Protecting Your Health in Erie, PA | Erie County Medical Society

 

The Erie County Medical Society is a voluntary, non-profit professional organization of physicians, both MD and DO, in Erie, PA, founded in 1828. Our mission is to advance the standards of medical care, to uphold the ethics of the medical profession, and to serve the public with important and reliable health information.



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6:15 PM
September 8th, 2017

Asthma and You

 

 

Asthma and You

 

Asthma is a common chronic disease that affects 26 million people in the United States. Adult-onset asthma, in people over 40, is more frequent among women.

 

On the other hand, asthmatic children, of whom there are seven million in the US, are almost twice as likely to be boys. Moreover, asthma is a common cause of hospitalization of children in the US. Fortunately, about half of children diagnosed with asthma will have a decrease or disappearance of symptoms by early adulthood.

 

What Is Asthma

Asthma is a disease in which the airways become inflamed, episodically obstructed, and hyper-responsive to stimuli. These processes are at least partially reversible. However, after long duration there may be some permanent changes in the airways.

 

Asthma Symptoms

Asthma symptoms include wheezing, coughing, shortness of breath, and chest tightness. These symptoms may occur acutely (suddenly and briefly), sub-acutely (less suddenly and of longer duration), or chronically (slowly and of prolonged duration).

 

Asthma Triggers

Asthma symptom flare-ups may occur in conjunction with exposure to environmental allergens, environmental irritants, viruses, cold air, exercise, gastroesophageal reflux disease (GERD), smoke, paint fumes, nitrous oxide, ozone, or emotional factors. Other triggering factors may be aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and sulfites.

 

Environmental allergens closely associated with asthma flare-ups include household dust mites, dog and cat allergens, fungi, and cockroach allergens.

 

Aspirin sensitivity accompanies asthma in 5-10% of patients in their 20s and 30s. Exposure to a single aspirin or NSAID tablet can provoke an asthma attack in these individuals.

 

Asthma patients are three times more likely than others to have GERD. Gastric acid in the distal esophagus provokes airway reactivity. One fourth of these patients do not realize that they have gastric reflux. Two thirds of these patients have a favorable response of their asthma when treated for GERD.

 

Asthma symptoms are somewhat more likely to occur between 4:00 and 6:00 AM due to the normal cyclical variations in body cortisol.

 

Exercise Induced Asthma

Exercise induced asthma is an asthmatic response to exercise, especially to that occurring in cold dry air. As many as half of those so affected, have asthmatic responses under no conditions other than exercise. This type response occurs more often in children and young adults than in older people.

 

Asthma and Wheezing

Wheezing does not always mean asthma. Other diseases causing wheezing are COPD, heart failure, cystic fibrosis, foreign bodies in the airway, sarcoid, upper respiratory tract infection, and vocal cord dysfunction.

 

Conversely, asthma does not always exhibit wheezing. Mildly afflicted asthmatics may not wheeze. On the other hand, since wheezing is caused by turbulence of air in the airway, severely afflicted asthmatics may not be able to move sufficient air to wheeze.

 

Avoid Environmental Exposures

  • The most effective way to deal with an asthma attack is not to have one. Helpful steps for asthmatics to follow are the following:           
  •           Avoid both first-hand and second-hand exposures to tobacco smoke.     
  •           Clean and dust regularly.

          Wear a facemask while vacuuming.

          Use impervious covers on mattresses and pillows.

          Limit upholstered furniture and window blinds.

          Put clothing away in closets and drawers.

          Wash soft toys often or periodically put them in the freezer.

          Do not allow animals in the bedroom

          Place filtering material over heating and cooling duct vents.

          Wash cats and dogs often.

          Never leave food uncovered.

          Store firewood outdoors.

          Stay inside midday when pollen counts are highest.

          Wear a facemask while gardening.

          Control GERD and sinusitis.

          If possible, exercise indoors in a warm, humid environment rather than outdoors in a cold, dry environment.

          When exercising outdoors, wear a facemask to warm and humidify the inhaled air.

          Avoid foods high in sulfites if sulfite sensitivity exists.

          Avoid aspirin or NSAIDs if sensitive to these.

          If obese, lose 5-10% of body weight to improve asthma control.

 

Medical Treatment

Numerous medical treatments for asthma are available. The medications include short-acting treatments to treat exacerbations and long-acting treatments to reduce the frequency of exacerbations. They include medications of various strengths commensurate with the degree of severity of the asthma. The medications also include drugs of several different families to act together in their primary effect to treat the asthma but with different secondary effects to reduce the side effect impact of the medications.

 

Your doctor has many choices to help you deal with asthma. Close coordination with your doctor will enable you to exercise the optimum control over your asthma.

 

References

Harding, S., Guzzo, M., & Richter, J. (2000). The Prevalence of Gastroesophageal Reflux in Asthma Patients without Reflux Symptoms. American Journal of Respiratory and Critical Care Medicine,162(1), 34-39. doi:10.1164/ajrccm.162.1.9907072

 

Morris, M. J., MD. (2017, August 17). Asthma - Medscape. Retrieved September 08, 2017, from http://emedicine.medscape.com/article/296301-overview

 

 

Thomas Falasca, DO

 

 

 

Asthma and You

Asthma is a common chronic disease that affects 26 million people in the United States.

...See More

Asthma and You

 

 

Asthma and You

 

Asthma is a common chronic disease that affects 26 million people in the United States. Adult-onset asthma, in people over 40, is more frequent among women.

 

On the other hand, asthmatic children, of whom there are seven million in the US, are almost twice as likely to be boys. Moreover, asthma is a common cause of hospitalization of children in the US. Fortunately, about half of children diagnosed with asthma will have a decrease or disappearance of symptoms by early adulthood.

 

What Is Asthma

Asthma is a disease in which the airways become inflamed, episodically obstructed, and hyper-responsive to stimuli. These processes are at least partially reversible. However, after long duration there may be some permanent changes in the airways.

 

Asthma Symptoms

Asthma symptoms include wheezing, coughing, shortness of breath, and chest tightness. These symptoms may occur acutely (suddenly and briefly), sub-acutely (less suddenly and of longer duration), or chronically (slowly and of prolonged duration).

 

Asthma Triggers

Asthma symptom flare-ups may occur in conjunction with exposure to environmental allergens, environmental irritants, viruses, cold air, exercise, gastroesophageal reflux disease (GERD), smoke, paint fumes, nitrous oxide, ozone, or emotional factors. Other triggering factors may be aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs), and sulfites.

 

Environmental allergens closely associated with asthma flare-ups include household dust mites, dog and cat allergens, fungi, and cockroach allergens.

 

Aspirin sensitivity accompanies asthma in 5-10% of patients in their 20s and 30s. Exposure to a single aspirin or NSAID tablet can provoke an asthma attack in these individuals.

 

Asthma patients are three times more likely than others to have GERD. Gastric acid in the distal esophagus provokes airway reactivity. One fourth of these patients do not realize that they have gastric reflux. Two thirds of these patients have a favorable response of their asthma when treated for GERD.

 

Asthma symptoms are somewhat more likely to occur between 4:00 and 6:00 AM due to the normal cyclical variations in body cortisol.

 

Exercise Induced Asthma

Exercise induced asthma is an asthmatic response to exercise, especially to that occurring in cold dry air. As many as half of those so affected, have asthmatic responses under no conditions other than exercise. This type response occurs more often in children and young adults than in older people.

 

Asthma and Wheezing

Wheezing does not always mean asthma. Other diseases causing wheezing are COPD, heart failure, cystic fibrosis, foreign bodies in the airway, sarcoid, upper respiratory tract infection, and vocal cord dysfunction.

 

Conversely, asthma does not always exhibit wheezing. Mildly afflicted asthmatics may not wheeze. On the other hand, since wheezing is caused by turbulence of air in the airway, severely afflicted asthmatics may not be able to move sufficient air to wheeze.

 

Avoid Environmental Exposures

  • The most effective way to deal with an asthma attack is not to have one. Helpful steps for asthmatics to follow are the following:           
  •           Avoid both first-hand and second-hand exposures to tobacco smoke.     
  •           Clean and dust regularly.

          Wear a facemask while vacuuming.

          Use impervious covers on mattresses and pillows.

          Limit upholstered furniture and window blinds.

          Put clothing away in closets and drawers.

          Wash soft toys often or periodically put them in the freezer.

          Do not allow animals in the bedroom

          Place filtering material over heating and cooling duct vents.

          Wash cats and dogs often.

          Never leave food uncovered.

          Store firewood outdoors.

          Stay inside midday when pollen counts are highest.

          Wear a facemask while gardening.

          Control GERD and sinusitis.

          If possible, exercise indoors in a warm, humid environment rather than outdoors in a cold, dry environment.

          When exercising outdoors, wear a facemask to warm and humidify the inhaled air.

          Avoid foods high in sulfites if sulfite sensitivity exists.

          Avoid aspirin or NSAIDs if sensitive to these.

          If obese, lose 5-10% of body weight to improve asthma control.

 

Medical Treatment

Numerous medical treatments for asthma are available. The medications include short-acting treatments to treat exacerbations and long-acting treatments to reduce the frequency of exacerbations. They include medications of various strengths commensurate with the degree of severity of the asthma. The medications also include drugs of several different families to act together in their primary effect to treat the asthma but with different secondary effects to reduce the side effect impact of the medications.

 

Your doctor has many choices to help you deal with asthma. Close coordination with your doctor will enable you to exercise the optimum control over your asthma.

 

References

Harding, S., Guzzo, M., & Richter, J. (2000). The Prevalence of Gastroesophageal Reflux in Asthma Patients without Reflux Symptoms. American Journal of Respiratory and Critical Care Medicine,162(1), 34-39. doi:10.1164/ajrccm.162.1.9907072

 

Morris, M. J., MD. (2017, August 17). Asthma - Medscape. Retrieved September 08, 2017, from http://emedicine.medscape.com/article/296301-overview

 

 

Thomas Falasca, DO

 

 

 

Narcotics Addiction and Overdose

The Erie County Medical Society shares the deep concern and sadness of the community locally and broadly over the rec ...See More


Narcotics Addiction and Overdose

Narcotics Addiction and Overdose

The Erie County Medical Society shares the deep concern and sadness of the community locally and broadly over the recent surge in narcotics related deaths. This surge is superimposed on the steadily climbing number of such deaths over recent years.

 

One factor contributing to the recent increase may be the emergence into availability of heroin forms that can be snorted or smoked instead of injected intravenously. First, this presents a less repulsive method of administration than intravenous injection. Second, it caters to the mistaken illusion that the drug is less dangerous when snorted or smoked than when injected.

 

While no “magic bullet” currently exists, progress toward the solution of the problem begins with understanding. Accordingly, we present this information to enhance understanding of the disease.

 

Scope of Problem

The year 2014 witnessed 47,055 drug overdose deaths in the US compared with 32,675 traffic accident deaths. These data are from the US Centers for Disease Control and the US Department of Transportation, respectively. Meanwhile,

here in Erie County, Pennsylvania, drug-related deaths rose 61% from 59 in 2015 to 95 in 2016.

 

Fentanyl has become a major factor in drug overdose deaths. Fentanyl is either legally manufactured but illegally obtained, or illegally manufactured and obtained. Fentanyl-related deaths increased 80% in 2014.

 

Internationally, the US is hit especially hard by opioid abuse. Americans constitute less than 5% of the world’s population, but consume 80% of the world’s opioids. Americans consume 99% of the world’s supply of hydrocodone, the active ingredient of VicodinTM. Finally, Americans consume two-thirds of the world’s illegal drugs.

 

Causes of Opioid Dependence

Opioid dependence is a disorder with pharmacologic, genetic, social, and psychodynamic causes. It is a true medical problem, not a moral failing or personality shortcoming.

 

Pharmacologic factors weigh heavily in opioid addiction. Certainly, drugs other than opioids have significant addiction potential; but, opioids, with their rapid development of physical dependence and their severe protracted abstinence syndrome, make abstinence especially difficult.

 

Genetic factors also contribute. There is a high degree of heritable vulnerability for opioid dependence. Gene polymorphisms for receptors for dopamine, serotonin, and other neurotransmitters also seem associated with opioid dependence vulnerability. Perhaps future medications can be designed to take advantage of these genetic factors.

 

Psychopathologic diagnoses seem to factor in. Preexisting mental health diagnoses seem to increase risk for long-term opioid use among adolescents with chronic pain.

 

Social factors have notable influence as indicated by the high rate of drug use in areas with poor parental functioning, high crime, and high unemployment.

 

Signs of Opioid Abuse

Opioid abuse is evidenced by any two of the following signs occurring within a 12-month period.

  1. Taking larger amounts than intended.
  2. Unsuccessful efforts to reduce use.
  3. Spending substantial time and activity related to opioids.
  4. Craving opioids.
  5. Failure to fulfill obligations of home, work, or school.
  6. Continuing opioid use despite opioid-related problems.
  7. Relinquishing social and other interests because of opioid use.
  8. Continuing opioid-related activities when those activities present a physical hazard.
  9. Tolerance and withdrawal, except when the opioids are used exclusively for medical reasons and under close medical supervision.

Tolerance, Withdrawal, and Addiction

Tolerance, withdrawal, and addiction are three separate entities. They are not just different ways of saying “addiction.”

 

Tolerance is the requirement for increased doses of the drug to achieve the same effect. Thus, increasing doses of the drug are needed to induce the same euphoria.

 

Withdrawal is the occurrence of symptoms on abrupt cessation of the drug. The onset and duration vary with the drug. Heroin withdrawal symptoms tend to peak in 36-72 hours and last 7-14 days.

 

The symptoms of withdrawal are typically diarrhea, runny nose, nausea, “gooseflesh,” restlessness, tremors, abdominal cramping, muscle aches, and craving for the drug.

 

Addiction consists of drug craving, compulsive use, and strong tendency to relapse after withdrawal.

 

Toxicity

At some unspecified point, the side effects of opioid use turn into toxicity. The typical side effects are small pupils, loss of appetite, sleep disturbances, and constipation. As side effects become toxicity, blood pressure may fall, stupor develops (sometimes to the point of unresponsiveness), and respirations slow (sometimes to the point of stopping).

 

Toxicity Treatment

Clearly, respiratory insufficiency is an emergency, as inadequate respirations lead to death or irreversible brain damage in only a few minutes. The treatment is to begin artificial respiration and reverse the opioid.

 

The principal opioid reversal agent is naloxone. At one time, this medication was supplied only in glass ampoules for professional use. The ampoules had to be broken open and the medication drawn into a syringe and subsequently injected into a flowing IV line. Administration systems for this medication have been redesigned to be more user-friendly so that the lay public can utilize them in an emergency situation.

 

In 2014, the FDA approved a naloxone autoinjector for home use by family members and caregivers. The device is designed for use on the outer thigh, through clothing. It has no visible needle, contains two doses of naloxone, and comes with voice prompts that begin playing as soon as it is removed from the box. A trainer mock-up allows the potential user to acquire the “feel” of the device without actually administering any medication.

 

In 2015, the FDA approved naloxone for intranasal spray. This permits bystander rescue by simply spraying half the naloxone charge into each nostril of an unresponsive patient.

 

A shortcoming of these two rescue technologies is the short duration of the reversal medication, naloxone. The reversal dissipates quickly and the respiratory depressant effect of the opioid reestablishes itself. The temporary reversal of the opioid requires subsequent transportation to the emergency department (ED) to preclude subsequent respiratory re-arrest. The newly revived patient sometimes refuses such transportation for fear of being put into a situation where the craved opioids are unavailable.

 

Addiction Treatment

 

Addiction treatment is a different matter from toxicity treatment. Toxicity treatment involves the emergency treatment of respiratory arrest. Addiction treatment is less emergent but more complicated.

 

The goals of addiction treatment are

  1. Ameliorating withdrawal symptoms
  2. Reducing cravings
  3. Reducing needle sharing and promiscuous behavior leading to the spread of other diseases as HIV and hepatitis
  4. Reducing relapse rates 
  5. Reducing drug diversionMaintaining longer abstinence

 

 

 Thomas Falasca, DO

This video is a narcotics overdose case from Saint Paul's Emergency Room in British Columbia

Back to School Health Tips

School days are upon us and that brings new concerns for our children’s health, concerns regarding backpacks, l ...See More


Back to School Health Tips

School days are upon us and that brings new concerns for our children’s health, concerns regarding backpacks, lunches, starting school, homework/study habits, and hygiene. Here are some helpful tips on how you can promote a healthier, happier school year.

 

Backpacks

  • Backpacks should have wide, padded shoulder straps and a padded back.
    The backpack should never weight more than 10-20% of the child’s weight.
    Both shoulder straps should be used so as not to produce uneven strain on either side of the back.
    Heavier items should be arranged close to the midline of the back.
    Do not ignore back pain in a child.
    If a child develops back pain that doesn’t improve, consider a second set of textbooks to keep at home.

 

Lunches

  • Consult school menus and consider packing a lunch on days when the menu includes items that your child doesn’t eat.
    Remember that a typical 12-ounce soft drink contains 10 teaspoons of sugar and 150 calories. Drinking just one can daily increases your child’s risk of obesity by 60%.

 

For Children Starting School

  • Answer any questions about school before classes begin.
    Introduce children to their school and, if possible, to their teacher, in advance.
    If possible, introduce them to classmates before the school year begins.
    Spend time talking with children about what happened in school.
    Make morning preparation as stress-free as possible by laying out books and clothes the night before.
    Let the child know that is normal to be a little anxious about starting school Assign a permanent workspace conducive to doing homework.

 

Homework and Study Habits

  • Schedule enough time for homework.
    Consider prohibiting TV and similar distractions during homework time.
    Supervise computer and internet use.
    Be available for consultation during homework time but do not do the child’s homework.

 

Hygiene

  • Stress hand washing before eating and after using the toilet,blowing the nose, tying the shoes, or playing outside.
    Handwashing should continue for as long as it takes to sing the “Happy Birthday Song” twice.
    Give the child an alcohol-based hand sanitizer to use whenever washing is unavailable and after using shared computers, pencil sharpeners, or other community objects.
    Remind the child to keep hands away from eyes and out of mouth.
    Stress the importance of not sharing food, water bottles, or other personal items.

 

So, with these tips in mind, the school year should bring peace of mind to the adults and new growth to the children.

 

Thomas Falasca, DO

 

 

For More Information Please Visit

American Academy of Child and Adolescent Psychiatry
http://www.aacap.org/page.ww?name=Starting+School&section=Facts+for+Families

 

American Academy of Orthopedic Surgeons
http://orthoinfo.aaos.org/topic.cfm?topic=A00043

 

American Academy of Pediatrics: Back to School Tips http://www.aap.org/en-us/about-the-aap/aap-press-room/news-features-and-safety-tips/pages/Back-to-School-Tips.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%253a+No+local+token

 

American Psychiatric Association
http://www.healthyminds.org/More-Info-For/Children/ABCs-of-Starting-School.aspx

 

Mayo Clinic
http://www.mayoclinic.com/health/childrens-conditions/CC00059/NSECTIONGROUP=2

Seasonal Flu

Influenza, or “flu,” is a highly contagious respiratory illness that occurs in seasonal epidemics.   ...See More


Seasonal Flu

What Is Flu?

Influenza, or “flu,” is a highly contagious respiratory illness that occurs in seasonal epidemics.  An episode of flu typically runs its course over several days.  Although usually just a severe nuisance, flu can sometimes result in respiratory failure and death.

 

Symptoms

An attack of influenza is usually accompanied by muscle aches, headache, fever, sore throat, red watery eyes, runny nose, and cough.  Only some of the symptoms may be present.

 

These symptoms sound like a cold, and like a cold, flu is a respiratory infection. However, influenza is caused by a different virus and is more severe.

 

Severity

Each year about 200,000 Americans are hospitalized because of flu complications. The number of deaths varies depending on the annual virus strain; but American deaths have recently ranged from 3,000 to 49,000 in a year.  While human lives are most important, it is noteworthy that even mild strains of the flu can impact the American economy by $10 billion annually in lost productivity.

 

Contagion

Influenza is typically spread by the aerosol droplets propelled in the course of a cough or sneeze.  Even people six feet from a sneeze are at increased risk of infection from these micro particles.  

 

Flu can also be spread from surfaces.  If a person coughs into their hand or sneezes into a handkerchief and then touches an object such as a doorknob or computer keyboard, that object becomes contaminated. A person who touches the object shortly afterward can be infected, usually when they transfer the virus from their hand to a mucous membrane such as the nose, mouth, or eye.

 

Because of the high level of contagion, it is important that flu patients remain home to avoid infecting co-workers.

 

Infectivity

Once a person becomes infected by the virus, it takes 1 to 4 days before they exhibit symptoms.  However, they may transmit the virus to others even before symptoms become evident. Thus it is not sufficient to avoid persons who appear to be sick.  It is important to make a habit of frequent hand washing as this can reduce both virus dissemination and acquisition.

 

Complications

Occasionally influenza does not run its normally uneventful course but instead results in complications.  Some of the most serious of these are viral pneumonia, bacterial pneumonia, respiratory failure, an inflammation of the heart (myocarditis), an inflammation of the membrane surrounding the heart (pericarditis), and multiorgan failure.

 

Vulnerability

Fatalities are most common in infants and the elderly. Thus it is important that senior citizens receive vaccination, the “flu shot.”  Vaccination is also important for pregnant women.  Pregnant females are not at risk from the flu shot and they need vaccination because they are at increased risk of complications from flu and they need to pass on their immunity to the newborn.

Others who are at increased vulnerability are those who are immunocompromised from disease or chemotherapy.

 

Pandemics

A pandemic is an epidemic that occurs over a broad area.  Four flu pandemics have occurred in the last century.  These epidemics occurred when a highly contagious and aggressive strain of the virus emerged.  

 

The infamous “Spanish flu” of 1918 killed nearly 675,000 people in the US and a possible 50 million people worldwide.  

 

The “Asian flu” of 1957 killed about 69,800 people in the US.  

 

The “Hong Kong flu” of 1968 took the lives of 33,800 people in the US.  The relatively modest number may have been largely due to the availability of antibiotics to treat secondary bacterial infections.  

 

The “swine flu” of 2009 caused between 9,000 and 18,000 deaths.  The reduced number of deaths in this epidemic may have been due to the fact that 80 million people were vaccinated.

 

Flu Vaccination Does Not Cause Flu

Vaccination against flu can be by injection or nasal spray.  The injection contains virus that is inactivated (“killed”). The nasal spray contains virus that is attenuated (“weakened”) and so altered that it can be active only at the cooler temperatures of the nose and not in the warmer temperatures of the lungs. The result is that flu vaccination does not cause the flu!

 

Vaccination Side Effects

Serious vaccination side effects are quite rare.  They are circumvented by avoiding certain flu vaccinations in specific groups of people.

 

Traditionally, flu vaccine was produced using chicken eggs and was contraindicated in persons with egg allergy.  Since 2012 a vaccine prepared in a different manner has been available for persons 18 years of age and older who are allergic to eggs.

 

An inactivated virus vaccination rather than an attenuated virus vaccination is generally appropriate for persons with weakened immune systems congenitally, from illness, or from chemotherapy.

 

In short, some type of flu vaccination should be appropriate for most individuals 6 months of age and older.

 

So If I Get Vaccinated, I Can’t Get the Flu, Right?

Not quite!  In the recent past flu vaccination has had 70% effectiveness against influenza B and 60% effectiveness against influenza A.  This is so because:

  • The US Center for Disease Control (CDC) must project in advance the virus strains of the upcoming flu season.
  • Different individuals have different capabilities of manufacturing antibodies in response to the stimulus of the vaccine.
  • It takes 1-4 days after infection for flu symptoms to emerge.  Persons can be infected before they receive the vaccination.
  • It requires 7-14 days for the body to build antibodies from the stimulus of the vaccination. Vaccinated people can be infected with flu during this time period.
  • Symptoms of flu can be simulated by other virus infections.  Flu vaccinated persons who seem to get the flu may have these other infections.

 

How Can I Prevent the Flu?

The best method of dealing with the flu is not to have it!  In order to greatly reduce chances of getting the flu, it is most important to take these precautions:

  • Practice frequent hand washing, especially after contact with objects touched by infected persons or the general public.
  • Avoid proximity to infected persons.
  • If infected, stay home and avoid contact with others. Bear in mind that you are infectious for 4-9 days after onset of symptoms.
  • Finally, present yourself for vaccination.  This is your surest way of protecting yourself from flu.  As an added benefit, remember that by getting vaccinated, you are also protecting newborns, elderly, chemotherapy patients, and others unable to fully benefit from their own vaccination.

 

Conclusion

So please stay well this season and protect yourself from flu.

 

Thomas Falasca, DO

View this fact-filled video on flu symptoms from the US Centers for Disease Control!

 

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