Dr. John L. Turner Blog

Friends have asked again about taking antiviral meds for suspected H1N1.

This is the latest: Treatment is recommended for all outpatients with confirmed or suspected influenza if they belong to groups known to be at higher risk for complications. These groups include:

* Children younger than 2 years;
* Persons aged 65 years or older;
* Pregnant females;
* Persons of any age with chronic medical or immunosuppressive conditions;     and
* Persons younger than 19 years who are on chronic aspirin therapy.

The entire article from Medscape follows:

What are the clinical indications to initiate antiviral treatment for patients with suspected H1N1 influenza? 

Response from James Wilde, MD
Associate Professor of Emergency Medicine & Pediatrics, Department of Emergency Medicine; Faculty, Pediatric Emergency Medicine, Medical College of Georgia, Augusta, Georgia 

 When novel H1N1 "swine flu" was first detected on April 22, 2009, little information was available about the virus. Soon after the Centers for Disease Control and Prevention (CDC) notified the public that a new subtype of influenza A had appeared in the US Southwest, reports came in from Mexico indicating that the virus may be highly lethal. Initial estimates of mortality rates from H1N1 infection in Mexico ranged as high as 8%.[1,2] This is a remarkably high mortality rate when viewed in the context of the 2% mortality rate observed during the 1918 Spanish Flu pandemic, the most deadly single-season pandemic in world history, which killed as many as 50-100 million people worldwide.

The CDC and other public health authorities responded quickly to what appeared to be the start of a new and deadly pandemic. The initial strategy was to treat anyone who had confirmed or suspected swine flu with the neuraminidase inhibitors oseltamivir (Tamiflu®) or zanamivir (Relenza®). Although the literature in general shows only modest benefit from the use of antiviral medications for influenza infections, some recent studies showed a reduction in influenza mortality in high-risk hospitalized patients after the use of neuraminidase inhibitors.[3,4] In an effort to stop the spread of the virus and reduce the mortality rate, treatment was recommended without regard for the severity of the illness or underlying health problems.

It soon became apparent that there was a mismatch between the information coming from Mexico and the experience with H1N1 in the United States and the rest of the world. Data from the United States and World Health Organization (WHO) indicated that the mortality rate from H1N1 infection outside of Mexico was very low, probably even lower than the mortality rate expected from seasonal flu, which kills an estimated 36,000 Americans each year.[4,5] Data over the ensuing months have confirmed that overall mortality from H1N1 infection is less than 1% and may be less than 0.1%.

Resistance to antiviral medications has been well documented in influenza viruses.[4] In 2006, resistance to adamantanes (amantadine, rimantadine) was detected in A/H3N2 seasonal flu viruses in the United States. By the next year, resistance was nearly 100%. Similarly, resistance to oseltamivir was noted in A/H1N1 seasonal flu isolates in 2008, and by 2009, the resistance rate was almost 100%. Given this history, public health authorities have reason to be concerned about the overuse of neuraminidase inhibitors and the development of resistance in the treatment of H1N1 infection.

New information about low mortality rates coupled with concerns about the development of resistant strains led to revised CDC guidelines on May 6, 2009. As of that date, treatment was recommended for hospitalized patients with proven or likely flu and all other patients with an influenza-like illness who are members of groups known to be at higher risk for seasonal flu complications. Those guidelines also contained recommendations for the prophylactic use of oseltamivir or zanamivir in certain populations, such as healthcare workers and others who had close contact with a person known or suspected to have an active H1N1 infection. Treatment with antiviral medications was not recommended for otherwise healthy patients who were not members of high-risk groups.

The May 6, 2009, guidelines remained in effect throughout much of the summer in the United States, during which time H1N1 remained in low-level circulation. In August, rates of infection increased dramatically, first in the Southeast United States and then in most of the rest of the country. By September, the May 6 recommendations became somewhat impractical, particularly in regard to prophylaxis. In response, the CDC published revised guidelines on September 8, 2009. Those guidelines removed the recommendation for prophylaxis in all but a handful of cases.

The September 8, 2009, guidelines still had some problems. The most significant was the inclusion of children younger than 5 years on the list of high-risk groups. Children younger than age 5 can be expected to have 4-8 upper respiratory infections each year, many associated with fever.[6] Because the clinical features of influenza and other upper respiratory tract infections overlap, including all children younger than age 5 on the list of high-risk patients meant that many of these children could be prescribed multiple courses of oseltamivir over the course of a 3- to 6-month fall and winter season. This could potentially deplete the supply of oseltamivir and accelerate the development of resistance.

In response to these concerns, the CDC published another revision to the treatment guidelines on September 22.[7] In this revision, children between 2 and 5 years of age were noted to be at only a slightly increased risk for hospitalization due to influenza and were, therefore, removed from the list of high-risk groups. Children younger than 2 years remained on the list because the data do show a substantially increased risk for hospitalization due to influenza in this age group.
Conclusion

Current recommendations by the CDC are to treat all hospitalized patients with likely or proven H1N1 infection with oseltamivir or zanamivir. Treatment of outpatients is recommended if the patient has an influenza-like illness and more severe symptoms, such as evidence of lower respiratory tract infection or clinical deterioration.

Treatment is recommended for all outpatients with confirmed or suspected influenza if they belong to groups known to be at higher risk for complications. These groups include:

* Children younger than 2 years;
* Persons aged 65 years or older;
* Pregnant females;
* Persons of any age with chronic medical or immunosuppressive conditions; and
* Persons younger than 19 years who are on chronic aspirin therapy.

Available rapid assays for influenza have shown very poor sensitivity in the detection of H1N1.[8] Antiviral therapy should be started as soon as possible after the onset of symptoms, ideally within 48 hours.[4] Treatment decisions should not be based on the results of assays performed for detection of influenza, due to poor sensitivity of detection of H1N1.[8]

Well, to be vaccinated or not is a choice, as per my last blog, that you will have to make. But what if you become ill, then do the antivirals work?

Interestingly, a friend mentioned that he started his teenage daughter right away on such medications when she became ill. She recovered in a speedy fashion. For those who are not opposed to such medications, this is the latest recommendation:

 CDC Issues Guidelines for Early Empiric Antiviral Treatment in Persons With Suspected Influenza CME/CE

 TAMIFLU (oseltamivir phosphate)  and   RELENZA (Zanamivir)

From Medscape Released: 10/29/2009

October 29, 2009 - On October 16, the US Centers for Disease Control and Prevention (CDC) issued interim guidelines for chemoprophylaxis and early empiric antiviral treatment in persons with suspected influenza, including 2009 H1N1 influenza infection and seasonal influenza.

The new interim recommendations, which update those from September 22, 2009, aim to assist clinicians during the 2009-2010 influenza season in prioritizing use of antiviral medications for hospitalized patients and those at higher risk for complications from influenza. The CDC notes that the recommendations can be modified as indicated by local epidemiologic data, patterns of antiviral susceptibility, antiviral supply considerations, or observed changes in the clinical presentation or antiviral susceptibility of 2009 H1N1 influenza. These guidelines should be considered interim recommendations and will be updated as needed.

"As of October 3, 2009, 99% of circulating influenza viruses in the United States were 2009 H1N1 influenza (previously referred to as novel influenza A [H1N1])," the guidelines authors write. "Among people who become infected with 2009 H1N1, certain groups appear to be at increased risk of complications and may benefit most from early treatment with antiviral medications. Based on currently available data, approximately 70% of persons hospitalized with 2009 H1N1 influenza have had a recognized high risk condition."

High-risk groups include children younger than 2 years, adults 65 years or older, and pregnant women and those up to 2 weeks after delivery or miscarriage. In addition, persons at high-risk include those with immunosuppression; disorders compromising respiratory tract function or handling of respiratory secretions or increasing risk for aspiration; or chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematologic (including sickle cell disease), or metabolic diseases (including diabetes mellitus).

Updated Guidelines

Updates since the September 22, 2009, guidelines include the following:

* The guidelines authors elucidate considerations for treatment and chemoprophylaxis in persons vaccinated with the 2009 H1N1 and seasonal influenza vaccines.
* In addition to pregnant women, those up to 2 weeks postpartum or after a miscarriage are now included as being at increased risk for complications from 2009 H1N1 influenza.
* For children younger than 1 year, additional oseltamivir dosing instructions are given.
* Adverse events and contraindications associated with use of oseltamivir and zanamivir are reviewed.

The guidelines note that antiviral medications can decrease the severity and duration of influenza illness and can lower the risk for severe illness, mortality, and other complications. Treatment or prophylaxis with antiviral medications is not necessary for most healthy individuals with an illness consistent with uncomplicated influenza or for those who appear to be recovering from influenza. Severe symptoms, including evidence of lower respiratory tract infection or clinical deterioration, in persons of any age or previous health status presenting with suspected influenza should mandate prompt empiric antiviral therapy.

All persons hospitalized for suspected or confirmed influenza should be treated with oseltamivir or zanamivir. Persons with suspected or confirmed influenza who are at higher risk for complications should be considered for early empiric treatment with oseltamivir or zanamivir.

Compared with older children and adults, children aged 2 to 4 years are more likely to need hospitalization or urgent medical evaluation for influenza. However, the risk is still much lower vs children younger than 2 years, and antiviral treatment is not necessarily needed for children aged 2 to 4 years with mild illness and without high-risk conditions.

When antiviral treatment is indicated, it should be started as soon as possible because maximal benefits ensue when patients begin treatment within the first 2 days of illness, although some studies of patients hospitalized for seasonal and 2009 H1N1 influenza have shown possible benefit of antiviral therapy started later than 48 hours after symptom onset.

Measures to minimize delays in starting treatment may include educating individuals who are at higher risk for influenza complications of the signs and symptoms of influenza and the need for early treatment as soon as possible after onset of influenza symptoms such as fever or respiratory tract symptoms. In addition, these patients and those who report severe illness should have rapid access to telephone consultation and clinical evaluation. Empiric treatment based on telephone contact may be considered for patients at higher risk for influenza complications, if hospitalization is not needed, and if this will result in markedly less delay before treatment is started.

Because a negative rapid test result for influenza does not rule out influenza, treatment should not be delayed pending laboratory confirmation of influenza. Sensitivity of rapid tests ranges from 10% to 70% for detection of 2009 H1N1.

In accordance with guidelines from local and state health departments, real-time reverse transcriptase-polymerase chain reaction testing for 2009 H1N1 influenza infection should be prioritized for individuals with suspected or confirmed influenza requiring hospitalization.

Consideration for antiviral chemoprophylaxis should usually be limited to individuals at greater risk for influenza-related complications who have been exposed to someone likely to have been infected with influenza. After a suspected exposure, however, early treatment may be an option preferred vs chemoprophylaxis.

Those persons at high risk who are household or close contacts of confirmed or suspected influenza cases can be educated regarding the early signs and symptoms, and if these develop, they can be instructed to contact their healthcare provider immediately for evaluation and possible early treatment. When vaccinated persons have a suspected exposure, early recognition of illness and treatment when indicated are preferred vs chemoprophylaxis.

Circulating Viruses

In the 2009-2010 influenza season, the most common influenza viruses among those circulating are likely to be 2009 H1N1 influenza viruses, especially in younger age groups, but circulation of seasonal influenza viruses is also anticipated. These predictions are based on global experience to date, but the timing and intensity of seasonal influenza virus vs 2009 H1N1 circulation may not be accurately predicted in advance.

The 2009 H1N1 viruses now circulating are susceptible to oseltamivir and zanamivir but are resistant to amantadine and rimantadine. Based on new antiviral resistance or viral surveillance data, however, recommended antiviral treatment regimens may change accordingly. The updated guidelines contain information on the dose and dosing schedule for oseltamivir and zanamivir. The emergency use of oseltamivir in children younger than 1 year is reviewed in an April 2009 Emergency Use Authorization.

The guidelines are available online on the CDC's H1N1 Web site. Published online October 19, 2009.
Clinical Context

The CDC guidelines issued October 16, which update those from September 22, 2009, aim to help clinicians prioritize use of antiviral medications for hospitalized patients and those at higher risk for influenza complications during the 2009 to 2010 season. As of October 3, a total of 99% of circulating influenza viruses in the United States were 2009 H1N1 influenza.

Updates since the September 22, 2009, guidelines include the following:

* Expanded considerations for treatment and chemoprophylaxis in persons vaccinated with the 2009 H1N1 and seasonal influenza vaccines.
* A new recommendation that women up to 2 weeks postpartum or after a miscarriage should be considered to be at increased risk for complications from 2009 H1N1 influenza.
* Additional oseltamivir dosing instructions for children younger than 1 year.
* A review of adverse events and contraindications associated with use of oseltamivir and zanamivir.

Study Highlights

* Dosing recommendations for antiviral treatment or chemoprophylaxis with oseltamivir for children younger than 1 year are as follows:
o Recommended treatment dose for infants younger than 3 months is 12 mg twice daily for 5 days.
o Because of limited data on use of oseltamivir in infants younger than 3 months, prophylaxis is not recommended unless the situation is judged to be critical.
o For infants aged 3 to 5 months, recommended treatment dose is 20 mg twice daily for 5 days, and recommended prophylaxis dose is 20 mg once daily for 10 days.
o At ages 6 to 11 months, recommended treatment dose is 25 mg twice daily for 5 days, and recommended prophylaxis dose is 25 mg once daily for 10 days.
o Prescribers should specify the concentration (eg, oral suspension 12 mg/mL) if prescribing in milliliters or teaspoons, or to prescribe the dose in milligrams.
* Oseltamivir and zanamivir are generally well tolerated.
* Compared with placebo, oseltamivir is more often associated with reports of nausea and vomiting in adults (nausea without vomiting, approximately 10% vs 6%; vomiting, approximately 9% vs 3%).
* In children, 14% of those treated with oseltamivir had vomiting vs 8.5% of placebo recipients.
* Sorbitol contained in oseltamivir suspension may cause diarrhea and abdominal pain in fructose-intolerant patients.
* Zanamivir is an inhaled formulation that may induce bronchospasm, and it is therefore not recommended in patients with underlying pulmonary disease.
* Zanamivir should be used only as directed, with use of the Diskhaler device provided with the drug product.
* Commercially available zanamivir (Relenza Inhalation Powder; GlaxoSmithKline) uses a lactose drug carrier and should not be used in any nebulizer or mechanical ventilator because the lactose sugar may obstruct proper functioning of mechanical ventilator equipment.
* Both oseltamivir and zanamivir have been associated with allergic reactions (rash, face or tongue swelling, or anaphylaxis).
* Transient neuropsychiatric events (self-injury or delirium) with oseltamivir and zanamivir have rarely been reported in postmarketing surveillance, mostly in children and adolescents living in Japan.
* However, influenza itself may cause neurologic and behavioral symptoms, so any causal role of the neuraminidase inhibitors in these symptoms is unclear.
* Retrospective analyses to date have not shown an increased risk for neuropsychiatric events after oseltamivir use.
* The FDA recommends that persons receiving neuraminidase inhibitors be monitored for abnormal behavior until additional data are available.
* Healthcare professionals should promptly report all serious adverse events seen after use of antiviral medication to MedWatch.

Clinical Implications

* The new CDC guidelines contain dosing recommendations for antiviral treatment (for 5 days) or chemoprophylaxis (for 10 days) with oseltamivir for children younger than 1 year. Because of limited data on use of oseltamivir in infants younger than 3 months, prophylaxis is not recommended in this age group unless the situation is judged to be critical.
* Oseltamivir and zanamivir are generally well tolerated. Oseltamivir use may be associated with nausea and vomiting. Zanamivir is an inhaled formulation that may induce bronchospasm, and it is not recommended in patients with underlying pulmonary disease. Both drugs have been associated with allergic reactions.

After much vacillation and indecision, I just want to say what our personal decision was concerning seasonal flu vaccination and the H1N1 shot/mist.

Why have I decided to have the vaccinations? I'll present the evidence.

We had AMLOST decided to have our son take the vaccinations. I had decided not to take them myself. Then a close friend about my age (I am 67) wrote:

From my perspective, there are a few conditions involving H1N1 that others need to know:

1.) That its assault is very fast and sudden. One feels fine, then suddenly intestines, joints, muscles commence to ache. In my case, I could not lie on right, left, or any side of my body, which precluded my sleeping at all, first night of the affliction.

2.) That likely, around second day of the virus, one suddenly feels as if all symptoms are fading away. Then, within several hours of feeling fine, original symptoms of the virus surge back like an incoming tide.

Symptoms that I experienced: Temps averaging 103, often as high as 106. Mountains of blankets (5 to 10) may take an entire day to break the shivers and fever. Then, profuse sweating brings relief only from chills, but not from joint and intestinal aches and discomfort. I was unable to eat anything for four straight days. I lost eight pounds, and likely more by now. That said, as of the very moment, my appetite has returned (fifth day of the virus), and I think I may survive okay.

Worth noting is that there is no H1N1 vaccine available here not even at the Vets Facility . So, I had no choice whether to obtain a vaccine. Had I a choice, I easily would have obtained the vaccine long ago. Frankly, I cannot comprehend why anyone would refuse taking H1N1 vaccine.

This made me reconsider my prior opinions. I thought (from the handful of reports) that for those over age 60, from the 1918 and WWII outbreaks, anyone in this age group should be immune. Not so, the writer above is older than I am and was surprised that he became ill.

I made a call to someone, an immunologist, and I trust his opinion and judgment. He feels that the CDC can indeed be trusted completely to post correct and scientific information. But first, some general remarks, then to the specifics:

The 1918 outbreak's 1st wave did not produce the high mortality rates that were seen in the 2nd and 3rd waves. Currently, the East coast may have now sustained the Fall 1st wave, but Winter and Spring waves are coming. He feels the H1N1 is truly a pandemic. As per my previous blogs, and as you know, the H1N1 has been hitting the younger age group the hardest. The FluMist live intranasal vaccine can be given to children and adults up to age 49. Beyond that, the mist has not been effective, at least, this is my understanding. However, the dead-virus shots can be offered. In a child under age 9, the H1N1 mist (or shot) must be given the vaccination twice, the second given 4 to 6 weeks later.

I guess it was this second direct "tug" hearing the agony of a close friend, then speaking with a physician who is well informed, were two things that caused me to finalize my choice. 

So, there you have it. As I have mentioned before, in addition to a fine edge of very rare side-effects of flu vaccinations, there are two sides of this H1N1 coin.

From the Mercola.com web site, the opinions of Dr. Mercola and Dr. Blaylock are diagrammatically opposite those of the CDC. Were you study only one side of the issue, your decision would be clear. Study the other side only, and your decision would be clear.

But what do you do when you have looked at both sides?

Ah, that makes it tough, but like in court, the evidence is presented and as so eloquently stated in A Murder of Crows, the jury votes on which side has the better lawyer.

I can only presents both sides for you and you will have to decide which evidence is for you, "Beyond A Reasonable Doubt."

What experience and history teach is this -- that people and governments never have learned anything from history or acted on principles deduced from it." G.W.F. Hegel

I have been following the evolving "pandemic" of H1N1 influenza beginning with the original discovery of the infection in Mexico in March of this year. In the course of this study I have tried to utilize as my sources high-quality, peer-reviewed journals, data from the CDC and accepted textbooks of virology.
As with all such studies one has to integrate and correlate previous experiences with epidemics and pandemics. As you will see, a great deal of my material comes from official sources, such as the Center for Disease Control and Prevention, the National Institutes of Health, the National Institutes of Allergy and Infectious Diseases and the New England Journal of Medicine. Thus my distracters cannot claim that I am using material that is not within the mainstream.

Pregnant Women NOT at Special Risk from Swine Flu
In the beginning, even before it was declared a level 6 pandemic by the World Health Organization (WHO), a group of "scientists" were sounding the alarm that this might indeed be the terrifying, deadly pandemic they had been expecting for over half a century.
Naturally, the vaccine manufacturers were doing all they could to fuel this fear and they were quietly making deals with WHO to be among the companies selected to manufacture the "pandemic" vaccine for the world. Being anointed by WHO would guarantee tens of billions in profits.
As the infection began to spread into the United States and then the rest of the world, its peculiar nature became obvious. Those born before 1950 seem to have a high degree of resistance to the infection and the disease seems slightly more pathogenic (disease causing) among those aged 25 to 49. Early on the official sources declared that pregnant women were at a special risk as compared to the seasonal flu.1 As we shall see later, this was a grand lie.

Initial Studies Show H1N1 NOT Dangerous or Highly Contagious
Once the pandemic had been declared, virologists tested the potency of this virus using a conventional method, that is, infecting ferrets with the virus.2 What they found was that the H1N1 virus was no more pathogenic than the ordinary seasonal flu, even though it did penetrate slightly deeper into the lungs. It in no way matched the pathogenecity of the 1917-1918 H1N1 virus. It also did not infect other tissues, and especially important, it did not infect the brain.
Next, they wanted to test the ability of the virus to spread among the population. The results of their tests were conflicting, but the best evidence indicated that the virus did not spread to others very well. In fact, an unpublished study by the CDC found that when one member of a family contracted the H1N1 virus, other members of the family were infected only 10% of the time -- a very low communicability.
This was later confirmed in a study of the experience of New York State, in which only 6.9% of the population contracted the virus, far below the 50% predicted by the President's Council of Advisors on Science and Technology.3 It is instructive to note that during the 1917-18 Swine flu epidemic the world infection rate was only 20%.4
They also predicted that 1.8 million people would need hospitalization and 300,000 would end up in the intensive care units (ICU). Further, they predicted that hospitals would be overwhelmed and that ICU units would not have enough beds to care for the sick and dying. Incredibly, they predicted that 90,000 people would die.

Much Fear Mongering
Not satisfied, they up the ante on fear mongering by peddling the idea that pregnant women were especially in danger as were small children. We were told daily that young, healthy people were dying, not just those with underlying medical conditions, such as heart disease, diabetes, cancer and other immune suppressive diseases. The Minister of Fear (the CDC) was working overtime peddling doom and gloom, knowing that frightened people do not make rational decisions -- nothing sells vaccines like panic.
These same dire predictions were extended to Australia and New Zealand, which began to show an increase in their reported cases of H1N1 and associated hospitalizations as they entered their fall and winter. Recently, two major articles were released in the New England Journal of Medicine, which analyzed the American hospitalization experience5 and the Australian/New Zealand ICU experience6. I will analyze these very interesting studies.
There is a dramatic disconnect between what the science is discovering about this flu virus and what is being broadcast over the media outlets. As you will see, this is a very mild flu virus infection for 99.9% of the population.

Australian and New Zealand Experience Prove U.S. is Wrong
As I stated, the countries in the southern hemisphere have already gone through their fall and winter, that is the seasons of peak flu infections. Epidemiologists and virologists have been surprised at how mild this flu pandemic has been in the Southern Hemisphere, with relatively few deaths and few hospitalizations in most areas.
The study reported in the New England Journal of Medicine on October 8, 2009, called the AZIC study, analyzed all ICU admissions in New Zealand and Australia, looking at a number of factors.6 Here is what they found.

ICU Hospitalizations
Out of a population of 25 million people, 722 were admitted to the intensive care unit (ICU) with a confirmed diagnosis of H1N1 influenza. Overall, 856 people were admitted with a flu virus, but 11.3% were a type A flu that was not subtyped and 4.3% were seasonal flu.
They also analyzed the number of people admitted with viral pneumonia and found the following:
Number of People Admitted to the Hospital each Year with Viral Pneumonia5
• 57 people in 2005
• 33 people in 2006
• 69 people in 2007
• 69 people in 2008
• 37 people in 2009
So we see that in 2009 they had 32 fewer people admitted with actual viral pneumonia. The CDC and other public health agents of fear like to imply that mass numbers of people are dying from "flu", that is, actual influenza viral pneumonia, when in fact, most are dying from other complications secondary to underlying health problems -- either diagnosed or undiagnosed.
They also found that the average person's risk of ending up in the ICU was one in 35,714 or about three thousandths of one percent (0.00285%), an incredibly low risk. When they looked at actual admission to the ICU, they found that it was people aged 25 to 49 who made up the largest number admitted. Infants from birth to age 1 year had the higher admission per population, and had a high mortality rate.

Majority of Children Respond POORLY to Flu Vaccine
It is interesting to note that babies this age respond poorly to either the seasonal flu vaccine or the H1N1 vaccine. One of the largest studies ever done, found that children below the age of 2 years received no protection at all from the seasonal flu vaccine.7
The recently completed study on the effectiveness of the new H1N1 vaccine reported by the National Institute of Allergy and Infectious Disease found that 75% of small children below age 35 months received no protection from the H1N1 vaccine and that 65% of children between the ages of 3 years and 9 years received no protection from the vaccine.

Flu Vaccine DOUBLES Risk of Getting H1N1
It is also important to view this in the face of the new unpublished Canadian study of 12 million people that found getting the seasonal flu vaccine, as recommended by the CDC and NIH, doubles one's risk of developing the H1N1 infection. It would also make the infection much more serious. So much for expert advice from the government.

Obese at Six Times Higher Risk from H1N1 Complications
As stated, most authorities agree that the H1N1 variant virus is quite mild as far as flu viruses go. The vast majority of people (99.99%) are having very brief and mild illnesses from this virus.
Keep in mind that when I am discussing numbers and risk, this does not intend to understate the devastation experienced by the people who are experiencing serious illness or even death.
Any death is a tragedy.
What we are discussing here is -- is the risk from this virus significant enough to justify draconian measures by the government and medical community? Should we implement mass vaccinations with a vaccine that is essentially an experimental vaccine, poorly tested and of questionable benefit?
The study also looked at the health risk of the people admitted to the ICU, but unfortunately did not look at the underlying health problems of those who died. We get a hint, since the American study did note that it was those over age 65 who were most likely to die, and that 100% of these individual had underlying health problems before they were infected.
One of the real surprises from this study, and the American study, was that one of the more powerful risk factors for being admitted to the ICU and of dying was obesity. Obese people are admitted 6x more often than those of normal weight. As we shall see, obesity played a significant role in the risk to children and pregnant women as well, something that has never been discussed by the media, the CDC or the public health officials.
This study found that 32.7% of those admitted to the ICU had asthma or other chronic pulmonary disease, far higher than the general population. The Australian and New Zealand study also had a large number of aboriginal patients and those from the Torres Strait. It is known that nutrient deficiencies are common in both populations, which means an impaired immune system.
Obesity is associated with a high incidence of insulin resistance and metabolic syndrome, both of which would increase one's risk of having a serious infection, even to viruses that are mildly pathogenic. (mild viruses).

H1N1 Vaccine is NOT Made the Same as Regular Flu Vaccine!!
I am really upset at the insistence by the CDC, medical doctors and the media that all pregnant women should be vaccinated by this experimental vaccine. The media repeats the manufacturers' mantra that this vaccine is produced exactly like the seasonal flu, when in fact it is not. Yes, they use chicken eggs, but the rest has been fast tracked and many shortcuts on safety procedures have been allowed.
There are 250,000 pregnant women in Australia and New Zealand combined. Only 66 pregnant women were admitted to the ICU, an incidence of 1 pregnant woman per 3,800 pregnant women or a risk of .03%.6 Put another way, a pregnant woman in these two countries can feel comfortable to know that there is a 99.97% chance that she will not get sick enough to end up in the ICU.

Pregnant Women NOT at Increased Risk, Obese Women Are!!
So, why did even 66 pregnant women end up in the ICU? As we shall see in the American study5, a significant number of these pregnant women were either obese or morbidly obese and most had underlying medical problems. The Australian/New Zealand study6 found that one of the major risk factors for pregnant women was indeed being obese and that obesity was associated with a high risk of underlying medical disorders.
They also found that death from H1N1 infection correlated best with increasing age, contrary to what the media says. They concluded the study with the following statement:
" The proportion of patients who died in the hospital in our study is no higher than that previously reported among patients with seasonal influenza A who were admitted to the ICU." 6
In fact, they report that of those infected with the H1N1 variant virus who were sick enough to be admitted to the ICU, 84.5 % went home and 14.3% died and that of those admitted with seasonal flu 72.9% were discharged and 16.2% died. That is, more died from the seasonal flu.

Recent NEJM Study of the American Experience
In the same Oct, 8th issue of the New England Journal of Medicine they reported on the American experience with the H1N1 variant virus.5 The study looked at data from 24 states with widespread influenza infection from April through June 2009. Remember, unlike most flu epidemics in the United States, this epidemic began early and by the end of September it was beginning to peak, with late October being the date it may begin to decline.
The study examined 13,217 cases of infection involving 1082 people who were hospitalized. Here is what they found:

Underlying Medical Conditions
Of the total hospitalized patients:
• 60% of children had underlying medical conditions
• 83% of adults had underlying medical conditions
They also found that 32% of patients had at least 2 medical conditions that would put them at risk. We are constantly told that it is the young adult aged 25 to 49 who is at the greatest risk. Note that 83% of these people had underlying medical conditions. This means that in truth only 292 "healthy" people out of 1082 in 24 states were sick enough to enter the hospital -- that is 292 healthy people out of tens of millions of people, not much of a risk if you do not have an underlying chronic medical problem.

Underlying Medical Conditions Risk Factor for H1N1 Deaths
When they looked at people over age 65 years of age, that is, the folks who are most likely to die in the hospital, 100% had underlying medical conditions -- all of them. So, there was not one healthy person over age 65 who has died out of 24 states combined.
What about the children, a special target of the fear mongering media and government agencies? This study found that 60% had underlying medical conditions and that 30% were either obese or morbidly obese.

A previous CDC study states that 2/3 of children who died had neurological disorders or respiratory diseases such as asthma.3 If we take the 60% figure, that means out of the 84 children reported to have died by October 24th, 2009, only 34 children considered healthy in a nation of 301 million people really died, not 84. It is also instructive to note that according to CDC figures, the seasonal flu last year killed 116 children.9
Remember, that is, 34 so-called healthy children out of a nation of 40 million children. In 2003 it was reported by the CDC that 90 children died from seasonal flu complications. Ironically, as shown by Neil Z. Miller in his excellent book -- Vaccine Safety Manuel -- once the flu vaccine was given to small children the death rate from flu increased 7-fold.10 Not surprising, since the mercury in the vaccine suppresses immunity.

Pediatric Flu Deaths by Year Made WORSE by Flu Vaccine
• 1999 -- - 29 deaths
• 2000 -- - 19 deaths
• 2001 -- - 13 deaths
• 2002 -- - 12 deaths
• 2003 -- - 90 deaths (Year of mass vaccinations of children under age 5 years)
• 2006 -- 78 deaths
• 2007 -- - 88 deaths
• 2008 - 116 deaths (40.9% vaccinated at age 6 months to 23 months)11
Parents should also keep in mind that this study, as well as the Australian/New Zealand Study found that childhood obesity played a major role in a child's risk of being admitted to the ICU or dying. This is another dramatic demonstration as to the danger of obesity in children and that all parents should avoid MSG (all food-based excitotoxin additives), excess sugar and excess high glycemic carbohydrates in their children's diets. This goes for pregnant moms as well.

Every Parent Needs to Know Other Vaccines INCREASE Risk of H1N1
One major factor being left out of all discussion of these vaccines, especially those for small children and babies, is the effect of other vaccinations on presently circulating viral infections such as the H1N1 variant virus. It is known that several of the vaccines are powerfully immune suppressing. For example, the measles, mumps and rubella virus are all immune suppressing, as seen with the MMR vaccine, a live virus vaccine.12, 13
This means that when a child receives the MMR vaccine, for about two to five weeks afterwards their immune system is suppressed, making them highly susceptible to catching viruses and bacterial infections circulating through the population. Very few mothers are ever told this, even though it is well accepted in the medical literature.
In fact, it is known that the Hib vaccine for haemophilus influenzae is an immune suppressing vaccine and that vaccinated children are at a higher risk of developing haemophilus influenzae meningitis for at least one week after receiving the vaccine.10,14 These small children receive both of these vaccines.
According to the vaccine schedule recommended by the CDC and used by most states, a child will receive their MMR vaccine and Hib vaccine at one year of age and both are immune suppressing.

At age 2 to 4 months, they will receive a Hib vaccine. Therefore at age 2 to 4 months, and again at age one year, they are at an extreme risk of serious infectious complications caused by vaccine-induced immune suppression. The New Zealand/Australian study found that the highest death in the young was from birth to age 12 months, the very time they were getting these immune-suppressing vaccines.6
The so-called healthy children and babies that have ended up in the hospital and have died may in fact be the victims of immune suppression caused by their routine childhood vaccines. We may never know because the medical elite will never record such data or conduct the necessary studies. Recall also that the seasonal flu vaccine, which is recommended for all children over the age of 6 months, each year, is also immune suppressing because of the mercury-containing thimerosal in the vaccine.15

Infants under the age of 3 receive mercury-free seasonal flu vaccines, but any child over the age of 3 will receive the mercury-containing flu vaccine year after year. (Each dose of seasonal flu vaccine typically containing 25 mcg of mercury.)
If parents allow their children to be vaccinated according to the CDC recommendations, that is 2 seasonal flu vaccines and 2 swine flu vaccines as well as a pneumococcal vaccine, that will increase the number of vaccines a child will have by age 6 years to 41. This amounts to an enormous amount of aluminum and mercury as well as intense brain inflammation triggered by vaccine-induced microglial activation.16

Risk of Serious Illness from the H1N1 Mutant Virus
Their survey of 24 states found that a total of 67 patients out of tens of millions of people ended up in the ICU. That is, only 6% of the people admitted to the hospital were so sick as to need intensive treatments. Of these 67 patients, 19 died (25%) and of these 67% had obvious underlying long-term medical illnesses. This means that only 6 patients out of tens of millions of people in 24 states that were considered "healthy" before their infection, had died. Is this justification for a mass vaccination campaign?
Of the 1082 hospitalized patients, 93% were eventually discharged recovered and only 7% died, a very low death rate. Their analysis of these cases concluded that those who died fell in three categories:
• They were older patients
• Antiviral medications were started 48 hours after the onset of the illness
• There was no correlation to having had seasonal vaccines
The last item is especially interesting because they assume that having had seasonal flu vaccine would have offered some protection -- it offered none.
What they did find was that none who died had been given antiviral medications (Tamiflu or Relenza) within 48 hours of getting sick. Those given the antiviral medications within the golden 48-hour period rarely died. Relenza is far safer than Tamiflu. This was the only factor found to correlate with survival of severely ill ICU patients.

What about the Danger to Pregnant Women? The American Experience
Our media is inundating the public with scare stories of the danger this virus poses to pregnant women. Most of us visualize the pregnant woman as being healthy, young and without underlying medical diseases. The study is quite revealing, but omits some very important factors.
We are told that pregnant women are 6x more likely to end up in the hospital than the general population. This figure is derived from the fact that it was estimated that pregnant women had a 7% greater chance of requiring hospital admission than did the general public at 1% (Even this is a far higher number than their own studies indicate -- actually it is a very small fraction of 1%).
Dr. Michael Bronze, a professor of internal medicine at the University of Oklahoma Health Sciences Center, writing for emedicine medscape.com (WebMD), states that the risk of a pregnant women being hospitalized with the H1N1 infection is 0.32 per 100,000 pregnant women (which is 1 in 300,000 pregnant women).17 One can safely say, based on the Australian/New Zealand experience (at the peak of their flu season) and the American data somewhere in the middle of their flu season, that pregnant women have about a 99.97% chance they will not become so sick as to require hospital care at any level.
The death rate of pregnant women who were admitted to the ICU was 7.7%, a fairly low figure for infectious ICU patients. Remember, most patients admitted to the hospital are admitted for hydration and are not that ill in terms of the infection itself.

Smoking and Obesity Increase Risk of H1N!
Now, most of us assume that these pregnant women are perfectly healthy as mentioned above, but the data shows something quite different. They found that greater than 30% of the pregnant women were either obese or morbidly obese, as did the Australian/New Zealand study. Of these, 60% had underlying medical conditions that put them at greater risk of overwhelming infections -- both viral and bacterial.
It is unfortunate that they did not enter any information on smoking, either by the mother or by anyone living in the household. It is known that smoking greatly increases ones risk of severe complications from any flu virus.18,19 This is for several reasons. One, smokers eat a much poorer diet than non-smokers.
Second, smoking destroys the cilia in the bronchial passageways that are essential for clearing mucus and debris -- thus increasing the risk of developing pneumonia.20 Finally, nicotine is a very powerful immune suppressant.21 The combined effect of all three is enough to land anyone in the ICU during even a mild flu season. Likewise, chronic smokers have low magnesium levels, which increase their risk of developing bronchiospasm that is resistant to normal drug treatments.22-24
They also failed to record possible illegal drug use, how many were living at poverty levels and how many were on prescription drugs known to suppress immunity or deplete nutrients essential for immune function. And, one must keep in mind, at this age, (age range of 15 to 39 years) many would have had numerous childhood vaccines and booster vaccines.

This was also not considered for obvious reasons. So, some critical information we all need to evaluate this "pandemic" is being excluded or purposely kept from us.

Bacterial Pneumonia and Swine Flu
The American study found that of the people admitted to the hospital, 40% were found to have X-ray evidence of pneumonia. Of these, 66% had pre-existing medical conditions, such as asthma, chronic obstructive pulmonary disease (COPD), immunosuppression for transplants or cancer or neurologic disorder.
We are not told how many were smokers or lived with smokers, again, something that puts people at great risk of having severe reactions to any infection. Smokers have much higher bacterial pneumonia rates every year. The CDC estimates that smokers have a 200% increased risk of flu virus complications as compared to nonsmokers.
The CDC released in the September 29 issue of the MMWR an analysis of the lung tissue from 77 fatal cases of H1N1 infection.25 Of these, 29% had a secondary bacterial infection -- pneumonia. This is an important study because the media and the CDC are telling adults they need to get a pneumococcal vaccine and that parents need to have their children vaccinated with the pneumococcal vaccine as well.
This adult study found that only half of the pneumonias were due to Streptococcus pneumoniae, the organism used in the vaccine. Half of the cases were due to other strains of streptococcus, staphlococcus or H. Influenza. Some 18% of the people had multiple organism cultured from their lungs.
It is important to note that they found that all of these autopsied patients had previous, serious medical problems prior to becoming infected with H1N1 variant and that not all bacteria were examined, meaning that even those with Strep pneumoniae could have had multiple infections, for which the vaccines would have offered no protection.
Parents should also know that the vast majority of pneumonias found in these infected children were not due to Strep pneumoniae, but rather Staph aureus. Again, the pneumococcal vaccine would have offered these children no protection.

Pregnant Women Given Vaccine Have Babies with More Health Problems
It has always been a principle of medicine that one should not vaccinate pregnant women, except in extreme cases, because the risk to the baby is too high. Recently, we have seen two examples of violation of this policy. When the HPV vaccine Gardasil was first released the CDC and the manufacturer (Merck Pharmaceutical Company) recommended that it be given to pregnant women.
Shortly after beginning this dangerous practice it was ordered halted because a number of women were losing their babies and babies were being born with major malformations.26
It is known that stimulating a woman's immune system during midterm and later term pregnancy significantly increases the risk that her baby will develop autism during childhood and schizophrenia sometime during the teenage years and afterward.27
Compelling scientific evidence also shows an increased risk of seizures in the baby and later as an adult.28 In fact, a number of neurodevelopmental and behavioral problems can occur in babies born to women immunologically stimulated during pregnancy.29-32
It is true that serious flu infections or E. coli infections during pregnancy are a major risk for all these complications, but a woman's risk of becoming infected, as we have seen, is a very small fraction of 1 %, yet they are calling for all pregnant women to be vaccinated with at least three vaccines, two of which contain mercury. There is also evidence to show that a large number of these women will gain no protection from the vaccine.
Dr. Bronze, quoted above, notes that animal studies have shown that vaccines harm unborn babies and that no safety studies have been done in humans. A recent study done by Dr. Laura Hewitson, a professor of obstetrics at the University of Pittsburg Medical Center, found that a single vaccine used in human babies, when used in newborn monkeys, caused significant abnormalities in brainstem development.33 This mass vaccination program for H1N1 variant virus will be the largest experiment on pregnant women in history and could end as a monumental disaster.

How Many Cases are Really Swine Flu?
CBS, to their credit, conducted a three-month long investigation that indicates that we have all been hoodwinked by the governmental "protection" agency called euphemistically, the Center for Disease Control and Prevention.34
What they tried to learn from the CDC was just what percentage of the "flu cases" were in fact H1N1. The CDC did all they could to protect this information and only after filing a Freedom of Information request and waiting 2 months did they finally release the data. Now we know why they wanted it protected and why they stopped testing for the H1N1 virus in late July.
The data revealed that in fact very few cases reported as swine flu were in fact H1N1 variant virus. CBS examined the data in all 50 states. What they found, for example, was that in Georgia only 2% of reported cases were H1N1 (97% negative for H1N1); in Alaska only 1% of reported cases were H1N1 (93% negative for flu and 5% seasonal flu) and in California only 2% of reported cases were H1N1 with 12% being other flu viruses and 86% negative for flu.
A recent release from the CDC found that their survey reported that of 12,943 specimens tested from around the country, only 26.3% of cases tested positive for H1N1 variant virus, but that 99.8% of the specimens tested positive for some type of other flu virus, most of which were regular seasonal flu.
The CDC has now changed all data reporting on the flu effects. They did this by stopping viral typing and subtyping and rolled back all previous numbers based on prior data. The new system for collecting data now started on August 30th, 2009.
The only reason I can imagine they did this is that the prior data was clearly demonstrating that the H1N1 variant virus was causing a very mild illness in most people (99.99%) with fewer hospitalizations, fewer cases of pneumonia and fewer deaths for all ages and groups than the prior seasonal flu in past years. This was true for the United States and the Southern Hemisphere, which has gone though the worst of its flu season.
Now that they are no longer typing the virus, they can attribute all cases of pneumonia, hospitalizations and deaths to H1N1, even though the majority of cases appear to be from a long list of other causes. In fact, they can classify many cases of primary pneumonia as caused by H1N1.

Actually LESS Flu Deaths this Year
One must always keep in mind that the CDC has told us that 36,000 people die every year from influenza and influenza-related complications. Thus far, we have seen (accepting their data) about 900 deaths and 21,829 cases of pneumonia.
This is far below the 36,000 figure. In fact, perhaps we should be breathing a sigh of relief that 35,000 fewer people have died this year from flu-related disorders. This would go down on record as the fewest flu-related deaths in recorded history.

In fact, worldwide, according to CDC and WHO data, far fewer people have died form H1N1 than any seasonal flu in the past. This graph from the CDC showing the "Pneumonia and Influenza Mortality for 122 US Cities" also show that, so far, this year's flu mortality is far below that of 2008.

In fact, worldwide, according to CDC and WHO data, far fewer people have died form H1N1 than any seasonal flu in the past. So, one must ask, why is the government and their handmaidens, the media, fueling this panic mentality? Why are we once again talking about mandatory vaccination for every man woman and child in the nation?
And I can assure you that soon we will hear an announcement that the adjuvant MF-59 or ASO3 (squalene) will be needed to save lives.
Now, if the CBS data forced from the files of the CDC is correct, why are so many people dying from this flu? The answer is that no greater number are dying now, for any age group, sex or state of pregnancy than have died in any previous flu outbreak.
By statistical slight of hand they have created this pandemic and continue to do so. One cannot foretell the future, but based on the data now available from the United States, Canada, Europe and the Southern hemisphere, there is no justification for the fear mongering by the media and government agencies.
It is accepted that the cognitive portions of the human brain work less well under two conditions -- fear and anger. Those who have survived deadly situations or who make their living surviving such situations tell us that controlling our fear is the most important thing in survival. More people have died from making poor decisions while overwhelmed by fear than have died as a result of the situation itself.
I am reminded of the poor elderly person who died several years back waiting in a very long line for a flu vaccine in the sweltering heat. It seems she passed out and struck her head on the hard asphalt.
She was standing in that line for hours because the CDC announced that that year's flu was going to be especially deadly for the elderly and there was a shortage of vaccine. As it turned out, that year they picked the wrong virus to make the vaccine -- so it was not only a dangerous vaccine, it would have given her no protection. But then, the vaccine manufactures got their blood money.

What Do They Not Know About This Vaccine?
Insurance companies in Australia would not insure doctors who gave the vaccine because it was a fast tracked vaccine and therefore experimental. They felt that the danger of complications was far too high to risk insuring the doctors. Unlike doctors in America, they did not have a special law that Congress would pass to insulate them from liability should severe complications arise from the vaccine.
It is also of special interest to note that tens of millions of babies were vaccinated with the Hepatitis B vaccine (providing no protection to the babies) only to learn later that it is linked to a 310% increased risk of developing multiple sclerosis.36 One has to ask -- What else do they not know about this vaccine?
Well, it turns out a lot.
Years after it was added to the recommended vaccine schedule, it was linked to a terrifying disorder called macrophagic myofascitis, which in children is associated with a severe dementia-like illness.
Then we have the case of the Gardasil vaccine. Millions of young girls were vaccinated and within several months pregnant women were losing their babies, babies were being born deformed, several of these very young girls died and a growing number have had serious reactions to the vaccine. Once again we have to ask -- What else do they not know about this vaccine?
Vaccine Safety Testing Only Done for ONE Week
Now we are being told that this new fast tracked, poorly tested vaccine is very safe and effective. The results of the testing on this vaccine were reported in the New England Journal of Medicine.39 It is instructive to learn that the tests for safety and to assess complications lasted only 7 days after the vaccine, an incredibly short period of follow-up. Gullian Barre paralysis can occur even months after a vaccine as can seizures, behavioral problems and neurodevelopmental disorders in children.
It is interesting to note that the authors of the safety study for our swine flu vaccine were all employees of the maker of the vaccine CSL Biotherapeutics and eight held equity interest in the company.39 This admission is part of the disclosure policy of the New England Journal of Medicine.
It is always important to keep in mind when you hear about this vaccine being safe and produced just like the seasonal flu vaccine -- What else do they not know about this vaccine that they will discover months, years or even decades later. Once injected with the vaccine and you develop a complication there will be little that can be done to treat the life-long degenerative disorder it produces. You will just be a sad story on 60 minutes.

Well, that is nicely presented and along with Dr. Mercola and Dr. Blaylock, there are others who stand on this side of the issue.

The Flip Side of the coin: The CDC

The position of the Centers for Disease Control and Prevention and their recommendations regarding flu vaccinations.

Every flu season has the potential to cause a lot of illness, doctor's visits, hospitalizations and deaths. CDC is concerned that the new H1N1 flu virus could result in a particularly severe 2009-2010 flu season. Vaccines are the best tool we have to prevent influenza. CDC recommends vaccination against seasonal and 2009 H1N1 flu to prevent the influenza this year. The seasonal flu vaccine is unlikely to provide protection against 2009 H1N1 influenza. The 2009 H1N1 vaccine is not intended to replace the seasonal flu vaccine - it is intended to be used along-side seasonal flu vaccine.
CDC's Advisory Committee on Immunization Practices (ACIP), a panel made up of medical and public health experts, met July 29, 2009, to make recommendations on who should receive the 2009 H1N1 vaccine While some issues are still unknown, such as how severe the flu season, the ACIP considered several factors, including current disease patterns, populations most at-risk for severe illness based on current trends in illness, hospitalizations and deaths, how much vaccine is expected to be available, and the timing of vaccine availability.
The groups recommended to receive the 2009 H1N1 influenza vaccine include:
• Pregnant women because they are at higher risk of complications and can potentially provide protection to infants who cannot be vaccinated;
• Household contacts and caregivers for children younger than 6 months of age because younger infants are at higher risk of influenza-related complications and cannot be vaccinated. Vaccination of those in close contact with infants younger than 6 months old might help protect infants by "cocooning" them from the virus;
• Healthcare and emergency medical services personnel because infections among healthcare workers have been reported and this can be a potential source of infection for vulnerable patients. Also, increased absenteeism in this population could reduce healthcare system capacity;
• All people from 6 months through 24 years of age
o Children from 6 months through 18 years of age because cases of 2009 H1N1 influenza have been seen in children who are in close contact with each other in school and day care settings, which increases the likelihood of disease spread, and
o Young adults 19 through 24 years of age because many cases of 2009 H1N1 influenza have been seen in these healthy young adults and they often live, work, and study in close proximity, and they are a frequently mobile population; and,
• Persons aged 25 through 64 years who have health conditions associated with higher risk of medical complications from influenza.
2009 H1N1 vaccination has begun but initial supplies are small. More doses are expected for shipment each week. We ask members of the public who want to receive this vaccine to be patient as this program expands and more vaccine becomes available. While we expect there will be enough vaccine available for anyone who wishes to receive it, the ACIP also made recommendations regarding which people within the groups listed above should receive the first available doses. For more information see the CDC press release CDC Advisors Make Recommendations for Use of Vaccine Against 2009 H1N1.
Once the demand for vaccine for the prioritized groups has been met at the local level, programs and providers should also begin vaccinating everyone from the ages of 25 through 64 years. Current studies indicate that the risk for infection among persons age 65 or older is less than the risk for younger age groups. However, once vaccine demand among younger age groups has been met, programs and providers should offer vaccination to people 65 or older.

 - - - - -

So, there you have it. For you, which side of the coin proves to you that they have presented the information Beyond A Reasonable Doubt?

Choose wisely.

 QED

In addition to Vitamin D, 2,000 IU to 4,000 IU/day, keep these tips in mind.

This was just sent to me by a friend, and I hope this blog entry will be a good way to pass this along to my friends:

Dr. Vinay Goyal is an MBBS, DRM, DNB (Intensivist and Thyroid specialist) having clinical experience of over 20 years. He has worked in institutions like Hinduja Hospital , Bombay Hospital , Saifee Hospital , Tata Memorial etc. Presently, he is heading our Nuclear Medicine Department and Thyroid clinic at Riddhivinayak Cardiac and Critical Centre, Malad (W).

The following message given by him, I feel makes a lot of sense and is important for all to know

The only portals of entry are the nostrils and mouth/throat. In a global epidemic of this nature, it's almost impossible to avoid coming into contact with H1N1 in spite of all precautions. Contact with H1N1 is not so much of a problem as proliferation is.

While you are still healthy and not showing any symptoms of H1N1 infection, in order to prevent proliferation, aggravation of symptoms and development of secondary infections, some very simple steps, not fully highlighted in most official communications, can be practiced (instead of focusing on how to stock N95 or Tamiflu):

1. Frequent hand-washing (well highlighted in all official communications).

2. "Hands-off-the-face" approach. Resist all temptations to touch any part of face (unless you want to eat, bathe or slap).

3. *Gargle twice a day with warm salt water (use Listerine if you don't trust salt). *H1N1 takes 2-3 days after initial infection in the throat/ nasal cavity to proliferate and show characteristic symptoms. Simple gargling prevents proliferation. In a way, gargling with salt water has the same effect on a healthy individual that Tamiflu has on an infected one. Don't underestimate this simple, inexpensive and powerful preventative method.

4. Similar to 3 above, *clean your nostrils at least once every day with warm salt water . *Not everybody may be good at Jala Neti or Sutra Neti (very good Yoga asanas to clean nasal cavities), but *blowing the nose hard once a day and swabbing both nostrils with cotton buds dipped in warm salt water is very effective in bringing down viral population.*
Neti pots and sinus rinse kits are available at the drug store and relatively inexpensive....under $15.

5. *Boost your natural immunity with foods that are rich in Vitamin C (Amla and other citrus fruits). *If you have to supplement with Vitamin C tablets, make sure that it also has Zinc to boost absorption.

6. *Drink as much of warm liquids (tea, coffee, etc) as you can. *Drinking warm liquids has the same effect as gargling, but in the reverse direction. They wash off proliferating viruses from the throat into the stomach where they cannot survive, proliferate or do any harm.

Again, make sure you have enough Vit D, at locations above Atlanta, GA, in the Winter, there is not enough sunlight to help you in this regard.

To be continued . . .

I'm happy to see that you took the time to read this short blog entry.

The "why" you did, might be answered in this short paragraph from an interesting paper:

"The latest research explains phenomena such as clairvoyance, intuition, spontaneous and remote acts of healing, self healing, affirmation techniques, unusual light-auras around people (namely spiritual masters), mind's influence on weather-patterns and much more. The Russian scientists also found out that our DNA can cause disturbing patterns in the vacuum, thus producing magnetized wormholes! Wormholes are the microscopic equivalents of the so-called Einstein-Rosen bridges in the vicinity of black holes (left by burned-out stars). These are tunnel connections between entirely different areas in the universe through which information can be transmitted outside of space and time. The DNA attracts these bits of information and passes them on to our consciousness..."

Analogous to tuning a radio receiver, the trick is to recognize the station!

To be continued . . .

I would say that this is entirely accurate from what I have read. Something to keep in mind along with frequent hand washing, healthy diet and lifestyle to keep the immune system up, and avoidance of being in the line of cough, etc.

 Check this out, article from Medscape today:

 H1N1 Influenza Reverses Seasonal Flu Mortality Trend

Daniel J. DeNoon

October 20, 2009 - H1N1 influenza has turned flu death statistics upside down, the US Centers for Disease Control and Prevention (CDC) confirmed today.

In a normal flu season, 90% of deaths are in elderly people. But since September, 88% of deaths have been in people under age 65 - with almost a quarter of the deaths in young people under age 25.

"It is almost completely reversed. Nearly 90% of our fatalities are occurring in people under 65," CDC respiratory disease chief Anne Schuchat, MD, said at a news conference. "This illustrates this H1N1 virus is disproportionally affecting the young."

As might be expected from the death toll, most people hospitalized with severe H1N1 swine flu are young. Surveillance data from 27 states show that more than half of swine flu hospitalizations - 53% - are in people under age 25. Only 7% of people hospitalized with swine flu are elderly.

While the majority of severe H1N1 swine flu cases are in people with conditions that put them at risk of flu complications, not all these conditions are severe. Well-treated asthma, for example, is common. And pregnancy isn't an illnesses at all. Yet the risk is there.

"Completely healthy pregnant women are coming down with horrible, horrible illnesses - and, tragically more deaths," Schuchat said. "And some conditions like asthma which is well controlled. So even if you have diabetes that's well controlled, if you have asthma that's well controlled, we want to you think of yourself as a higher risk and recommend that you be vaccinated."

H1N1 Swine Flu Vaccine Rollout Still Bumpy

If you're thinking of taking the CDC's advice and getting the H1N1 swine flu shot (or sniff), it's time to start making plans.

The flu.gov web site has a flu vaccine finder that links to each state. Most states have detailed information that show which providers near you will be offering the H1N1 swine flu vaccine.

The first vaccines are going to health care workers and people at risk of flu complications. So far, about 13 million doses have been available to states, more than half in the form of flu shots. States have placed orders for about 11 million of those doses; those orders are being filled quickly.

Spread nationwide, that means not everyone who should get the vaccine will be able to get it this week, or even next week. Availability is increasing, but it's unlikely that the vaccine will reach everyone who wants it before the end of November.

Will that be too late? The CDC's mantra is, "It's too early to say it's too late."

Schuchat points to what happened in 1957, when pandemic flu hit hard in the early fall - and was followed by a second wave of flu.

"In 1957, the pandemic hit early around September/October, like what we're seeing here. They had another big wave after the first of the year," Schuchat said. "And I think we have an opportunity right now to try to limit the disease and to protect as many people as we can with the vaccine as it becomes available."

Meanwhile, Schuchat said, the CDC is not planning to stop its H1N1 swine flu effort when all 250 million doses of the vaccine have been delivered.

"At CDC, we're planning a long response. We don't want to let our guard down too soon on this," she said.

SOURCES:

Anne Schuchat, MD, director, National Center for Immunization and Respiratory Diseases, CDC, Atlanta.

It is something to keep in mind for those who want to avoid any type of flue vaccine shot and many of my other blogs address both sides of the flu-shot issue. However, NY may have ducked the bullet of forced vaccinations. 

It is time to remember suggestions about what to do if you are forced to take the shot and have doubts about its saftey~

 This is from today's Merilian Newletter

The Following was composed by Dr. Russell Blaylock as a method to reduce autoimmune reactions to the flu vaccines only. Do not use this if you have the flu itself. These are just general observations and not medical advice. You should work with your doctor for a specific program.

Treatment for Toxic Vaccine Exposure

1.

Place a cold compress on the site of the injection immediately after the injection and continue this as often as possible for at least two days. If symptoms of fever, irritability, fatigue or flu-like symptoms reoccur -- continue the cold compresses until they abate. A cold shower or bath will also help.
2.

Take fish oils -- I recommend the Norwegian fish oil made by Carlson Labs -- it has the correct balance of EPA and DHA to reduce the cytokine storm. The dose is one tablespoon a day -- if severe symptoms develop -- two tablespoons a day until well and then switch to one tablespoon a day. Children -- one teaspoon a day.
3.

Curcumin, quercetin, ferulic acid and ellagic acid as a mixture -- the first two must be mixed with extravirgin olive in one teaspoon. Take the mix three times a day (500 mg of each)
4.

Vitamin E (natural form) 400 IU a day (high in gamma-E)
5.

Vitamin C 1000 mg four times a day
6.

Astaxanthin 4 mg a day
7.

Zinc 20 mg a day for one week then 5 mg a day
8.

Avoid all immune stimulating supplements (mushroom extracts, whey protein) except beta-glucan -- it has been shown to reduce inflammation, microglial activation and has a reduced risk of aggravating autoimmunity, while increasing antiviral cellular immunity.
9.

Take a multivitamin/mineral daily (one without iron -- Extend Core)
10.

Magnesium citrate/malate 500 mg of elemental magnesium two capsules three times a day
11.

Vitamin D3:
1.

All Children -- 5000 IU a day for two weeks after vaccine then 2000 IU a day thereafter
2.

Adults -- 20,000 IU a day after vaccine for two weeks then 10,000 IU a day thereafter
3.

Take 500 mg to 1000 mg of calcium citrate a day for adults and 250 mg a day for children under age 12 years.
12.

Avoid all mercury-containing seafood
13.

Avoid omega-6 oils (corn, safflower, sunflower, soybean, canola and peanut oils)
14.

Blenderize parsley and celery and drink 8 ounces twice a day
15.

Take Jatoba tea extract (add 20 drops in on cup of tea) one day before the vaccine and the twice a day thereafter. (you can get it at www.iherb.com/Amazon-Therapeutics-Jatoba-1-oz-30-ml/14429?at=0 ) It is inexpensive.

Will This Vaccine Be Tested?

According to Anthony Fauci, director of the National Institutes of Allergy and Infectious Diseases, 5 tests are planned. It is not clear as to the use of the squalene adjuvants, ASO3 and MF-59.

Because of concerns raised, the FDA is now hedging. Independent studies of squalene used as a vaccine adjuvant indicates that it is associated with a very high incidence of autoimmune diseases, such as an MS-like neurological syndrome, rheumatoid joint disease and especially Lupus.

The developer of MF-59 is Chiron pharmaceuticals, which was purchased by Novartis pharmaceutical company, who will be the main supplier of the swine flu vaccine for the world. According to Dr. Fauci, testing in both children and adults will be without this adjuvant and he admits that we have no data on the safety in children.(See Nature Vol 460/30 July 2009, p 562 for the interview.)

There are 5 tests scheduled for safety before mass vaccinations will resume. I looked up on clinicaltrials.gov the actual studies being done. It is instructive to note that the only studies actually being done do not contain any adjuvant (the immune booster) either for babies or adults. Yet, when the mass vaccinations begin, the vaccines will have adjuvant added, possibly squalene.

The real irony here is that this is the same bait and switch game they played in the 1976 swine flu vaccine disaster.

They tested one vaccine and gave a different one during the mass vaccinations.

Here we go again. Over 500 people were paralyzed with Guillain Barre disorder. The incidence was much higher, because it was not a reportable disease. And over 300 people died, which is also a very low figure.

Dr. Fauci admits that they have no idea what will happen when they mix the three viruses from the vaccines together or when they are given sequentially. When he was asked if the results of the studies would be reviewed by the health authorities, he answered, "yes, except for those done by the Novartis company."

He justified this secrecy by saying that Norvartis had a very advanced testing system, which was done "in-house" -- that is, in secrecy.

It is also important to appreciate that this vaccine has been fast-tracked, meaning that many of the usual safety precautions used to prevent contamination of the vaccines will be overlooked by the regulatory agencies.

According to a number of studies, vaccine contamination is widespread, with vaccines containing pestivirus, mycoplasma, viral fragments, DNA fragments and bacterial components, all of which can produce chronic systemic disorders, cancer, neurologic diseases and even slow brain degeneration.

...Behind the push to vaccinate the entire population are the pharmaceutical makers of the vaccines, who are working in conjunction with the government to make the vaccine mandatory.

Homeland security and FEMA are pushing for forced vaccinations and the medical experts, virologists and epidemiologists are calling for calm and resorting to voluntary vaccination only. The former have links with the vaccine manufacturers via political contacts. A great deal of money will be made by the manufacturers, should forced vaccinations be mandated.

For more information and to view the original article, please click here!

For other facts, please visit http://bestbiodefense.com/vaccine.htm

More articles on Dangerous Swine Flu Vaccination

Health Officials Admit Fast Tracked H1N1 Vaccines Will Not Be Tested for Safety

 Dr. Blaylock is a board certified neurosurgeon, author and lecturer. He attended the LSU School of Medicine in New Orleans and completed his general surgical internship and neurosurgical residency at the Medical University of South Carolina in Charleston, South Carolina. During his residency he ran the neurology program for one year and did a fellowship in neurosurgery after his residency. For the past 25 years he has practiced neurosurgery in addition to having a nutritional practice. He recently retired from both practices to devote full time to nutritional studies and research. Dr. Blaylock serves as the medical consultant for the Fluoride Toxicity Research Collaborative. He was recently awarded the Integrity in Science award by the Westin Price Foundation. 

Presently, Dr. Russell Blaylock is a visiting professor in the department of biological sciences at Belhaven College in Jackson, Mississippi. At present he is a member of the American Association of Physicians and Surgeons, the American Nutraceutical Association, the International and American Associations of Clinical Nutritionist, American College of Nutrition, American Association Health Freedom, National Health Federation, American Academy of Anti-Aging Medicine and the Price-Pottenger Nutrition Foundation. He was recently appointed as a member of the Scientific Advisory Panel of the Life-Extension Foundation. For more information please visit www.russellblaylockmd.com

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Chapter 1

Divine Intervention-

God Giveth, God Taketh

Away: Mrs. Ibarra's Gift

Hold off your hands... and know that I am God.

-Psalm 46:10

In operating room 3, the only audible sounds were the soft wheeze of the anesthesiologist's respirator and the occasional soft click of instruments being passed between rubber-gloved

hands. Through the lenses of the operating microscope, I could clearly see the magnified stereoscopic images of Mrs. Ibarra's brain tumor, a large peach-sized outgrowth of the dura (a thin leather- like membrane) that covers the brain. This benign lesion was behind this 72-year-old woman's right eye; total removal would be a cure. For the past four hours I had been slowly, but steadily, removing the growth piecemeal-the hard way-with electric forceps and wire-cutting loops (small circular heated wires on the end of a plastic wand). As the loop sliced through the tumor, smoke and vapor obscured the field. My assistant, Dr. Peterson,sucked the smoke away with his metal suction tip. I longed for the ultrasonic aspirator that I had used in training; it would have made this job much easier.

Four hours had elapsed since Mrs. Ibarra's surgery began and I had one remaining portion of tumor left-a small, scraggly clump of cells at the bottom of the operative field hardly bigger than a pencil eraser.

"Just one little piece remaining," I told Dr. Peterson. He could see it too; he had an excellent view through his observer's eye­pieces. I easily sliced through the remaining tumor with the cut­ting loops and then suddenly, like an explosion, the field of view turned bright red.

"Suction!"

Eventually, through the process of suctioning away the ob­scuring blood, I came to a startling realization: the last small piece of tumor had invaded the carotid artery, the major artery supplying the right side of the brain. The overlying tumor cells hid this fact from me. Removal of that final portion had taken out a section of the artery's wall; without applying pressure to seal it off, the vessel would bleed profusely. I initiated repair of the vessel.

"Silver clip," I commanded. The nurse handed me long- handled clip-applying forceps.

Because of the invasion by the tumor, the clips would not take a solid grasp; no matter how many times I tried, they didn't work.

Dr. Flower, the anesthesiologist, said, "Are you going to get it? I've given her three units of blood.

Divine Intervention-God Giveth, God Taketh

The carotid artery has cut loose; I have to repair the arterial wall," I replied. Dr. Flower returned to his position at the head of the table behind the drapes.

"Suture, eight zero," I requested as I continued to peer into the microscope lenses. I began the slow and tedious process of sewing the vessel, but was confronted with another problem: the walls of the artery were softened by the tumor, and the suture would not take a solid grip but merely pull through when tightened, causing further injury to the vessel.

I repeated my efforts with clips and sutures while minutes multiplied. I had spent four hours trying to stop the blood loss. Dr. Flower replaced the woman's entire blood volume with do­nor blood; she was now a candidate for developing dreaded com­plications that can result after massive blood transfusion. My patient had been under general anesthesia for more than eight hours and had received 10 pints of blood. I was nowhere close to being finished. It appeared as through I were about to experience my first loss of a patient during surgery, and would be intro­duced to the feeling of having caused a patient's death. I should have foreseen the possibility that the last remaining piece of tu­mor was a sticky wicket and just left it alone.

All eyes in the operating room were on me. All ears waited. What was I to do? I had exhausted all of my options... all but one! I never thought of praying before this day. Although I had been an acolyte in the Episcopal Church as a youth, I had no interest in religion. Having trained in physics, I doubted the sig­nificance of prayer and was skeptical about the existence of God. I had been too busy with academics during the past 21 years to allow time for religion. But today I prayed with sincerity. I would have fallen to my knees if I had not been scrubbed in and sterile.

I felt incapable of saving the life of this patient. I took a deep breath and exhaled slowly. I needed to connect with that force. As I looked through the scope, I prayed silently: If there is a God, a higher power, then I need your help. It is not Mrs. Ibarra's fault that she may die. I have done all that I can do. I am asking for help. Don't let her die on the table; help me to repair this damaged artery. Please!

I took a second deep breath... and went back into the breech.

"Suture," I said. For what seemed to be the umpteenth time, the scrub nurse obeyed my request. Once more, I carefully tried to approximate the torn vessel's walls.

"Clip," I said. She handed me clip after clip until, after 15 minutes, I had applied several clips and snippets of suture, trying to bring the remaining walls of the artery together without oc­cluding the vessel. To my amazement, the operative field remained as dry as a bone! No bleeding. I was pleasantly stunned. I'd done nothing out of the ordinary during that last 15 minutes except to repeat the previous attempts of the past few hours. But this time, the sutures and clips held firm. The prayer-the silent plea-had worked. The damaged artery showed no sign of bleed­ing. Everything at the base of the skull looked perfect.

"We're out of here," I told the scrub nurse and my assistant. All that remained was to close the operative site. This took 45 minutes, but it was a walk in the park compared to the ordeal I had faced over the past nine hours. Now, believing that my prayers had produced the miracle, I put forth another silent request: I have one more favor to ask. Please do not let her be comatose. Let her wake up and heal quickly. Do not let her become stroked out and paralyzed, but instead let her speech and strength be normal.

Divine Intervention-God Giveth, God Taketh

Let her come out of this in the best possible way. If you do this, I'll be as good a person as I can possibly be.

When helping to move her from the operating table for the trip to the Intensive Care Unit, Dr. Flower said, "You know, you have to learn that you can't make ‘good enough' better."

This case taught me that there is a higher power. It had seemed to flow through me when called upon. Was this the God who created us in His image? Alternatively, was it a force, an energy that is available when summoned to supercharge our meager hu­man efforts? At the time, I was unsure just what to call it. It was there waiting for my call, and when asked, it came to my assis­tance. Although signs pointed to God, a nagging question both­ered me. Was it something within me that required the slow, deep breathing and mental refocusing for its activation? What­ever the mechanism, it was now a moot point-Mrs. Ibarra was going to at least make it to the ICU and I would be forever thankful. Now if she could just pull through intact, I would be the second-happiest person on the island.

Mrs. Ibarra not only survived the surgery, but she healed quickly with little neurological sequelae. She was discharged in seemingly normal condition one week later. Besides ptosis (a slight droop) of her right eyelid, she had a second problem. I found out about it three months after surgery when she came to my office for a final post-operative checkup.

"How is your eye?" I asked.

"Oh about the same, doc," she replied, "I've learned to live with it, and it's not bad at all. But I have a problem. My husband will not give me enough sex!" She smiled at me, and I smiled back. That was a great complaint for a woman in her seventh decade of life.

"I don't think I can help you with that," I replied. "Are there any other physical problems?"

"Not really. Say, I have something for you, doctor." She pulled a large piece of lacquered wood from her shopping bag. On it were two engraved Japanese kanji. The patient, however, was from the Philippines. I was confused. The Japanese characters must be of special importance.

"What is this?" I asked. "What does it say?"

"Oh, I don't really know, I'm not Japanese. But when I found it, I had the feeling that somehow, in some way, doctor, it was for you. This is what you need."

"Well, thank you very much. I will treasure it and think of you often."

She smiled again, and I returned her smile in kind.

"This is your last visit with me, Mrs. Ibarra. You have done well; the scan we did last week reveals no further tumor growth; in fact, the scan was normal. I will recommend to your doctor that he perform a follow-up scan in six months to confirm that everything is still okay. If you have a question or would like to see me, please call anytime."

Later on, I asked a few of my surgical colleagues if they had experienced a case where they could not stop the bleeding. The response was uniformly, "Yes, why?"

"What did you do?"

And again, the reply was always the same: "What can you do?"

At the end of the year, I hosted a Christmas party at my office. During the festivities, I pulled my friend Dr. Nagashima aside and showed him the calligraphy that Mrs. Ibarra had given me. "What does that mean?" I asked.

He peered at it for a moment through his thick eyeglasses.

"Heiwa," he said.

"Roughly translated, it means peace."

And indeed, as a result of my intraoperative prayer, Mrs. Ibarra survived. Now that I knew a higher power was with me, I was at peace, confident that I could over-come any difficulties either on my own or with help, on those rare occasions when good enough truly needs to be made better.

Every life has dark tracts and long stretches of somber tint, and no representation is true to fact which dips its pencil only in light, and flings no shadows on the canvas.

-Alexander MacLaren

I continued to bask in the blissful feeling of serenity that resulted from the prayerful experience that ostensibly saved the life of Mrs. Ibarra. I augmented my budding conviction in the unseen spiritual world (and a higher power) when I became "born again" at a local Pentecostal church.

Medicine, Miracles, and Manifestations

I'd connected with the uni­versal force (that I now called God), and felt as if I could ask it to aid me at any time. I became filled with the Holy Spirit. Time passed, until an otherwise routine day changed dramatically into one of the saddest days of my life. It was an experience that caused me to rethink my recent religious conversion and to search for another answer to the mysteries of life and death.

Sara DeAngelo came with her parents for a consultation. Nine years old, she radiated great beauty and spirit. Her smile was adorable and by her appearance and manner, I could tell that one day she could potentially be a fashion model. She had been blessed with great looks. I was struck by her natural charm and her soft- spoken, friendly nature, seemingly years beyond her age. Her parents worked in the sugar industry and had recently moved to Hawaii. The girl had a ventriculoperitoneal shunt-a bypass tube with a valve that drains cerebrospinal fluid (CSF) from the brain to the abdomen to treat hydrocephalus (enlargement of the fluid spaces of the brain). The shunt was performed in the first days of her life. There had been no problems with the device since its insertion, but in time, she would outgrow the length of tubing in her abdomen and it would have to be replaced. Shunts also can become obstructed.

Shunts come in many varieties. The most common type is a flexible silicone catheter that is inserted into the brain. This is done by placing a small hole in the back of the head and inserting the catheter into the ventricular fluid system deep within the brain. A valve mechanism allows one-way flow of CSF from brain to abdomen. Tunneled under the skin, a discharge tube allows drainage into the abdominal cavity. Babies born with "water on the brain" suffer from CSF buildup when egress from the ventricular cavities of the brain is blocked. A pressure-relieving procedure must be performed quickly. Sara had such a shunting procedure after birth and had done well.

Divine Intervention-God Giveth, God Taketh

Sara conversed with me easily and submitted to a neurologi­cal examination without duress. Her parents were pleased as they observed our interaction, and at the end of the consultation they requested that I be available should the shunt require surgical treatment. I agreed and told them how to contact me in case of emergency. I scheduled an X-ray to estimate the remaining length of tubing. As a result, I determined that she could grow a few more inches in height before modification would be necessary. I admired this little girl and mused about someday having a child of my own as sweet as Sara DeAngelo.

Everything stayed quiet for many months. Then one day, the emergency room called. Sara had suddenly become seriously ill with complaints of severe headache and came to the emer­gency department for treatment. A CAT scan showed obstruc­tive hydrocephalus with her ventricular system under high pressure. The shunt was blocked. I arrived at the hospital within minutes to find the mother holding her retching child over a sink in the X-ray department, suffering from the increased pres­sure in her head that, if untreated, would soon lead to brain her­niation as pressure forced brain tissue through the opening at the base of the skull. Coma and death would quickly follow. My evaluation showed the shunt to be occluded at the valve; I planned to insert a new system. I explained the procedure and its risks to the parents and they requested that surgery be done. Within the hour, I was scrubbing for surgery.

Medicine, Miracles, and Manifestations

In the operating room I glanced at the monitor; her respira­tory and heart rates were normal. The anesthesiologist waited for me to begin. I put on gown and gloves and went to the table.

"Knife," I said. The nurse gave me the necessary scalpel and I opened the old incision, disconnected the valve and-suddenly, without warning, the ventricular catheter fractured and disap­peared into the brain.

"Damn it!" I exclaimed, perhaps a little too loud.

It had been old and brittle. To retrieve it could cause injury to the brain and might stir up bleeding that could be difficult or impossible to control. It was better to let it float forever within the ventricular chamber. I inserted a new system without diffi­culty and made sure that it properly drained the fluid drop by drop. I closed both incisions and applied sterile dressings. Sara went to recovery and then to the pediatrics unit, her room di­rectly across from the nursing station. The nurses would keep a close eye on her. Sara's father planned to spend the night in her room. I told him of the difficulty with the old tubing breaking off and disappearing within the brain, and of my decision not to try and recover it. He understood.

I returned home that evening feeling good about the surgery. Before retiring, I called the pediatric floor. Sara was reported to be sleeping comfortably with normal vital signs.

"Remember to check on her routinely as ordered."

"Of course doctor," the nurse replied, "she's doing just fine." I awoke with a start at 6 a.m., rubbed my eyes, and wondered about Sara. I had slept through the night without a phone call, so apparently she was doing well. Showering, I mentally reviewed my schedule for the day: office appointments were the only tasks after morning rounds. I would have preferred surgery, as office evaluations tend to be tedious, although nec­essary, drudgeries.

Suddenly, the phone rang. It was my answering service. "Code Blue Pediatrics, doctor, your patient!"

I could not believe it. I threw on a scrub suit and ran to my car. I lived only a mile or two from the hospital and I arrived within minutes to face a flurry of activity in Sara's room. The on-call anesthesiologist was there with several nurses and a crash cart of medical supplies. The child was intubated; a machine ven­tilated her lungs.

I grabbed a hypodermic needle from the cart and inserted it quickly through the scalp and into the shunt valve. Maybe the new shunt had malfunctioned or the old ventricular catheter had caused an obstruction and buildup of fluid pressure. To my amaze­ment, there was no sign of high pressure. Only a few small drops of fluid came from the needle. The valve has a plastic portion that can be pumped with using thumb pressure-it operated normally. I lifted her eyelids; her pupils were fully dilated and did not respond to light. This was an ominous sign of brain death. Sara was transferred to the intensive care unit. I spoke with her dad, who had just walked into the room.

"What happened?" he cried.

"I'm not sure. Can you tell me how it went during the night? The nurses report that she had a peaceful sleep until just before six this morning when they found her comatose and unresponsive."

Medicine, Miracles, and Manifestations

"I spent the entire night with her," he said slowly, crushed by the rapidity of recent events and the now critical condition of his daughter. "She whimpered occasionally and complained of mild pain where you made the incisions, but all in all, I was quite pleased with her progress. I thought it would be okay to run down for a cup of coffee. When I returned, the room was filled with doctors and nurses. They said her heart stopped."

As we walked to the ICU, I told Sara's distraught father that I wanted to do a brain scan to see if the shunt was decompressing the ventricles and if the old tube had somehow caused damage, bleeding, or obstruction. He consented, and we went from the ICU to the CT scan with Sara. The scan was normal. Sara re­mained comatose with fixed and dilated pupils. She had no his­tory of cardiac or any disease other than the aforementioned hydrocephalus at birth.

I sat by the bedside holding her hand, thinking and rethink­ing this case. Would I have done anything differently? Should I have sent her to the ICU after surgery with a special monitor in case her breathing stopped? No, the pediatric nurses were always on top of things, and her room was directly across from their station. There was really no need for special monitoring. Should I have tried to recover the lost tubing from the ventricle? No, that may have caused more problems.

"Doctor, may I begin?" said Thomas Bearden, the brain-wave technician, as he prepared to wheel his electroencephalograph (EEG) into the room. This test would confirm brain death.

"Of course," I said. As he attached the scalp electrodes using conductive paste, I turned to look out the window. The parking lot was slowly filling up as doctors arrived to begin their daily ritual of morning rounds. It was quiet in the room except for the occasional hiss of the ventilator as it kept Sara's lungs and blood well oxygenated.

Divine Intervention-God Giveth, God Taketh

After Thomas finished, I saw that the recording was flat line (no electrical activity) at the highest sensitivity setting of the ma­chine. There could be no question about brain death, an irrevers­ible condition in spite of the continued beating of her heart and mechanical inflation of her lungs.

I gave the parents the sad news. I told them I had no idea how or why their daughter died suddenly. I requested an au­topsy. Maybe it would reveal if the catheter was the cause of her death. In addition, it might have disclosed an unknown heart condition that could have led to cardiac arrest. I needed to know the etiology of her demise.

"Doctor," the father said, "we understand your concern and your pain. It may be that we will never know what happened. Although an autopsy may help you to understand, we have care­fully thought this out. We would prefer, as would Sara, that she be an organ donor. Her heart, liver, kidneys, and eyes may give someone else a better life. My wife and I sincerely believe this would be her wish."

"Are you sure? There is a chance the old tubing may have-"

"Please doctor," he interrupted. "I really do understand your concern, and we empathize with you, but we feel the most ben­efit will be to donate her organs."

I wiped a tear away. It was indeed a sad day to see this beautiful child gone from the world. Yesterday, she had been her normal cheerful self, dressing for school, when she began to com­plain of a headache. By the afternoon she had started to vomit, a result of the pressure developing within her brain. Now it was over. I was dumbfounded and unable to understand this fatal series of events.

The organ harvest team took Sara to the operating room. Her heart, lungs, liver, and kidneys were deemed suitable for donation, as were the corneas of her eyes. As she was wheeled from the room, I sighed in grief, lowered my head and gave Sara a silent farewell.

A few days later, the parents called to invite me to a funeral event for Sara, which they called a "Celebration of Life." As I drove the 50 miles to the small church, I again pondered the case. If I had to do it over I would do the same thing: leave the old tube, nurse the patient on the pediatrics floor, and leave the same routine orders for post-op nursing assessment. I would feel comfortable, even if it were my child. Would this ever happen a second time? It could, as medicine is an art as well as a practice. But I sincerely hoped that I would not have to face such a tragic situation again. I arrived at the church in time for the celebration of life.

"We thank all of our family and friends for coming today," the mother said. About 50 or more friends and relatives had gathered for the event. "We want to say how fortunate we feel to have had Sara in our lives for the past nine years. She was truly a gift from God and provided us with untold joy and happiness." Her remarks were followed by a message from the father and brief remarks from a few friends of the family. The service ended with a meal of local-style food and drink. I offered my condo­lences to the family and left.

Divine Intervention-God Giveth, God Taketh

The universal force, the higher power that came through with Mrs. Ibarra, was unaccountably absent in Sara's case. I was more than disappointed. I felt deeply saddened and baffled. I decided to continue my investigation of a spiritual world to determine if there was such a thing as a universal force. It is of note that years later, when I observe my 3-year-old son laughing and playing, and when seeing how he fondly looks at me, I can't help but wonder, could this be Sara?

NB: I hope this sample chapter had stimulated your interest in this book. I might add, that after publication in March 2009, by a strange series of events, I was drawn to a second volume which I plan to title:

Beyond Medicine, Miracles and Manifestaions :Beyond A Reasonable Doubt

It will go deeper into the explanation of "The Afterlife."

"Before we allow ourselves to be consumed by our regrets, we should remember that our mistakes we make in life are not so important as are the lessons we draw from them. Events in our past seem to slip further away with time. But what happens when they com back and meet us head on in the present?"

                                                     ~  The Outer Limits, Season 3, Vol 1, 1997