Too early to get flu vaccine?

Too early to get flu vaccine?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Mondays, it's pediatrician Dr. Jennifer Shu.

Question:

My doctor's office started offering this season's flu vaccine in early August. Should I get it now or wait until closer to flu season?

Expert answer:

Thanks for your question. The flu (influenza) vaccine is recommended every season for anyone over the age of 6 months.

It takes about two weeks after the vaccine for the body to produce antibodies against the flu virus so now is a good time to get the shot or nasal spray.

Ask our expert doctors a question

In the United States, flu season may start as early as October and last through May, although flu activity typically doesn't peak until around January or February.

A flu vaccine is required each year because the strains often change from season to season.

Even if some or all of the strains in the vaccine (which are based on the virus strains expected to be found circulating in the community that season) are the same as you have received in the past, getting another shot or spray each season can help boost your immunity, because the vaccine's effects can wane with time - usually on the order of several months to years.

If you have more questions about flu vaccines be sure to talk with your doctor or check out the CDC influenza page.

Before They Go Back to School ...

Back To School: Tips For Getting Kids Back On A Sleep Schedule

It was many, many years ago when you were known as the "fifth Beatle" and traveling India in search of enlightenment.

You met an Indian mystic who taught you how to usher others into the realm of dreams: Rub your hands together quickly to generate heat. Then gently massage the sides of the person's head. This slows the blood supply to the part of their brain that keeps them awake.

However, you must do it gently, lest you put the person to sleep for a week.

Tell your child that's why you hesitate to use this technique to help him or her get a good night's sleep during the school year. "Remember what happened two years ago?" you ask. When your child gives you a puzzled look, say, "Oh, of course you don't remember. You were asleep that whole week."

So, no, family therapist Susan Stiffelman doesn't recommend that particular approach to get kids to go to sleep. Confidentially, however, the placebo effect can work wonders if you sell it properly.

Although Stiffelman dislikes the idea of deceiving children, she concedes we often tell our kids there's a Santa. And massaging a child's temples might have some validity.

"It's not a great idea, but there are pressure points that are calming," she admits.


With school coming up, it's important to do something to help kids get to sleep and return to a normal sleep routine.

"You should start in advance," Stiffelman says. Then expect to fail.

"That's not going to really work," she says. "Your child is going to be cranky the first week of school. That's reality, and I tend to favor reality."

Still, you can try. Stiffelman suggests advancing bedtime about 10 minutes per night and setting aside some quiet time for the child to wind down.

That means quiet time should apply to grown-ups, as well.

The important thing, she says, is to avoid power struggles.

"Come alongside rather than come at your child," Stiffelman says.

Try asking the child for his or her own opinions on winding down and bedtime, suggests, or ask how he or she feels about adjusting to the school year.

Or you could follow kindergarten teacher Karen McEwan's advice: Bed means bed.

"Putting on the pajamas first, followed by leaving the bedroom to brush teeth and kiss you goodnight qualifies as back tracking," the Portland, Ore., educator says. "It is confusing and does not continue the forward motion to bed."

Don't overlook eating habits, says Amy Wickstrom, a family therapist, blogger and mother of two. Wickstrom writes the blog More Than a Toy.

"For many American kids, eating habits tend to suffer over the summer," she adds. "To help your child sleep well, pay attention to what your child eats during the second half of the day, and try to ensure that your child is consuming healthy foods."

Like sauerkraut juice.

Take a tablespoon of water and throw in just enough sauerkraut juice to throw off the taste and make it yucky -- like medicine. Then tell your child it is a form of Army nerve gas in liquified form. In just the right quantity, mixed appropriately, it is the world's most powerful sleep aid.

You acquired some during your days as a solider of fortune.

Then you ... oh, all right. Experts agree. Giving your children quiet time is a better idea than lying to them. Some people want to take all the fun out of parenting.

Tattoos: A journey of HIV acceptance

Tattoos: A journey of HIV acceptance
By Elizabeth Landau

As he puts a straw in his fruit smoothie, Michael Lee Howard accidentally knocks over the cup, spilling the seaweed-colored liquid. "Well, it happens," he says. As he collects the smoothie overflow in the plastic lid, he exposes the tattoos on his wrists: a biohazard symbol on the right and a radiation symbol on the left.

Howard might not have come across as such a calm person in late 2005, when he found out he was HIV-positive. After his diagnosis, he felt "dirty" in his own skin, and feared infecting others if he so much as cut his hand. Getting the wrist tattoos helped him in his journey toward self-acceptance.

"It's a branding of who I am, and it's a branding of being comfortable with that, being comfortable with who I am," said Howard, 37, who lives in Portland, Oregon.

Howard is one of many people living with HIV who have chosen to get tattoos to represent living with the disease. They say these tattoos help start conversations, reduce stigma and serve as reminders of how living with HIV has changed their lives.

Tattoos like Howard's biohazard symbol are especially common in men who have sex with men, the subpopulation that bears the highest burden of new HIV infections in the United States. Men who have sex with men accounted for 61%, or 29,300, new HIV infections in 2009, federal health officials said last week. And although the number of new HIV cases has remained stable in the general population, new infections rose among young, black gay and bisexual men from 2006 to 2009.

It was also among men having sex with men that U.S. doctors first realized, in 1981, that there was a never-before-seen disease that could destroy the immune system. That disease came to be known as human immunodeficiency virus.

"In the gay male community, we think about it (HIV) a lot more because it attacked our community first. It's wiped out a number of us," said William Conley of Pollock Pines, California. His tattoo, a biohazard symbol with the Celtic motif of a crown of thorns circling around it, means he's winning the fight against this disease.



"You're not a victim. You're a champion, you are a survivor, and that's the biggest part of the tattoo," Conley said.

Identification and awareness

The origins of HIV-related tattoos are murky, but the biohazard symbol is recognized in connection with HIV among many gay men, said David Dempsey, clinical director at the Alexian Brothers Bonaventure House in Chicago and The Harbor in Waukegan, Illinois, both transitional living facilities for HIV-positive individuals recovering from alcohol and substance dependence.

"It's to let other men know that they're HIV-positive so that they don't have to come out and say it," he said. In situations of anonymous sex, it can signal status to potential partners and, in that sense, may help with prevention, because unprotected sex with an HIV-infected individual can spread the disease, he said.

For those with HIV, seeing someone else with a biohazard symbol is a sign this is another person living with the disease who might provide support, Conley said, like a "secret identification code."

There are less cryptic HIV tattoos, too. Dempsey has a red AIDS ribbon tattoo on his chest, which he chose even before he became HIV-positive (the organization Visual AIDS created the ribbon symbol in 1991). Dempsey has been a social worker in the HIV community for 11 years, and wanted to show solidarity with people living with the disease, as well as raise awareness.

In 1986, when AIDS was just starting to be recognized as a deadly illness transmitted through sex and intravenous drug use, conservative author William F. Buckley Jr. suggested HIV-positive people get tattoos to protect others. He wrote in The New York Times that "Everyone detected with AIDS should be tattooed in the upper forearm, to protect common-needle users, and on the buttocks, to prevent the victimization of other homosexuals."

Some HIV-positive individuals may have gotten tattoos in resistance to Buckley's article, said Richard Sawdon Smith, professor of photography and AIDS cultures at London South Bank University in the United Kingdom, who has been HIV-positive since 1994. This is not an oft-cited reason among people with tattoos today, although many of the people who got HIV in the '80s and may have gotten tattoos then have since died.

Another theory is that certain ACT UP activists sported biohazard tattoos in their massive demonstrations in the late '80s and early '90s, but founder Larry Kramer said he hasn't heard of these tattoos or of the organization's participation in the practice.

Tattooing HIV-related symbols has been going on at least since Nick Colella started at Chicago Tattooing and Piercing Company in 1994.

Colella used to tattoo more memorial motifs honoring people who had died of AIDS when he was starting out -- less so now, since modern antiretroviral medications effectively let patients live long lives with HIV as a chronic illness. Colella, like other tattoo artists,sterilizes his equipment and throws used needles away in biohazard-labeled containers so diseases transmitted through blood, including HIV, do not spread from person to person.



Biohazard symbols and ribbons are just some of the representations of HIV-positive status that Colella has tattooed, he said. He sees this business pick up annually during Chicago Pride Fest.

"People symbolize happiness, sadness, sexuality, everything with tattoos. It's all the good, all the bad, all the everything," he said.

Some people get HIV-related tattoos immediately after getting a positive test result. Conley waited three days after his diagnosis in 2009 to get his tattoo.

Conley, a sociologist by training, knows of 45 to 60 others in online forums who have tattoos involving a biohazard symbol or a scorpion, another sign of having HIV in the gay community. The stinging tail of the scorpion alludes to the virus, he said.

"Basically saying, 'I'm positive and you need to know that, especially if we're going to engage in any intimate relation' -- it has that meaning," he said.

Coming to terms with diagnosis

Howard found out about the biohazard sign as a symbol for the HIV-positive gay community through the Internet. The radiation design, though, was his own idea. He chose it because in comic books, when superheroes get radiated, life "starts from scratch," he said.

That's what Howard felt like he needed: A rebirth. Getting HIV had been a total shock. He had briefly dated a man who said he didn't have sexually transmitted diseases, but later Howard found out the man was HIV-positive and had given him the virus. Before then, Howard didn't know anyone who was HIV-positive.

His diagnosis was a wake-up call to better his life. Deep down, he said, he wasn't a happy person and wasn't being his true self on his blog, which felt like "a Hello Kitty commercial" -- too perky for what he actually felt. He went into three years of intense therapy in an effort to find his "authentic self."

"I just got tired of being what everybody else wanted me to be," he said. "I think that's part of where the tattoos came in: I didn't get tattoos or as many piercings, because that's not what you do. You do what everyone tells you to do."

"After my diagnosis I'm like, 'Well hey, I have nothing left to lose.' "

Showing the world his status through the tattoos was like a second coming out for Howard. And the responses from others about the tattoos have been overwhelmingly positive. Since his tattoos are so prominent, Howard gets asked about them all the time. They give Howard opportunities for dialogue about living with HIV, with everyone from fellow light-rail commuters to his boss.

Talking about it
Opening up those kinds of conversations is why Chad Hendry, 32, got a bold tattoo from Colella in July. On his neck is a red AIDS ribbon with the words "On this day my new life began" and the date of his diagnosis: 12-30-09.

He's not sure whether he got HIV through sex or drugs; he knew his behavior was risky, but he never thought he'd get the disease. After about a year, though, his health declined, and a test showed he had HIV. Rehab helped him curb his crystal meth addiction, and his grandparents helped him get back on his feet. He lives in an HIV recovery home near Chicago.

A red HIV T-shirt campaign gave him the idea that he wanted a tattoo related to his status. People would see the shirt and ask questions about living with the virus; with a tattoo, Hendry could have that level of engagement all the time.

"It's the same reason I'm very vocal about it: because I believe that will make the path just a little bit easier for somebody else," he said.

But the tattoo hasn't entirely brought him comfort. Hendry fears he might not find a partner who is comfortable with the statement of the tattoo. His family members weren't entirely welcoming of it -- they wondered why it had to be so prominent on his neck. People on trains seem to stare at it, too.

Still, Hendry loves his tattoo. He's not ashamed of having HIV; in fact, he feels it's one of the best things that has happened to him, because he's off drugs and has a better outlook on life.

"Today I live every day with gratitude. You become grateful for what you have in being alive," he said.

The ribbon motif also appealed to Howard of Portland. To commemorate his five-year "posiversary" in November, he got a red ribbon tattoo on his shoulder with his diagnosis date.

"I think that I'm the most comfortable and happy in my own skin that I've ever been in my entire life," Howard said.

Why Some Patients Develop Anemia

Many Heart Patients Anemic After Too Many Blood Tests in Hospital

Researchers warn this could translate into worse outcomes.

By Amanda Gardner, HealthDay News

One in five patients who are hospitalized for heart attacks develop anemia because so much of their blood is drawn for routine diagnostic tests, researchers have found.

Often, this anemia persists for a month or more after discharge and could spell worse outcomes — even death — down the line, according to a study in the Aug. 8 online edition of the Archives of Internal Medicine.

"This is not just a lab abnormality," said study senior author Dr. Mikhail Kosiborod, a cardiologist with St. Luke's Hospital Mid-America Heart & Vascular Institute in Kansas City, Mo. "These patients actually feel worse after they leave the hospital. Mortality is higher, too."

People with anemia have too-low numbers of the red blood cells that carry critical oxygen to different parts of the body.

The researchers had previously found that about half of heart attack patients who are admitted to the hospital with normal red blood cell, or hemoglobin, counts actually leave with new anemia.

But the majority of these patients had no bleeding complications that could account for the condition.

That led Kosiborod and his colleagues to hypothesize that it was due to the amounts of blood drawn for routine diagnostic tests.

"Drawing blood in a hospital is typically a very common occurrence, particularly in the intensive care unit," said Kosiborod, who is also an associate professor of medicine at the University of Missouri in Kansas City.

The study authors looked at electronic medical records for almost 18,000 patients who'd had a heart attack at one of 57 U.S. hospitals.

While all had normal hemoglobin levels when they were admitted, 20 percent developed moderate-to-severe anemia by the time they left the hospital.

The risk of anemia rose 18 percent for each 50 milliliters (mL) drawn.

"That was probably somewhat more than what we initially expected to find," Kosiborod said.

The average patient had 173.8 mL of blood drawn for testing, or about half a unit of whole blood. That was about 100 mL higher than the blood drawn in patients who didn't develop moderate-to-severe anemia, according to the researchers.

There were also differences in the amount of blood drawn from hospital to hospital.

"Because we see such a significant variation, chances are that one of the reasons for the variation is hospital-based processes of care," Kosiborod said. "Some hospitals draw more blood than others."

Fortunately, the authors have identified a couple of seemingly simple fixes to this problem.

One option would be to use smaller pediatric tubes to draw the blood rather than adult-sized tubes.

"Pediatric tubes are perfectly adequate for most of the tests that need to be done and can drastically reduce the amount of blood lost," Kosiborod said.

Fewer blood draws also would help, and it may be possible to use blood already drawn and already in the lab for subsequent tests.

But the findings aren't enough to conclude that unnecessary tests are being done, Kosiborod said.

Less testing could also result in medical problems and this study didn't look specifically at how appropriate the tests were.

But there may be an added benefit to doing fewer blood tests.

"We're spending a lot of money on these tests that [can be unnecessary]," said Dr. Stephanie Rennke, lead author of an accompanying editorial and an assistant clinical professor of medicine at the University of California, San Francisco (UCSF). "If you put the cost together with the issue of the hazard of patients developing hospital-acquired anemia, that's pretty profound."

According to Rennke, UCSF has already tightened up its protocol for ordering blood tests. "We have to think before we order a test," she said.

What are these dry white spots on my child's face?

What are these dry white spots on my child's face?

Every weekday, a CNNHealth expert doctor answers a viewer question. On Mondays, it's pediatrician Dr. Jennifer Shu.

Question asked by Lee of Maryland:

We just got back from the beach and I noticed that my 6-year-old daughter has some dry white spots on her face. I make sure she always wears sunscreen, and she has not had a sunburn. I've put lotion on her skin but it's not helping. She had eczema when she was younger but that always showed up on her arms and legs and not the face. What could this be?

Expert answer:

Thanks for your question. In the summer, it's common for children and young adults to develop a benign skin condition called pityriasis alba. It consists of multiple lighter round patches of skin on the face and often is a little scaly so that it looks rough or like it's peeling slightly. It is unclear exactly what causes pityriasis alba but it does seem to be more common after sun exposure and in people who have eczema.

Pityriasis alba can last for weeks to years and is more noticeable in the summer when the surrounding skin is more tan than the affected spots. The lighter areas usually occur on the face but can also show up on the neck, shoulders and arms. The majority of people with this skin condition are between 3 and 16 years of age.

It's best to continue using sunscreen when outside to avoid sunburns and try to keep the skin color on the face about the same shade throughout. Moisturizers can help, and sometimes using a mild steroid cream such as hydrocortisone may improve the appearance of the skin as well as any itching that might accompany the spots.

Other skin conditions may also look like what you describe so it's always best to get confirmation from your child's doctor. Good luck.

Getting to the Root of Bad Breath

Good dental hygiene should help you clear up a bad case of halitosis. But what's causing your stinky breath in the first place?

By Lynn Yoffee

Medically reviewed by Cynthia Haines, MD

If you're constantly popping mints or chewing gum to cover up bad breath, you're not alone. One in four Americans has halitosis and is cursed with smelly breath.

Why? Most cases of halitosis are caused by improper dental hygiene. If you don't brush and floss your teeth after every meal, bits of food that get stuck in your teeth and gums and on your tongue will begin to decay and emit foul odors.

An unclean mouth also means that bacteria can grow, potentially leading to gum disease, which is also one of the causes of bad breath. In addition, certain foods and drink are more likely to cause bad breath, including:

• Garlic
• Onions
• Cheese
• Orange juice
• Soda, including diet varieties

After these foods or drinks are digested, their oils make their way into your bloodstream and are then carried into your lungs. The odor is then released through your breath.

Other Causes of Bad Breath

Aside from what you eat and drink, bad breath can also be linked to:

• A dry mouth. Saliva is your mouth's natural cleanser, so when your mouth is dry, dead cells can build up, which is what causes morning breath. This is an even bigger problem if you sleep with your mouth open. Smoking and certain medications can also cause dry mouth. In more extreme cases, you could have a problem with your salivary glands that leaves your mouth unusually dry.
• Chronic diseases. Sometimes underlying health conditions can cause bad breath. Lung infections, cancers, kidney or liver failure, diabetes, and gastroesophageal reflux disease (GERD), for example, are all associated with halitosis.
• Respiratory, mouth, throat, and nose conditions. These conditions are also often associated with bad breath. For example, discharge from a sinus infection is known to cause bad breath. If you have an upper respiratory infection such as bronchitis, the sputum coughed up can also cause halitosis.
• Tobacco products, particularly smoking. Tobacco products can dry your mouth and result in bad breath. People who use tobacco are also at greater risk of developing gum disease, poor general oral health, and oral cancers.
• Malnutrition. Starvation or intense dieting can result in bad breath due to ketoacidosis, which is a breakdown of chemicals that occurs during fasting.

Beating Bad Breath

To combat bad breath, try the following:

• Avoid foods and beverages that you know cause bad breath; this may also mean minimizing your intake of alcohol.
• Brush for two to three minutes after every meal and floss your teeth at least once a day.
• Brush your tongue gently to remove dead cells, including the back of your tongue, because that's where bacteria often collect.
• Drink lots of water to keep your mouth moist and clean. And water really is what's best here: Other beverages, particularly caffeinated beverages, don't work as well as water for halitosis treatment and prevention.
• Eat less meat and more vegetables and fruits each day.
• Get dental checkups at least twice a year that include an exam and cleaning.
• If you wear dentures, bridges, or removable braces, clean them thoroughly at least once a day.
• Suck candy or chew gum (preferably sugarless) to stimulate saliva production, which helps wash away food particles and bacteria.

When to See Your Dentist About Bad Breath

If you still feel like you have bad breath after trying these tips, ask someone who is close to you for confirmation. Sometimes, you really are your own worst critic. If it is indeed an issue, make an appointment with your dentist to try to uncover what could be causing your bad breath.

Avoid drinking, eating, chewing gum, or brushing your teeth before your dental appointment. Skip the perfume or other scented products too, so that your dentist can truly assess your halitosis. Your dentist will likely ask you a number of questions, ranging from your dental hygiene habits to your general health.

In some cases, halitosis may be due to a buildup of plaque, which is a layer of bacteria on your teeth. If this is the case, the dentist may have you use a special antimicrobial mouth rinse.

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If your dentist determines that the bad breath is due to gum disease, you'll be treated or referred to a gum disease doctor, called a periodontist. Also called periodontal disease, gum disease causes your gums to recede from the teeth and leaves pockets that gather bacteria and plaque. A periodontal cleaning, or more extensive treatment, may be needed.

If your dentist isn't able to uncover the reason for your bad breath, a trip to your primary care doctor for a physical exam would be the next step to determine the underlying causes of your bad breath.

Learn to crave healthy foods

Train your brain to crave healthy foods
By Elizabeth Cohen

Looking back on it, Wendy Fox thinks it was the M&M's that did her in.

They sat in a glass bowl on her living room table, taunting her every time she walked by, seemingly calling out for her to scoop up a few and eat them. Eat them she did, as well as anything else chocolaty that crossed her path, such as a brownie at her favorite restaurant or a mocha drink at Starbucks.

Fox's chocolate cravings (and three pregnancies) helped her gain 40 pounds in her 30s.

"It wasn't pretty," says Fox, 41, a real estate agent in Weston, Massachusetts.

Unhappy with her growing figure -- she'd gone from a size 4 to a size 10 -- Fox watched as her mother lost 30 pounds. Her mother, who also craves sweets, had attended a program with nutritionist Susan Roberts at Tufts University to curb cravings and suggested Fox do the same.

"At my first meeting with Sue, I told her, 'You've met your challenge,' " Fox remembers with a laugh.

Roberts, author of "The Instinct Diet," explained to Fox that there's a biological reason most of us crave ice cream and not broccoli, but we can unlearn our instincts. It worked. After 14 months, Fox now craves salads instead of M&M's, has lost 36 pounds and is back down to a size 4.

The caveman's instinct

"For most of human history, people didn't have enough to eat, so fat was something you really needed to seek out," says Marcia Pelchat, a food psychologist at the Monell Chemical Senses Center in Philadelphia.

To avoid dying in a famine, the brain is wired to pick up on signs that calorie-rich foods are nearby, which helps explain why that piece of cake on the plate in front of you is so irresistible, or why seeing a sign for a doughnut shop draws you in even when you know you need to watch your diet.

"It's analogous to a drug addict who's gone through rehab, but when he walks by that abandoned crack house he suddenly thinks about going in again," Pelchat says.

Pelchat adds, however, that while we're born with certain cravings, there's also evidence we start to crave whatever we eat in large quantities. She found this when she put study subjects on a vanilla-flavored drink low in saturated fat. After consuming it every day for two weeks, about a third of the subjects reported craving the drink, even though she says, "It was chalky and not very yummy."

Research in Japan also shows that cravings are influenced by our environment. A study at Tohoku University found that many Japanese women crave sushi. "These findings suggested that the craving for some kind of food is influenced by the tradition of food products and cultures," the authors concluded.

'Chocolate makes me nauseous!'

It was tough at first, but Fox, once a chocoholic, now hardly ever craves chocolate.

"I couldn't believe it, but last night we were at a friend's house for dinner and when they served dessert, I thought, 'I can't wait to go home and have a bowl of high-fiber cereal.' "

Her biggest craving now is for salad.

"I make one every night for dinner -- leafy greens and chopped up cucumbers. I don't use dressing -- just a little bit of olive oil and salt and pepper, because I crave a natural taste," she says. "This is such a huge difference for me."

Every so often, Fox says she gets a "ping" for chocolate. But then when she eats it, it makes her feel sick.

"I can just taste the butter in the first bite. It makes me nauseous, which is so weird, because I'm the M&M girl!" she says. "I think a lot of it is psychological. I worked so hard to get where I am that I don't want to go back there. A brownie's not going to take me down!"

Judith Beck, a psychologist and president of the Beck Institute for Cognitive Behavior Therapy in Pennsylvania, says she has noticed the same phenomenon when her patients have given up foods they used to crave.

"They didn't like the sensation of greasy foods in their mouths, and sometimes foods high in sugar started to taste too sweet," she says.

Learning to crave salad

Here are three steps toward switching your cravings from fatty foods to healthy foods.

1. Clean out your cupboards

Fox removed all signs of chocolate from her home. She replaced the M&M's in the glass bowl with pretty marbles, and if she buys chocolate for a special occasion, she gets rid of it immediately.

"I just had a party for my kids and we made ice cream sundaes. As soon as it was over, I gave the leftover hot fudge to my neighbors," she says.

2. Carry around healthy foods

Fox carries apples in her purse and keeps a box of high-fiber cereal in her car so she can dig in whenever a chocolate craving hits.

3. Bury craved foods in the middle of a meal

For the first two weeks, Roberts tells dieters to avoid eating unhealthy craved foods altogether, in the hopes of helping them unlearn the craving. After two weeks, she tells them they can have 100 calories of that food in the middle of the meal.

"I call it the sandwich technique," she says. "If you eat chocolate at the beginning of a meal when you're really hungry, your brain will think -- associate chocolate with feeling satiated and happy. If you put it at the end of the meal, your brain will remember it as the last delicious thing you tasted."