Flu season is almost upon us.  As far as I can tell from the flu activity monitoring of the CDC and the L.A. Department of Public Health Acute Communicable Disease Control site L.A. County has not yet reported any significant numbers of flu cases.

So now is a good time to review the CDC recommendations for flu vaccination and decide if you should have the flu vaccine.  The following groups of people should be vaccinated:

People at high risk for complications from the flu, including:
Children aged 6 months until their 5th birthday,
Pregnant women,
People 50 years of age and older, and
People of any age with certain chronic medical conditions;
People who live in nursing homes and other long term care facilities.

People who live with or care for those at high risk for complications from flu, including:
Household contacts of persons at high risk for complications from the flu (see above)
Household contacts and out of home caregivers of children less than 6 months of age (these children are too young to be vaccinated)
Healthcare workers.

The following groups of people should not be vaccinated:

People who have a severe allergy to chicken eggs.
People who have had a severe reaction to an influenza vaccination in the past.
People who developed Guillain-Barré syndrome (GBS) within 6 weeks of getting an influenza vaccine previously.
Influenza vaccine is not approved for use in children less than 6 months of age.
People who have a moderate or severe illness with a fever should wait to get vaccinated until their symptoms lessen.

The Medical Letter recommends the vaccine for anyone who doesn’t have any of the above contraindications.  We expect our delivery of flu vaccine in the next few weeks.  In the meantime, if you find the vaccine at another convenient location (a pharmacy, etc.) get it.

I’ve written before that quitting smoking is the hardest thing I ask my patients to do.  Losing weight is the second hardest.  Many patients struggle for years with their weight, and frequently after successfully losing weight, slowly regain it.

Last week’s New England Journal of Medicine had an important article about keeping weight off:  A Self-Regulation Program for Maintenance of Weight Loss.  The study enrolled people who had already lost at least 10% of their body weight in the last 2 years.  On average, they had lost 42.5 lbs.  They were randomized to three groups.  The control group received only quarterly newsletters.  The two intervention groups were counseled to weigh themselves daily and to self-regulate their diet and exercise in order to return their weight to normal if it increased.  The intervention groups met weekly.  One group met face-to-face, and the other met over the internet.

The sobering results are that, while the intervention group did much better, all three groups gained weight.  The face-to-face group gained an average of 5.5 lbs, the internet group an average of 10.4 lbs, and the control group an average of 10.8 lbs.  So daily self-weighing, self-regulation of diet and exercise in response to weight changes, and weekly face-to-face meetings to reinforce and support the self-regulation training seems to have done best.

I’ve always asked patients to weigh themselves weekly, thinking that daily weighing would increase anxiety without adding useful information.  This is clearly not the case.  A daily habit is probably much easier to maintain than a weekly one.  The authors note in their conclusion

Although concern has been expressed about possible adverse effects of regular self-weighing, there is little evidence to support this concern and no evidence of adverse consequences of the interventions in our trial.

This is a good reminder that regardless of how people lose weight, ongoing intervention is required to prevent regaining the weight.  Daily self-weighing and weekly face-to-face meetings worked best, which is similar to the strategy used by Weight Watchers, a weight loss and weight maintenance program I’ve recommended to many patients.

So if you’re trying to lose weight or you’ve lost weight and don’t want to gain it back, dust off your scale, get into a regular exercise program, and think about joining a weight loss program.  If you’d like a weight loss coach who can meet with you personally, or a personal trainer to help you exercise, let me know.

Most of us think of ourselves as people who go out of our way to do the right thing, especially if it helps those less fortunate than ourselves.  We donate to charities; we volunteer our time; we tell our friends about worthy causes.  Nevertheless I was surprised to find that I had forgotten about a much-needed gift that most of us can give:  blood.  A few weeks ago I was embarrassed to find out it had been six months since my last blood donation.

Though my last donation was to the Red Cross, I found out since then that the Red Cross charges hospitals for the blood they collect.  I don’t object to this.  After all, the Red Cross has operating costs and they do not make a profit.  Still, I thought it would be much more efficient and helpful to donate directly to a hospital.  So two weeks ago I donated at the Cedars-Sinai Blood Donor Facility.  I learned a lot about how fragile our blood supply is and how grateful the hospital is to their regular donors.  Platelets have a very short shelf life, so they are in constant demand.  I was asked to donate platelets and plasma, and I did.  The nurses were great.  They knew all the regular donors by name and treated them like family.  I was struck by the life saving commitment the regular donors had made.

If you would like to donate a life-saving gift to a stranger you’ll never meet, please look at the Blood Donor Facility website for contact information and for guidelines about who can donate.  If no local hospital is convenient for you, look at the American Red Cross blood donation website for their locations.

Thank you very much.

About a month ago the FDA released a warning about an interaction between very commonly used medications:  aspirin and ibuprofen.

Many patients have been instructed to take low dose aspirin (81 mg daily) for heart attack or stroke prevention.  Aspirin prevents heart attacks and strokes by binding to an enzyme in platelets called cyclooxegenase (COX) and preventing its normal function.  COX is essential for platelet function, so aspirin prevents platelets from aggregating into small blood clots, which is an essential step in heart attacks and some strokes.  For the same reason, aspirin increases the risk of bleeding, since it inhibits normal blood clotting.

Patients on low dose aspirin sometimes need pain relief or anti-inflammatory medication, for example for a headache or a muscle sprain.  Doctors frequently prescribe ibuprofen (which is the medicine in Motrin and Advil), since it is a more effective pain medication than aspirin, and since additional aspirin will further increase bleeding risk.

The FDA alert cautions us that since ibuprofen also binds COX, though much more briefly than aspirin, taking the two together could prevent aspirin from binding, and potentially diminish aspirin’s effectiveness in heart attack and stroke prevention.  The alert suggests that in patients taking daily low dose aspirin who also need ibuprofen, the ibuprofen should be taken least 8 hours before or at least 30 minutes after the aspirin to minimize any interaction.

Another alternative is to use a pain reliever in an entirely different family, like acetaminophen (Tylenol).  This would eliminate any interaction with aspirin, but usually gives less pain relief than ibuprofen and has no anti-inflammatory properties.

I’m grateful to my colleague, Dr. Yaron Elad, for pointing me to this story.  It’s sobering that even with medications that have been around for many years and are used very commonly, we’re still learning new reasons to be cautious.