her wedding) and fake pathos doesn’t raise cancer awareness, as Goody claims.  It buries it.  Cancer is about moments behind closed doors, about private thoughts late in the night, about quiet courage to face suffering, about tears shed over concerns for oneself and one’s children that are unspeakable, except to those we love, for real.

Goody has apparently defended her reality series because it will provide money to raise her two children.  She could have left them something else:  The certain knowledge that they mattered more than fame, that they should never sell their souls to the highest bidder, that being alive on the face of this great planet means coming to terms with death, not denying it or trivializing it by turning it into a taped, partly faked spectacle or last ditch try for fame.

Nope, there’s nothing good about this at all.

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His newest book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement. Check out Dr. Ablow’s website at livingthetruth.com or e-mail him at info@keithablow.com.

Is spicy food to blame for the death of a British newlywed? Not so fast, doc!

A recent story about a 24-year-old woman who died from an asthma attack  still lacks many facts. Her doctor believes it was triggered by the spicy foods she had eaten three days earlier – but we still don’t know the exact cause of death.

First, we need to have a postmortem report, which we don’t have yet. And second, to say that spicy food was a possible contributing factor in this woman’s death gives these popular foods a bad rap.

There are many foods – and not necessarily spicy ones – which contain food allergens that can trigger a histamine release in the body, ultimately leading to an asthma attack.

There are also medical reports that have documented things like food additives, excessive sweets, and fried or oily foods as poor nutritional choices for asthmatic patients. However, there are many asthmatic patients that feel just great after eating jalapenos in a salad.

So before you throw out your Tabasco sauce, consult your doctor to see which diet is best for you.