I have discussed Tamiflu (oseltamivir) and Relenza (zanamivir) previously – see Bird Flu: Tamiflu and Relenza for Prevention and Treatment in the Articles section on our Web site, http://www.AvoidBirdFlu.com. This current article adds important information about making your supply of Tamiflu go farther in an emergency situation. First, as I noted in my previous article, it is important to be aware of the fact that the effectiveness of Tamiflu and Relenza has been studied against circulating strains of human influenza (so called seasonal influenza), not against the bird flu virus. In a study reported in the August 2005 issue of the Journal of Infectious Diseases, Dr. Yen and others from St. Jude Children’s Research Hospital in Memphis, Tennessee found that in animal experiments eight-day regimens of Tamiflu were more effective than the suggested five-day regimen for treating infections with the H5N1 bird-flu virus. The authors concluded that a prolonged and higher-dose oseltamivir regimen may be required for the most beneficial antiviral effect. This possibility was recently underscored when two Vietnamese (one a 13 year old girl) died of bird flu—as reported in a December 2005 issue of the New England Journal of Medicine—even after receiving treatment within the required 48 hours after the start of infection with standard doses of Tamiflu. Let’s assume that you have one treatment course of Tamiflu (one 75 mg tablet taken twice a day for five days, for a total of 10 pills), that you either acquired on your own or that was given to you by your healthcare provider or by the government. Unfortunately you are still not home free yet, so to speak. You now may face one of two problems: Problem # 1: If preliminary scientific studies indicating that a course of treatment of bird flu using higher doses than those currently recommended by the FDA, for more than the current recommended five days of treatment are correct—as indicated by Dr. Yen’s research—you will need more that one dose pack. In fact, the best treatment might mean taking two pills (150 mg) twice a day for eight or even ten days. That would mean that you should have FOUR dose packs (40 pills) for the treatment of one person, not just one! Problem # 2: You have a dose pack—officially the amount need to treatment one person—but there are two people who just became infected with bird flu in your family. If you combine this problem with problem number one, you now actually need EIGHT dose packs, not just two! What can you do? There are two possible solutions: SOLUTION # 1: Take PROBENECID, a medicine approved for the treatment of gout, along with the Tamiflu. Probenecid interferes with the normal metabolism of Tamiflu, increasing the blood level of Tamiflu and keeping it in circulation longer—effectively doubling the amount of Tamiflu “exposure.” The precise dose is unclear. Until more scientific information becomes available, in an emergency situation, for otherwise healthy adults, I would recommend taking one 500 mg table twice daily. Probenecid is generally very safe. Nevertheless, I have included detailed information about it below. According to information about probenecid from the National Library of Medicine’s and the National Institutes of Health’s Web site Medline Plus (available at http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202480.html): Probenecid (proe-BEN-e-sid) is used in the treatment of chronic gout or gouty arthritis. These conditions are caused by too much uric acid in the blood. The medicine works by removing the extra uric acid from the body. Probenecid does not cure gout, but after you have been taking it for a few months it will help prevent gout attacks. This medicine will help prevent gout attacks only as long as you continue to take it. Probenecid is also used to prevent or treat other medical problems that may occur if too much uric acid is present in the body. Probenecid is sometimes used with certain kinds of antibiotics to make them more effective in the treatment of infections. Probenecid is available only with your doctor’s prescription, in the following dosage form (tablets): a. Before Using This Medicine In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For probenecid, the following should be considered: Allergies—Tell your doctor if you have ever had any unusual or allergic reaction to probenecid. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes. Pregnancy—Probenecid has not been shown to cause birth defects or other problems in humans. Breast-feeding—Probenecid has not been reported to cause problems in nursing babies. Children—Probenecid has been tested in children 2 to 14 years of age for use together with antibiotics. It has not been shown to cause different side effects or problems than it does in adults. Studies on the effects of probenecid in patients with gout have been done only in adults. Gout is very rare in children. Older adults—Many medicines have not been studied specifically in older people. Therefore, it may not be known whether they work exactly the same way they do in younger adults. There is no specific information comparing use of probenecid in the elderly with use in other age groups. Other medicines—Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking probenecid, it is especially important that your health care professional know if you are taking any of the following: • Antineoplastics (cancer medicine)—The chance of serious side effects may be increased • Aspirin or other salicylates—These medicines may keep probenecid from working properly for treating gout, depending on the amount of aspirin or other salicylate that you take and how often you take it • Heparin—Probenecid may increase the effects of heparin, which increases the chance of side effects • Indomethacin (e.g., Indocin) • Ketoprofen (e.g., Orudis) • Methotrexate (e.g., Mexate)—Probenecid may increase the blood levels of these medicines, which increases the chance of side effects • Medicine for infection, including tuberculosis or virus infection—Probenecid may increase the blood levels of many of these medicines. In some cases, this is a desired effect and probenecid may be used to help the other medicine work better. However, the chance of side effects is sometimes also increased • Nitrofurantoin (e.g., Furadantin)—Probenecid may keep nitrofurantoin from working properly • Zidovudine (e.g., AZT, Retrovir)—Probenecid increases the blood level of zidovudine and may allow lower doses of zidovudine to be used. However, the chance of side effects is also increased Other medical problems—The presence of other medical problems may affect the use of probenecid. Make sure you tell your doctor if you have any other medical problems, especially: • Blood disease or • Cancer being treated by antineoplastics (cancer medicine) or radiation (x-rays) or • Kidney disease or stones (or history of) or • Stomach ulcer (history of)—The chance of side effects may be increased b. Proper Use of This Medicine If probenecid upsets your stomach, it may be taken with food. If this does not work, an antacid may be taken. If stomach upset (nausea, vomiting, or loss of appetite) continues, check with your doctor. For patients taking probenecid for gout: • After you begin to take probenecid, gout attacks may continue to occur for a while. However, if you take this medicine regularly as directed by your doctor, the attacks will gradually become less frequent and less painful than before. After you have been taking probenecid for several months, they may stop completely. • This medicine will help prevent gout attacks but it will not relieve an attack that has already started. Ev
Children: The dose will have to be determined by the doctor. It depends on the child’s weight, as well as on the condition being treated. Older children and teenagers may need the same amount as adults. Missed dose— If you are taking probenecid regularly and you miss a dose, take the missed dose as soon as possible. However, if you do not remember until it is almost time for the next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses. Storage— To store this medicine: • Keep out of the reach of children. • Store away from heat and direct light. • Do not store this medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down. • Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children. c. Precautions While Using This Medicine • If you will be taking probenecid for more than a few weeks, your doctor should check your progress at regular visits. Before you have any medical tests, tell the person in charge that you are taking this medicine. The results of some tests may be affected by probenecid. For diabetic patients: • Probenecid may cause false test results with copper sulfate urine sugar tests (Clinitest), but not with glucose enzymatic urine sugar tests (Clinistix). If you have any questions about this, check with your health care professional. For patients taking probenecid for gout or to help remove uric acid from the body: • Taking aspirin or other salicylates may lessen the effects of probenecid. This will depend on the dose of aspirin or other salicylate that you take, and on how often you take it. Also, drinking too much alcohol may increase the amount of uric acid in the blood and lessen the effects of this medicine. Therefore, do not take aspirin or other salicylates or drink alcoholic beverages while taking this medicine, unless you have first checked with your doctor. d. Side Effects of This Medicine Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention. The following side effects may mean that you are having an allergic reaction to this medicine. Check with your doctor immediately if any of the following side effects occur: • Rare Fast or irregular breathing; puffiness or swellings of the eyelids or around the eyes; shortness of breath, troubled breathing, tightness in chest, or wheezing; changes in the skin color of the face occurring together with any of the other side effects listed here; or skin rash, hives, or itching occurring together with any of the other side effects listed here Also, check with your doctor as soon as possible if any of the following side effects occur: • Less common Bloody urine; difficult or painful urination ; lower back or side pain (especially if severe or sharp); skin rash, hives, or itching (occurring without other signs of an allergic reaction) • Rare Cloudy urine; cough or hoarseness; fast or irregular breathing; fever; pain in back and/or ribs; sores, ulcers, or white spots on lips or in mouth; sore throat and fever with or without chills; sudden decrease in the amount of urine; swelling of face, fingers, feet, and/or lower legs; swollen and/or painful glands ; unusual bleeding or bruising; unusual tiredness or weakness; yellow eyes or skin ; weight gain Other side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. However, check with your doctor if any of the following side effects continue or are bothersome: • More common Headache; joint pain, redness, or swelling ; loss of appetite; nausea or vomiting (mild) • Less common Dizziness; flushing or redness of face (occurring without any signs of an allergic reaction); frequent urge to urinate; sore gums Other side effects not listed above may also occur in some patients. If you notice any other effects, check with your doctor. SOLUTION # 2: Unless you are a divine follower of the late Mahatma Gandhi, who used to drink his urine daily, this solution is not nearly as appealing as taking probenecid. However, it apparently would be very effective. Dr. Grattan Woodson, a specialist in internal medicine at the Druid Oaks Health Center in Decatur, Georgia, offers the following advice for emergency treatment of bird flu: This is an advanced, potentially life-saving emergency strategy, that should only be done under medical supervision—unless none is available. Tamiflu Re-Administration Strategy: Tamiflu is excreted unchanged almost entirely in the urine. If Tamiflu supplies are limited, as they most certainly will be [during a bird-flu pandemic], consider giving the patient two Tamiflu tablets at the same time, collect the patient’s urine and re-administer it to the patient via naso-gastric (NG) tube or orally. If managed carefully, this approach means that you can completely treat a patient with only 2 Tamiflu tablets [by re-administering the patient’s urine daily for five to 10 days]. Woodson G: Preparing for The Coming Influenza Pandemic. Fluwikie.com. Available at: http://fluwikie.com/annex/WoodsonMonograph.htm#_Toc116746508.§ Adults: The amount of probenecid will depend on the condition being treated. Sometimes, only one dose of 2 tablets is needed. Other times, the dose will be 1 tablet four times a day. § Children: It is not likely that probenecid will be needed to treat gout or to remove uric acid from the body in children. If a child needs this medicine, however, the dose would have to be determined by the doctor. • For helping antibiotics work better: § Adults: 250 mg (one-half of a 500-mg tablet) two times a day for about one week, then 500 mg (one tablet) two times a day for a few weeks. After this, the dose will depend on the amount of uric acid in your blood or urine. Most people need 2, 3, or 4 tablets a day, but some people may need higher doses. §en if you take another medicine for gout attacks, continue to take this medicine also. If you have any questions about this, check with your doctor. For patients taking probenecid for gout or to help remove uric acid from the body: • When you first begin taking probenecid, the amount of uric acid in the kidneys is greatly increased. This may cause kidney stones or other kidney problems in some people. To help prevent this, your doctor may want you to drink at least 10 to 12 full glasses (8 ounces each) of fluids each day, or to take another medicine to make your urine less acid. It is important that you follow your doctor’s instructions very carefully. Dosing— The dose of probenecid will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of probenecid. If your dose is different, do not change it unless your doctor tells you to do so. • For treating gout or removing uric acid from the body:

Sleep Apnea or Obstructive Sleep Apnea as it is sometimes called, usually involves loud snoring as one of the symptoms. Anyone that has ever slept with a snoring partner knows that it can be seriously disruptive to one’s own sleep. But what effect, long term, does it have on a marriage? It is a common situation in many marriages and apparently has more impact than many couples think. Obviously the experience of sleeping with a loud snoring partner is not positive, but what can be done? This is the question that The Sleep Disorders Center at Rush University Medical Center recently set out to ask and hopefully solve. In doing so, they hope to save marriages that might be in danger of divorce due to this cronic, ongoing struggle to get enough rest at night….and all the interpersonal implications of not achieving a balanced level of sleep. The Center is currently evaluating 10 couples in which the male has been diagnosed with obstructive sleep apnea. The couples begin by completing surveys about sleepiness, marriage satisfaction and quality of life. After this step the couples spend the night in the Center’s sleep lab where technicians determine each partner’s quantity and quality of sleep. Two weeks after these tests, and treatment, the couple repeats a night’s sleep in the sleep lab for comparison purposes. The results have been very interesting and mostly positive. According to press releases from the Center, the early results show that there is indeed a significant impact on the wife’s quality and quantity of sleep. It is termed a serious problem that does indeed lead to a hostile and tense situation within the marriage. In one example cited, the husband’s snoring was arousing the wife out of sleep over eight times an hour. Her sleep efficiency rating (the percentage of time she was actually asleep) was 73%. The average person’s sleep efficiency is closer to 90%. In this example, the wife had attempted to use ear plugs, earphones and had finally given up and started to sleep alone. To treat the husband, the Center used a device known as a continuous positive airway pressure machine (CPAP). This machine is non-invasive and the flow of air it delivers prevents the upper airway from collapsing during sleep, allowing the lungs to perform normally. In this particular case, the wife’s quality of life measure jumped from a 1.2 to a 7.0, indicating that the snoring had been alleviated and was no longer significantly bothering her. Her sleepiness scale (how tired she felt) dropped from 12 to a 6. Marital Satisfaction scores improved from a 3 to 5.8 and the wife’s sleep efficiency moved up from 73% to 82%. Obviously on every level, this treatment had made great strides for the couple and showed promise in other situations. The Rush Center is continuing tests expected to be completed in April 2006. The Center will evaluate the results and expand on the information being provided to the public. Their press release is very specific about the measures taken as each couple enters the program. As stated «…both the husband and wife undergo simultaneous polysomonography, a sleep test that monitors brain activity, eye movements, muscle activity, heart rate and rhythms, breathing patterns, blood oxygen level and body movements and respiratory sounds. All sensors are noninvasive and do not cause pain or discomfort. The study involves first diagnosing the sleep apnea. The husband will sleep alone in the center as technicians monitor his sleep. If he has sufficient sleep apnea, he will undergo a split night study to determine the appropriate CPAP treatment. Sleep apnea is a serious health problem that should be treated. Obstructive sleep apnea occurs when the tissue in the back of the throat collapses and blocks the airway. The breathing pause lasts at least 10 seconds and can occur 10 or more times an hour. Apnea lowers the oxygen level in the blood leaving the patient vulnerable to hypertension, stroke and other cardiovascular problems. Obstructive sleep apnea can occur in men and women of any age; however, it is most common in obese, middle-aged men. The most common signs of sleep apnea are loud snoring, choking or gasping during sleep, and fighting sleepiness during the day. In addition to continuous positive airway pressure, treatment includes losing weight, sleeping on your side instead of your back, avoiding alcohol and tobacco.» For more information go to www.sleep-apnea-facts.com.   ann robinette

Mental health authorities estimate that more than 2 million adults have been diagnosed with bipolar disorder (also called manic-depression), a chemical imbalance in the brain causing extreme mood swings from manic highs to agonizing lows. Although a diagnosis of bipolar disorder can be frightening and confusing, it is a treatable and manageable condition. If you or someone close to you has been diagnosed with bipolar illness, the first step in relieving fear and uncertainty is education. The more you know about the disorder, the less control it will exert over you and others who may be affected. The National Institute of Mental Health (www.nimh.nih.gov), The National Alliance for the Mentally Ill (www.nami.org), and The National Mental Health Association (www.nmha.org) are just a few of the recognized national organizations providing information, facts and support to anyone who may be directly or indirectly affected by bipolar disorder. Below are some essential facts about bipolar disorder provided by these organizations that may alleviate some of your concerns and questions surrounding a recent diagnosis. Bipolar disorder affects many people: According to the National Alliance on Mental Illness (NAMI), bipolar disorder affects approximately 2.3 million adults, or 1.2 percent of the population, in any given year. Bipolar disorder has many potential causes: There does not appear to be one cause for bipolar disorder. Evidence suggests that many components may come into play, all of which affect the chemical balance of certain parts of the brain. Several studies on the occurrence of bipolar disorder in families demonstrate a genetic disposition toward the illness. Other factors may include extremely traumatic life events, chronic illness, alcoholism, and drug abuse. Bipolar disorder has varied symptoms: The most pronounced symptoms of bipolar disorder are dramatic mood swings consisting of extremely “high” manic episodes to debilitating episodes of depression and then back again with relatively normal moods in between. Behaviors during a manic episode include heightened feelings of euphoria, extreme energy, decreased need for sleep, extreme irritability and distractibility, and increased aggression. Depressive episodes bring about excessive feelings of despair, hopelessness, worthlessness, guilt, and sometimes thoughts of suicide. Bipolar disorder affects both sexes in children to adults: Manic depression is not selective in who it touches. Women and men are equally affected, as are children and adolescents (although a diagnosis in children and teens is more difficult to determine). A majority of those diagnosed with bipolar disorder have a least one family member with the illness. And children of parents with the illness are more likely to develop it themselves. Bipolar disorder has effective treatment modalities: Bipolar disorder is treated with medications, called mood stabilizers, to assist in controlling fluctuation in moods. The important thing to understand about bipolar disorder is that it is a life-long, recurring illness requiring ongoing care. In addition to medication, psychotherapy is also prescribed in the management of the illness. Psychotherapy assists people to understand their illness and to develop coping skills to help deal with life events and stressors that may trigger manic and depressive episodes. Bipolar disorder has no cure: As of today, there is no known cure for bipolar disorder; however, it is a treatable and manageable illness. With a close relationship with a mental health professional, a proper diagnosis, and vigilant adherence to taking medications and sticking to prescribed treatment plans, most individuals with bipolar illness lead very productive and rewarding lives. These are just a few of the facts pertaining to bipolar disorder. It is not a simple illness, yet it is manageable and treatable. If you or someone you know has been diagnosed with bipolar disorder, do not hesitate to seek information and help. Any one of the above-mentioned organizations can offer you education, guidance, and support. Obtaining knowledge is one of your first steps in alleviating the uncertainty and anxiety of dealing with such a diagnosis.

We seem to be quite happy and satisfied with everything we have and keep developing and wanting more. We feel safe on one side of a barricade that we’ve built up between us and those poor people who suffer from the most severe malady, the plague of the twenty first century. It is quite obvious that we divide our world on “us” and “them”. While we feel quite happy and live our lives to the fullest, they constantly suffer from prosecution, problems with arranging a life and finding friendly faces in the crowd. Nobody seems to know where the plague came from. The information provided is taken from a sample term paper that gave some additional light onto the problem. Another piece was taken from a custom research paper of those, who are infected. AIDS appeared on African continent as a result of a bad experiment. Peoples of Africa were suffering from a complicated form of malaria and a group of European scientists was sent to help with the vaccination. This group was to find a vaccine from malaria and test it. In the vaccine they used ape tissues and tested. The vaccine mutated and turned into a very serious problem. Now AIDS is a very spread disease. There is no country in the world that doesn’t have this problem. Some say that it is a terrible curse given to people for not living an honorable life. Indeed, humans are guilty in spreading this plague all over the world. As we know AIDS is not spread by slight contact, only through blood transfusion, sexual contact or injection made by an infected syringe. After several cases of infection through using infected tools and transfusion of infected blood now all these things are tested and checked for AIDS. The possibility to get it is minimal. The only way is by sexual contact and using not sterilized syringes to make intravenous injections. That means that Intravenous Drug Addicts and quite vulnerable to AIDS and most of them are the carriers. People who don’t protect themselves before sexual interference can also be victims. Now the carriers of the virus are separated by an invisible wall that limits their freedom of action. On the first of January we celebrate the day of Struggle against AIDS. But it should be better called the day of Struggle against people who have AIDS. They really feel themselves as outsiders and there is still nothing done to improve the situation. It doesn’t necessary mean that people who have AIDS are in the gutter of the society. Some of the virus carriers are quite respectable and stand pretty high on the social ladder. What we lack now is information. One can not be infected by communication, hand shaking, having fun together with a virus carrier. They are also people with various interests and ambitious. Not the malady, but we ourselves prevent them from developing. So let’s treat them as usual members of society and help them to overcome their fears.