Chronic Pain and Fibromyalgia

What do your symptoms mean?

Everyone experiences pain occasionally, whether it’s a headache, muscle stiffness, or an upset stomach. Some people, such as migraine sufferers or those with irritable bowel syndrome, have to deal with pain and discomfort on a more frequent basis. And then there are people with fibromyalgia—a chronic pain disorder whose often debilitating symptoms overlap with many other diseases.

Now that three drugs have been approved to treat fibromyalgia, you may be hearing a lot about this condition. And if you’ve experienced unexplained pain recently, it’s easy to wonder whether you might even suffer from it. (Between 80% and 90% of those diagnosed with fibromyalgia are women.) Diagnosis can be tricky, but experts say that with the right information, it is possible to find the true cause of your pain—whether it’s fibro or something else—and get the treatment you need.

So where do your aches, pains, and everyday health woes fit in? Here’s our guide to what’s normal and what’s not, and when you should see your doctor.

Headaches

Headaches can be caused by any number of factors, and, rarely, they can be an indicator of a more serious health condition. More often, headaches are temporary and not dangerous, and can be treated with over-the-counter pain medication or by addressing an underlying issue—dehydration or sinus problems, for example.

People with fibromyalgia, however, can suffer from constant tension or migraine headaches. The key word is constant—meaning daily—headaches, combined with other fibromyalgia symptoms: Even having repetitive on-and-off headaches, say 10 a year, could just mean that you suffer from chronic headaches and should consult a neurologist to find effective treatment.

Memory problems

An inability to concentrate and difficulties with memory can be linked to sleep deprivation, attention disorders, Alzheimer’s disease and other forms of dementia, or just simply being overworked and overstressed.

People with fibromyalgia often experience these problems as well, known to doctors and patients as “fibro fog”, in addition to chronic pain and discomfort. Research has shown that fibromyalgia is associated with a decrease in “gray matter” tissue in areas of the brain that are involved in memory and cognition.

All-over pain

The number-one symptom of fibromyalgia is persistent pain all over your body in your muscles and joints for an extended period of time. “[If a patient says,] ‘I hurt all over,’” says rheumatologist Daniel Clauw, MD, director of the Chronic Pain and Fatigue Research Center at the University of Michigan, “that’s a big blinking neon light that it’s fibro.” Rebecca, who has lived with fibromyalgia for more than three decades, says it feels “like a bruise that covers your entire body.”

Other conditions, such as lupus and rheumatoid arthritis, can initially cause a feeling of widespread pain. “If it’s just in the joints, that person really should see a rheumatologist or someone who specializes in rheumatic or musculoskeletal disorders to make sure they don’t have arthritis,” says Dr. Clauw. Chronic pain that is exclusively in the muscles, on the other hand, can sometimes be polymyalgia rheumatica. But any pain that persists for years in both the muscles and the joints, Clauw explains, is most likely fibro.

Upset stomach

Irritable Bowel Syndrome (IBS), which is characterized by stomach cramping, bloating, and diarrhea or constipation, is a common symptom of fibromyalgia. But many people have the condition on its own.

IBS can be triggered by stress, hormonal changes, certain foods, or even antibiotics, and it can be treated with diet and lifestyle changes and with medication. If you have chronic abdominal discomfort with diarrhea or constipation accompanied by the pain described in the previous slide, it’s worth asking your doctor if you might be suffering from fibromyalgia.

Bladder pain

Experts are increasingly recognizing the role that chronic bladder pain may play in fibromyalgia. “It’s a new focus [in pain research],” says Dr. Clauw. “It’s basically the irritable bowel syndrome of the bladder.” Symptoms include pain in the bladder or pelvic region accompanied by feeling the need to urinate frequently.

If these symptoms are short-lived, the most likely culprit is an easily treated bladder or urinary tract infection. Or, if the only symptom is the urge to urinate, the condition is called overactive bladder syndrome.

When combined with all-over chronic pain, bladder pain may be a component of fibromyalgia. Though currently called interstitial cystitis, Dr. Clauw says the name is rapidly changing to “painful bladder syndrome,” which more accurately describes it.

Insomnia

More than 40 million Americans have difficulty sleeping, but only an estimated 5 million people live with fibromyalgia—which means there are plenty of reasons why you may not be getting a good night’s sleep. Learn about some of the more common sleep disorders in Health.com’s comprehensive sleep resource center.

If you suffer from serious fatigue that limits your daily activities, accompanied by difficulties with concentration and memory, and chronic pain,you have the three most significant symptoms of fibromyalgia. “These three group together,” says Dr. Clauw. “If you have all three, it’s likely you have fibro.” Still, he cautions that the type of pain you have is the single most important predictor of whether you have fibromyalgia.

Putting it all together

With so many symptoms to choose from, it can seem easy to assume that if you experience one, you may be suffering from fibromyalgia. But Dr. Clauw emphasizes that for each of these symptoms, the question to ask is: “What company does it keep?”

With the exception of chronic, multifocal pain, almost all the other symptoms listed here are not a sign of fibromyalgia on their own. It’s when you put them all together that it counts—and that’s when your doctor may be able to make a diagnosis and recommend medication and treatment options. Clauw recommends seeking help when symptoms become bad enough that they are impairing you function; he warns that doctors may be dismissive of mild fatigue, pain, or memory problems, for instance.  And he says your primary care doctor is “the best place to go.”

Side Effects of Prescription drugs

Should you worry?

If you’ve ever considered sleeping pills, you may have worried about how you’d feel the next day, whether you’d get hooked, and what other effects the medication might have on you. When used correctly, prescription sleep drugs are safe and effective, and can help you get through a patch of insomnia or fitful sleeping. In fact, doctors say they’re more reliable than over-the-counter meds for any extended period of time.

Side effects can occur, however, especially if you’re not taking the best type of medication for you, at the right dosage. Here are a few problems you may experience, and what you can do to avoid them.

Hangover

Many people worry that, should they decide to take sleeping pills, they’ll feel tired, fuzzy-headed, or dizzy; experience headaches or nausea; or have trouble waking up the morning after. These side effects are possible, but avoidable, says Ralph Downey III, PhD, director of the Loma Linda University Sleep Disorders Center in Loma Linda, Calif. If your doctor has prescribed the correct dosage, and you take the pill according to your doctor’s instructions, the medication should work effectively without any morning hangover, Downey says. Older drugs such as benzodiazepines are more likely to cause morning drowsiness or dizziness, because they have longer half-lives—meaning the effects take longer to wear off.

Dependence or addiction

Patients are often nervous about becoming addicted to or dependent upon sleeping pills. But studies show that the risk of sleeping pill abuse is decreasing as new medications are released. Researchers have found that Rozerem, a relatively new drug, may have the fewest side effects of all, and it seems to be non-habit-forming. However, addiction and dependence are still possible with other drugs, especially benzodiazepines.

Taking sleep medications long-term can mask the real cause of insomnia—such as poor sleep habits or too much stress. Patients often tell their doctors that they’re dependent on medication, but it’s possible they haven’t addressed underlying issues affecting their sleep, and that they don’t really need the pills.

Rebound insomnia

One of the most important things to know about sleep medication is how and when to stop taking it. Abruptly stopping the use of a sleep aid can cause rebound insomnia, meaning you may experience the same or even worse symptoms of your sleep disorder without medication. “To be safe, I assume that the effect may occur” in all patients, Downey says. That’s why he tells patients to never stop using a sleeping pill without first consulting a doctor.

Many sleep experts will wean their patients off sleep medications by prescribing lower doses or different medications, until they’re ready to sleep on their own.

Chemical taste

The makers of Lunesta (eszopiclone) alert patients to a common side effect: a bitter or chemical taste in the mouth. In a 2004 study of 300 adults with insomnia, 34% of people taking 3 milligrams of Lunesta experienced an unpleasant taste, and 17% noticed the taste from a 2-milligram dosage. Other patients may experience dry mouth.

Sexual side effects

Although Downey hasn’t observed any significant problems at the doses at which Rozerem is prescribed, he says it is possible for this medication to interact with hormones.

“[Rozerem] is a melatonin agonist, so it increases the level of melatonin by about 16 times what it would normally be in the brain,” says Downey. This increase in melatonin will put you to sleep, but could also alter testosterone levels. You could experience changes in your sex drive as well as your menstrual cycle.

Sleep-walking, eating, and driving

Patients taking sleep medication have reported such automatic behaviors as walking, eating, and even driving in their sleep—and not remembering it in the morning. “The most problematic thing is not that they just eat. I have patients that will get up and cook and leave the gas on overnight,” says Downey. Zolpidem (Ambien) in particular has been linked to sleep eating, although this apparent trend may be a function of the large number of people taking zolpidem, rather than a specific quality of the drug.

Downey stresses that automatic behavior is relatively rare, however. “We’ve only had one person here do that, and we evaluate over 1,000 people a year.” Nevertheless, the Food and Drug Administration considered the risk serious enough to request that all sedative-hypnotic drug products carry a warning about the potential for sleepwalking and similar behaviors.

7 Birth Control Side Effects

Hormone-based birth control often comes with side effects that can range from slightly annoying to bad enough to make you switch. You may not know what you can tolerate until you’ve given a couple of them a try. But here are some solutions for the most common problems.

Headache, dizziness, breast tenderness
Be patient. “These side effects seem to go away after you’ve been taking the Pill for a while,” says Hilda Hutcherson, MD, an ob-gyn professor at Columbia University. If they don’t, switching brands may help.

Nausea
It will probably go away in a couple of months. If not, and you’re taking oral contraceptives, try taking it with food. If you’re taking the ring or the patch, you might need to switch methods.

Breakthrough bleeding
“I think this is the side effect that drives women crazier than any other side effect,” says Dr. Hutcherson, mostly because it’s so unpredictable. Taking the Pill at precisely the same time every day may help. Especially with shots, the mini-Pill, and the implant—the progestin-only methods—the lining of the uterus is so thin that it sometimes sloughs off a little bit. (On the upside, this also makes your periods lighter and sometimes makes them disappear entirely.)

Talk to your doctor if you’re concerned about spotting, because there may be a solution. “You can sometimes add an anti-inflammatory such as ibuprofen, or occasionally you can add a little estrogen,” says Anne Foster-Rosales, MD, chief medical officer for Planned Parenthood Golden Gate and a professor at the University of California, San Francisco.

Decreased libido
Try another formulation. “Some women, if you change the Pill to one that’s more androgenic [testosterone-like], the libido comes back,” says Dr. Hutcherson. Otherwise, find another method completely.

Mood swings
If it’s really the birth control and not some other factor that’s bringing you down, you may need to find a nonhormonal method. “In my experience, if a woman has depression with one pill, switching [formulations] usually doesn’t help,” says Dr. Hutcherson. All hormonal methods are likely to cause the same problem. For some patients who really want to stay on the Pill, Dr. Hutcherson sonetimes prescribes an antidepressant as well, with good success.

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10 Best Food for Heart

oat meal

Oatmeal

Start your day with a steaming bowl of oats, which are full of omega-3 fatty acids, folate, and potassium. This fiber-rich superfood can lower levels of LDL (or bad) cholesterol and help keep arteries clear.

Opt for coarse or steel-cut oats over instant varieties—which contain more fiber—and top your bowl off with a banana for another 4 grams of fiber.

Salmon

Salmon

Super-rich in omega-3 fatty acids, salmon can effectively reduce blood pressure and keep clotting at bay. Aim for two servings per week, which may reduce your risk of dying of a heart attack by up to one-third.

“Salmon contains the carotenoid astaxanthin, which is a very powerful antioxidant,” says cardiologist  Stephen T. Sinatra, MD, the author of Lower Your Blood Pressure In Eight Weeks. But be sure to choose wild salmon over farm-raised fish, which can be packed with insecticides, pesticides, and heavy metals.

Not a fan of salmon? Other oily fish like mackerel, tuna, herring, and sardines will give your heart the same boost.

avocado

Add a bit of avocado to a sandwich or spinach salad to up the amount of heart-healthy fats in your diet. Packed with monounsaturated fat, avocados can help lower LDL levels while raising the amount of HDL cholesterol in your body.

“Avocados are awesome,” says Dr. Sinatra. “They allow for the absorption of other carotenoids —especially beta-carotene and lycopene—which are essential for heart health.”

Olive oil

Full of monounsaturated fats, olive oil lowers bad LDL cholesterol and reduces your risk of developing heart disease.

Results from the Seven Countries Study, which looked at cardiovascular disease incidences across the globe, showed that while men in Crete had a predisposition for high cholesterol levels, relatively few died of heart disease because their diet focused on heart-healthy fats found in olive oil. Look for extra-virgin or virgin varieties—they’re the least processed—and use them instead of butter when cooking.

Nuts

Nuts

Almonds, walnuts, and macadamia nuts are all full of omega-3 fatty acids and mono- and polyunsaturated fats.

Almonds are rich in omega-3s, plus nuts increase fiber in the diet, says Dr. Sinatra. “And like olive oil, they are a great source of healthy fat.”

berries

Berries

Blueberries, raspberries, strawberries—whatever berry you like best—are full of anti-inflammatories, which reduce your risk of heart disease and cancer.

“Blackberries and blueberries are especially great,” says Sinatra. “But all berries are great for your vascular health.”

legumes

Legumes

Fill up on fiber with lentils, chickpeas, and black and kidney beans. They’re packed with omega-3 fatty acids, calcium, and soluble fiber.

Spinach

Spinach

Spinach can help keep your ticker in top shape thanks to its stores of lutein, folate, potassium, and fiber.

But upping your servings of any veggies is sure to give your heart a boost.  The Physicians’ Health Study examined more than 15,000 men without heart disease for a period of 12 years. Those who ate at least two-and-a-half servings of vegetables each day cut their risk of heart disease by about 25%, compared with those who didn’t eat the veggies. Each additional serving reduced risk by another 17%.

soy

Soy

Soy may lower cholesterol, and since it is low in saturated fat, it’s still a great source of lean protein in a heart-healthy diet.

Look for natural sources of soy, like edamame, tempeh, or organic silken tofu. And soy milk is a great addition to a bowl of oatmeal or whole-grain cereal. But watch the amount of salt in your soy: some processed varieties like soy dogs can contain added sodium, which boosts blood pressure.

Flaxseed

Flaxseed

Full of fiber and omega-3 and omega-6 fatty acids, a little sprinkling of flaxseed can go a long way for your heart. Top a bowl of oatmeal or whole-grain cereal with a smidgen of ground flaxseed for the ultimate heart-healthy breakfast.

Swine Flu Drug

Scientists are exploring the possibility that drugs that affect the immune system might one day serve as potent weapons to fight the flu, even the swine flu that’s currently circulating around the globe.

The concept has worked with a group of lab mice that were treated with the rheumatoid arthritis drug abatacept (Orencia) after being given a lethal dose of influenza A virus, researchers report.

The mice were also loaded up with “memory” T-cells —white blood cells that were programmed to react to this strain of flu.

Eighty percent of the treated mice lived, compared to only 50 percent of those left untreated, said Donna Farber, senior author of a paper published in the June 1 issue of The Journal of Immunology.

Basically, the drug enabled infection-fighting “memory” T cells to fight off the initial infection, but prevented them from overactivating the immune system, a process that can cause worse illness and even death.

The findings could have implications not only for the seasonal flu, which reappears with regularity each year, but for surprise outbreaks such as the swine flu.

“For the swine flu, there really are indications that you do get this sort of hyperimmune reaction,” said Farber, who is a professor of surgery and microbiology and immunology at the University of Maryland School of Medicine in Baltimore. “Currently there is no treatment for people who are really ill from the flu, and there is already an indication that the immune system is too revved up [in these severe cases]. This could be a potential treatment for the flu.”

The study was sponsored by Bristol-Myers Squibb, which makes Orencia, and the U.S. National Institutes of Health.

Orencia was approved for use in the United States in 2005 and introduced to the market in early 2006 to treat rheumatoid arthritis, an autoimmune disorder. It prevents activation of T lymphocytes, or white blood cells, whose function is to fight off infection.

“Memory” T-cells are a subset of T lymphocytes. They are “good” in that they can fight off an invading virus, but “bad” because they can also contribute to a hyperactive immune system that can lead to more illness and even death.

When a person becomes infected with a flu virus, the immune system dispatches these white blood cells to the lungs to get rid of the virus. But, if the cells don’t know when to stop, they can cause tissue damage in the lungs, pneumonia and even death, Farber said.

“About half of your T-cells are memory T-cells. They persist and remember that you’ve seen a pathogen,” she explained. “A response [to infection with the influenza virus] is likely to include some contribution of memory T-cells.”

“With a lot of influenza, especially these pandemic strains, what really makes you sick and causes pneumonia is your immune response,” Farber added.

The researchers injected mice with memory T-cells that had been programmed to react to an H1N1 strain of influenza A virus (the same “subtype” as the currently circulating swine flu) and then infected them with either a sub-lethal or lethal dose of the actual virus. In addition, at the start of infection, before the mice actually fell ill, half were given Orencia while the remaining half were left untreated.

In both sets of mice, those that had received Orencia cleared the virus quicker, got less sick and recovered faster than mice in the control group. The drug also tempered the immune response of the memory T-cells, the researchers found.

“It didn’t dampen the immune response so much that it wasn’t able to get rid of the virus but it tempered down the immune response,” Farber said. “The mice didn’t get as sick, they recovered a lot better and the lungs looked a lot healthier.”

Orencia and similar drugs would have the added advantage of being effective against different strains of the flu virus because they’re targeting the immune system, not the virus. The annual vaccine, on the other hand, is only effective against specific viral strains, the researchers said.

Robert Alaniz is an assistant professor of microbial and molecular pathogenesis at Texas A&M Health Science Center College of Medicine. He said, “Although the paper is a mouse study, the drug used is currently approved for human use and effective in humans. As far as I know, the use of abatacept has not been tested for its effects in humans infected with the flu, which is what makes this study novel and interesting.

“Although the results from this study are intriguing, much more work is warranted to ensure safety in humans infected with seasonal flu. However, the promise of the approach used in this study is that it maintains protective immunity against the virus while reducing disease pathology — a very important point because overwhelming disease pathology is often a major contributing factor in flu-related deaths,” he added.

Tea Benefits

Steamy or iced, chai or green, bottled or not: Tea is hot, and getting hotter. Tea drinkers can be as passionate and picky about their drink of choice as the most snobby oenophile is about her wine. There are more and more choices. And annual tea sales in the United States have jumped from nearly $2 billion in 1990 to $5.5 billion last year, says Joseph Simrany, president of Tea Association of the USA Inc.

What you’ll see in restaurants
Chefs across the country are weaving tea into signature dishes and specialty drinks. Munch on tea-smoked chicken at New York City’s Yumcha (“drink tea” in Cantonese), or sip green-tea martinis infused with pear at Jack Falstaff in San Francisco. And the first green-tea liqueur—Zen—hit the U.S. market this summer and is being served up in hot spots like New York’s Sushi Samba.

Even rock stars are getting in on it
After electronic-music king Moby opened his own New York teahouse, Teany, he decided to get even more creative. “He was a mad professor behind the counter,” says partner Kelly Tisdale, experimenting with different flavors and launching the Teany line of chilled bottled teas, like the new white tea with pomegranate, carried in New York and the U.K.

Tea as wine
At the chic tea boutique Le Palais des Thés in Beverly Hills, sections of the store are devoted to teas from different regions, similar to the way most wine shops are organized. Increasing numbers of tea snobs are seeking out teas sourced from a single place, like Darjeeling Puttabong, the first tea estate in the Himalaya and the mother of the Darjeeling tea industry.

The coffee comparison
While many people still want their Starbucks coffee fix, a growing crowd is looking for a leafier sip. “The difference between people who drink coffee and those who drink tea is similar to the difference between beer and wine drinkers,” says Le Palais des Thés’ David Barenholtz. Tea drinkers are looking for a relaxing experience, while coffee drinkers tend to slug coffee for a jolt of energy.

The payoff
Beyond its pure enjoyment, tea is packed with health perks. The heart-health and cancer-preventive benefits of black and green teas are well-publicized. And more research is under way; some studies suggest tea may also increase bone-mineral density, boost immunity, fight cavities, combat diabetes, and reduce body fat.

What makes it so healthy? Scientists point to a group of natural antioxidants called catechins present in all teas, but not in coffee. Certain antioxidants can protect against exposure to ultraviolet light and its consequences, such as sun damage and skin cancer. And while coffee’s caffeine is known to sharpen concentration, tea has caffeine too, sometimes as much as or more than coffee.

Breast Cancer

Although the exact cause of breast cancer is not known, most experts agree that there are several factors that increase your risk of breast cancer.

Top risk factors linked to breast cancer
Aging. Your risk of breast cancer increases as you get older. By age group, breast cancer is diagnosed in:

•4 out of 1,000 women in their 30s.
•15 out of 1,000 women in their 40s.
•26 out of 1,000 women in their 50s.
•37 out of 1,000 women in their 60s.
Being female. Although breast cancer can occur in men, most breast cancer is found in women.

Conditions that increase the risk of developing breast cancer
Personal history of breast cancer. Women who have had breast cancer in one breast have an increased chance of having another breast cancer. The breast cancer can come back in the same breast, in the opposite breast, or in other areas of the body, such as the lungs, liver, brain, or bones.

Family history. A woman’s risk of breast cancer increases if her mother, sister, daughter, or two or more other close relatives, such as cousins, have a history of breast cancer, especially if they were diagnosed with breast cancer before age 50.

•Women who inherit specific changes (genetic mutations) in the BRCA1 and BRCA2 genes are much more likely to have breast cancer. They are also more likely to have colon or ovarian cancer. But most women who have a family history of breast cancer do not have changes in BRCA genes.
•Mutations in the BRCA1 and BRCA2 genes are more common in certain ethnic groups, such as Ashkenazi Jews.
•Genetic tests are available to determine whether you have the genetic mutations long before any cancer appears. In families where many women have had breast or ovarian cancer, genetic testing can show whether a woman has specific genetic changes known to greatly increase the risk of breast cancer. Doctors may suggest ways to try to prevent or delay breast cancer or to improve the detection of breast cancer in women who have the genetic mutations.

Breast changes. Women who have atypical hyperplasia, ductal carcinoma in situ (DCIS), or lobular carcinoma in situ (LCIS) or who have had two or more breast biopsies for other noncancerous conditions are more likely to have breast cancer.

Other factors that increase the risk of breast cancer
Race. In the United States, breast cancer occurs more frequently in white women than in black, Hispanic, or Asian women. But black women are more likely to get breast cancer at a younger age and are also more likely to die of breast cancer. This may be linked in part to genetic differences—an aggressive type of breast cancer called basal-like tumor seems most likely to affect young African-American women. Lower survival rates among black women may also be linked to lower quality health care.

Radiation therapy. Women whose breasts were exposed to significant amounts of radiation at a young age, especially those who were treated for Hodgkin’s lymphoma, have an increased risk for developing breast cancer. Studies show that the younger a woman was when she received her treatment, the higher her risk for developing breast cancer later in life.

Late or no childbearing. Women who had their first child after the age of 30 have a greater chance of developing breast cancer than women who had their children at a younger age. Women who never had children have an increased risk for developing breast cancer.

Not breast-feeding. Women who don’t breast-feed have a higher risk of breast cancer than those who breast-feed. The more months of breast-feeding, the lower the breast cancer risk.

Hormones. Female hormones play a part in some types of breast cancer.

•The use of hormone therapy after menopause for more than 4 years causes an increased risk of developing breast cancer. This increased risk occurs with current use of hormones and returns to normal over time after hormones are stopped.
•Beginning menstruation before age 12 and beginning menopause later than age 55 increase a woman’s risk of breast cancer. The years when you have a menstrual cycle are your high-estrogen years. Experts think that the longer you have higher estrogen, the more risk you have for breast cancer.
•Having extra body fat and drinking alcohol both lead to higher levels of estrogen in the body. Especially after menopause, when your estrogen levels are naturally low, this raises your breast cancer risk.

Fish Oil Supplements are Good for the Skin

Q: I’ve heard that fish oil supplements with their omega-3 fatty acids are good for the skin. Is that true?

A: Absolutely. Fish oil contains two main types of omega-3 fatty acids: docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). DHA keeps the brain functioning properly. And EPA greatly benefits skin by regulating oil production to boost hydration and prevent acne, and by delaying the skin’s aging process to stave off wrinkles. A 2005 study in the Journal of Lipid Research discovered that EPA can help block the release of the UV-induced enzymes that eat away at our collagen, causing lines and sagging skin. Because EPA is both an antioxidant and an anti-inflammatory agent, it can protect against sun damage and help repair it.

Most of us don’t get enough omega-3s in our diets—oily fish like herring, mackerel, salmon, anchovies, and tuna are the best sources—so it’s a good idea to take a supplement. Look for one that contains 180 milligrams of EPA and 120 milligrams of DHA; take one capsule with each meal, for a total of three per day. (Try Barlean’s Organic Fish Oil, $24.99.) If you’re pregnant, talk to your doctor before adding a supplement to your diet.

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64 Confirmed US Swine Flu Cases, 5 Hospitalized

There are now 64 confirmed cases of swine flu in the United States, including five people who have been hospitalized in California and Texas, the Centers for Disease Control and Prevention reported Tuesday.

The CDC says some cases of swine flu will be potentially life-threatening. “I fully expect that we will see deaths from this infection,” said Richard Besser, MD, acting director of the CDC, at a press briefing. “They are seeing many deaths in Mexico, and we’re trying to learn more about that and why the situation in Mexico is different from here, and as we continue to investigate cases here, I expect that we will see deaths in this country.”

Even ordinary seasonal flu causes many deaths each year; about 36,000 people die each year in the United States from seasonal flu, Dr. Besser said.

According to the California Department of Public Health, two deaths in the Los Angeles area have been investigated as potentially due to swine flu. One death was not caused by swine flu, and the other is still under investigation.

The World Health Organization upgraded the swine flu outbreak on Monday from level three to level four in its six-point pandemic scale. This indicates that there has been a significant movement toward a pandemic, but the outbreak still falls short of a global flu pandemic.

“What we call this means a lot less than what we do,” said Dr. Besser. “What we are doing is being very aggressive looking at what’s going on at the community level and adjusting and adapting our guidance and our actions based on what’s taking place on the ground.”

In addition to the 64 U.S. cases, there have been 26 confirmed cases in Mexico (and a reported 149 deaths), six cases in Canada, three in New Zealand, two in the United Kingdom, two in Israel, and two in Spain. (For the most recent case number, check the World Health Organization swine flu site.)

“We are in a pre-pandemic period,” said Dr. Besser.

In the United States, the patients have ranged in age from 7 to 54 years, with a median age of 16; the incubation time for the virus seems to be about two to seven days (similar to seasonal flu). In general, cases have been mild except for the five hospitalized cases (three in California and two in Texas).

The CDC is also contemplating changing the name of swine flu, since the name is causing many people to think the flu can be contracted from eating pork or pork products, which is not possible.

Dr. Besser said that the CDC is currently growing stocks of the swine flu virus, which could be used to make a vaccine. “A vaccine is something we are looking at very intently,” he said. “We are moving forward aggressively so if a decision is made to rev up production to make that vaccine, we would be ready to do so.”

The CDC has issued a number of important recommendations, including:

How to protect yourself: Dr. Besser recommends washing your hands and using alcohol hand gels to reduce the spread of viruses, as well as covering your nose and mouth when you cough (with an arm or elbow, not your hand).

What to do if you get sick: The CDC suggests staying home if you’re sick and keeping a sick child home from school. If a family member is sick and you are in an area where there are confirmed cases, other family members should consider staying home, too. You can also read more about how to take care of a sick person at home.

A travel advisory: People in the United States should avoid any nonessential travel to Mexico, the CDC says.

What schools should do: Schools in California, New York, and Texas have closed temporarily after swine flu cases were identified. The CDC recommends that schools that have a case of swine flu send students home, at least temporarily.

Who should take antiviral drugs such as Tamiflu: The CDC currently recommends antiviral medication for many people, including those who are at high risk of complications and have come into contact with someone who has a confirmed case of swine flu. The drugs should also be considered in other cases, including health-care workers in areas with swine flu cases.