M. P. Ravindra Nathan

The blue skies are fading, outside temperature is dropping and the cold air mass from north is slowly moving in. The flu season is upon us. And it will be with us till April or even May.

So, did you get the flu (influenza, a viral infection) shot? The flu vaccine is given in October and November every year. If you missed, please do take it as soon as possible. It may take up to three weeks or more to develop protective immunity.

And who should take them? Some segments of the population are particularly vulnerable to flu � the young (not recommended for babies under 6 months) and old, pregnant women, persons over 50 years of age and those who travel a lot. It is a must for people who already have compromised health status such as the ones suffering from heart disease, diabetes, strokes, chronic lung problems, etc. They simply cannot afford to get the infection, which has the potential to turn into pneumonia and respiratory failure. Those who have, for some reason, an immune deficiency status � the cancer patients, those on drugs suppressing the immune system and the heavy alcohol users - are at risk too.

Barry, just 48 years old, is a case in point. He is a moderately heavy drinker but tolerated it well, till he developed flu symptoms. This progressed to pneumonia quickly and has been on ventilator for many days in our hospital before a slow recovery. His wife said he simply didn�t believe in flu shots and was worried if the shot itself would produce some harm. He learned his lesson the hard way. Yes, a small percentage of patients would develop mild flu-like illness after the shot, but that is self-limited.

Recently, I was puzzled to read in CV News Digest (an Internet publication of American College of Cardiology) that �According to a nationwide survey, more than one in three heart disease patients do not intend to receive flu shots this year.� Health officials have already warned that death from influenza is more common among individuals with heart disease than among patients with any other chronic diseases. Only half of them received flu shots last year. If it is of any consolation to you, even among health care workers, including physicians, the professionals who work at the front lines and hence highly susceptible to infections, the vaccination rate has hovered around just 40 percent for the last decade, a low figure.

And the Centers for Disease Control and Prevention (CDC) say vaccination is the best way to prevent influenza and its severe complications. Every winter, the admissions in our local hospital double or triple, mostly from worsening of heart disease such as heart failure or respiratory infections. And flu is a contributory factor in many of these. It is interesting to note that in spite of all our knowledge about this infection, its complications and its prevention, we are often woefully unprepared for the eventuality.

Why do people shun the vaccine? Lack of awareness that influenza can be a serious illness, lack of access (?), the worry that the shot itself can lead to flu symptoms, etc., are some of the reasons cited. According to CDC, every year, one in five Americans get the flu, 200,000 are hospitalized, including 20,000 children, and about 36,000 die � that is 2.4 percent of the total deaths in USA! Influenza leading to pneumonia is among the top10 leading killers in this country. Staggering statistics, right? CDC now recommends that all eligible health care providers should be offered free influenza vaccine annually to protect staff, patients and family members. This is the new standard for influenza infection control.

At least vaccines are in ample supply this year and easily available. Not like what happened a couple of years ago when the distribution was plagued by delays, short supplies and other conundrums. Our hospital started giving flu shots to all the employees from the third week of October. October and November are the best months to get the shots; but if you happened to miss it because of Navratri, Diwali, Id, Thanksgiving holidays or miscellaneous excuses, you could take get it in December and even in January. Family physicians, health departments and now the big chain stores such as Publix, Wal-Mart, Winn Dixie, CVS pharmacies, etc., would give these shots for $10 per injection.

Not bad, eh? So, please go and take this simple precaution. Get a flu shot � the earlier, the better, for sufficient protection.

Cardiologist Dr. M. P. Ravindra Nathan, director of Hernando Heart Clinic in Brooksville and editor-in-chief of the AAPI Journal, lives in Brooksville.

	Payal Patel

In this article, I would like to stress the importance of prevention of obesity since it is much easier than treating it. Prevention is the key to protection against many diseases that go hand in hand with obesity such as hypertension, diabetes, etc.

Prevention should begin from early stages of life as a newborn. Breast feeding is essential along with delay in introduction of solid foods at six months of life instead of four months. The American Association of Pediatrics (AAP) recommends that breastfeeding be continued for one year or longer for substantial benefits along with availing weight gain. Introducing the right foods also is important such as introducing vegetables before fruits as a way of introducing taste development to less sugar, and less calorie-rich foods. Avoiding processed and junk food through toddler hood also helps develop healthy eating habits that will last lifelong. In this day and age, processed foods as well as food coloring are leading cause of increased attraction to such foods, which are related to obesity, diabetes, Attention Deficit Hyperactivity Disorder (ADHD), etc, in kids.

As parents, we are responsible for making choices for our kids. Offering them a banana as a snack, instead of a cookie is a matter of choice that we should make. This does bring changing our own habits into account. As I had mentioned in Part I of my article, don�t expect your child to eat a salad if you are eating French fries. Moderation is the key. None of us can completely eliminate high calorie, processed food completely, but having them occasionally is the alright. It is not easy to ask a child to give up candy when his friends are having the same, but limiting it to no more than one is important.

Children are often picky eaters in their toddler years, but making healthy food part of the household has to be a repeated effort. Some foods have to be introduced to kids about 10-15 times before they develop a taste for it. It can be frustrating but knowing you are doing the right thing should be a reward in itself. Involving the kids in food choices from early on also is essential. Giving them a choice between a banana and an apple is correct, but giving them a choice between banana and a cookie will result in failure to comply. Involving the kids via taking them for grocery shopping and asking them to help pick the right foods will give them a sense of control and understanding about a healthy lifestyle.

When preparing a meal, asking them to get a tomato from the refrigerator or pretend play in making roti also is helpful. Eating together as a family stresses the importance of everyone eating the same type of food in the family as well as cultivates positive thinking. Eating at home vs. outside also gives control over food choices and eliminates the possibility of having calorie-rich foods. When eating outside, making choices such as grilled foods vs. fried, and a glass of water vs. soda stresses healthy eating habits inside and outside the home. Food should not be used as a reward. For example, putting his shoes in the right place should not warrant the child to have candy but instead offering a star sticker or a penny for his piggy bank is okay.

Exercise also is important for the family starting from early ages. Children should play for one hour a day or do an activity as a family such as walking after dinner, or bike riding, or just playing catch. Parents should stress the importance of exercise by discussing with their children why they chose to join a gym or run on a treadmill to be role models for their childrens' future. Limiting TV watching or videogames to no more than one hour a day also decreases chances of inactivity.

Overall, Prevention plays a huge role in a family. Children should never be punished for making the wrong choices, because they are influenced by myriad of family and friends. Instead, parents need to be patient, and build self-esteem in a positive fashion via explanation of why right choices such as healthy food and exercise are important. Children may not get it completely, but they will learn from their parents and value their choices eventually. In my next article, with the help of a board-certified dietician and a close friend Bhavi Patel, I will talk in depth about detailed food choices that will benefit children as well as adults.

Happy holidays and best wishes for the New Year.

Payal Patel, a board-certified pediatrician, is at Sunshine Pediatrics, 18928 N. Dale Mabry Highway, Suite 102, Lutz, FL 33548. She also can be reached at (813) 948-2679.